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Empowering Community Health Workers through Resilient Supply Chains in Kenya

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Community Health Promoters receive commodities from Magacha Community Health Officer David Odhiambo, Suna West,
Migori County, Kenya. Photo credit Joseph Ngaruiya

Supply chains are only as strong as their weakest link. This holds particularly true for health supply chains, where any break or delay can be deadly — life is at risk when communities don’t receive medical supplies on time. At the heart of community health, Community Health Workers (CHWs) play a critical role in achieving Universal Health Coverage (UHC) and improving health outcomes—but only when they have the necessary tools, including access to medicines and supplies.

Around the world, however, CHWs often face stockouts of essential medicines and supplies, a challenge that weakens the entire health system. Recognizing this, Lwala Community Alliance and VillageReach partner with the Kenya Ministry of Health to build a resilient supply chain system that empowers CHWs (Community Health Promoters in Kenya) and ensures uninterrupted access to essential health services. Our current efforts are focused on Migori County, Kenya, and extend to the national level through collaboration with the Ministry of Health.

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Tackling Supply Chain Challenges in Migori County
Our journey began with a baseline assessment of Migori County’s health supply chain in March 2023. The findings indicated a 45% stockout rate for essential medicines, including many commodities required for community health services. Such stockouts not only diminish the quality of care CHWs can provide but can also reduce morale. Additionally, the assessment found gaps in stock management, revealing the need for training and mentorship for CHWs and facility-based providers.

Lacking essential supplies makes us feel helpless. When we can’t identify health issues early, it leads to poorer health outcomes in the community. At times, we are forced to refer residents to distant health facilities for services that could have been provided locally,” says Millicent Miruka, a Lwala-supported CHW. “Since we received the CHW kits from the national government last year, we’ve addressed these challenges more effectively and enhanced the care we provide to our community.”

Building CHW Skills for Better Commodity Management
Our strategy emphasizes equipping CHWs with the skills they need for effective commodity management. VillageReach and Lwala partnered to develop a training curriculum for CHWs on the supply chain. “The training comprehensively covers all aspects of commodity management from ordering and reporting to proper storage and handling,”. says Hellen Okello, Lwala’s Supply Chain Coordinator. “In addition, we are conducting training sessions within health facilities to enhance the competency of health care workers in commodity management and reporting”.

Zipporah Owino, the Nurse in charge at Magacha Health Dispensary collects medical supplies from the
pharmacy. Photo credit: Joseph Ngaruiya

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With 80% of CHWs in Migori County now equipped with essential supplies and resources to provide basic health services to their communities, this training helps them manage their supply of medicines, keep accurate records, and make informed decisions on restocking. Following a successful pilot in Migori County, this training was officially integrated as a module in the recently revised National CHW Curriculum. This achievement is evidence of how a local initiative can have a positive, sustainable impact at the national level.

“From the start, it was clear that addressing these challenges required a comprehensive and an integrated strategy that encompassed workforce development, strengthening of supply chain governance structures and continuous improvement through supply chain audits” noted George Nzioka, Senior Supply Chain Manager at VillageReach.

Using Data to Improve Supply Chain Decisions
At the heart of our approach is an electronic inventory management tool that simplifies inventory control and data collection. We have integrated a commodity management module into the electronic community health information system (eCHIS)—a new digital platform for CHWs developed by government and community health partners in Kenya.

This integration empowers CHWs to make informed decisions for optimizing stock. We are currently in the advanced stages of piloting this module in Migori County, paving the way for its broader implementation. We have also collaborated with other community health and technology partners in Kenya to document best practices for digital CHW stock management in this technical brief.

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Hellen Okello, Supply Chain Coordinator at Lwala Community Alliance, trains CHWs alongside George Nzioka, Senior Manager of Supply Chain at VillageReach, at the Magacha Dispensary in Suna West, Migori County, Kenya. Photo credit: Joseph Ngaruiya

Driving Lasting Change in Supply Chains
Our advocacy efforts are focused on integrating CHWs into the county and national supply chain tools, processes, policies and strategies. In Migori, we worked with the county government to develop the Migori County Supply Chain Strategy–the first in Migori, and the second in Kenya–which includes commodities used by CHWs. This collaborative effort seeks to transform the planning and budgeting of essential commodities, aiming to reduce stockouts and improve access to life-saving medicines.

By prioritizing the integration of community health commodities into our forecasting and planning strategies, we are ensuring Migori County can effectively meet its stock needs and enhance the delivery of critical health services.

To further strengthen supply chain operations, we provide technical support to health products and technologies units (HPTUs) at both county and sub-county levels. HPTUs were formed to ensure access to health products and technologies of assured quality, safety, efficacy, and cost-effectiveness. We are also conducting thorough audits of supply chains to identify areas for improvement, working closely with the government to refine standard operating procedures for supply chain management at the community level in Migori County and the national level.

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A CHW checks the blood pressure of a Magacha community member. Photo credit: Joseph Ngaruiya

Stories of Success
Our efforts are beginning to bear fruit. We are seeing improved access to essential medicines due to enhanced commodity management training. Introducing a mentorship framework for CHWs has improved service delivery and made health interventions more effective “In my community, I serve 80 households, visiting at least seven each day. Before heading out, I ensure I have my health education tools, equipment and supplies in my bag,” shares Millicent Miruka, a CHW supported by Lwala in Migori County. “Having these tools gives me the confidence to serve my community and deliver high-quality health care services.”

Looking Ahead
We are in the early stages of implementing the Supply Chain for Primary Health Care (SC4PHC) solution in Kenya, focusing on building robust supply chain systems at both the national and county levels. Our goal is to scale up these initiatives and ensure that every community has access to essential health services.

“This effort is about more than just strengthening supply chains; it’s about building a healthier future for all Kenyans,” says Julius Mbeya, Lwala Co-CEO. “By empowering CHWs and equipping them with the resources and support they need, we can create a world where every community has access to the health services needed to thrive.”

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CHWs with commodities at Magacha Dispensary in Suna West, Migori County. Photo credit: Joseph Ngaruiya

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Donald Trump’s ‘gunman’ Ryan Routh, 58, charged with attempted assassination of ex-President over golf course plot – The Sun

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Donald Trump’s ‘gunman’ Ryan Routh, 58, charged with attempted assassination of ex-President over golf course plot – The Sun

THE man who allegedly staked out Donald Trump on his golf course in Florida has been charged with attempting to assassinate him.

Suspect Ryan Wesley Routh, 58, was denied bail at a court hearing on Monday – hours after prosecutors cited a letter offering $150,000 to “finish the job” as evidence of why he should be kept locked up pending trial.

Suspect Ryan Wesley Routh, 58, was denied bail at a court hearing on Monday

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Suspect Ryan Wesley Routh, 58, was denied bail at a court hearing on MondayCredit: AFP
Cops arrest Routh after his alleged assassination attempt of Trump on September 15, 2024

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Cops arrest Routh after his alleged assassination attempt of Trump on September 15, 2024Credit: AFP
A letter written by Ryan Wesley Routh about his ambition to kill Donald Trump

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A letter written by Ryan Wesley Routh about his ambition to kill Donald TrumpCredit: DOJ

Routh had been initially charged with two federal firearms offences but the upgraded charges reflect the Justice Department’s assessment that he plotted to kill Trump.

They claim this is through Routh aiming a rifle through the shrubbery surrounding Trump’s West Palm Beach golf course on an afternoon the ex-president was playing on it.

Routh left behind a note in which he described his intention.

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Ryan Routh’s letter

The Justice Department released a chilling letter from would-be assassin Ryan Wesley Routh about his plan to kill Donald Trump on Monday.

“Dear world,” the note began.

“This was an assassination attempt on Donald Trump but I failed you. I tried my best and gave it all the gumption I could muster.

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“It is up to you now to finish the job; and I will offer $150,000 to whomever can complete the job.

“Everyone across the globe from the youngest to the oldest know that Trump is unfit to be anything, much less a U.S. president.

“US presidents must at bare minimum embody the moral fabric that is America, and be kind, caring and selfless and always stand for humanity.

“Trump fails to understand any of [that],” the letter concluded.

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On September 15, 2024, the former president was taking part in a round at Trump International Golf Course in West Palm Beach, when shots were heard.

It came after agents spotted someone they suspected of aiming the weapon from nearby bushes.

The would-be assassin, who managed to get within 400-500 yards of Trump, attempted to flee the scene in an SUV but was caught by officials and taken into custody.

Officials said it’s unclear whether the suspect fired a shot – or the Secret Service did.

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An eyewitness saw the suspect fleeing from the bushes in a black Nissan.

The witness contacted law enforcement and provided images of the vehicle and its license plate.

The FBI confirmed they saved Trump from an “assassination attempt” as he played golf.

Bodycam footage shows moment cops arrest would-be Trump ‘assassin’ who spent ’12 hours prowling by golf club with rifle’

An AK-47-style rifle, backpacks, and a GoPro camera were later found discarded by the golf club.

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It was then revealed that Ryan Routh was arrested in connection with the incident.

More details about the alleged suspect have since been revealed.

He reportedly lived in North Carolina for most of his life.

According to the Associated Press, Routh then moved to Kauai, Hawaii, in 2018, and he and his son appear to operate a company building sheds.

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In 2022, he traveled to Ukraine in the aftermath of Russia’s invasion.

On his social media profile, he urged the US to send more arms and called for civilians to join him.

AMMO BOX

The witness who turned the letter in to the DOJ said they received the chilling note inside a box from Routh several months prior to the attempted assassination.

The rifle used in the attempted assassination of Trump

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The rifle used in the attempted assassination of TrumpCredit: Reuters
Courtroom sketch of Routh during his hearing on September 23

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Courtroom sketch of Routh during his hearing on September 23Credit: Reuters

The recipient only opened the box after hearing Routh was identified as the wannabe assassin, officials said.

Along with the note and several handwritten letters, the box reportedly contained ammunition, a metal pipe, and other items.

The Justice Department also revealed that a search of Routh’s car revealed a list of dates and venues where Trump was scheduled to appear.

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Cops found six phones in his car, along with a notebook filled with anti-government criticism.

The U.S. Sun contacted the DOJ for comment.

‘VERY DANGEROUS GAME’

Routh allegedly set out to kill Trump as the Republican nominee was playing on a West Palm Beach golf course – but a Secret Service agent spotted his rifle poking out of the course’s treeline.

He fled the scene and was captured 45 minutes later. The wannabe assassin left a loaded rifle with a scope, a digital camera, and a plastic bag with food at the scene, according to an FBI affidavit.

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Cell phone records showed Routh was in the area of the tree line outside the golf course for about 12 hours, from around 2 am until 1:31 pm on Sunday, the affidavit revealed.

Security at the golf course rushed Trump to safety and he was unharmed in the attempted attack.

The former president later joked about the incident in an appearance on comic Greg Gutfeld’s show.

“I always said golf is a very dangerous game,” he said.

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The incident happened on September 15, 2024, when the former president was playing golf

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The incident happened on September 15, 2024, when the former president was playing golfCredit: Getty

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Burrito chain listing gives rare dose of spice to Australia’s IPO market

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Unlock the Editor’s Digest for free

The number of companies going public in Australia is at its lowest since the global financial crisis 15 years ago, leaving a Mexican fast-food chain as the biggest listing in a market once buzzing with new mining and energy stocks.

The 12 initial public offerings so far in 2024 on the Australian stock exchange have raised just $371mn, according to data provided by LSEG, the lowest year-to-date levels since 2009 and little more than a quarter of the historic average since the turn of the century.

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The dearth is being partly blamed on Australia’s uncertain economic outlook. Growth has faltered and interest rates have been kept high to tackle stubborn inflation.

Also to blame is voracious competition from private capital for assets, exemplified by the A$24bn (US$16bn) takeover of former IPO candidate AirTrunk by Blackstone this month.

Larger companies have paused potential floats hoping for more stable conditions, said Marcus Ohm, a partner at HLB Mann Judd, which compiles an annual report on Australia’s new listings market. “There’s no certainty” on valuation, he said, adding: “It’s a cyclical market and it’s been a bit of a ‘wait and see’ mentality.”

Steven Marks wearing a black and yellow GYG hoodie
Steven Marks, who previously worked at hedge fund SAC Capital, co-founded Guzman y Gomez with a childhood friend in 2006 © Brent Lewin/Bloomberg

The only listing of significant size this year has been of burrito chain Guzman y Gomez, which raised A$335mn at a valuation of A$2.2bn in June. The chain was founded by New Yorkers Steven Marks, who previously worked at Steve Cohen’s hedge fund SAC Capital, and his childhood friend Robert Hazan, who spied an opportunity to build a Mexican-themed fast-food chain in Australia in 2006.

The market capitalisation of the company, which also operates in Japan and the US, has rapidly risen to A$4bn as investors have bought into its growth plans. That has encouraged some other companies to dust off their listings plans.

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A more esoteric IPO is expected from Western Australia’s Good Earth Dairy, which wants to turn wild camels’ milk into ice cream and baby formula. Having called off listings in 2020 and 2022, it has started talks with potential cornerstone investors, hoping to raise A$20mn.

Milk from Australia’s 1mn feral camels has fewer allergens than other dairy products and could be used in exports to China and the Middle East, according to chief executive Marcel Steingiesser.

Yet ASX, the stock exchange operator, needs a bigger pipeline of larger companies to follow in Guzman y Gomez’s wake.

The lack of IPOs comes despite a surge in Australian equity markets, with the ASX benchmark index hitting record highs this week.

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It is also at odds with the huge demand for investable assets from institutions including Australia’s A$4tn pension fund sector. Aware Super, the country’s third-largest pension fund, acted as a cornerstone investor for Guzman y Gomez.

James Posnett, general manager of listings at ASX, said demand from institutional investors was “the loudest it has been” in his 12 years with the exchange.

The ASX also pointed to a string of capital raising by listed companies as a testament to the strength of investor appetite. NextDC, a data centre rival to AirTrunk, has raised A$2.7bn in the past 18 months by issuing new shares. “There’s a lot of money looking for a home,” Posnett said.

A slump in prices of commodities including lithium has stemmed the usual steady flow of small-cap mining listings, although CleanTech Lithium — which operates in Chile and is already listed on London’s junior AIM market — is to raise up to A$20mn with a secondary listing in the coming weeks.

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Rob Jahrling, head of equity capital markets at Citigroup in Sydney, said institutional and retail investors were keen for the IPO market to reopen after a number of large listed Australian companies — such as technology company Altium — were taken over and delisted in recent years. “There’s not enough listings to redeploy that capital,” he said. “The universe has shrunk.”

Significant activity is not tipped to pick up until later in the year or early 2025, when the bigger listings are most likely to be by companies that have halted floats in recent years due to market conditions.

They include payments company Cuscal, which is partly owned by Mastercard, and airline Virgin Australia, owned by Bain Capital, have both been tipped to revive stalled IPO plans before the end of the year by investment bankers. 

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Karen Chan, a fund manager at Perennial Private Investors, said Guzman y Gomez’s strong performance had “piqued the interest” of shareholders looking for brands with global potential. “The IPO option is now on the table,” she said. “There is demand for high-quality companies.”

Jahrling also said the success of Guzman y Gomez provided “a blueprint and confidence” for other companies. But he added that competition from venture capital, infrastructure funds and pension funds to invest in high-growth companies could yet intensify, as was the case with AirTrunk. “I don’t think that [competition] is going away,” he said.

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Exact animal to spot on sought after King Charles III 50p coin worth up to £41

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Exact animal to spot on sought after King Charles III 50p coin worth up to £41

IF you pay close attention to your change, you might spot an animal on your King Charles III 50p that could make it worth more than £40.

Coins with a distinctive design could be worth a small fortune because very few make it into circulation.

The King Charles III Atlantic Salmon 50p can be worth more than £40

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The King Charles III Atlantic Salmon 50p can be worth more than £40Credit: ROYAL MINT

For this reason, they are very attractive to collectors who are sometimes willing to pay large sums in exchange for one.

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One of the most current sought-after coins is the King Charles III Atlantic Salmon 50p, which first entered circulation on November 2023.

The coin was one of eight new special varieties released by the Royal Mint, reflecting the King’s passion for conservation and the natural world.

Despite an estimated 500,000 Salmon 50ps entering circulation in, collectors have been finding them hard to come by, according to ChangeChecker.

The coin is marked with an engraving of salmon fish jumping out of Atlantic ocean water.

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It has become much harder to find in change, and prices on online marketplaces such as eBay and Amazon have continued to rise.

Copes Coins previously told The Sun that Atlantic Salmon 50p could become “one of the rarest coins to enter circulation in the last 15 years”.

You can make money from these rare coins by selling them at auction, either online or in person, or through a dealer.

The Sun found that one of these coins recently sold on eBay for £41 on September 22 with 13 bids.

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Another sold for £25 on September 20 with 18 bids.

How to spot a 50p worth £50 and mule 20p that sells for £30

On September 11, one of these coins sold for £28 with nine bids.

The price of a coin varies based on things like demand at the time and how common it is.

It’s important to remember that you aren’t guaranteed to fetch huge amounts if you do choose to sell your change.

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Sometimes you’ll get better individual prices if another enthusiast needs your coin to complete their collection.

Anyone can list a coin on eBay and charge whatever amount they wish, but it’s only ever worth what someone is willing to pay.

By checking the recently sold items you will get a more accurate indication of what people are willing to pay for a specific coin.

What are the most rare and valuable coins?

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How to sell a rare coin

If, after checking, you realise you’ve come across a rare coin, there’s a number of ways you can sell it.

You can sell it on eBay, through Facebook, or in an auction.

But be wary of the risks.

For example, there are a number of scams targeting sellers on Facebook.

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Crooks will say they’re planning to buy the item and ask for money upfront for a courier they’ll be sending around.

But it’s all a ruse to get you to send free cash to them – and they never have any intention of picking your item up.

It’s always best to meet in person when buying or selling on Facebook Marketplace.

Ensure it’s a public meeting spot that’s in a well-lit area.

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Avoid payment links and log in directly through the payment method’s website.

Most sellers prefer to deal with cash directly when meeting to ensure it’s legitimate.

The safest way to sell a rare coin is more than likely at auction.

You can organise this with The Royal Mint’s Collectors Service. It has a team of experts who can help you authenticate and value your coin.

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You can get in touch via email and a member of the valuation team will get back to you.

You will be charged for the service, though – the cost varies depending on the size of your collection.

Meanwhile, you can sell rare coins on eBay.

But take into account that if you manage to sell your item then eBay will charge you 10% of the money you made – this includes postage and packaging.

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The design of the coin, its condition and whether or not the coin is in circulation also affects how much it could be worth.

You can easily figure out how rare a coin is, by checking its mintage figures.

This relates to how many coins were produced by The Royal Mint.

If a coin has a low mintage, it means there are fewer of them in circulation and is therefore rarer and it could potentially be worth more than its face value.

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But remember a coin is only ever worth what someone is willing to pay at the time.

Either way, you’ll want to keep an eye out for some in particular which can sell for big numbers.

A rare Blue Peter Olympic 50p has been flogged on eBay for £205 in the past.

The coin shows an athlete doing the high jump and was drawn by nine-year-old Florence Jackson after winning a competition on the kid’s TV show.

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Plus, one seller managed to pocket a whopping £63,000 flogging his Battle of Hasting’s 50p too.

So-called ‘error coins’ tend to be worth a lot too, because there’s rarely more than a few thousand of them in circulation.

One 50p that was mistakenly struck twice sold for as much as £510 on eBay because it was rare.

It’s not only 50ps either – a rare error 10p coin sold for over 1,000 times more than its face value on eBay in the past.

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Likewise, there are several rare £2 coins in circulation which could be worth just under £50.

Do you have a money problem that needs sorting? Get in touch by emailing money-sm@news.co.uk.

Plus, you can join our Sun Money Chats and Tips Facebook group to share your tips and stories

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Travel

We went on holiday to tiny crumbling shack & drank river water to survive… it was rough but we didn’t spend a penny

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A couple spent the night at Grwyne Fawr in the Welsh countryside

A COUPLE who spent the night in a derelict shack with no plumbing were forced to drink water from a local river to survive.

But the duo were treated to lush views of the Welsh countryside during their overnight stay at Grwyne Fawr.

A couple spent the night at Grwyne Fawr in the Welsh countryside

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A couple spent the night at Grwyne Fawr in the Welsh countrysideCredit: YouTube/Heitor Visuals
The cramped space is usually left unlocked and available

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The cramped space is usually left unlocked and availableCredit: YouTube/Heitor Visuals
The two-storey building has essentials such as canned food for visitors

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The two-storey building has essentials such as canned food for visitorsCredit: YouTube/Heitor Visuals

“For this year 2023 I’ve decided to challenge myself and stay in every bothy in Wales this summer,” adventurer Heitor Visuals wrote on the video’s caption.

“And how better way to start than by spending the night at the smallest bothy in the UK – Grwyne Fawr.”

After walking through rural woodland and across rolling hills, the hikers arrived at the mould-infested shack.

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The cramped two-storey space is stocked with some necessities – including tinned meals, tools, loo roll and a stove for cooking meals.

A bothy is a basic shelter, usually left unlocked and available for anyone to use free of charge.

The majority of bothies are repurposed structures with histories of offering respite in isolated locations: crofters’ homes, shepherds’ huts, remote farmsteads.

Located at the bottom of a deep ravine, Grwyne Fawr is easy to overlook.

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And getting to the building from the main path while wearing a heavy pack takes careful footwork.

As darkness descended, the couple fired up the stove to cook their respective dinners – a hearty bowl of penne pasta with cheese sauce and Uncle Ben’s Mexican Style rice with a tin of chilli con carne slopped on top.

They also sourced water from the bone-chilling river located next to Grwyne Fawr.

Floating glampsite with your own rowing boat has been crowned one of the best in the UK

The following morning, the two tucked into an all-day breakfast sachet washed down with a piping hot cup of tea before heading home.

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SANDS NICE

Meanwhile, Brits can still enjoy a summer staycation, with many beach huts now having kitchens and bathrooms inside.

But some even let you stay overnight – with beds squeezed inside too.

Similar to glamping, many huts have been kitted out with everything you might need for an overnight stay.

And some cost as little as £49 a day – compared to the average price of buying a beach hut of around £123k.

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For example, Beach Hut 409 on Mudeford Split is right on the beach, with four beds inside.

This is along with a kitchen, complete with fridge and cooker, as well as outdoor shower and portaloo.

Or there is Sea Angel Vintage Beach Chalet in Cornwall, which sleeps four as well thanks to a double bed and bunk bed.

Previous guests even said there was a “bottle of bubbly and chocolates waiting for them” on arrival.

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The cheapest option is staying at Branksome Chine in Dorset, which costs less than £50 a night.

The duo had to source water from the local lake

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The duo had to source water from the local lakeCredit: YouTube/Heitor Visuals
The bothy was equipped with a stove

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The bothy was equipped with a stoveCredit: YouTube/Heitor Visuals

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12 Rare Birds Discovered in Passenger’s Luggage at Uzbekistan Airport

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12 Rare Birds Discovered in Passenger's Luggage at Uzbekistan Airport

Uzbekistan customs officials at Tashkent International Airport uncovered 12 rare bush warblers hidden in a passenger’s luggage.

According to Uzdaily, the birds, valued at over $200,000, were found concealed in fruit boxes within the baggage of a traveler arriving from Cam Ranh, Vietnam.

The State Customs Committee of Uzbekistan reported that the passenger had not declared the protected species, clearly intending to smuggle them into the country.

Tragically, three of the birds did not survive the journey due to improper transportation conditions.

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Europe’s carmakers must not stall on emissions goal

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Banker all-nighters create productivity paradox

One could be forgiven for thinking that the EU’s clean car rules have been dropped on carmakers at the last minute (“EU carmakers seek review of emissions law”, Report, September 20).

But the European car industry has had since 2019 to plan for next year’s emissions target, and manufacturers have numerous pathways to comply without paying fines. These include not just selling more battery electric vehicles but also hybrids. The still very profitable European carmakers may need to sell fewer big polluting SUVs, but then that is the aim of the emissions regulation.

As for the industry’s demand that the 2035 zero-emission car target be reviewed in 2025, this would be too early to take into account the impact of current developments in the EU cars market. Carmakers are just now introducing a lot of affordable EV models for 2025, so let us first see how they perform in the market. We forecast this will lead to a surge in electric vehicle sales next year.

A proper assessment before changing such a transformative law takes time. So, a full legislative proposal next year is not possible without cutting corners, which should not be acceptable.

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Julia Poliscanova
Senior Director, Vehicles & Emobility Supply Chains
Transport & Environment, Brussels, Belgium

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