Modeling the Past and Current Distribution and Habitat Suitability for Two Snake-eyed Skinks, *Ablepharus grayanus* and *A. pannonicus* (Sauria: Scincidae)

*Rasoul Karamiani, Nasrullah Rastegar-Pouyani and Eskandar Rastegar-Pouyani*


The foregoing is based especially on the fact that their identity constructions go beyond the binary conception of gender, according to which there is a natural relationship and full correspondence between sex and gender [6, 7]. This sustains a system of oppression, under which "everyone" must identify and recognize themselves as they were assigned at birth, and becomes the most legitimized by society, generating as a consequence segregation, discrimination, and violence against anyone who identifies in a different way to those established and that are not normative [1].

The scenario that trans people face, with respect to the development and expression of their experiences and the construction of their gender identities, in Colombian society at the time of receiving medical care, makes it necessary to specify the definitions of the key concepts that make up these processes and that allow us to understand that they are different for each individual [3]. They are constantly nurtured from diverse identity experiences and therefore deserve that the whole of society and health providers respect and recognize their diversity [5].

The transgender population faces a social and historical problem, since the establishment of the so-called "sexual dimorphism" established in the eighteenth century, from which a whole culture arises to name the anatomical variations of the bodies, and the supposed correspondence of this with gender, whether feminine or masculine [1, 6]. All this has been implanted as an ideal for many centuries in people, causing a marginalization of everything that is outside these terms, which can also be expressed as limits.

In the field of health, there is a misunderstanding due to the differences that make up their identities, corporalities, and gender expressions, in the same way that happens in other areas of society, making it necessary for there to be an adequate provision for their needs and particularities. A situation that has given rise to discrimination, artisanal medical practices, apathy toward the health system, among others; hindering the free development of the personality of these people and the right to a life in conditions of dignity and equality [7]. The foregoing has meant that they direct their struggles so that the State and health providers guarantee adequate and continuous care, which has been materialized in different normative instruments at the international and national levels, as explained below.

#### **2. Methodology**

A theoretical design study was carried out using the bibliographic review method, which allowed to provide a systematic framework of products in terms of scientific publications and official publications on the health of transgender people.

The units of analysis were scientific articles of primary type, located through seven databases recognized for their scientific rigor. In addition, the official web pages of activist and/or related groups were searched.

The search equation used in the keywords field (KW) was: "Health" AND "Transgender," "Trans" OR "LGBT" AND "Paraguay." These keywords do not necessarily correspond to thesauri, since they were chosen to ensure the widest possible number of articles published on the subject.

The search for documents included the Spanish, English, and Portuguese languages, no time period restriction was applied, and that they had been published and/or carried out in scientific journals and official web pages of activist and/or related groups.

A database of bibliographic records was generated to describe each unit of analysis with the following inductive categories: (a) bibliographic data: author and year of publication; (b) study objective and most important findings; (c) contextual variables: country where the study was conducted; (d) methodological variables: instruments and data collection techniques used. From the analysis of the bibliographic records, the deductive categories emerged: application method, study method, models, and evaluation.

### **3. Key concepts**

Currently, the demand for health care from trans people is more frequent, so it is necessary for the doctor, even if he is not a specialist, to know general aspects regarding terminology, health needs, legal medical treatment, and considerations regarding possible effects of medical treatments to which these patients are subjected in their transition to felt gender identity [8].

The expression of gender that encompasses aspects of behavior in which men and women are different according to culture and historical stage (male or female gender behavior according to cultural patterns). In recent decades, it is more common to see expressions of gender behaviors other than those classically known as masculine or feminine, including people who are androgynous, bigenders, or who do not identify with either of the two genders (non-binary).

• Sexual orientation refers to whom the sexual desire is directed toward, existing people with homo, hetero, bisexual, pansexual, demisexual orientation, none (asexual), etc., depending on where the individual's erotic-affective attraction is directed, which it is not necessarily defined by the sex assigned at birth [9].

In short, we will have individuals with:

Thus, we can see that sex, gender, and sexual orientation are not synonyms.

#### **Table 1.**

*Definitions.*

There is scarce and inaccurate information on the prevalence of transgender people in the general population; This is because population statistics reports exclude them, because trans people identify more with the denominations "man" or "woman" than with the identity of "trans," or because of the lack of inclusion of the "nonbinary" category (neither masculine nor feminine) in the studies (**Table 1**) [11].

#### **4. Social determinants for trans health**

Social determinants of health are social and economic factors that influence people's lives and circumstances in ways that predispose them to certain healthrelated behaviors and health outcomes [12].

According to the WHO Commission on Determinants of Health, these determinants *" … are largely responsible for inequities in health—the unfair and avoidable health condition observed within and between countries*" and include factors such as social position, education, occupation, income, gender, and ethnicity/race.

The distribution of these factors has been empirically shown to correlate with how health problems are distributed across populations and within subpopulations. Addressing inequity in these factors would have multiple potential benefits in terms of better health and better life experiences and opportunities in general [13].

Increasingly, sexual orientation is recognized as a social determinant of health.

 Sexual stigma influences health by causing unequal access to health services, psychological stress, and internal feelings of shame that influence health-related behavior [15].

The stigma associated with sexual orientation can also influence the social conditions and life opportunities available to sexual minorities. Access to these resources by sexual minorities is restricted because sexual stigma devalues people who are homosexual, bisexual, or who hold gender identities that do not conform to heterosexual norms [8, 9].

Restricted access to these resources can, in turn, influence "livelihood strategies," or the activities that people carry out and the decisions they make, in order to meet basic life needs such as food and shelter.

Transphobia plays a fundamental role as the determinant that conditions the health of people in this group.

#### **5. Transphobia**

Transphobia is "*the specific discrimination suffered by trans people since they put in question the prevailing sex/gender system from its roots, since they challenge the identity of gender assigned at birth"* [16].

Transphobia is etymologically a term of recent appearance, not yet included in the most current edition (2014) of the Dictionary of the Spanish Language of the Royal Spanish Academy (RAE). Despite this, the absence of an official description of a term does not imply its nonexistence. Continuing with the etymology, the word is made up of the particle "trans," which according to the RAE means "on the other side," and the word "phobia," which means "distressing and uncontrollable fear of certain acts, ideas, objects or situations, which it is known absurd and approaches the obsession" [17, 18].

Although according to this definition, we are faced with a fear that is supposed to be personal, arbitrary, and irrational, it is far from being so. This considered "phobia" has a much deeper root than a simple irrational fear, since it is anchored to a series of values and prejudices that we internalize when socializing in a certain culture [18].

Transphobia can manifest itself from subtle forms such as fear or negative beliefs, to much more explicit and aggressive forms such as intimidation, abuse, and even violence. There are two types of transphobia, direct and indirect. Indirect occurs when a supposedly neutral practice, rule, or criterion excludes or causes disadvantages either for reasons of gender identity, sexual orientation, or belonging to the LGTB group.

Direct transphobia consists of, for the reasons mentioned above, receiving less favorable treatment than another person who does not meet these characteristics and is in the same or equivalent situation [17].

Some noteworthy aspects in the activist and academic depathologizing discourses are the demand for recognition of both legal and health trans rights, the review of the healthcare model, and the questioning of the labels in the diagnostic classification manuals (ICD-10 and DSM) [18].

The controversy that is formed around this definition is wide, as well as the existing one about the psychiatric classification systems. This is due to the fact that, as we have commented and some authors explain, the deviation from the mean is considered abnormal, but frequently what is abnormal does not imply what is pathological. A clear example is homosexuality, excluded from the DSM in 1973 [19–21].

Thanks to activists and campaigns such as *Stop Trans Pathologization* (STP), these diagnostic manuals have adapted labels in order to abandon the psychopathological model that characterizes trans care.

The changes introduced in the DSM-V are still insufficient according to the STP, since the change of the title to "Gender Dysphoria" tries to reduce the stigma, but it is still debatable. For STP, this term associates the transition these people go through with a state of discomfort [9].

Although the terminological differences can be seen in the diagnostic criteria of last DSM speaks of "incongruence," which implies a "congruence" based on the normativity and pathologizes both transit and previous experiences. In addition, the criteria in the DSM-V require for their fulfillment that the person shows at least two of those described in the figure, during a period of 6 months or more [19].

As for ICD-10, the term "Transsexualism" is found within Mental and Behavioral Disorders, while in ICD-11 we find a new chapter called "Conditions related to sexual health", where the "Discordance of gender" in adults, adolescents. and infants.

Other barriers include: financial barriers (lack of insurance, lack of income), discrimination, lack of cultural competency by healthcare providers, health systems barriers (electronic records, forms, lab referrals, inappropriate clinical facilities), and socioeconomic barriers (transportation, housing, mental health). While other minority groups face some of these healthcare barriers, many are unique, and many are significantly magnified for transgender people [22].

#### **6. Situation of the trans population in Paraguay**

Paraguay has ratified numerous international instruments for the protection of human rights, by which it is obliged to adopt measures to guarantee the sexual and reproductive health of all people and nondiscrimination based on sex, sexual orientation, and gender identity.

The amount of information referring to this situation in the country is scarce. Regarding the development of guarantees and rights in the matter, our legal framework is manifested in the following ways:

The National Constitution of Paraguay (1992) states [23]:

#### • **ARTICLE 24 - RELIGIOUS AND IDEOLOGICAL FREEDOM**

Religious freedom, worship and ideology are recognized, with no other limitations than those established in this Constitution and in the law. No confession will have an official character.

The independence and autonomy of churches and religious denominations are guaranteed, with no other limitations than those imposed in this Constitution and the laws.

Nobody can be bothered, investigated or forced to testify because of their beliefs or their ideology.

#### • **ARTICLE 25 - EXPRESSION OF PERSONALITY**

Every person has the right to free expression of their personality, creativity and the formation of their own identity and image.

Ideological pluralism is guaranteed.

#### • **ARTICLE 46 - EQUALITY OF PEOPLE**

All the inhabitants of the Republic are equal in dignity and rights. Discrimination is not allowed. The State will remove the obstacles and prevent the factors that maintain or promote them.

The protections that are established on unfair inequalities will not be considered as discriminatory factors but rather as egalitarian.

#### • **ARTICLE 68 - RIGHT TO HEALTH**

The State shall protect and promote health as a fundamental right of the person and in the interest of the community.

No one shall be deprived of public assistance to prevent or treat diseases, pests or plagues, and relief in the event of catastrophes and accidents.

Every person is obliged to submit to the sanitary measures established by law, while respecting human dignity.

It is recognized that sex work is the main economic activity of 86% of trans people, although it is work that is not punished in Paraguay, but it is also not recognized or regulated by law. Access to jobs is impeded by discrimination due to the fact of assuming a different sexual identity, since transgender people are not hired in private entities, except in hairdressing salons or volunteering in the field of health [24].

Working life is further complicated by the fact that more than half (52%) of transgender people did not complete primary school and ended up dropping out of school due to the "*teasing, harassment, physical punishment and degrading treatment*" they received from other students and teachers [25].

Transgender encounter the same degrading treatment when they go to health services, where they are subjected to psychological aggression and humiliation when they require health care in general, and especially when they go to obtain treatment and care for HIV and AIDS.

According to the Ministry of Public Health and Social Welfare of Paraguay (MSPyBS), in the general population, the prevalence of HIV infection (2017) was 23% in this population. The cascade of the continuum of HIV care in 2019 in the population of trans women shows that, for the period cited, there are 187 (96.4%) people alive who know their diagnosis, are on ART 114 (58.8%).

Lastly, 63 (32.5%) of people living with HIV have their viral load suppressed, representing a gap of 67.5%. In this case, the pillar of diagnosed trans women is practically saturated, and the main difficulty is observed in the low percentage of trans women who maintain a suppressed viral load. It can be concluded that some type of barrier must exist to ensure that this population group maintains adherence to antiretroviral treatment [26].

#### **6.1 Paraguayan health regulations for the trans population**

Regarding the Regulations, in Paraguay Resolution No. 72/2012, of the General Directorate of Penitentiary Establishments and Criminal Enforcement of the Ministry of Justice, "*Which establishes new regulations for the operation of the benefit of private visits in penitentiaries and correctional facilities for women of the Republic.*" Among these, neither the sex nor the gender of the visiting partner of the person deprived of liberty is determined [27].

In addition to this, in 2015, the Protocol for Attention to Trans Persons Deprived of Liberty was established. On the part of the MSPyBS, through Resolution No. 695/2016, the use of the social name for trans people is recommended [28].

This is why determining the knowledge and biases of the existing medical workforce should be included: medical students, physicians in training, practicing physicians, and other health workers across the spectrum of training; the adequacy of enough providers for the care required, and the state of a framework for paying for adequate care.

There is a specific need to determine if providers receive adequate training in transgender medicine and, if not, determine the gap. There is also a specific need to determine the current state of discrimination against transgender people in the healthcare system. Additionally, studies should determine possible solutions to address gaps (including training for knowledge gaps and policy changes for financial gaps) along with mechanisms to validate such solutions.

#### **7. Discussion**

This population faces a series of problems to access health services in their countries, and Paraguay is no exception, many of the situations are linked to stigmatization, lack of medical care protocols, and lack of information on how to act in certain situations, which is determined by the lack of inclusion in the training curricula of health professionals [12, 25, 26].

Although the health problems that affect transgender people are similar to those that affect the rest of the population, some conditions are more widespread within these groups because they face situations that increase their vulnerability or risk of exposure to pathogens [1, 6].

#### *Health of Trans People in Paraguay DOI: http://dx.doi.org/10.5772/intechopen.106488*

Different studies indicate that they are mostly affected by infectious diseases such as HIV, syphilis, gonorrhea, hepatitis, or genital herpes, to mention a few examples [7].

The first challenge that trans people face, and the one that permeates almost all the other challenges, is the one that has to do with the adequate recognition of their identities, and the fight for the reduction of transphobia, for the purposes of offering comprehensive and quality care [8].

There is also a great lack of education in all the staff, about their realities and rights; as well as the appropriate care protocols since there are women with a penis and men with a vulva, who require different treatments and accompaniments to achieve the full enjoyment of their identities, these points must be discussed by decision-makers in order to help the inclusion of all groups within the health service. Although, in Paraguay, the use of the social name can be found, discrimination and stigmatization continue to be an important problem [10–13].

In the development of trans identities, acceptance is an aspect that perhaps has the most serious consequences for the health and full development of all the rights of these people. Although the medicalization of their bodies and sexualities has existed since the nineteenth century, due to the fact that all their diverse expressions were marginalized and cataloged by scientific discourse as abnormal and disturbed, requiring medical intervention to undo everything that does not fit into the imposed ideal dichotomy [14, 26].

An important point to note is also that 39% of the transgender population suffers from serious psychological distress (compared with 5% of the general population) that they have a nine times higher risk of suicide attempts and a five times higher frequency of infection for HIV (mostly transgender women), 25% did not seek medical care for fear of mistreatment in care services, which is striking due to the constant increase [25–27].

Violence motivated by sexual orientation or gender in sexual minorities indicates the presence of 68% of physical violence inflicted and 49% of sexual violence [15], in Paraguay there is a lack of studies that can demonstrate the real impact of transphobia in services of health and in addition to this study on the burden of diseases and disorders.

The limitations of this review are based on the scarcity of studies to carry out the study, so it is suggested to carry out a study to provide evidence on the health of trans people in Paraguay.

#### **8. Conclusions**

In conclusion, it is highlighted that although Paraguay has ratified numerous international instruments for the protection of human rights, there is still a lack of measures to guarantee the sexual and reproductive health of all people and nondiscrimination based on sex, sexual orientation, and gender identity.

In addition to public policies aimed at this group, it is necessary to establish gender regulations or laws that allow the population to develop in an integral manner.

#### **Conflict of interest**

The authors declare no conflict of interest.

*Transgender Health - Advances and New Perspectives*

#### **Author details**

Carlos Miguel Rios-González1,2,3

1 Faculty of Medical Sciences, National University of Caaguazu, Paraguay

2 Ministry of Public Health and Social Welfare, National Institute of Health, Asunción, Paraguay

3 South American University, Pedro Juan Caballero, Paraguay

\*Address all correspondence to<EMAIL_ADDRESS>
© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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[2] Council of Europe. Commissioner for Human Rights. Strasbourg: Council of Europe; 2015

[3] European Union Agency for Fundamental Rights (FRA). The Fundamental Rights Situation of Intersex People. 2015. Available from: https:// fra.europa.eu/en/publication/2015/ fundamental-rights-situation-intersexpeople

[4] World Health Organization (WHO). Eliminating Forced, Coercive and Otherwise Involuntary Sterilization: An Interagency Statement. Geneva, Switzerland: OHCHR, UN Women, UNAIDS, UNDP, UNFPA, UNICEF and WHO; 2014

[5] Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, et al. Global health burden and needs of transgender populations: A review. Lancet. 2016;**388**(10042):412-436

[6] Barrington C, Wejnert C, Guardado ME, Nieto AL, Bailey GP. Social network characteristics and HIV vulnerability among transgender persons in San Salvador: Identifying opportunities for HIV prevention strategies. AIDS and Behavior. 2012;**16**(1):214-224

[7] Andrinopoulos K, Hembling J, Guardado ME, de Maria Hernández F, Nieto AI, Melendez G. Evidence of the negative effect of sexual minority stigma on HIV testing among MSM and transgender women in San Salvador,

El Salvador. AIDS and Behavior. 2015;**19**(1):60-71. DOI: 10.1007/ s10461-014-0813-0

[8] Suess SA. Trans health care from a depathologization and human rights perspective. Public Health Reviews. 2020;**41**(1):1-17

[9] Hanssmann C. Epidemiological rage: Population, biography, and state responsibility in trans-health activism. Social Science & Medicine. 2020;**247**:112808

[10] Schwend AS. The trans depathologization perspective: A contribution to public health approaches and clinical practices in mental health? SESPAS Report 2020. Gaceta sanitaria. 2020;**34**:54-60

[11] T'Sjoen G, Arcelus J, De Vries AL, Fisher AD, Nieder TO, Özer M, et al. European Society for Sexual Medicine position statement "Assessment and hormonal management in adolescent and adult trans people, with attention for sexual function and satisfaction". The Journal of Sexual Medicine. 2020;**17**(4):570-584

[12] Davies C, Elder CV, Riggs DW, Robinson KH. The importance of informed fertility counselling for trans young people. The Lancet Child & Adolescent Health. 2021;**5**(9):e36-e37

[13] Bouman WP, Schwend AS, Motmans J, Smiley A, Safer JD, Deutsch MB, et al. Language and trans health. International Journal of Transgenderism. 2017;**18**(1):1-6

[14] Giffort DM, Underman K. The relationship between medical education and trans health disparities: A call to research. Sociology Compass. 2016;**10**(11):999-1013

[15] Wagner PE, Kunkel A, Asbury MB, Soto F. Health (trans) gressions: Identity and stigma management in trans\* healthcare support seeking. Women & Language. 2016;**39**(1):49-74

[16] Lombardi E. Public health and transpeople: Barriers to care and strategies to improve treatment. In: The Health of Sexual Minorities. Boston, MA: Springer; 2007. pp. 638-652

[17] Jaspal R, Nambiar KZ, Delpech V, Tariq S. HIV and trans and non-binary people in the UK. Sexually Transmitted Infections. 2018;**94**(5):318-319

[18] Zeeman L, Sherriff N, Browne K, McGlynn N, Mirandola M. A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities. European Journal of Public Health. 2019;**29**(5):974-980

[19] World Health Organization (WHO). Sexual Health, Human Rights and the Law. Geneva, Switzerland: World Health Organization; 2015

[20] Valenzuela AV, Velásquez RC. Salud comunitaria, la experiencia de salud trans en el Servicio de Salud Talcahuano. Chile. Psicoperspectivas. 2020;**19**(2):153-165

[21] Coleman E, Botzer M, Cohen-Kettenis P, De Cuypere G, Feldman J, et al. Normas de Atención para la salud de personas trans y con variabilidad de género: La Asociación Mundial para la Salud Transgénero. International Journal of Transgenderism. 2018;**19**(3):287-354

[22] De Benedictis-Serrano GA, Rios-González CM. The LGBT community and HIV: An incorrect medical judgment. Travel Medicine and Infectious Disease. 2018;**25**:18-19. DOI: 10.1016/j. tmaid.2018.04.017

[23] Restar A, Jin H, Operario D. Genderinclusive and gender-specific approaches in trans health research. Transgender Health. 2021;**6**(5):235-239

[24] Constitución Nacional de la Republica del Paraguay. 2022. Available from: https://www.bacn. gov.py/leyes-paraguayas/9580/ constitucion-nacional

[25] Ortiz-Martínez Y, Ríos-González CM. Need for more research on and health interventions for transgender people. Sexual Health. 2017 Apr;**14**(2):196-197. DOI: 10.1071/ SH16148

[26] Aguilar G, Samudio T, Lopez G, Jimenez L, Wilson EC, McFarland W, et al. High HIV prevalence among transgender women in Paraguay. International Journal of STD & AIDS. 2020 Nov;**31**(13):1308-1314

[27] Ministerio de Justicia. Resolución N.° 72/2012. 2022. Available from: https:// codehupy.org.py/ddhh2020/wp-content/ uploads/2020/12/IGUALDAD-LGTBI\_\_ WEB.pdf

[28] Ministerio de Salud Publica y Bienestar Social. Resolución N.° 695/2016. 2022. Available from: http:// www.panambi.org.py/noticias/ detalle/132/Las+personas+Trans+podr% C3%A1n+utilizar+su+nombre+social+en +cl%C3%ADnicas.++

Section 3


**Studying the Flow Dynamics Within Endografts in Abdominal Aortic Aneurysms**

Efstratios Georgakarakos, Antonios Xenakis, George S. Georgiadis, Konstantinos C. Kapoulas, Evagelos Nikolopoulos and Miltos Lazarides

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/46034


**7. Conclusion**

Muscles are one of the main constituents of the human body and are complex and numerous. In this regard, complementary methods are needed in the diagnosis of neuromuscular diseases and the choice of treatment methods.

The results of the study show that assessment of the degree of asymmetry of muscle strength allows an expert doctor to accurately assess the differences in the biopotentials of the studied muscles of the limbs. The segmental method also gives informative values about the composition and differences between individual body *Methods and Tools for Assessing Muscle Asymmetry in the Analysis of Electromyographic… DOI: http://dx.doi.org/10.5772/intechopen.103061*

segments. The multifractal nature of human allows use of the quantities used as key features of multifractals as an informative sign that can be used to detect a violation of the asymmetry of the limbs. The isokinetic test results help to assess asymmetry in measuring muscle strength, relying on the randomness of the dynamic processes of the biological system, which again contains informative parameters. Research and practical calculations show that these methods can be used to assess asymmetry and are used as a complementary tool in making diagnostic decisions.


**2.1.1 Implementation of BDAM**

The WiMAX Network Reference architecture is given in the fig. 3.

Fig. 3. WiMAX Network Reference Architecture.

Bandwidth allocation is done for all the service class for the three types of users as per fig. 2

Start

Allocate bandwidth to UGS service

Allocate bandwidth *to high-priority* service flows of this service

Allocate bandwidth to *regular* service flows of this service class

Allocate bandwidth to *low-priority* service flows of this service class

All service classes done

Stop

Yes

No

Move to the next service class (ertPS >> rtPS >> nrtPS >> BE)

From the algorithm in fig.2, we see that when the BS receives bandwidth requests for BE traffic from High-Prioirty, Regular and Low-Priority users, BS shall allocate bandwidth first to the high-priority user then the regular user and finally to the low-priority user

The WiMAX Network Reference architecture is given in the fig. 3.

Fig. 3. WiMAX Network Reference Architecture.

Fig. 2. DBAM Algorithm.

(Kumar et al. 2011a).

**2.1.1 Implementation of BDAM**

Each network service provider (NSP) has a Authentication, Authorization and Accounting (AAA) server.. This server maintains the information about the users. The Access Service Network (ASN) interacts with the AAA server to obtain the information about the user.

The AAA server shall maintain a table of MAC address for the users and the priority value associated with the user. A sample state of the table could be as shown in Table-2

Table 2. Sample state table of priority values for users.

When the MS initiates the ranging process, it sends the Ranging Request (RNG-REQ). Upon receiving the ranging request, BS shall query the AAA server to obtain the priority value associated with the user. BS shall store the priority value for the user in its local cache.

Subsequently, when the MS makes bandwidth request for any of its service flows, BS shall check the priority of the MS. Based on the priority value, bandwidth shall be allotted to the service flow.


**3. Results**

Research material obtained during the work in Singapore and Kigali was compiled, and then subjected to the comparative analysis, which is presented in the following part of this article.

#### *3.1. Singapore—City of the Future*

In international smart city rankings, Singapore has for years been presented as one of the smartest. According to the IMD Smart City Index 2019 developed by the IMD World Competitiveness Center, Singapore took first place in the ranking [45]. The Asian city-state owes this very favorable position not only to the application of modern solutions as regards ICT and the high rate of economic growth, but first and foremost to the way citizens are assured a high quality of life [46]. Nonetheless, the technocratic-style solutions introduced by the authorities of Singapore are sometimes criticized and regarded as activities directed at the consolidation of power in authoritarian governments as well as the reinforcement of a pragmatic and rather depoliticized ethos in Singaporean society [47], which is contradictory to the smart city concept.

Once independent in 1965, Singapore very quickly set off along the track of dynamic (but also sustainable) development, with matters of environmental protection thus being taken account of in the spatial planning process from the very outset. This was necessary in the aftermath of a colonial period whose legacy was an almost total lack of natural plant cover [48]. Further decades of urban greening followed, ensuring the current status of Singapore as an exemplar of a metropolis in which vegetation forms a foundation for the whole urban ecosystem [49]. Moreover, thanks to the introduction of vegetation on roofs and building walls along with broad reforms seeking to restore the original structure of the urban ecosystem (a priority i.a. taken into account in The Singapore Green Plan 2012) Singapore is regarded as a pioneer of the new 'biophilic urbanism' [50].

While the above activities can be regarded as a spectacular example of the effective implementation of the sustainable development concept, Singapore is faced with the need to achieve a greater density of built-up area, due to steady growth of the population in a very limited amount of space [51]. In spite of actions to preserve greenspace within the city, Singapore's built-up areas doubled between 1965 and 2000, at the expense of forests and farmland [52]. On account of the cut-throat rivalry for land, activity not efficient from the economic point of view cannot be continued within the city space. What first and foremost fell victim to built-up areas was the urban agriculture analyzed in this paper. On account of Singapore being compelled to import almost all of its food [53], local production should be a priority for today's authorities. However, as resources of land are lacking and as there is a great deal of competition for land exerted by other, more profitable forms of land use, there are many urban gardens and farms unable to remain on the market. Urban agriculture in Singapore is, thus, faced with a difficult situation engendered by an existing institutional and legal framework that necessitates the restructuring of land use for the benefit of built-up areas.

#### 3.1.1. Spatial Policy and Urban Agriculture Management

Once independence was gained, power passed to the People's Action Party, which has remained in power to date. Key policy at once focused on acquiring control over the use of land, allowing for very effective steering of the economic activity—agricultural activity included—pursued within the borders of Singapore. As early as 1966, the Land Acquisition Act (LAA) did much to further facilitate the purchase of land by the state [54]. Currently, all transactions, along with those concerning land intended for cultivation, are managed by state institutions, such as the Singapore Land Authority and Urban Redevelopment Authority [54,55]. The level of state ownership of land in 1992 was 80% [56], as compared with 90% now [55]. Such wide-ranging remits in the hands of the authorities not only ensure income for the Treasury, but also allow for a very centralized system of spatial planning that is now proving to be of model importance, and therefore gaining application in the Global South, where serious development challenges are faced [54]. Moreover, the land tenure system is critical to the decision-making process regarding the spatial distribution of agricultural activity within the city limits.

In Singapore, the main institution governing urban agriculture was, until recently, the Agri-Food & Veterinary Authority of Singapore (AVA). However, on 1 April 2019, this organization split into the Singapore Food Agency (SFA) providing 'food-related services', and the Animal & Veterinary Service (AVS) providing 'non-food related animal, plant and wildlife management services' [57]. These institutions extend technical and technological support, as well as provide for strategic collaboration over research and development. Local farmers can avail of the services of a dedicated advisor when it comes to their introduction and testing of modern technology, as well as the development of business and receipt of funding under the Agriculture Productivity Fund (APF). Until June 2016, the permissible period of land lease for agriculture in Singapore was a maximum of 10 years, with the possibility of extension for another 10 years. This constituted a serious obstacle for the operation of Singaporean farms, which were not able to achieve financial stability in such a short time. After much contradictory information from the representatives of the authorities, the AVA's decision was announced to extend this period to 20 years. It is worth emphasizing, however, that it is the Singaporean government that decides to extend the lease agreement and has full authority in this regard. According to the documents posted on the website of the Singapore Land Authority—the institution responsible for land management—the government's policy in this regard is unambiguous. Although it is possible to extend the lease period, this practice is rarely used, and each case is considered individually [58].

The main argument for the regular review of municipal land ownership is the scarcity of land resources and the need to adapt the methods of its use to the changing needs of the Singaporean economy [58]. In the case of agriculture, the lease term can only be extended if the tenants have made substantial investments in land or real estate and their activities are essential to 'strategic national needs'. This means that farms that are not profitable enough or do not fit in with the development directions promoted by the authorities may be moved, or, if they fail to obtain land use rights elsewhere, closed. The Singapore Food Agency also offers another form of lease—short-term land lease for agriculturelasting from 1 to 3 years. In this case, urban agriculture is considered a temporary activity that can hardly be regarded as strategic for urban development. In addition to the timelimited lease term, city-state authorities can also control agricultural deployment through a farm license system. Residents interested in such activities, with the right to use a given area, are required to submit a business plan to the Singapore Food Agency, which then undergoes a comprehensive assessment [59]. The above practices show that authoritarian authorities limit the freedom and decision making of Singaporeans in the shaping of urban space. The government inhibits the bottom-up initiatives of residents as long as they do not fit into the chosen policy. Short-term solutions that change urban space indeed only temporarily comply with the concept of the soft city and provide for the city space dynamic character. Nevertheless, strict control of the residents' activities limits their influence on the nature of changes taking place in the city, and the concepts of the soft city, smart city and resilient city include the participation of residents in the decision-making process. In the context of the future of urban agriculture in Singapore, a matter of importance are the provisions contained in the latest Singapore Master Plan [38]. Firstly, according to the document, agricultural activity is considered to embrace units enjoying the status of agrotechnology park, aquaculture farm, plant nursery, hydroponics farm or agricultural research/experimental station. The Master Plan therefore does not take into account the soil-based cultivation that actually dominates in the farms studied here. Secondly, in line with the document, the only areas designated for agriculture are in the Lim Chu Kang district as well as the area between Tengah and the Peng Siang River [38]. However, this is not an extensive area and does not coincide with that occupied by urban farms at the present time.

Thus, the Singaporean authorities have a number of tools to control and steer the directions of urban agriculture development. The conducted field research confirms that institutional and legal structures have a key impact on the distribution and inherent features of urban farms in the city state. Strong centralization, however, prevents grassroots initiatives and inhabitants' agency, whose individual needs are usually not taken into account in the strategies implemented by state institutions. Considering the fact that, currently in the smart city concepts, emphasis is also placed on support for communitybuilding among urban inhabitants as well as investment in human and social capital [12], Singapore should not be set as an example to follow in this area.

#### 3.1.2. Contemporary Urban Agriculture in Singapore

#### Spatial Distribution of Urban Agriculture

In the context of the present research, locations represent important carriers of information. On the one hand, a location reflects the activity of authorities within the existing institutional and legal structures as well as such external factors exerting an influence as the availability of land with particular desirable attributes, and the socioeconomic situation. On the other hand, the location influences agriculture's internal features, such as methods of production and forms of organization. It thus carries with it a series of aspects making up the broader picture where the presence of agriculture in a city is concerned. The location of 36 Singaporean urban farms analyzed in this paper is presented in Figure 1.

**Figure 1.** Land use and spatial distribution of urban farms in Singapore.

The 36 urban farms in Singapore (of total area 188.8 ha and mean area 5.24 ha) analyzed in this text may be categorized into two main groups. The first, comprising 28 farms of total area 178.76 ha and mean area 6.39 ha, includes the growing of plants and the raising of animals ongoing in the northwestern part of the island, named the Kranji Countryside (Figure 2). This area, in which two nature reserves (the Sungei Buloh Wetland Reserve and the Kranji Marshes) are also located, is characterized by a limited share of residential neighborhoods and is promoted as a place of recreation in the bosom of nature for Singaporeans tired of the city. However, despite the name, it is rather a stretch to consider this an area that is particularly rural in character. While it does indeed include a rather large number of urban farms, most of these exemplify 'industrial' farming, whereby cultivation and animal husbandry often take place behind walls or in greenhouses. In essence, the Kranji Countryside is a productive hinterland for Singapore located rather far from the city center. The urban farms here do produce food of both plant and animal origin, but their neighbors include defense establishments and enterprises dealing with the production of ornamental plants and pond fish. As a consequence, a specific kind of industrial and agricultural landscape is shaped here.

**Figure 2.** Land use and spatial distribution of urban farms within the Kranji Countryside.

The second group of farms in Singapore coming under study comprises eight sites of a total area of 10 ha and mean area of 1.25 ha, located in the central districts where transport links are good. Three are located in the south of the island and five in the north, on either side of the Lower Seletar Reservoir. On account of the high-density built-up area, sitting urban farms in central parts of Singapore is very much hindered and requires appropriate adaptive measures. Thus, for example, one of the farms—owned by Comcrop—is on the roof of the \*SCAPE Mall, less than 200 m from one of Singapore's main transport arteries, Orchard Road (Figures 3 and 4a,b). A rooftop location denotes appropriate methods of production that revolve around soil-free hydroponics.

**Figure 3.** Satellite imagery of the Comcrop farm located on the roof of the \*SCAPE building, map data: Google Earth ©2016.

**Figure 4.** (**a**) Hydroponic modules visible from the ground floor of the \*SCAPE building and (**b**) rows of hydroponic modules placed on the rooftop.

> In the second case, the owners of the firm Citizen Farm, which is located in the Queenstown district of southern Singapore, noted the ever-greater density of construction in their area, assumed that they might need to move sooner or later, and therefore decided on the use of port containers in plant production. Thanks to that decision, the farm is, indeed, almost completely mobile and thus, ready for its probable transfer elsewhere. Limited space and current land-use policy therefore have an impact on the application of innovative solutions in the field of urban agriculture in Singapore. Ability to adapt to changing economic conditions is in line with the concepts of smart, resilient and soft cities.

Nevertheless, the need to change locations emerged as one of the key challenges facing many individual farms, and hence, urban agriculture in Singapore in general. During the course of interviews with farm employees and owners, seven respondents indicated that the upcoming expiration of their lease was a problem they were having to face up to, with the attendant prospects of either moving elsewhere or closure. This is mainly true of farms not producing food on an industrial scale, such as Bollywood Veggies and Onesimus Garden, as well as farms located more favorably—in the north (the Oh Chin Huat Hydroponic Farm and Green Valley Farm) or in the island's central part (Citizen Farm). The system of land management in Singapore is based mainly around a 20 year lease period, which will end in the coming years in the above cases. It will depend on the state authorities whether this period is prolonged or not. It is likely that farms not profitable enough will be moved, or, if they prove unable to acquire the right to use land elsewhere, will most probably be closed down. The situation of two analyzed farms, which had been still operating in the course of the fieldwork—Oh Chin Huat Hydroponic Farm and Onesimus Garden—was recently settled. The former was closed shortly after the fieldwork in 2019. The plot it had leased is now intended for the development of housing. The latter was most probably shut down too, as the website of the farm is no longer available. That complies with what the respondent of the farm had stated during the interview, that the farm would be closed before long.

As, in line with the Master Plan published in 2019, the area designated for agriculture is limited, the closure of other farms needs to be anticipated. Moreover, by the end of 2021, the Singaporean authorities plan to allocate significant areas within the Kranji Countryside for military purposes [60]. The sites that will have to be relocated, including the 14 farms analyzed in this paper, with a total area of 84.8 hectares, were offered 60 hectares of land adjacent to the Sungei Tengah Reserve (Figure 2). Taking into account the fact that in this study, not all farms within the Kranji Countryside were examined, the area of land proposed by the government will most likely be insufficient (the area of only the farms examined is already larger by almost 25 ha). The militarization of areas so far occupied by agriculture is another form of legal and administrative pressure toward urban farmers who have no possibility of any objections. Out of 36 farms researched here, only 13 (of a total area of 79.6 ha) are located in areas in which, according to the Master Plan, it is possible to engage in agricultural activity. The location of the remaining 23 farms of a total area of 109.2 ha (including 14 within the Kranji Countryside) is not consistent with the provisions of the document, and therefore, they will be relocated or closed.

Although the situation of urban farms in Singapore is difficult and volatile, the government's 2019 Master Plan includes an alternative to traditional cultivation that could become an opportunity for the development of agriculture in the city. The document promotes the adaptation to produce food of the space hitherto unused but present, inter alia on roofs, and even inside buildings [38]. In line with the work conducted by L. Y. Astee and N. T. Kishnani [61], public housing estates in Singapore are suitable to apply rooftop farming based around soil-less hydroponics, with this obviously doing much to increase the output locally. The authors estimate that, in terms of yields, such farms could satisfy approximately 31% of Singapore's vegetable needs. This is then a possible direction that the development of the urban agriculture on the island could take, while being in line with the current policy on the part of the authorities. It requires, however, extensive activities in the cooperation of state, cooperative and private entities. The potential of the development of rooftop farms was also studied in other cities, e.g., Guangzhou [62,63], Hong Kong [64,65], Malaysian George Town [66], Bologna [67] and Dhaka [68]. Y-L Su et al. [63] proved on the basis of their research that sufficient roof space is available in Guangzhou for vegetable crop self-sufficiency. This shows that investments in roof farming can be an opportunity for the development of local food production also in other cities of the world.

Features of Urban Agriculture

The new policy of the authorities in Singapore takes the defined direction of investment in modern, intensive, income-generating agriculture, with simultaneous efficient use of limited space. The production of food is to be based around high technology, thanks to which the city is to move up to a new level of 'smartness'.

Only a few forms of agricultural activity are included in the Master Plan from 2019. Thus, in the future, the document will have a significant impact on the changes of inherent features of urban farms in Singapore. Moreover, the Singapore Food Authority and Singapore Land Authority also have a wide scope of control over farming practices within the city. Obtaining the land use rights for the purpose of agricultural production depends on the decision of these institutions. In an interview, the executive director of the Food Supply Resilience Group, an organizational unit of the AVA (former SFA), emphasized that the Singaporean government is committed to promoting highly productive and innovative commercial agriculture, based on high technology and production carried out in a controlled environment, enabling the generation of maximum profits. As such practices are approved by the government, it might be assumed that farms will be willing to implement them, in order to gain the state's support. Technologically advanced practices are, therefore, most likely to become ever more popular in Singapore. The changes are already taking place, which was proved during the fieldwork.

Among the 36 farms studied, a clear majority (28 farms—77.8%) are based exclusively around plant production. It is mainly vegetables that are grown, including so-called Asian leafy vegetables (e.g., bok choy, Chinese lettuce, butterhead lettuce, Korean lettuce) cultivated on 21 farms (58.3% of all farms analyzed and 70% of farms specialized in plant production). The other 6 farms (16.7%) are specialized in animal production, while 2 (5.5%) combine crops and livestock. Among the farms in which crops are cultivated, the prevailing methods are not the modern hydroponics that the authorities promote (although this is present at 7 farms, 19.4%), but rather, the more traditional soil-based cultivation that characterizes 14 of the places studied (38.9%). In regard to the two cases in which the methods are present side by side, respondents (representing Orchidville, as well as the Kok Fah Technology Farm) noted that hydroponic was only a supplementary method, not proving efficient enough at present, with the soil-based output thus representing the main source of income for both. The owners of both farms, however, are ready for further investment in hydroponics as well as aquaponics (Orchidville).

Four of the farms visited (11.1%) are also trying organoponics, which is to say cultivation in raised container beds, a production method that is widespread in Cuban cities, especially Havana [31,32,43]; Pacific Agro Farm involved in growing plants in growbags, as well as pots and other containers. Eight sites (22.2%) are involved in the growing of ornamental plants.

Two study sites stand out from the others in the diversity of their methods of production. The first of these is Citizen Farm, which applies soil-cultivation methods, hydroponics, organoponics, aquaponics, mushroom-growing and the raising of poultry. However, as may be imagined, this wide spectrum of forms of agricultural activity is a deliberate choice based around the idea of the techniques being presented (i.a. for educational and also trial purposes). Activity here includes workshops for Singapore's inhabitants in regard to sustainable food production, as well as research pursued to further perfect the modern methods on show. The second example is that of Green Valley Farm on Bah Soon Pah Road. This area actually belongs to the AVA, hence the presence here of more than 80 separate greenhouses that individuals are able to rent. Different greenhouses thus play host to various production methods, including soil-cultivation, hydroponics, organoponics or container growing. Six of the studied farms—located in the Kranji Countryside—are engaged in aquaculture, producing both ornamental pond fish and edible fish. The Jurong Frog Farm raises American Bullfrogs (*Lithobates catesbeianus*), while Hay Dairies engages in goat keeping. It is worth noting that 33 analyzed farms (91.7%) are private companies, and the food they produce is intended for sale. In the remaining three facilities, the products

are intended solely for the community members or for the restaurant operating on the farm. In addition, 12 farms (33.3%) also offer educational and recreational services. Taking into account the difficult financial situation of a large part of the surveyed Singaporean farms, income diversification may be an opportunity to keep them on the market. Expanding their activities to include educational or recreational events may stimulate sales and at the same time, increase the farm's revenues.

On the urban farms researched, there were 14 respondents who, upon interviewing, recalled the assistance of state institutions. In 7 cases (those of the Kok Fah Technology Farm, Orchidville, the Nippon Koi Farm, Oh Chin Huat Hydroponic Farms, Pacific Agro Farm, Green Valley Farm and Comcrop), representatives said they had been supported by the AVA. The assistance extended mainly took the form of expert opinions, as well as the testing of new technology and the quality of food produced. In turn, representatives of the remaining 7 farms noted how they were not taking advantage of support from the authorities, as that was either unnecessary or deemed too expensive. According to the representatives of both Bollywood Veggies and Onesimus Garden, the state only supports high-income farms that deploy the latest technologies.

In essence, their opinion overlaps with what was said in an interview by the manager of the Food Supply Resilience Group (AVA). Farms like Bollywood Veggies and Onesimus Garden, whose operations depend in large measure on education and social activity (and whose methods of cultivation should be regarded as traditional), do not fit in with the model of modern urban agriculture that the authorities are backing. Units of this kind must, therefore, rely on the assistance of a different kind, which is cooperation between producers within the framework of the Kranji Countryside Association. This brings together 40 operating farms, not only in the Kranji Countryside, but also in other parts of the city. The association offers a platform for the exchange of experience, technology transfers, joint promotion of local output and agritourism, and also coordinated activity, seeking to improve the performance of public transport [69]. Interviews held showed that farm owners and employees at various locations know one another and cooperate on a regular basis. Examples might be the composting of wastes from the Seng Choon Farm poultry breeders at the Onesimus Garden and Farm 85 in the Kranji Countryside. This is the way in which farms create the foundations of a sustainable and self-supplying system, limiting any loss of resources.

#### *3.2. Kigali—'The Singapore of Africa'*

At the other extreme, our considerations turn to Kigali, the capital of Rwanda and a city of over a million inhabitants. On account of the observed dynamic development, the 'Singapore of Africa' epithet was first applied by The Economist in 2012 [1], and was taken to reflect the rapid development of the services sector and pro-environmental solutions introduced by local authorities. Rwanda offers an example of a very radical policy as regards the fight with plastic. Citizens also participate in unpaid work for the community, comprising, for instance, monthly cleaning of streets [70,71]. Due to this activity, Rwanda's capital has come to be known as 'the cleanest city in Africa' [72]. The term is taken to refer to the country as a whole, as much as to its capital, with references being made to a smart city model, African style. As one aspect of the smart city entails skillfully managed resources of urban greenspace (including areas set aside for agriculture), it is worth comparing and contrasting this capital city in Central Africa with a southeast Asian city it often seems to be compared with. Verification (or otherwise) of this point of view, often repeated in media discourse, in relation to urban agriculture has constituted a key task of the work presented here.

In general terms, a genuine resemblance between Kigali and Singapore—at least at moments—reflects the large share of urban greenspace within the city as well as (first and foremost) a level of cleanliness on the streets that stands out when comparisons are made with other African metropolises. However, a matter of much wider significance is the fact that the Rwandan authorities have for years drawn directly on Singapore's example and experience when it comes to spatial planning. Indeed, Lee Kuan Yew, co-founder of the People's Action Party and first long-term Premier of Singapore (1959–1990), spent part of his time in the first decade of the 21st century as an advisor to President of Rwanda, Paul Kagame, in matters of effective governance [73]. What is more, Kigali is an example of an African metropolis in which, similar to Singapore, the assumptions of the smart, sustainable and resilient city concepts are being pursued [74].

It is worth looking at the transformation that Kigali went through, from being a subordinate colonial city to being a model vis-à-vis spatial planning [73,75]. The city was a minor trading center dominated by low-rise, informal housing, with most of the area taken by marginal districts [73]. The situation began to change slowly after 1962, when Kigali became the capital of an independent state. Three decades later, the population had exceeded 200,000. However, the genocide in 1994 led to the city being abandoned, with its infrastructure left devastated. In spite of the marked decline in population that occurred, several years on from the genocide, a major increase in population had already taken place in the capital. Kigali authorities, faced with the explosive population growth typical for so many metropolises in the region, and with the resulting sprawl of an informally built suburb, were not in a position to meet the inhabitants' increasing basic needs. The result was a succession of conflicts over spatial resources [75–77]. In addition, one of the major problems was how to provide the growing population with a sufficient amount of food with most of the farmland being destroyed or abandoned. That is when Kigali's residents started to turn wastelands into cultivated plots. Soon after, urban agriculture was implemented in the city's long-term development strategy.

#### 3.2.1. Spatial Planning and Urban Agriculture Management

An important issue influencing the effectiveness of spatial planning is the system of land ownership in Rwanda, which differs from that in Singapore. In the period immediately after the genocide, in the face of returning refugees again settling in Kigali, the city authorities had to deal with the problem of claims for building plots. The inadequate supply and then-dominant system of land distribution were not in a position to meet the needs of a dynamically growing number of urban residents. The population flowing in was forced to purchase land belonging to the state prior to gaining a right to use or right of ownership [78].

This kind of situation prevailed for a decade until 2005, when the Organic Law was introduced [79]. This ensured a possibility for land to be purchased and rights of ownership to be acquired, irrespective of ethnic affinities or gender [79]: Article 4. Moreover, a possibility of 'expropriation due to public interest' was introduced, albeit on the basis of prior compensation at an appropriate level [79]: Article 3. This provision aroused considerable controversy, especially on account of the flexible approach to what are regarded as 'public interest projects' [73]. In turn, the Land Governing Law assumed a need for the purchase of land to be registered in line with the Land Tenure Regularization (LTR) Program [80]. Though, unlike in Singapore, it is not the authorities that are the main landowners, in Rwanda, like in the Asian city state, the whole process is the subject of close scrutiny on the part of state institutions that are, at the same time, the main decisionmakers.

The comparison between Kigali and Singapore may also involve the directions taken by spatial development policy in both. Work on the devising of the Kigali Master Plan 2013 was i.a. a matter for foreign specialists associated with the Singaporean consulting firm Surbana Jurong Private Limited, whose services relate to infrastructure and planning in urban areas, and the drawing up of planning documents for various different cities, including Singapore itself [39]. The same firm took part in work to draw up detailed area plans following the 2007 publication of the earlier Kigali Conceptual Master Plan prepared by the American firm Oz Architects [73]. The Master Plan 2013 introduced zoning, and thus regulated the means of land use, the heights of buildings and permissible densities of population in each area. A further assumption is that people living in hazardous areas will be resettled [75,81], and this may be a serious matter for the most vulnerable groups, with

such negative socioeconomic consequences as loss of means of upkeep and reduced food security, the severing of social ties, marginalization, or even induced homelessness [82,83]. Resettlements therefore lead to the exclusion of the most vulnerable city residents, which is in contradiction with the concepts of smart, resilient and soft cities that comprise solutions aimed at social inclusion.

As early as 2009, urban agriculture gained incorporation in the Kigali Conceptual Master Plan as an element to a strategy whereby the level of food security of inhabitants of the Rwandan capital was to be raised [84]. According to the cited document, 47,000 ha (or 65% of the city's administrative area) was to be deemed natural, i.e., subject to safeguarding against regular construction. Within that area, some 3481 ha was designated for urban agriculture. At the same time, a 10-people-per-hectare limit was set on permissible population densities in these areas [84]. The Master Plan 2013 encompasses integrated activity to ensure the retention of agriculture across the city-space, an improvement in its level of efficiency, and a curbing of any negative influences on the natural environment. The document assumes conservation measures on cultivated land adjacent to wetlands in areas where slopes are of less than 15% as well as restrictions on mechanized intensive agriculture on the steeper slopes. Beyond that, to safeguard against erosion where slopes are of 15–25%, there is an effort to promote agroforestry using slope terracing, while slopes in excess of 25% should only be used for forestry. Two districts are associated with priority cultivation of certain crops, i.e., maize, vegetables, legumes, fruit, rice and soybeans in the Gasabo District as well as coffee and fruit in the Kicukiro District [39].

The document that in the nearest future will shape the spatial distribution of agricultural activities in Kigali is the Master Plan 2020 [40]. Its provisions are, however, ambiguous. On the one hand, according to the document, the area designated to agriculture is 165 km2, which constitutes 22.7% of the city's total area. Therefore, the projected share of agricultural land is lower compared to the one presented in the 2013 version of the document, where it amounted to 192.9 km2 and 26.4%, respectively [39,40]. Thus, in both Kigali and Singapore, there is a tendency to reduce the area occupied by agriculture. On the other hand, one of the objectives of the latest Kigali Master Plan is the reclamation and conservation of agricultural land as well as the promotion of sustainable production methods that would allow the preservation of high-quality soil. As part of the document, zones of 'Zero Net Loss of Agricultural Areas' are to be designated in the city; horticulture is to be integrated in the urban design; and kitchen gardens as well as rooftop farms are to be promoted. However, unlike in the case of Singapore, the Kigali Master Plan does not include modern production methods, such as hydroponics or aquaponics. The implementation of the above provisions of the document is to be possible thanks to the development of the Urban Agriculture Development Plan, the Urban Agriculture Extension Manual and the Integrated Urban Agriculture Management Plan. Moreover, the document also provides for the organization of a series of awareness-raising trainings on sustainable agricultural techniques aimed at city residents. In contrast to Singapore, in Kigali, there is no institution that can provide financial support, especially in the implementation of innovative agrotechnical solutions.

The Kigali Master Plan provides for integrated measures to protect urban agriculture in some valleys and in areas with a slight slope as part of a strategy of increasing the food security of residents. However, crops from most of the valleys within the city limits are to be moved to the highlands in order to protect naturally valuable wetlands. Therefore, the actions contained in the document indicate the will to preserve agriculture in Kigali's space. It turns out, however, that most of the above protective provisions refer to rural areas within the administrative boundaries of Kigali. In line with the division of the city into different land use zones, agriculture is to be maintained only in rural areas in the northern part of Gasabo and in the south of Nyarugenge. However, the planned share of agriculture in central parts of the city is small. It is to occupy only a limited part of the valleys in the Kicukiro district (south and north of the airport), on the border of densely built-up areas [40]. Taking into account the fact that agriculture is currently present also within the urbanized zone, even in the central districts of the city, it should be expected

that, in the nearest future, similar to Singapore, large-scale agriculture will be pushed to peripheral areas. However, contrary to the Asian city-state, the planning documents do not include wide-ranging implementation of innovative urban production methods based on modern technologies that could serve as an alternative to traditional agriculture.

In comparison to Singapore, the Kigali authorities adopted a slightly different policy with regard to small, cultivated plots in wastelands. A common practice mentioned in the interview with a representative of the Kigali City Hall is the granting of a temporary right to lease unused plots of land (both state-owned and privately owned land) for the purpose of food production. A sole condition here is that this activity should not be pursued on an industrial scale but should rather serve to meet people's own nutritional needs, albeit with the possibility also envisaged of surplus produce being sold. Nonetheless, when the original owner expresses their will to develop a plot of land, local farmers must change their location. Such a practice allows for the temporary use of wastelands while supporting the local population in improving their food security. As it is based on a grassroots initiative of residents, it also fits into the concepts of sustainable, smart, resilient and soft cities. A similar practice has been used since the 1990s in Havana. In the Cuban capital, however, agricultural activity that was originally intended to be temporary turned out to be long term, as gardens founded almost three decades ago continue to operate today [33,44]. In turn, in Singapore, even though it is possible to obtain a short-term license or land lease for urban agriculture, such permits are rarely issued. In addition, in order to obtain them, residents must meet a number of administrative requirements, and their applications are subject to prior scrutiny by the authorities [57,58].

Another practice that is part of the policy against malnutrition in Kigali is the promotion of the so-called kitchen gardens (Kinyarwanda: *akarima k'igikoni*). The city authorities support the cultivation of fruit and vegetables for the needs of individual households. The campaign named 'Promoting Diversified Diet and Innovative Urban Farming for a better and Well-Nourished City' implemented in 2017 by the City Hall of Kigali in cooperation with the International Potato Center is one of the examples of actions taken by the city authorities to increase the food security of residents and to enrich and diversify the diet, especially among children. The action involved a series of trainings aimed at educating the population in the field of organic fruit and vegetable cultivation and healthy nutrition. Similar initiatives are not undertaken or even supported by the Singaporean authorities. Urban farms that focus on educational and social activity, if they are not economically viable, are unlikely to survive on the market or to have their lease agreement prolonged.

Based on the abovementioned policy, significant changes in the distribution and characteristics of urban agriculture in Kigali are to be expected in the following decades. It is worth emphasizing that, despite the fact that, as in Singapore, the city authorities are the main decisionmaker in shaping the spatial policy of the Rwandan capital, including the spatial distribution of agricultural areas, the existing institutional and legal framework gives residents a certain degree of agency in this respect. As a result of the possibility of using wastelands for cultivation, urban dwellers have a chance to transform their immediate surroundings in a bottom-up manner in accordance with their needs, even if these changes are only of a short-term nature.

#### 3.2.2. Contemporary Urban Agriculture in Kigali Spatial Distribution of Urban Agriculture

The total number of agricultural areas identified with Google Earth tools in Kigali was 780.98 (of total area 1170.4 ha and mean area 11.9 ha), which were further analyzed during fieldwork. They will be discussed in detail in this article (initially 100 sites were planned to be visited, but due to the limited time of the research and difficult access to two of the selected arable plots, 98 of them were analyzed during fieldwork). The largest number of agricultural sites, 48, is located in the Gasabo district. In the two remaining districts, the number is two times smaller—23 in Kicukiro and 17 in Nyarugenge. In addition, 5 agricultural areas are located on the border of Nyarugenge and Gasabo districts, 2 on the border of Nyarugenge and Kicukiro, and 3 on the border of Gasabo and Kicukiro.

Features of spatial distribution of urban agriculture in Kigali differ markedly from those in Singapore. First of all, there is no concentration in particular parts of the city, but rather a presence in all districts. Unlike in Singapore, whose relief is not very varied, differences in altitude in Kigali can reach 300 m, and it is largely this factor that determines the distribution of urban agriculture mainly present, where the development of built-up areas is either impossible or very much hindered. The places involved are either extensive and humid valley bottoms between hills, or else the steep slopes of the latter. Among the 98 agricultural sites examined, 35 (of total area 1011.49 ha and mean area 28.9 ha) are located in valleys. Due to high humidity, the use of valley bottoms for development is very difficult and therefore, they are intended for agricultural activities. Often, large areas occupied by agriculture are adjacent to densely built-up residential neighborhoods, occupying the slopes of the valleys. The two contiguous forms of land use create a clear sharp border in space. Otherwise, the vicinity of residential buildings and urban agriculture in the valleys compose a specific rural–urban landscape. It is characteristic of even the most central parts of Kigali (for instance, the area on the border of Nyarugenge and Kicukiro districts). It is worth noting that agricultural areas are adjacent to both densely built-up informal neighborhoods inhabited by the poorest social groups, as well as the formal ones, having a slightly lower building density occupied by the middle and upper–middle classes. The second group of agricultural sites analyzed during fieldwork consists of 63 (of total area 158.89 ha and mean area 2.52 ha), located on the hill slopes. They usually take the form of small, cultivated plots or vegetable gardens and are situated between residential buildings. They are present in all surveyed districts. Figure 5 presents the distribution of urban agriculture in Kigali, both of the 98 agricultural sites examined during fieldwork and the remaining 682 previously identified in Google Earth.

**Figure 5.** Land use and spatial distribution of urban agriculture in Kigali.

In the central parts of Kigali, small, cultivated plots on slopes and hilltops are less frequent. The agriculture is concentrated here mainly in vast valley bottoms. This is mainly due to high building density in central sectors. The short distances between buildings limit the possibility for cultivation and setting up vegetable gardens. However, the further away from the center of Kigali, the share of micro-scale agricultural sites located on slopes and hilltops increases significantly. This results from the decline in the building density toward the outskirts of the city. The majority of small, cultivated plots are located on the outer parts of the research area, characterized by the least compact spatial form. In turn, in Singapore, farms of a small total area dominate in the central parts of the city, while large-scale farming is concentrated in the periphery, mainly within the Kranji Countryside.

In Kigali, the spatial distribution of agriculture is, in part, a manifestation of the needs of the capital city's inhabitants. Unlike in Singapore, farming is mainly carried out in the immediate vicinity of residential buildings, sometimes taking the form of the so-called 'kitchen garden' in a person's backyard. What can be regarded as a spatial similarity between Kigali and Singapore is that urban agriculture is present alongside green areas that are highly valuable from the natural point of view. In the case of Singapore, these are the natural wetlands in the Kranji Countryside, while in Kigali, they take the form of wetlands in valley bottoms. In addition, in neither of the cities does agriculture appear commonly in areas in which the services sector or administration hold sway. Hence, the small number of urban farms in Singapore's downtown, and their absence from the summits of the Nyarugenge and Kimihurura heights in Kigali (which, according to spatial planning documents, are to become prestigious service–business centers).

A key practice underpinning the ubiquitous nature of urban agriculture in the city space of Kigali is the transformation of even the smallest wasteland into arable plots. Although this practice is based on a grassroots initiative and enables the participation of residents in the shaping of the city space, it also poses a significant threat. The use of land unsuitable for cultivation, for example, too-steep slopes of hills, leads to the intensification of soil erosion and, consequently, to mass movements hazards. In addition, valuable natural wetlands located in the valley bottoms are also endangered, as they are turned into cultivated plots. The above problems were taken into account in the directions of spatial planning outlined by the Kigali authorities. According to the published master plans from 2009, 2013 and 2020, agriculture, mainly large-scale, is to gradually disappear from the central districts of the city. Additionally, most of the wetlands in the valleys, which are currently occupied by crops, are to be protected as naturally valuable areas where no agricultural activities are planned. The exceptions are agricultural areas in the valleys on the border of the Niboye and Kanombe sectors and the Nyarugunga sector in the Kacukiro district. Moreover, according to the latest 2020 document, agricultural activity is to be restricted in areas with steep slopes (more than 15%) in order to prevent soil erosion.

The dynamic in-fill development as well as spatial expansion of the residential neighborhoods are the factors that may significantly contribute to intensified displacement of agriculture from the central districts of the city in the following years. Kigali is an example of a city that, contrary to Singapore, has a relatively high share of wastelands in its space. However, due to the strong economic and political position of Rwanda as well as the increase in the number of foreign investments, gaps in the urban tissue in the central sectors, such as Nyarugenge, Kimihurura, Kacyiru, Kinyinya and Remera, are being filled by buildings. Due to the fact that, so far, these gaps have been occupied by crops and the land use rights granted to inhabitants are short-term in nature, the share of agricultural land in the fastest-growing parts of Kigali will decline. Similar processes took place in Singapore. Urban farms in favorable locations (such as Oh Chin Huat Hydroponic Farms analyzed above) were shut down in order to be replaced by residential neighborhoods.

An example illustrating both the situation of urban agriculture as well as the transformations occurring in Rwandan society is presented in Figure 6a,b. The June 2019 satellite image available in Google Earth clearly points to the plot of 23 ha in the Kinyinya sector in the Gasabo district being under cultivation (Figure 6a). The presence of agriculture in

this area was also confirmed during fieldwork in July 2019. According to the March 2020 Google Earth image (Figure 6b), the plot was almost completely cleared and was recently turned into a golf course. The area allocated to cultivation was radically reduced to 4.9 ha. Agriculture was only preserved on the edge of the golf course. The fact that farmlands have been replaced by a luxury recreational facility demonstrates the increasing demand for similar leisure activities and may indicate the growing wealth of Rwandan society as well as the influx of foreign tourists and businessmen. The displacement of urban agriculture to the outskirts of the city was observed by M. Taguchi and G. Santini [85]. The authors point out that since the 1990s, when agriculture was included in the Kigali spatial planning policy on the advice of FAO, the city experienced a dynamic development. The Rwandan capital has become one of the fastest growing cities in the world, and agriculture—which was slowly losing its importance, similar to Singaporean urban farms—has begun to be replaced primarily by residential buildings. Our results also attest to what was stated by S. Reuther and N. Dewar [30] with regard to Khayelitsha in Cape Town, that very often land tensions occur between urban agriculture and the development of housing and other uses, such as ecological corridors and public open spaces.

(**a**) (**b**)

**Figure 6.** Area occupied by urban farming (limited by the red outline) in the Kinyinya sector in (**a**) June 2019; (**b**) in March 2020 during the construction of the golf course, map data: Google Earth ©2021/Maxar Technologies.

#### Features of Urban Agriculture

As in Singapore, location exerts an influence on the methods of production used as well as the species of plant cultivated. The valley bottoms are divided into smaller plots that are leased by the city or represent the property of individual farmers (Figure 7a). What are mainly grown here are bananas, maize, and tuberous crops, such as manioc, yams, sweet potatoes, as well as vegetables (e.g., cabbage, lettuce and tomatoes). Particular plots are also used in rice growing, even if this is more typical of suburban areas (Figure 7b). In contrast, on the slopes, the main cultivated species are resistant to the water stress arising due to the low level of the water table. Involved first and foremost is the growing of manioc, sweet potatoes and yams, whereas vegetables are rarely cultivated here. Moreover, bananas and maize are very widespread where slopes are steeper. Taking into account all the studied urban agriculture sites, the dominant crops are maize (68% of sites analyzed), bananas (48%), manioc (39%), yams (37%) and sweet potatoes (24%). In all of the agricultural areas visited, plants are grown directly in the ground, and only traditional production methods are applied. Despite the fact that Kigali follows the example of Singapore when it comes to the implementation of ICT, innovative methods of agricultural production are yet to be introduced.

**Figure 7.** (**a**) Valley bottom divided into smaller cultivated plots in the Gasabo district, (**b**) rice plots in the valley on the border of Gasabo and Nyarugenge districts.

(**a**) (**b**)

Nevertheless, it is not merely relief, natural conditions or the needs of inhabitants that influence crop cultivation in given areas, as the city authorities are also involved. Fieldwork shows, however, that it is difficult to observe the effects of implementation of provisions concerning the priority of certain crops included in the Kigali Master Plan 2013. There seems, in practice, to be no difference in what crops are being grown in the three districts. While Gasabo does indeed have dominant cultivation of maize, the document refers to (present at 29 sites) manioc also frequently being present (at 20), along with yams (14), bananas (13) or sweet potatoes (11). In Kicukiro—the area slated for coffee and fruit production under the Master Plan 2013—it is, again, maize that dominates (17 sites), as well as manioc (11), bananas (8) and yams (5). A similar situation applies to the Nyarugenge District. Taking into account the fact that 6 years have passed since the publication of the 2013 version of the Master Plan to the fieldwork conducted, some effects of its implementation can already be expected. According to the document, depending on the district, the species of plants cultivated should be different; in reality, however, fieldwork attested to them are quite similar.

The role of urban agriculture in Kigali differs greatly from that in Singapore. First and foremost, as subsistence agriculture predominates within the city limits, it is primarily aimed at ensuring food security for urban dwellers. Nevertheless, it is worth noting that in the face of the city's current development and the improvement of living standards of its inhabitants, the functions of agriculture are also changing. It is increasingly becoming an activity that provides additional income to those involved. Farmers sell their crops to intermediaries or distribute their products themselves at local markets. Moreover, taking into account the recent initiatives of the Kigali authorities to promote kitchen gardens, agriculture in the city is also expected to play a role in diversifying the inhabitants' diet and popularizing healthy eating.

In Singapore, some farms, in addition to selling food, also provided trips and educational services, which were an important part of their operation. In Kigali, agriculture mainly brings other social benefits, such as an improvement in the economic situation of inhabitants, as well as the inclusion of excluded social groups. However, these benefits are rather indirect and appear, as it were, alongside the basic function, which is food provision.


2. Organ transplantation and organ donation: an overview

Organ transplantation involves the surgical implantation of an organ or section of an organ into a person whose own organ is failing. The donor organ may come from both deceased individual as well as from a living donor. The patients psychological and behavior aspect as well their emotional response and mental health and adherence to medical regimen should be assessed before and after organ transplantation. The living donor's psychological response towards organ donation (most commonly for kidney and liver segment transplantation) is an important aspect to consider in the transplantation process.

Organ donation is defined as "giving an organ or part of an organ to be transplanted into another person" (Organ procurement of Transplant Network (OPTN), 2015), organ donation has the potential to save lives. The organs donated from one single donor can save up to eight lives. Organ transplantation may be one of the options left to sustain someone's life. However, the disparity that exists between the supply and demand of donated organs, leads to a loss of many lives. Based on recent OPTN data, approximately 21 people will die each day while waiting for a transplant in the United States (US). Currently, 123, 358 people are awaiting organs and on the transplant list in the US with this number growing and the number of donated organs declining.

Asian Indians are more likely to have higher rates of having obesity and diabetes when compared with other Asian subgroups which make them at an increased risk of needing a donated organ [35]. These conditions can lead one to develop coronary artery disease and hypertension which then can lead to chronic kidney disease and other chronic illnesses. Patients who suffer from chronic kidney disease need regular dialysis which can ultimately lead them to organ transplantation to improve one's quality of life. Also, conditions such as diabetes and obesity can be detrimental to one's life and can lead to fatty liver disease which can lead to chronic liver disease requiring liver transplantation if the liver decompensates.

The development of organ transplantation in the second half of the 20th century has been a remarkable achievement. Recently; organ transplantation is one of the most effective options for those with an end-stage organ failure. Its success has been basically dependent on public awareness, support and active participation. Without these factors, the efficiency of organ transplantation and the consequent saving or extension of lives would have undoubtedly suffered adversely.

The number of patients in need of organ transplantation has increased at a rapid pace; in contrast, the number of available organs has increased only slightly. Expanded criteria for donor selection, such as older age, have resulted in more people who meet the criteria for brain death becoming organ donors although fewer organs are transplanted from each donor. Improvements in automobile and highway safety, as well as increased enforcement of gun control laws, have also contributed to a plateau in the number of young, healthy donors. Public education efforts that encourage organ donation may be effective in getting more people to sign organ donor cards, but most individuals who do so will never be in a position to become organ donors.

Faced with increasing numbers of patients who need transplantation, deaths on the waiting list, and a fixed number of available organs, some transplant programs are working to increase the number of transplants from living donors. Although living donation has always been an option for some types of transplants, many programs have been reluctant to promote it, as living donation requires invasive surgery on a healthy person with associated risks of morbidity and mortality. For example, since dialysis is an option for patients with end-stage renal disease, surgery on a healthy donor may be difficult to justify, despite the dialysis patient's diminished quality of life.

The most important in organ donation is to maximize the psychological status and well-being of the donors before and after transplantation has become the foremost goal of all transplantation centres. The psychological issues that mainly concern with the living organ donation includes prevention of psychological harm, ensuring the donors are fully informed and decide to donate without coercion, monitoring donor psychosocial outcomes are intimately linked to the factors that historically served as barriers to use of organs from living donors. These barriers can be overcome by the motivating of the public and creating awareness and responsibility among oneself.

Organs that can be transplanted from the living donor includes one kidney, part of intestine, pancreas, islets of Langerhans, bone, part of liver, one testis, bone marrow and blood. The organ that can be transplanted from the deceased donor are heart, kidney, pancreas, stomach, hand, skin, blood vessels, lungs, liver, intestine, testis, cornea and heart valve.

Types of organ donation

Organ transplantation currently depends on the availability of human organs. Their scarcity means that there is a waiting list of almost 63,000 in the European Union, and over 100,000 people in the United States according to the recent survey. The process of obtaining organs for donation and transplantation purely depends on the resources of health services and by health professionals' performance in potential donor identification and management tasks. However, in accordance with the current legislation it is mainly subjected to a personal or family decision, strongly mediated by psychosocial processes. Therefore, the need to analyze and intervene both in the practices of the professionals involved in the process of organ generation and in the attitudes of the general population

Organ transplantation involves the surgical implantation of an organ or section of an organ into a person whose own organ is failing. The donor organ may come from both deceased individual as well as from a living donor. The patients psychological and behavior aspect as well their emotional response and mental health and adherence to medical regimen should be assessed before and after organ transplantation. The living donor's psychological response towards organ donation (most commonly for kidney and liver segment transplantation) is an

Organ donation is defined as "giving an organ or part of an organ to be transplanted into another person" (Organ procurement of Transplant Network (OPTN), 2015), organ donation has the potential to save lives. The organs donated from one single donor can save up to eight lives. Organ transplantation may be one of the options left to sustain someone's life. However, the disparity that exists between the supply and demand of donated organs, leads to a loss of many lives. Based on recent OPTN data, approximately 21 people will die each day while waiting for a transplant in the United States (US). Currently, 123, 358 people are awaiting organs and on the transplant list in the US with this number growing

Asian Indians are more likely to have higher rates of having obesity and diabetes when compared with other Asian subgroups which make them at an increased risk of needing a donated organ [35]. These conditions can lead one to develop coronary artery disease and hypertension which then can lead to chronic kidney disease and other chronic illnesses. Patients who suffer from chronic kidney disease need regular dialysis which can ultimately lead them to organ transplantation to improve one's quality of life. Also, conditions such as diabetes and obesity can be detrimental to one's life and can lead to fatty liver disease which can lead to chronic liver disease requiring liver transplantation if the liver decom-

2. Organ transplantation and organ donation: an overview

important aspect to consider in the transplantation process.

and the number of donated organs declining.

pensates.

need to stressed and addressed [1–5].

18 Organ Donation and Transplantation - Current Status and Future Challenges

1. Autograft: Transplanting a person's tissues from one site and use it in another site of his body and is called autograft. For example, removal of skin from the legs and using it for damaged skin face or other exposed part.

2. Allograft: Transplant of an organ between two genetically non identical individuals, it is called allograft. Due to the genetic difference, the donor's organ will be treated as foreign by the recipient and will try to destroy it. This is called s rejection.

3. Current scenario: trends

candidates.

Despite advances in medicine and technology, and increased awareness of organ donation and transplantation, the gap between supply and demand continues to widen. Each year, the number of people in the waiting list is increasing in both donor and transplant. The donation statistics according to OPTN Annual report shows that in 2016, total of 41,335 organs were donated. It can be either deceased or living and four out of five donations came from deceased donors and four out of ten from living donors. According to the report by OTPN 2018, 115,033 people need life-saving organ transplant, of those 74,926 people are the active waiting list

Organ Donation and Transplantation: "Life after Death" http://dx.doi.org/10.5772/intechopen.76962 21

The real reason behind a living person's interest in donating one's organ is important to determine but it is often difficult. Now days, money has become the motivation for donation. The relationships also have played a great role in increasing donation rates. The shortage of available organs can be reduced if; people choose to donate their organs after they die. If more

The trend is expected to accelerate each year. Many organ procurement and the Joint Commission on Accreditation of Healthcare Organizations actively participate to increase the donation

The approach, known as "donation after cardiac death" (DCD), usually involves patients who have suffered brain damage, such as from a car accident or a stroke. After family members have made the difficult decision to discontinue a ventilator or other life-sustaining treatment, organ-bank representatives talk to them about donation. Sometimes, the donor is suffering

people did that the issue regarding organ shortage can be minimized.

rates. The organizations take various to steps against traditional social taboos.

from an incurable disease also end up with the decision of organ donation.

Types of donors