GREECE IS | HEALTH | 2017-2018 by GREECE IS

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HEALTH

2 0 1 7 - 2 0 1 8 e d iti o n

ISSN: 2529-041X

ISSUE#27

04 - 17

WELCOME

What makes for a prime health tourism destination? Greece ticks every box on the list: climate, nature, food, and top quality wellness and medical services.

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ORIGINS

In ancient times, those who were struck ill used to pray for health. Then Hippocrates came along, and paved the way for medical science as we know it.

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EX PERIENCE

Thereâ&#x20AC;&#x2122;s so much more to Greece than just the sun and sea. Nature has blessed this country with resources that stimulate the senses and promote well-being.

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EX PERT IS E

Letâ&#x20AC;&#x2122;s explore the specialties and meet some of the doctors that give Greece its competitive edge in the growing realm of medical tourism.

welcome

Foundations of Medicine B Y G IO R G OS TSI R OS / e d i t o r - IN - C H IE F, G R EECE IS

Mythology and history, the natural environment and dietary customs, wellbeing and physical exercise, natural products and medical innovations, all combine to create Greece’s profile as a health tourism destination – and comprise the subject matter of this second edition of Greece Is Health. Instead of an introductory note, we have chosen to publish the Hippocratic Oath in its full version. This monumental pledge from 460-370 BC, a symbol of Greece’s golden age of intellectual achievement, set down the fundamental principles according to which the Western world has practiced medicine and advanced medical sciences for the past 2,500 years. (This is the classical version of the oath, translated by classical scholar and historian of medicine Ludwig Edelstein.) “I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant: To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art – if they desire to learn it – without fee and covenant; to give a share of precepts and oral instruction and all the other learning

to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else. I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art. I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work. Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves. What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about. If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.”

Hippocrates refusing the gifts of Artaxerxes. Engraving by Raphael Massard, 1816, after A.L. Girodet-Trioson, 1792. H E A LT H 2 017- 2 018

Contents Greece I s - ISS U E # 2 7 H E A LT H 2 0 17 - 2 0 1 8 E D I T IO N

84 04. A Perfect Place to Heal. Greece has unique potential as a health tourism destination.

36. Train Like an Ancient Greek. How to get those sculpture-perfect abs and glutes.

18. Gods of Health. Their mythical skills and deeds offered solace and hope.

42. Small Miracle Workers. A close look at ten endemic plants with healing properties.

22. The Holistic Approach. How ancient Greek philosophy and medicine laid the foundations for the modern concepts of healthcare.

50. Cups of Good Health. Four Greek companies have created delicuous blends of nature’s beneficial herbs, wrapped in modern packaging.

30. Snakes, Dogs and Dreams. Asclepieia, the sacred hospitals of antiquity.

54. Liquid Gold and a Great Healer. The beneficial properties of extra virgin olive oil.

60. Greek Superfoods. From dried figs to Chios mastic. 68. Eat Greek. An introduction to the country’s nutricious and delicious cuisine. 76. Feeling Whole. Greece’s holistic health retreats. 84. Harmony in the Hills. Three destinations for getaways that reinvigorate body and soul. 92. Fountains of Life. From ancient water worship to the recent natural spa revival.

100. The Greek Path to Well-Being. By the authors of the international best-seller The OPA! Way. 104. Lifesaver. The amazing story of the man who developed the Pap Test. 109. Brilliant Minds. What’s so special about Greek doctors, anyway? 116. The Pillars of Medical Tourism. From IVF treatment to robotic surgery. 127. Medical Services Brief.

ON THE COVER: Illustration by Anna Tzortzi

ISSN: 2529-041X published by:

Exerevnitis-Explorer S.A. Ethnarchou Makariou & 2 Falireos, Athens, 18547, Greece Tel. (+30) 210.480.8000 Fax (+30) 210.480.8202

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Greece is – HEALTH

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WELCOME

The Cradle 04

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EDESSA WATERFALLS, CENTRAL MACEDONIA

This Greek version of paradise on earth, some 90k west of Thessaloniki, features steep slopes, dense vegetation, waterfalls up to 70 meters high and amazing views of the fertile Macedonian plain.

Greece has unique potential as a medical and wellness tourism destination.

B Y G I OR G O S T S I RO S & M AR I A C O V EO U

of Health

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ÂŠ BABIS GIRITZIOTIS

Rodopi Advendurun 100 Miles, a very difficult footrace (for experienced runners) through the amazing scenery of the Rodopi Mountains National Park in Northern Greece, takes place every fall.

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RUNNING FREE In the land that spawned the Olympic ideal of excellence through athleticism, people are rediscovering this most basic of sports thatâ&#x20AC;&#x2122;s all about participating and enjoying nature. Read the full story and check out our calendar of running events across the country.

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WELCOME

hen you need to spend four hours a day on dialysis during your vacation, you want to make sure that the rest of your day will be perfect. This is exactly what 45-yearold Edinburgh patient D.S. was looking for after suffering acute kidney failure that had nearly cost him his life during a trip to France. After researching various destinations with the requisite medical facilities available so that he and his wife could combine a vacation with his treatment, the couple chose to spend 10 days in sunny Greece, splitting their time between Athens and Crete. And they had a wonderful time. On the island, a member of staff from a local clinic would pick D.S. up from his hotel at 6:30 sharp, take him for treatment and bring him back at 10:30, after which he was free to enjoy the charms of Crete for rest of the day. D.S. used his European Health Insurance Card, which meant that cost was not a serious concern. 08

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SFAKTIRIA ISLAND, MESSENIA, PELOPONNESE

Costa Navarino resort has put southwest Messenia on the global tourism map and Navarino Bay, where the most crucial naval battle of the Greek War of Independence took place, is one of the area’s landmarks. Seen here are the impressive rock formations of the island of Sfaktiria, a giant breakwater for the bay’s inner lagoon.

This story is but one among thousands and demonstrates just one of the many categories of medical services offered in Greece. It also illustrates something that most people don’t know: that the country which attracts more than 25 million visitors a year from around the world, mainly for its sun, sea and antiquities, is also equipped with all the facilities and services needed to have a dynamic presence in the rather “closed” global health and wellness tourism market. The worldwide value of this market is hard to pinpoint, but international estimates put it at anything between $5 billion and $440 billion. The facts are simple: Greece is a safe European country, very accessible, with state-of-the-art private medical facilities

and highly skilled healthcare professionals. Its natural environment is extremely diverse and, in many parts of the country, pristine: from high mountains with crisp, clean air, to ancient forests and a lacework of sandy beaches with crystalline bathing waters. Its mild Mediterranean climate is ranked among the best in the world, without unusual weather phenomena or violent fluctuations in temperature. The bounty of its land and sea, moreover, has shaped its quintessentially Mediterranean cuisine, which experts agree has multiple health benefits: its emphasis on extra-virgin olive oil, honey, wine, nutrient-rich seafood, fresh vegetables and pulses is a quality that has distinguished it since ancient times. Its rich cultural heritage, local habits and customs, the laidback

ARVI GORGE, HERAKLION, CRETE

One of Crete’s most spectacular gorges is 2.5k long, 2-3m wide and has vertical sides as high as 400m. It features impressive waterfalls and passages, as well as a whirlpool formed by an underwater cave 150 meters deep. A must-see for experienced canyoneers.

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WELCOME

lifestyle and the hospitality of its people are assets cherished by visitors from far and wide. In many senses, Greece is the epitome of joie de vivre. The country is blessed with natural springs that rejuvenate body and mind, and mountain trails that delight the eye and raise the spirits. It has award-winning luxury spa resorts that combine ancient healing practices, natural local ingredients and modern scientific methods, and a philosophy towards health and wellness services that dates all the way back to ancient times. For its many doctors (Greece has the highest ratio in terms of population of any member state of the Organization for Economic Cooperation and Development), itâ&#x20AC;&#x2122;s an added honor and a responsibility to practice their medicine in the country where the first medical principles were set down by Hippocrates. Their skill and quality is evidenced by the fact that they continue to prop up a national healthcare system that is being stretched to an unprecedented degree by the economic crisis; they maintain the highest standards at private hospitals, diagnostic centers and clinics; and, in the past few years, have been sought after in highly developed nations that are experiencing shortages in expert medical staff, such as the UK and Germany.

The country is blessed with natural springs that rejuvenate body and mind, and mountain trails that delight the eye and raise the spirits.

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ÂŠ KATERINA TSAGARAKI

FROM SPACE TO CRETE The islandâ&#x20AC;&#x2122;s temperate climate, legendary hospitality, diet and culture are just what the doctor ordered for the rehabilitation of a Russian crew of cosmonauts.

After months spent in space, there is no better way to reconnect with Mother Earth than standing barefoot on a beach with your loved ones. Oleg Skripochka and Alexey Ovchinin did exactly that.

WELCOME

THE SPA TREATMENT Visit our updated guide to the most luxurious, sophisticated, cutting-edge and pleasingly personalized spas around the country.

Anazoe Spa at Costa Navarino, Messinia, has been acknowledged as The Best Global Eco Spa by World Luxury Spa Awards 2017. Ιts signature Oleotherapy© treatments are based on ancient local practices inscribed on clay tablets discovered at the nearby Palace of Nestor.

A quick scan of the media and medical journals on pioneering procedures and accomplishments attributed to Greek doctors yields the following: a novel surgical approach to a complex penile urethra stenosis; successful, freeof-charge cardiothoracic surgery on a 13-month-old infant with severe cyanotic congenital heart disease; the first live-streamed global interactive rhinology and endoscopic skull base surgery; the successful excision of a tumor in an inaccessible and sensitive area of the 12

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brain of a five-month-old infant; the first transcatheter closure of a patent ductus arteriosus (PDA) successfully completed on a low birth-weight preterm neonate; transcatheter techniques for aortic valve insertion; laser prostatectomy with the latest generation XPS GreenLight Laser; total hip arthroplasty using the revolutionary ASI technique causing minimal trauma to the soft tissue; the successful artificial insemination without hormones of a woman with polycystic ovaries after two unsuccessful IVF attempts abroad…

and the list goes on and on. What is not on the official record but is widely recognized by Greeks overseas and foreigners seeking medical treatment in Greece is the personal touch offered by doctors and medical staff here, the confidence inspired by professionals who never lose sight of their humanity: the encouraging pat on the shoulder and the warm smile are part of being treated as person, not just as a patient. What Greece did not have until a few years ago was a coordinated image-building strategy to promote its qualities as a top medical tourism destination. It has been making significant inroads, however, building an ever-more dynamic presence in the sector through efforts spearheaded since 2013 by the Greek Medical Tourism Council (ELITOUR), an NGO whose members consist of medical and tourism service professionals, air carriers, travel and marketing agents and all the other players in the health tourism business. In 2018, ELITOUR will offer its support to the IMTJ Medical Travel Summit 2018 – organized by the International Medical Travel Journal – which will take place in Athens from May 21to May 24. The summit will bring together key opinion leaders and senior executives to debate the challenges faced by the developing medical tourism sector. Since 2016, the efforts of ELITOUR have been augmented by the Greek

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Doctors – whose objective is to become the international hub for the interconnection of Greek doctors around the world – and Greece’s International Medical Tourism Center, a think tank that will help promote and establish Greece as a trusted medical tourism destination. With a presence at international conferences and exhibitions, targeted campaigns in key markets and innovative proposals on how the Greek state can embrace and coordinate the effort, the private sector has seized the initiative to give the country the place it deserves on the global health service map. The time is ripe, and this publication hopes to do its part so that more visitors can discover – and benefit from – the many qualities of Greece that contribute to a healthy, happy life.

Health Tourism Association, the brainchild of pediatrician Dr. Constantine Constantinides, a visionary who is proposing a more “holistic” approach to give Greece a competitive edge by combining cultural, sports, gastronomic, nature, and geriatric tourism in tandem with health tourism. During the past two years, the Athens Medical Association, in collaboration with the Central Union of Municipalities of Greece (KEDE), both presided over by George Patoulis, have been systematically promoting Greece as a health tourism destination abroad, by organizing conferences in cities with a large Greek diaspora presence, such as New York, Chicago, Montreal and Melbourne. Most recently, the Athens Medical Association has also established the World Institute of Greek

BLUE CAVE, KASTELORIZO, SOUTH AEGEAN

Over 75m long and 35m high, this cave owes its color to the refraction of the sunlight in the water. It is the most popular stop for day-cruise boats operating on the easternmost island of Greece. Floating inside it is an out-of-this-world experience.

WELCOME

The “Greek sun” is a thing Fresh sea breezes, mild temperatures and stark topographical contrasts have earned Greece a special place on the global bioclimatic map. B Y G I ANN I S ELAFRO S

raditionally, the Greek National Tourism Organization ads featured sun-drenched locations, bright blue skies and seas like glass. But Greece is much more. As environmental scientist Michalis Petrakis, former director of the National Observatory of Athens, explains, it is the bioclimate that makes this country so special on a global level. “By ‘bioclimate,’ we mean all of the climatic factors prevalent in a particular biosphere which affect all living organisms, even humans. They are responsible for our sense of well-being,” he says. So what about the Greek sun? In contrast to other countries, where the sun is hot enough to burn the skin, or where it might also come with unbearable humidity, the climate in Greece is rather dry, particularly in the summer, with a normal humidity of less than 50 percent. Meanwhile, the northerly meltemi winds that blow through the Aegean and the localized sea breezes provide a refreshing respite. Greece lies in the Mediterranean climate zone, with mild winters and relatively hot, dry summers. It enjoys a high rate of sunshine almost all year round – as much as 2,000 hours a year in the northwestern regions and up to 3,000 hours a year in the Dodecanese. Even in winter, the sun shines an average of 70 hours a month (compared to 300-390 hours a month

in summer). The critical role of the sun in human health and well-being has been scientifically proven. Among other benefits, the sun helps synthesize vitamin D, which is important for building bone strength and combating osteoporosis. The hottest period in Greece comes in late July and early August, when the average maximum temperature ranges from 29 to 35°C. In winter, minimum temperatures in the plains and in cities are not that low. For example, the low in the Athens district of Nea Filadelfia in winter averages about 5°C. And even in mid-winter, stretches of bad weather are often interrupted by sunny days and milder temperatures during what has been known since antiquity as the “halcyon days,” usually in January. Periods of rain do not last very long, and the Greek sky remains fair, clear blue and without the thick, gray cloud cover that is common in other regions of the world. The variable geomorphology of Greece is of particular significance to the overall Greek bioclimate. The mountains and the sea are often close neighbors. Meanwhile, the ever-changing landscape throughout the country provides a pleasing diversity for the traveler, and also creates a variety of microclimates within the overall Mediterranean environment. This means that, after relaxing on the beach on a hot summer day, one can easily find refuge in the cooler mountain altitudes just a short distance away.

KOMMOS, SOUTHERN CRETE In the Minoan Age, Kommos, located approx. 64k south of Irakleio, was a proper city with its own harbor. Now it is famous for its sandy beach, one of the longest in Crete.

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Â© GETTY IMAGES/IDEAL IMAGE

ORIGINS

Gods of Health Apollo, Chiron, Asclepius and Heracles were leading healers, teachers or promoters of public health whose mythical skills and deeds offered solace and hope. BY Ge r a si mos A . R igatos

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Asclepius and (behind) his sons, Machaon and Podalirius, and daughters, Iaso, Aceso and Panacea. To their left, a family of worshipers and a maidservant. Marble votive relief of the first half of the 4th c. BC (National Archaeological Museum, Athens).

MEDICINE in homer Read how the Iliad and the Odyssey serve as the earliest source of information we have about Greek medicine.

he art of healing emerged as a crucial human need eons ago while our species attempted to survive and adapt within a hostile environment. Early humans – sometimes healing themselves instinctively, at other times through a skilled member of the community – were able to deal with simple health issues, such as removing a thorn from the foot, piercing the skin to relieve a purulent infection or covering open wounds with tree leaves. However, the actual causes of ailments were not always clear. Diseases of unknown origin or those with dire prognoses created the need for a magical healer to serve as an intermediary between ordinary people and unseen superior forces. As human knowledge and thinking became more sophisticated, these higher forces became personified as gods and, eventually, as healing deities. The ancient Greek mythological tradition of healing deities is rich with leading figures. According to the Homeric epics that describe the time of the Trojans (probably the 12th century BC), the god of medicine was Paion or Paieon. He served as physician to his fellow gods, including Hera and Ares, as well as to mortals. He was familiar not only with injuries, but also with many useful plants, both therapeutic and poisonous. For his part, Asclepius had not yet been deified at this time. He was still a common mortal whose advanced years kept him from participating in the Trojan War. Instead, he sent to Troy his sons (also mortals), Machaon and Podalirius, as both military leaders and doctors. The “deification” of Asclepius was brought about sever-

al centuries after the fall of Troy, by the distant descendants of those same sons. Ancient myths likewise preserve the names of other healing deities, demigods and deified heroes. Prometheus, described masterfully by Aeschylus, was a Titan, the only one who supported Zeus against the power of Cronus. The rift between them came later. The Titan “philanthropist,” as the myth unfolds in “Prometheus Bound,” taught people how to build healthy, sun-filled houses, how to prepare nutritious food and what plants and other substances could soothe their pain. “All the civilizing arts [were taught] by Prometheus,” writes Aeschylus. Prometheus, moreover, offered this knowledge at his own expense and became “the first saint and martyr of the philosophical calendar.”

Diseases of unknown origin or those with dire prognoses created the need for a magical healer to serve as an intermediary between ordinary people and unseen superior forces.

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Apollo, the centaur Chiron and Asclepius. A wall painting from Pompeii, 1st c. AD (National Archaeological Museum of Naples).

Among the demigods was the centaur Chiron, a healer and teacher of the therapeutic and other useful arts. His legendary amalgamated form – which combined the upper torso of a man with a horse’s body and legs – perhaps alludes to the totemic symbol of a certain tribe, or to the ubiquitous role of the horse in ancient transport, or to cultic activities with horses. Chiron was a great educator. Common people, kings and gods entrusted to him the education of their children. Apollo himself, patron deity of medicine, tasked Chiron with instructing his son Asclepius, whom for many centuries mythology presented as the succeeding god of medicine. Chiron’s “educational program” included the treatment of wounds; knowledge of the rich pharmaceutical flora of the Greek landscape; and exorcisms (“incantations”), to be offered as psychic 20

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support for the injured and the sick. Heracles was another of the demigods, the scion of the god Zeus and the mortal Alcmene. He too is associated with ancient health, as some of his labors are clearly readable as reflective of major health-promoting projects pursued during the Mycenaean era. The slaying of the Lernaean Hydra, for instance, represents one of those prehistoric efforts. As early as the 6th century BC, the reformer Servius Tullius, sixth king of Rome, believed that the monster with nine heads was actually a swamp fed by multiple underground water sources; when one of these was closed, water sprang from elsewhere through one of the other sources. The exhalations of the Lernaean Hydra/ swamp – that is, the swamp’s malodorous fumes – poisoned the surrounding area. According to Servius, Heracles drained

the area with fire, then blocked the underground sources. Also health-related was Heracles’ task of exterminating the Stymphalian Birds, interpreted by some as representing mosquitoes that spread malaria. Even clearer is Heracles’ fifth labor that required him to clean out the manure-filled Augean Stables – which he successfully accomplished by diverting two regional rivers. Heracles was also worshiped in Athens as a he alth deity (Heracles Alexikakos), notably during the years of the Peloponnesian War (431-404 BC).

ABOUT THE AUTHOR

Gerasimos Rigatos is assistant professor of Medicine and Honorary Doctor of the Pedagogical Department, University of Athens.

LEGAC Y

The Holistic Approach By establishing the connection between body, soul and environment, ancient Greek philosophy and medicine laid the foundations for the modern concepts of healthcare. BY Ya n n i s T ou n ta s M D, M P H , P h D

he idea of “health promotion,” according to the WHO’s 1986 Ottawa Charter, is a health strategy that aims to incorporate skills and community development and to create supportive environments for health. The theoretical framework for such a strategy stems from the development of the new “biopsychosocial” model for health and disease, which questions the dominance of the biomedical model, by putting emphasis on the role of the environment and of human behavior and on the biological, psychological and social dimensions of both positive and negative health. However, despite the commonly held assumption that such basic concepts are recent in origin, they actually have their roots in ancient civilizations, particularly in classical Greece. The ancient Greeks understood that good health was tied to physical and social environments as well as to human behavior. They defined health as a state of dynamic equilibrium between the internal and external environment. In addition, they considered the physical and social determinants of health, they empowered individuals and communities through new democratic and participatory institutions and placed emphasis on health education and skill development. They also recognized the importance of supportive environments and healthy public policy and reoriented medicine towards a more naturalistic and humanistic perspective.

New Ideas in an Ancient World The Greeks were the first to break with the metaphysical/supernatural conceptions of health and disease that had previously dominated human societies, seeking out answers in the physical world rather than in the actions of invisible forces. Aristotle (384–322 BC), the son of a physician, questioning Plato’s transcendental ideas, called for the sys-

tematic observation of nature. The mythical world was replaced by one forged through the power of independent human intellect, a world which demanded that reality be explained through natural causes.

Early Explanations for Health and Disease: Pythagoras, Socrates and Plato The ancient Greeks’ understanding of health and disease was based on the theory of the four “humors” or fluids (blood, phlegm, yellow bile, black bile), which in turn is premised on the theory of the four elements (fire, earth, water, air) and their four corresponding qualities (hot, dry, humid, cold). The Pythagoreans maintained that health is a condition of harmony and the perfect equilibrium of the fluids. Illness results when this balance is upset; thus, the important thing for maintaining health is to practice a way of life that allows for minimum disturbances to occur in the body. Since this balance can easily be disrupted by external factors, efforts are concentrated on regulating the human body’s physical and nutritional conditions. The Greek word “hygieia” describes a condition of completeness and contentment. A healthy body is a well-balanced body – one that exists in harmony with cosmic laws and order. The Teachings of Hippocrates Health theories were elaborated in greater detail in the work of the ancient physician Hippocrates (ca. 460– 370 BC). Unfortunately, little biographical information can be confirmed about this important figure. The 60 or so works comprising his corpus were probably written by a variety of authors, including both Hippocrates himself and his disciples, who together developed the starting point of medical science. According to the text

A portrait of Hippocrates (ca. 460-370 BC), a Greek physician, known as the “father of medicine,” who developed the belief that four fluids (or humors) of the body (blood, phlegm, yellow and black bile) are the primary seats of disease.

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Â© GETTY IMAGES/IDEAL IMAGE

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entitled “On Airs, Waters and Places,” a groundbreaking achievement and the Hippocratic school’s most important contribution to medical science, health is similarly defined on the basis of an equilibrium, achieved between environmental forces on the one hand (wind, temperature, water, ground, food) and individual habits on the other (diet, alcohol, sexual behavior, work and leisure). The “internal” equilibrium of the four bodily fluids depends on the “external” equilibrium between a person and his/her environment. The pathogenic process, according to the Hippocratics, results from the overturning of equilibrium and the predominance of one of the four fluids, thus leading to disease. The Hippocratic physician who came to attend to a town’s population had to consider not only the season, the winds, the water people used and the geography of the place, but also the way people lived: did they drink a lot of wine, eat well, exercise, get adequate rest and work hard? The ancients stressed that good diet was crucial to health. The Greek word diaita, however, meant more than food and drink: diatetica (dietetics), the cornerstone of the healing art, involved an entire lifestyle. The Hippocratics posited a natural theory for the cause of illness. In the case of male impotence among the Scythians, for example, Hippocrates made certain observations that were connected to factors such as horse riding, rheumatism, physical tiredness, weather conditions, ground conditions, and dietary practices.

Empowerment and Education for Better Health Today’s Ottawa Charter proclaims that a key factor for the achievement of skills and community development is the empowerment of people – both as individuals and in communities – which is achieved mainly through health education and supportive environments. Although the term “empowerment” is not mentioned in ancient Greek philosophy and medicine, the Greek intellect in general was very much centered around the individual’s emancipation from the clutches of ignorance and superstition, leading people towards “self-sufficiency” – which, as a concept, is very close to contemporary ideas of empowerment. The philosopher Protagoras (ca. 490–420 BC) defined “self-sufficiency” as a state of being in which one is not dependent on others. Pythagoras’ followers likewise placed an emphasis on self-maintained hygiene – the well-known “Pythagorean way of life.” Health was a con-

Hippocrates and Galen; fresco in the Crypt of St Mary Cathedral, Anagni, Italy, 13th century (De Agostini Picture Library/A. Dagli Orti). H E A LT H 2 017- 2 018

LEGAC Y

dition of perfect equilibrium achieved by practicing self-control, moderation and calmness. The use of diet, gymnastics and even music were directed to the goal of restoring health when it had been “upset.” Thus, for someone to live “as he should,” systematic preparatory education was needed. Later, Aristippus (ca. 435–356 BC), a student of Socrates, drawing on the principle of self-sufficiency, advanced a theory and practice of life according to which our single aim is to enjoy life as much as possible – provided, however, that we are in control of both ourselves and circumstance at all times. It was only in this broad 5th–4th-century BC philosophical context that ancient “health education” could emerge.

Health Effects of Physical, Social and Political Environments The Hippocratics recognized “endemic” diseases – those always present in a given population – and “epidemic” diseases – those not always present but occurring in greater frequency at certain times. Both terms are still widely used today. (The text “On Airs, Waters and Places” attempts to identify the factors behind local endemicity by addressing climate as well as the quality of the soil, water, way of life and nutrition.) Hippocratic physicians also paid attention to the location of an individual’s dwelling, the winds to which it was exposed and how near it was to rivers, swamps or the seashore. Winds and their influence on health held particular interest for the Hippocratics: “Cities which are faced towards the sunrise are healthier than those which are faced towards the North and … warm winds.” Hippocratic writings go even further, recognizing the importance of the social and political environment as well, and often referring to the “health” of the polis. With the birth of democracy in ancient Greece came a departure from the heteronomous status quo and a movement towards autonomy. Athenians reformed their political system to increase the possibility of real participation of the people in the exercise of power, in a state of autonomy in which the political community created its own laws. Autonomy precludes the idea of an extra-social source of laws and institutions. This is the highest kratos (strength) that exists in a society: the giving

Isonomy (equality of rights) positively affects not only citizens’ health but also democracy. In contrast, monarchy, a system of governance based on the rule of one, gives birth to disease. 26

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Hippocrates in the center of an artistic composite image, depicting: Achilles tending to Patroclus’ wounded arm, Attic kylix by the painter Sosias, circa 500 BC, Berlin, Museum of Ancient Art; surgical instruments, 4th-7th c. AD; wild blackberries described and illustrated in a publication of Dioskourides’ De Materia Medica, AD 512, Vienna, National Library of Austria. Published courtesy of Kapon Editions.

of ourselves to the laws and institutions under which we live and the government that determines our direction. Society is never just a simple synthesis or summation of persons, since people are to some extent created by their society. Therefore, an autonomous society means ipso facto autonomous persons, which in turn means an empowered society and empowered persons. The notion of empowerment is thus related not only to self-sufficiency, but also to autonomy. Even before the flourishing of Greek democracy, however, social conditions had already been considered to affect health. The philosopher and medical theorist Alcmaeon (born ca. 510 BC) does not hesitate to define health in terms borrowed from the political vocabulary of his time. He asserts health is isonomy, the equality of rights, the total balance of forces – “fluids, dry, bitter and sweet” – active in the human body. Isonomy positively affects not only citizens’ health but also democracy. In contrast, monarchy, a system of governance based on the rule of one, gives birth to disease. It destroys the polis (city) by imposing the rule of a single element on the others, thus destroying isonomy.

The Rise of Naturalistic and Humanistic Medicine Little is known of Greek medicine before the testimony of written texts in the 5th century BC, but it can be assumed that Ancient Greece, like many other places in prehistory, possessed folk healers, priest healers and chief tribunes employing divination and drugs. In Homer’s Iliad, Apollo appears as the god of healing. Various other gods and heroes were also identified with health and disease, the most predominant being Asclepius, whom Homer portrays simply as a tribal chief and a skilled healer of wounds. Physicians were apparently little appreciated in Homeric times, perceived merely as lowly craftsmen of inferior standing. Physicians are classed in Homeric epic with other itinerant laborers while Asclepius is not even recognized as a son of Apollo. Only with Hesiod and other authors does Asclepius become the son of divine Apollo and thus a semigod. This upgrading of his position signified an upgrading of medicine and, at the same time, a reorientation of medical care. Scholars attribute Asclepius’ rapid ascendancy, after ca. 700 BC, to his popularity among the poor and lower classes, who saw him as a god particularly interested in their welfare, a lover of all people regardless of station. Physicians who followed Asclepius as the god of health and medicine had a clear obligation to treat the rich and the poor alike. The ensuing rise of Hippocratic teachings represented a decisive step in refounding medicine on a quite different basis: as a healing system independent of the supernatural and built on

LEGAC Y

natural philosophy. This separation of medicine from religion is indicative of the openness of ancient Greek intellectual activity. Hippocratic medicine was not only an appeal to reason, however, and thus an early scientific endeavor; it was also a patient-centered rather than disease-oriented approach, concerned more with observation and experience than with abstractions. Ancient medicine shared close ties with ethics – the philosophical study of morality. Today, biomedical ethics include four key principles – autonomy, beneficence, nonmaleficence and justice – considered to be of equal weight or priority in any particular situation. Autonomy and justice were also key principles in ancient Greek medicine. In healthcare, autonomy involves respect for clients’ rights to make decisions about and for themselves and their care. Beneficence and nonmaleficence are age-old requirements of the Hippocratic Oath, stipulating that health professionals to “do good” and “do no harm.” Hippocratic doctors took care to consider their patients’ social circumstances and potential limitations when administering advice and guidance. To care for the poor and for wounded warriors, the institution of “public doctors” was established in ancient Greece. In Athens, such doctors were selected by the popular assembly. The city paid for their salaries and medicines through a special public taxation. Plato, the earliest writer to mention Hippocrates and his theories in his dialogue Timaeus, taught that morality was not simply a matter of education. Since the mind is influenced by the body, the doctor has a part to play in teaching virtue. Plato’s Timaeus went on to become a highly influential text, linking medicine and philosophy, health and politics. Nowadays, it also reminds us of the contemporary conception of sociopolitical determinants in health.

A Medical Revolution The innovative ideas of the ancient Greeks, from the 7th to 4th centuries BC, laid the foundations for later Western thought and achievement in many areas of learning including medicine. Pioneering Greek philosophers fashioned the basic concepts underlying philosophical and scientific inquiry. Since these pursuits were originally interwoven, the discursive framework in which they developed fostered the emergence of core natural science concepts, out of which European philosophy and science later evolved. The Hippocratic tradition in particular, with its definition of health as a state of balance between internal and external environment, brought a revolution in the concepts of health and disease and in medical practices. The naturalistic approach of the Hippocratics, today held up as a precious heritage, can be characterized by its spontaneity, scientific value and humanistic attitude. In the end, Hippocrates and his followers

The Greek word “hygieia” describes a condition of completeness and contentment. A healthy body is a well-balanced body – one that exists in harmony with cosmic laws and order.

have transformed medical thought. In Western civilization, health continues to be considered a state of perfect balance. The difference between ancient and modern concepts has more to do with what the human body is comprised of. As Henry Sigerist writes, “we know today that the human organism is made of cells and intercellular substances that are kept alive and function because of chemical and physical forces in a state of dynamic equilibrium defined by the internal and external environment.” Ancient Greek medicine’s naturalistic foundations are of fundamental importance to the development of modern health science. Aristotle put forward very influential views on the constitution of life and health, and his discussions of physiology have long intrigued doctors and philosophers alike. Today, health promotion and educational approaches that emphasize correct diet and physical exercise can clearly be traced back to the ancient Greeks, whose health education, based on a holistic perception of health, incorporated ideas regarding both the physical and social environment and laid the foundations for the concept of health promotion in the modern era. The institution of ancient Athenian democracy, despite its tolerance of slavery and discrimination against women, reflected a supportive social environment for health and the promotion of healthy attitudes and behaviors. In large part based on the health-related legacy and principles of ancient Greece, medicine today is undergoing a reorientation as it seeks to provide more humane, fair and efficient health services. “Public doctors” to care for the poor, the Hippocratic oath’s humanitarian approach towards patients and the development of patient-friendly, easily accessible healthcare units all fall within the basic values and goals of any contemporary healthcare system that strives to restore a more humanitarian and equalitarian spirit in contemporary medicine.

ABOUT THE AUTHOR

Yannis Tountas is Professor of Social and Preventive Medicine in the Medical School University of Athens.

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Snakes, Dogs and Dreams Dedicated to the healing god, the Asclepieia functioned as sacred hospitals, nursing homes, centers of religious worship and of popular entertainment, as well as gathering places for teachers and students of medicine. BY John Leona r d

In ancient Greece and Rome, an asclepieion (Latin aesculapÄŤum) was a healing sanctuary sacred to Asclepius, the Greek god of medicine, where patients could come to be healed through spiritual or physical treatments.

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A More Human Face of Healing With the emergence of the divine healer Asclepius, first mentioned in the 7th/6th c. BC texts of Homer and Hesiod, the infirm found a new champion, a figure usually depicted as bearded, mature and fatherly, like Zeus, and highly

knowledgeable in medicine – like his own reported father Apollo – but more ordinarily human, more approachable and seemingly more genuinely concerned with the human condition. He usually carried a staff or walking stick and kept around him a snake and a dog as companions or sacred symbols. Where deities including Eileithyia (the Cretan/Minoan goddess of childbirth and midwifery), Apollo and his sister Artemis, or mythical creatures such as the centaur Chiron (Apollo’s foster son, Asclepius’ teacher) had previously been main mythical sources of medical skill and solace, Asclepius came to represent the new generation, at a time in Classical Greek history when knowledge of medicine and the practice of health care were becoming more scientific endeavors. It was only with Asclepius that more formal “hospitals” were established. As his cult spread, sanctuaries dedicated to the healing god sprang up throughout many areas of the known Mediterranean world.

ealthcare represented a primary concern for people of the ancient world, just as it still does today, but until the 6th and 5th centuries BC healing was rooted mostly in religion and magic. When people became ill or suffered injuries, they did not visit hospitals or clinics, but often sought out treatment and comfort from priests, offered sacrifices and prayers to certain gods, or consulted learned practitioners who might prescribe the use of medicinal herbs or the following of other, sometimes more mysterious, traditional rituals.

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The Asclepieion of Kos: a Corinthian-style temple of the 2nd c. AD, likely dedicated to Apollo, father of Asclepius.

Healing Melodies Sound as therapy in the ancient Greek world

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Origins of Asclepius Asclepius originally appeared in ancient Greece at ancient Trikka (modern Trikala) in Thessaly. Trikka was considered his birthplace, from which, according to Homer, his sons Machaon and Podalirius traveled with the Greek army to fight at Troy. The Roman geographer Strabo reports that Trikka was the site of Asclepius’ oldest, most famous sanctuary. Two other major centers were Epidaurus and the island of Kos. The cult of Asclepius may have reached Epidaurus by ca. 500 BC and a later local tradition suggested that he had been born there, rather than at Trikka. Epidaurus became the main, highly influential base from which numerous other Asclepieia were founded — usually through a ritual in which a statue of the god or one of his sacred snakes was ceremonially transported to the prospective site and bequeathed to the new sanctuary during its dedication rites. Kos, too, became known for Asclepius in the 5th c. BC. His famous multi-tiered sanctuary there began to rise after the mid-4th c. BC. Expansion The 5th and especially 4th centuries BC were a time of great expansion for Asclepius, as his sanctuaries also appeared at sites including Athens, Corinth, Sicyon, Tegea, Megalopolis, Argos, Sparta and Messene. Asclepieia were also founded on the islands of Paros, Aegina and Crete (at Leben, a port of Gortyn); at Pergamum in Asia Minor, Alexandria in Egypt and Cyrene in Libya; as well as in the West at Rome — where the god occupied Tiber Island and was called Aesculapius. Altogether, hundreds of large and small Asclepieia were established in ancient Greek and Roman times, with almost every big town seeking to provide what was essentially a health-care facility for its residents and neighbors. Asclepius’ cult spread usually thanks to the well-intending actions of individuals and became increasingly popular because it appealed to individuals and reflected a growing interest in more reasoned, humanistic approaches to medicine.

Asclepieia functioned as sacred hospitals, nursing-homes, centers of religious worship and of popular entertainment, as well as gathering places for teachers and students, especially those interested in becoming doctors. Followers of the pioneering physician Hippocrates (ca. 460-ca. 370 BC) taught medicine at Kos, while the Roman doctor Galen (AD 129-ca. AD 200) received training at Pergamum before assuming his duties as personal physician to the emperor Marcus Aurelius.

Epidaurus Sanctuaries of Asclepius shared many common characteristics. In addition to Asclepius, other health-related deities were also regularly worshiped in or near these places, including his father Apollo; his “aunt” Artemis, his sons Machaon and Podalirius; and his daughter Hygieia — the personification of health, cleanliness and hygiene. The 2nd c. AD traveler Pausanias records that, as a child, Asclepius was nurtured by a goat and protected by a dog — thus explaining why no goat

Hundreds of large and small Asclepieia were established in ancient Greek and Roman times, with almost every big town seeking to provide what was essentially a health-care facility for its residents and neighbors.

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sacrifices were allowed at Epidaurus, but dogs were a common sight generally in Asclepieia. Besides altars and temples, another distinctive, colonnaded building of central importance (the Abaton) was provided, in which patients arriving at the sanctuary would undergo enkoimesis (incubation), spending the night there and waiting for the god to come to them in their dreams with a proposed course of therapy. At the exemplary site of Epidaurus, visitors also had access to bath complexes, a large dormitory-like hostel (Katagogion), ceremonial dining rooms, a stadium, a palaestra, a large gymnasium and a theater that would eventually seat more than 12,000 spectators.

A distinctive circular structure (Tholos or Thymele) near the colonnaded Abaton and the Temple of Asclepius may have housed the god’s sacred snakes, which embodied ideas of rebirth and rejuvenation. In some Asclepieia, non-venomous snakes were allowed to slither about freely on the floors of the visitors’ accommodations, while at Epidaurus the serpents, including a peculiar yellowish variety, were tame, according to Pausanias. The snakes in the Asclepieion at Alexandria were said by Aelian (ca. AD 175-ca. 235) to be gigantic, some reaching 6-14 cubits (about 3-6m) in length. Springs, wells and reservoirs were also common features in Asclepieia. A sacred well inside the Abaton at Epi-

Jungian scholars have suggested the dream healing therapy practiced at Epidaurus and elsewhere represents the early forerunner of modern psychoanalysis and psychotherapy.

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Asclepius, bending forward and extending his arms as he offers therapy to a woman lying on a couch. Behind him is Hygieia, goddess of health, while, opposite, the patient’s relatives plead for her recovery. A votive relief of Classical date, from the Asclepieion in Piraeus (Piraeus Archaeological Museum).

daurus served in the visitors’ purification process, prior to incubation. Following these two initial stages of treatment, actual medical therapies were often provided. Testimonials describing the frequent miraculous cures achieved at Epidaurus were inscribed on a series of stone slabs publicly displayed in the sanctuary. These fascinating accounts, which record the names of specific patients, their illnesses and the method of their cure, were read some 1,800 years ago by Pausanias and can still be examined by visitors today in the archaeological site’s museum. One such inscription reads: “Arata, a Spartan, suffering from dropsy (oedema, the retention of water in the body). On her behalf, her mother slept in the sanctuary while she stayed in Sparta. It seemed to her that the god cut off her daughter’s head and hung her body with

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the neck downwards. After a considerable amount of water had flowed out, he released the body and put the head back on her neck. After she saw this dream, she returned to Sparta and found that her daughter had recovered and had seen the same dream.” In more recent times, Jungian scholars have suggested the dream healing therapy practiced at Epidaurus and elsewhere represents the early forerunner of modern psychoanalysis and psychotherapy.

Kos Concerning Kos and other major Asclepieia, it was not accidental that they were located in the open countryside, among beautiful, clean surroundings, where the climate was healthy and the water pure. Indeed, these sanctuaries provided a holistic, innovative approach to health and the prerequisites for physical, psychological, social and spiritual well-being. During its heyday in Hellenistic and Roman times, Kos’ elaborate Asclepieion must have been a stunning sight, set 100m above sea level on the eastern slopes of Mt. Dikeos, about 4km outside the town of Kos. Rising in three artificial terraces above the ground, the sanctuary was adorned with monumental gateways and staircases; U-shaped stoas (colonnaded, roofed walkways/shelters); Doric, Ionic and Corinthian temples; altars; fountains; statues displayed in wall niches; and eventually a large Roman bath complex (3rd c. AD). Kos was a headquarters for the close-

knit priestly order of the Asklepiadai, supposed descendants of Asclepius, who guarded their secrets of medicine and advocated the treatment of patients not through dreams, but in accordance with the teachings of Hippocrates.

Athens On the South Slope of the Athenian Acropolis, a small Asclepieion was established in 420/419 BC, during the Peloponnesian War, when Athens’ inhabitants were largely penned inside their defensive city walls and disease was rampant. Plague had broken out in 430 BC and claimed as one of its first victims Pericles, the city’s great leader. To stem the rising tide of illness, a private citizen, Telemachos of Archanes, took the initiative of having a sacred serpent representing Asclepius brought across the Saronic Gulf by boat to Piraeus, then up to the Acropolis. A diminutive sanctuary was established that included the main components of the mother site at Epidaurus: a sacred spring, altar, temple dedicated to Asclepius and Hygieia, two-storied Doric stoa/abaton, ceremonial dining room and a monumental gateway (propylon). Pausanias (1.21.4) writes that the Athenian Asclepieion “is worth seeing both for its paintings and for the statues of the god and his children.” He also describes an unusual votive offering displayed in the sanctuary: a military/hunting breastplate produced by Sauromatae craftsmen (from western Scythia, north of the Black and Caspian Seas), consisting of a linen garment covered with snake-like

scales made from horses’ hooves. Marble “Kouros” statues were also brought to Asclepieia as dedications to the healing god, a large example of which, from the sanctuary in Paros, is now in the Louvre Museum. In the 1st c. AD, the Roman emperor Domitian sent locks of his hair, a mirror and a jeweled box as votive gifts to Asclepius at Pergamum. The practice of transferring the power and cult of Asclepius through the conveyance of sacred serpents was not unique to Athens, but also reported at sites including Sikyon, where, according to Pausanias (2.20.2), “the god was carried to them from Epidauros on a carriage drawn by two mules…in the likeness of a serpent.” The establishment of the Asclepieion at Rome was also triggered by an onset of plague (293 BC), although the cult of Asclepius/Aesculapius had previously begun spreading into the Italian peninsula during the 5th c. BC. In the face of rising illness in the city, a delegation was dispatched to bring a serpent from Epidaurus – which, upon its arrival at Rome, legend holds, slithered off the ship and swam onto the small island in the midst of the Tiber river. There, the Romans founded an Asclepieion safely removed from the crowded city. Later, the island’s Travertine seawalls were configured to resemble the bow and stern of a Roman ship – a tribute to the original vessel that had arrived from Epidaurus. Today, the water-worn traces of a relief carved on the island’s downstream “bow” still depict Aesculapius’ snake-entwined staff.

Artistic reconstruction of the Asclepieion at Epidaurus (drawing: Marina Roussou). H E A LT H 2 017- 2 018

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Train Like an Ancient Greek Would you like abs like Polykleitosâ&#x20AC;&#x2122; diadem-bearer, or glutes like Myronâ&#x20AC;&#x2122;s discus thrower? Sports training in ancient Greece was a very different experience from the modern workout... or was it? B Y G E O R G IA NAK O U

The Diadoumenos (Diadem bearer), a sculpture portraying the ancient Greek athletic ideal and the perfect anatomical proportions of a nude male body; a copy (ca. 100 BC) of a famous bronze original (450-425 BC) by Polykleitos (National Archeological Museum, Athens).

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he first thing you should know about sports training in ancient Greece is that it wasn’t for gym bunnies. The Greeks of the Classical era believed that physical fitness and mental clarity were two sides of the same coin. A good citizen was virtuous in mind and in body; training was a civic duty, rather than a lifestyle choice. Training facilities and professional trainers were provided by the city – for ordinary citizens as well as for champion athletes. The biggest names in philosophy devoted extensive passages of their works to laying out the rules for proper training and healthy eating. Athletic training, what we now know as “sports science,” was considered equal in status to medicine, while the “locker-room talk” of 5th c. BC Athens laid the foundations for Western political thought. Nevertheless, there was little interest in fancy sporting gear or branded accessories. The gymnasium, now shortened to “gym,” derives its name from the word gymnos, meaning naked. But if you are put off by the idea of your wobbly bits being scrutinized by the opposite sex, fear not. In most places, physical exer-

The Discobolus (Discus thrower); a copy (1st c. BC) of a famous statue (460-450 BC) by Myron (Vatican Museums, Rome). H E A LT H 2 017- 2 018

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cise, like politics, was a male-only affair. The one notable exception was the city of Sparta, where both boys and girls were put through a militaristic boot camp from an early age. Most ancient writers attribute the development of systematic training to the establishment of the Olympic Games in the 8th c. BC, which made the pursuit of sporting excellence one of the ties that bound the Greek world together. Plato mentions several famous champions-turned-coaches and medics who pioneered the notion of a rules-based training regime as the foundation for sporting success. Hippocrates and Galen, best known for their contributions to medicine, observed athletes while they trained, in order to understand the human body, and developed anatomical and nutritional guides to improve performance. Aristotle wrote detailed coaching manuals that were embedded in his philosophical works. By the 2nd c. AD, Philostratus was writing treatises devoted

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entirely to professional training regimes. The exchange between sport and science went both ways: Galen suggested that doctors must train like athletes to achieve excellence in their practice. Philostratus wrote that systematic training evolved out of the more empirical methods that early Olympic athletes devised to improve their fitness. He describes (Gymnasticus, 44), somewhat imaginatively, how “they lifted weights, raced horses and hares, bent or straightened metal bars, pulled ploughs or carts, lifted bulls and wrestled lions, or swam in the sea so as to exercise their arms and their entire body. Their diet was natural, with whole grain bread and meat from oxen, bulls, goats and deer. They slept on hides or straw mattresses, and anointed themselves with plenty of olive oil. They were healthy and did not get sick easily. They stayed youthful into old age, and competed in many Olympics, some in eight and others in nine.” As sports pundits of any age always seem to maintain, he felt that no athlete of his day could hold

a candle to the real champions of yore. Part of the job of a professional trainer was to design a training regime, taking into account weather conditions, the psychological condition of the athlete, and any pre-existing injuries. There were then, as today, conflicting ideas on the best methods, rival coaching “schools” and sports fads. Galen expends a fair amount of time trashing, on medical grounds, the ideas of popular contemporary trainers. A structured training regime in ancient Greece included three stages: warm-up, training and cool-down – much in line with current advice from the American Heart Association. However, there were also some extra elements which have not made it into present-day exercise routines.

A long jumper performing his event, depicted alongside a musician playing the diaulos (double-flute), judges and other athletes; Attic red-figure kylix, 480 BC (Antikenmuseum Basel und Sammlung Ludwig, Basel).

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The warm-up started with a massage, followed by gentle movements to boost blood flow and prepare the muscles for more intense exercise. What followed will be unfamiliar to modern exercisers: a rubdown with olive oil by a professional aleiptes. Oiling was an art because it played a critical role in sports such as wrestling, where a deft application could make it almost impossible for an opponent to perform a hold. To counteract the oiling, the athletes applied dust or sand. A wrestler would throw sand on their opponent tactically, with a view to covering those critical parts of the body that would receive their grip. In the main workout, a range of options were available: total-body workout, zone workouts, or training geared toward competitive sport. Training could follow the same routine daily or rotate from day to day. There were specialized exercises for boxing, wrestling and the pankration – an ancient mix of martial arts that combined boxing and wrestling. Punching bags were used, as well as shadow-boxing techniques. Bends were used to strengthen the upper body. Various running exercises, including high-resistance running in sand, were employed to improve lower body fitness and aerobic performance. A variety of jumps are also described, while upper body strength was cultivated using rope climbing and other instruments. In addition to repetitive exercises, training also encompassed daily physical activities believed to enhance conditioning, such as digging, horse riding, walking, hunting and fishing. Galen rated most highly those activities that work a variety

A youthful jumper in training; Attic red-figure lekythos, by the Bowdoin Painter, 475-470 BC (National Archaeological Museum, Athens).

of muscle groups, including riding and swimming. He distinguished between high-impact and low-impact exercise, also mentioning the principle of circuits or interval training — where bursts of exercise alternate with short rest periods. He differentiated between general exercise and specialized training for professional athletes. The duration of training sessions was at the discretion of the trainer and determined by the athlete’s physical condition. It continued for as long as the athlete retained a lively color, was able to move steadily and rhythmically, and kept “growing in bulk.” It was time to call it a day when the athlete became more sluggish and started falling to his knees to rest. Different forms of exercise were expected to yield different results on the athlete’s body. Running slimmed the body and inflated the muscles, due to its emphasis on breathing. Wrestling increased body heat, as well as the density and mass of muscles. The pankration was thought to dry out the flesh because it was more intense and shorter in duration. Lifting exercises and running were believed to cleanse the body from toxins through sweating. The cool-down, or apotherapeia, was considered necessary for the body to return to its natural condition. It started with breathing exercises, which were said to relieve the heart. Next came the cleansing of the body from oil, sand and sweat. A metal strigil was used to scrape the skin; these special implements are found in excavations and depicted in vase paintings and sculptures. A post-workout massage followed, at the hands of

Most impressive is that training was a total discipline, combining elements of biology, physiology, ergometry and sports medicine, and was fully integrated with philosophy and politics.

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a professional who used a variety of techniques described in some detail by Galen. Medical writers also praised the benefits of various types of baths − not only for cleaning but also for soothing tired muscles and inducing euphoria in the athlete: a kind of rejuvenating spa. Athletes took dips in natural springs and rivers, but also bathed in purpose-built facilities adjacent to the gymnasium. Baths could be hot or cold, and steam baths were also popular. When athletes were not training, they rested, as this was part of a total regime also calling for repose and sleep. Sunbathing was similarly recommended – not only to build endurance against the sun, and thus be able to perform in outdoor competitions, but also because solar rays were seen as beneficial to health. An enormous body of knowledge went into sports training in Classical Greece,

much of which remains in use today, or is being rediscovered. Most impressive is that training was a total discipline, combining elements of biology, physiology, ergometry and sports medicine, and was fully integrated with philosophy and politics. The results can be seen in the impressive physiques of ancient statues. Before getting too idealistic, however, it is worth remembering one more thing: if you look at Greek statues and think, “maintaining those abs must have been a full-time job,” you are not far off. Many citizens in ancient Athens were not expected to hold down jobs in the modern sense, as most labor was done by slaves and commerce carried out by resident aliens. When he was not at war or politicking in the agora, an Athenian man had all day to do pull-ups with Plato and sculpt his abs with Aristotle − he did not have to fit his workout into his lunch hour.

EXERCISE & HEALTH Ergophysiology professor Vassilis Kleisouras on a link dating back to Greek antiquity.

SOURCE

“Sports training of the Ancient Greeks” (in Greek) by Dimitris Komitoudis and Thomas Giannakis, Department of Physical Education and Athletics, University of Athens.

Athletes in a running race approaching the finish line; Panathenaic amphora, by the Berlin Painter, 480-460 BC (Vatican Museums, Rome).

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Small

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The country is endowed with dozens of endemic plants that have significant medicinal properties and aromatic qualities â&#x20AC;&#x201C; and are in need of protection. B Y ORE S T E S D AV IA S * / ILL U S T RA T IO N s : G EOR G E S F IKA S

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wander around any of nature’s gardens in Greece is a journey back to a land of legend and symbolism, a magical place where men are heroes and where gods give shape to every plant. This is where nymphs elude their pursuers by transforming themselves into fragrant shrubs and where god-sent herbs bring us comfort and succor in abundance. Greece’s natural environment is known for its diverse landscape and myriad microclimates; this variety creates ideal conditions under which certain herbs and medicinal plants can thrive. Dwarf oregano, thyme from the Aegean archipelago, Greek sage and dozens of other herbs that grow here are all endowed with aromatic qualities and medicinal properties more powerful than those found in other countries. What’s more, Greece’s wild plants seem quite happy to flourish in the rugged mountain fields which far outnumber lush irrigated farms. At the same time, we must not overlook the important presence of Greece’s endemic plants. Some of these constitute remnants of older geological periods, though most appeared more recently as a result of the particular conditions prevailing in a part of the world where three continents converge. Intense phenomena such as the birth of new islands and mountain ranges, sinkholes and volcanic eruptions have reshaped the landscape again and again through the eons, forcing some species into isolation. Naturally, only a handful of these have survived and can still be found in the wild; they are nature’s acrobats, successful experiments of evolution, because they managed to adapt to and survive the harshest of conditions. The parts of Greece considered “hot houses” of endemic plants are Central Greece, the Peloponnese and the islands of the Aegean, including Crete. To put it in numbers, of the 6,500 species and subspecies that constitute Greek flora, some 1,300, or one in five, are endemic. Imagine that Crete alone has 165 native plants

when Germany – roughly 45 times the size of the Greek island – has just 42. The bad news is that 25 percent of Greek endemic plants are considered endangered or at risk of extinction. Those that appear only in a restricted geographical area in particular are at risk from factors as mundane as the opening of a new mountain road, the installation of a wind farm, forest fires, prevalent over-grazing or the aggressive development of our coastlines. Another foe that has been around for at least three centuries now is the collector: sundry botanists, nature lovers and hunters of rare plants are scouring the Greek countryside in search of treasures to complete their collections. This means that visitors to botanical gardens across Europe can admire some 300 native Greek plants, while about 100 are even available for purchase abroad. But for every plant that survives the process of being uprooted and transplanted to foreign lands, several dozen are destroyed, thus putting the survival of the species under even more strain. The last of these plants find shelter in remote, inaccessible parts of the country, often high up on its mountains. It is estimated, in fact, that one-third of the country’s native species live at an altitude of over 1,000 meters. Measures are desperately needed to ensure the survival of Greece’s endemic plants, as we have seen time and again that domestic legislation and international agreements have little if any effect. The most promising way forward, is for these plants – or at least those which could be used in cosmetic and pharmaceutical products or as edible or ornamental plants – to be cultivated organically at protected farms near their natural habitat. A significant part of the proceeds from their sale could then go towards protecting the wild population so that it can continue to act as a living treasury of their valuable genetic secrets. * Orestes Davias is a biologist and writer.

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Portraits

10 exceptional endemic species

Cretan dittany

Origanum dictamnus Since ancient times, Cretan dittany has been the absolute panacea of folk healing on the southern Aegean island. Its reputation was greatly helped by a reference by Aristotle suggesting that when wild goats were hit by poison-tipped hunting arrows, the animals would eat dittany to counteract the venom and heal the wound. In its wild form, this low-lying bush is found in rugged craggy terrain, but it is also cultivated in the valley of Embaros near Irakleio, which has taken some of the pressure generated by its traditional collectors off wild dittany. 44

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The Cretans drink dittany as a tisane to ward off colds and headaches, to ease rheumatic and stomach pain, and as a general tonic. In older times, it was also used in poultices to heal wounds, chewed to soothe toothache and swollen gums, and added to baths to preserve youth and increase virility. A plethora of scientific studies have attributed its efficacy in these uses to antibacterial, expectorant, astringent and antispasmodic properties. Studies are still being conducted into its potential but it is certain that Cretan dittanyâ&#x20AC;&#x2122;s age-old reputation will survive for centuries to come.

FLOR A

Olympus yarrow

Achillea ambrosiaca This is a small plant found only on the ancient world’s holiest mountain, Olympus. It grows from the mountain peak where Zeus launched his fearsome thunderbolts – at an altitude of 2,900 meters – down the rocky slopes, across the alpine meadows and along rocky crags, and only rarely at altitudes below 2,000 meters. Collecting its fragrant feathery leaves and the snow-white flower clusters that emerge in the summer is strictly forbidden, as the area is protected. This also means that it cannot be cultivated in the area either, while at lower altitudes, the plant is vulnerable to diseases. Nevertheless, its unusual fragrance, the usefulness it almost certainly has in the production of cosmetics and its association with the mountain of the gods – a great marketing attribute – dictate measures to overcome these obstacles. With coordinated efforts in the laboratory and out in the field, it is certain that the day is not too far away when, thanks to its anti-aging effect on skin, this plant justifies its specific epithet (ambrosia being the food of the immortal gods).

Wild saffron crocus

Crocus cartwrightianus One of the splendid frescoes found in the prehistoric settlement of Akrotiri in Santorini (and dating from around the mid-second millennium BC) depicts two women in colorful robes filling their baskets with wild crocuses growing in abundance in a rocky landscape. Even today, the women of Santorini continue to collect the bloom every November, bending down again and again to snip out every gram of pure saffron. This arduous work is followed by the equally challenging task of separating the stigmas and stamens from the blooms, then drying and storing them so they can be used a few months later to add color and

fragrance to traditional Easter cookies. Some locals claim that Santorini’s wild saffron has stimulative and aphrodisiac properties, echoing the views of ancient Greek healers. This bloom – the progenitor of the more familiar domesticated species cultivated in different parts of the world – still grows wild in parts of the Cycladic islands, western Crete and Attica. Like the tame species, it has antioxidant, expectorant, anti-inflammatory and anticoagulant properties, just to name a few of its characteristics, so maybe it is time to “rediscover” this wonderful plant and give it back some of its ancient glory. H E A LT H 2 017- 2 018

FLOR A

Laconian thyme

Thymus laconicus Its similarity to the prolific conehead thyme (Coridothymus capitatus) that is found all over southern Greece and its own rarity have kept this species practically unknown until recently. However, if you know what youâ&#x20AC;&#x2122;re looking for, it can be found in the fallow fields and rocky shrub land of the southeastern tip of the Peloponnese at Cape Maleas. It prefers areas that are cooled by the sea breeze, though it also has a remarkable tolerance for drought, and can be found at altitudes of up to 900 meters.

Mount Athos immortelle

Helichrysum sibthorpii Despite strict regulations banning its collection and its own ability to hide at altitudes of 2,000 meters in inaccessible crags on sacred Mt Athos in northern Greece, this rare species of immortelle could, until a few years ago, be purchased in pots online. Any plant at risk of extinction inevitably stirs the interest of collectors hunting down rare floral treasures. Part of this plantâ&#x20AC;&#x2122;s popularity, and one of the reasons why it struggles to survive, is its impressive appearance when in bloom during the summer months; it exemplifies alpine beauty. When carefully dried, the plant keeps for a long time and maintains its delicate fragrance, a trait that reminds us of all the wonderful properties and rare powers contained in its blooms. Judging by close relatives of the same genus, we can surmise that its exceptionally fragrant essential oils are beneficial to the skin, and particularly older skin, protecting and healing it from the ravages of time. It seems a good idea to cultivate this wonderful shrub near its native lands, not only to ensure its survival but also to tap into its rejuvenating powers. 46

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It has multiple branches, a woody stem and an incredible heady aroma, which explains the frenzy of bees seeking the nectar of its rosy blooms at the start of summer. There have been no comprehensive studies of this plant so far, but this is certainly about to change, as there is little doubt that it has significant antimicrobial and expectorant properties as well as digestive uses. This, combined with the fact that it is rare yet grows with relative ease, suggests that Laconian thyme has a bright commercial future.

FLOR A

Greek knapweed

Centaurea raphanina subsp. mixta That this endemic Greek plant has more names in the Greek language than any other is indicative of the huge culinary interest it engenders in the Peloponnese, Central Greece and many Aegean islands. Fortunately, it is extremely adaptable and grows at high altitudes, on rocky slopes, in olive groves and brush land, so that there is still plenty to be found, despite intensive harvesting. It stands out for its rosettes of dark-green and deeply lobed leaves and particularly for the purple blooms that emerge in later spring on a short stem. Its leaves are gathered when they’re still sweet and tender, and they are eaten boiled, sautéed or even pickled, as a delightful meze to go with ouzo. However, it also has many promising pharmaceutical properties (both fungicidal and antioxidant), making it very likely that it will soon be cultivated systematically for its extracts.

Taygetus mountain tea

Sideritis clandestina subsp. clandestina This is one of seven endemic species of the Sideritis genus – also known as ironwort or shepherd’s tea – that is native to the rocky terrain of Greece’s mountains. I had the good fortune to observe a magical harvest two years ago. The collectors’ scythes became a blur of slashing blades as soon as we arrived at the spot, and our bounty soon piled up. The intense, heady aroma of freshly-cut mountain tea is said to evoke a sense of euphoria, and I observed this firsthand in my fellow collectors’ broad smiles and in the wild bees diving deep into the yellow blossoms to suck up their stimulating nectar.

However, decades of unregulated harvesting in combination with over-grazing have placed this particular subspecies and the genus in general at risk. There are a lot of reasons to introduce controlled cultivation, especially now as the international community is becoming aware of the great potential of Greek mountain tea. Scientists have proven that its infusion acts as a tonic without causing restlessness, helps digestion, softens a cough and does marvelous things against colds. It also has a bright future ahead in the food and cosmetics industries, as its extract has anti-inflammatory, antioxidant and antimicrobial properties. H E A LT H 2 017- 2 018

FLOR A

Apple-bearing sage

Salvia pomifera subsp. pomifera This species of wild sage that is endemic to southern Greece is not cultivated yet, but it is collected from the pine forests and rocky mountainsides where it thrives, often in large numbers. It is a low-lying bush that does not exceed one meter in height, and stands out among several native Greek sage species for its beautiful and relatively large red-blue spring blooms.Its hairy leaves give off a strong and pleasant fragrance, and just a few are needed to prepare a delightful beverage that acts as a tonic and aids digestion, while also helping combat the effects

of a cold. It has quite a high concentration of essential oils, which are further activated during the warmer summer months. Even though this species has not been adequately studied, we do know that it has antiseptic, anti-inflammatory, antispasmodic and antiperspirant qualities. The essential oils are said to boost concentration when inhaled and to relieve headaches and swollen gums when applied locally. Apple-bearing sage is also very promising as an additive in cosmetics, as it helps cleanse oily skin and prevent acne.

Mount Juktas St John’s wort

Hypericum jovis Only found on the cliffs and crags of the mountains of Central Crete, this plant grows at altitudes ranging from 5001,500 meters and only in rocky, calcareous soil; as such, it is extremely difficult to cultivate in different territories. It has tiny leaves speckled with numerous glands that look like dark spots, and produces bright yellow blooms in the spring. It is not endangered, as it is not collected locally, but it is considered vulnerable. The plant belongs to the same genus as Hypericum perforatum – renowned mainly for healing wounds and acting as an antidepressant – while its epithet, jovis, is derived from Jupiter, after the ancient Roman name for the king of the Olympian gods. The reason it was given this epithet was that the Cretan believe Zeus’s tomb to be on one of the mountains on which it grows, Juktas. In ancient Crete, the gods died and were reborn in spring. It is a funny coincidence, therefore, that the isolation of two new derivatives – hyperjovinols A and B – found from the plant demonstrated powerful antioxidant and anti-aging properties, which will almost certainly attract the interest of the pharmaceutical and cosmetics industries in the future. 48

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botanical medicine Natural remedies based on the best of nature’s bounty.

FLOR A

Greek peony

Paeonia parnassica With large, dark-purple petals that come out in May, this native plant gives us one of Greeceâ&#x20AC;&#x2122;s most beautiful flowers. It is a relatively small plant (usually no taller than 70cm) that is endemic to Mount Parnassus and nearby Mount Helicon. It is found in the clearings of conifer forests, in humid meadows and in ravines, usually tucked away between rocks, and at altitudes of up to 1,500 meters. It grows in small populations and is considered vulnerable because it is collected intensively for its decorative attributes, despite European Union regulations for its protection.

The genus Paeonia is named after Paean, a healer of the ancient gods who, according to legend, first discovered the powers of these plants. From Hippocrates to Galen, ancient physicians had no doubt that its roots and seeds cure spasms, nightmares, epilepsy and numerous female ailments. The ancients actually thought it a magical plant and would collect it according to a ritual that ensured it would not be harmful. Modern science has so far discovered that its roots have useful antimicrobial properties, but it is certain that it will reveal many more secrets in the future. H E A LT H 2 017- 2 018

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BEVER AGES

Cups of Good Health

Four Greek companies have created delicious blends of nature’s beneficial herbs wrapped up in stylish modern packaging. BY NENA DI M ITR IOU

ANASSA www.anassaorganics.com

“The idea was to present an easy way to prepare teas, without a strainer, so we settled on a simple, do-it-yourself process that allows the herbs’ qualities to shine,” say Afrodite Florou and Yanna Matthaiou about the kit (a specially designed tea bag with a wooden stick that can be suspended in your cup) that comes in their company’s herbal tea packages. Founded in 2013, Anassa Organics produces teas made of whole leaves of ironwort (mountain tea), chamomile, lemon verbena, mint and sage, sourced from a network of associated farmers on the mountains of Olympus and Taygetus and in Kozani, Agrafa, Evrytania and Epirus. These are packed as soon as they’ve finished drying (retaining all of their aromas and beneficial properties) in attractive tin boxes that protect them from further exposure to light and air. Other than single-herb teas, Anassa also offers a series of blends, such as Pure Defense with ironwort, dog-rose, Cretan dittany and pennyroyal for protecting the body against winter colds, or Pure Youth, an antioxidant and anti-aging beverage based on ironwort, rockrose and rosemary. The company works with Athens University’s Pharmacy Department in analyzing herbs and their properties. Its products are also available in the UK, France, Belgium, Austria, Korea and Dubai, among other countries. H E A LT H 2 017- 2 018

BEVER AGES

OREANTHI www.oreanthi.gr

DAPHNIS and CHLOE www.daphnisandchloe.com

Back when she was a university student in Bologna, Italy, Evangelia Koutsovoulou would cook for her friends using the oregano from Mt Oiti in central Greece, that was sent by her parents. Soon, she was bringing bags of the herb back from every trip to Greece to give to her enthusiastic friends. “Their interest compelled me to ask another friend, an agriculturalist here in Greece, to teach me more about the characteristics of Greek herbs, which are superior to the stuff typically found on supermarket shelves around the world,” she explains. In 2013, she started sourcing herbs on the basis of their terroir, much as is the case with wine. “Assyrtiko from Santorini is wildly different to that cultivated in northern Greece. The same is true with oregano, though not many people seem to have thought of that,” she says. Four years on, her company Daphnis and Chloe sells 24 different herbs, the most popular of which are oregano and bay leaves from Mt Taygetus, mint from Samos and sage and wild thyme flowers from the Peloponnese. All of the products are from farms in particular areas and some are from farmers who work exclusively with D&C. Other than herbs for cooking, the company also produces teas, like the Office Blend, a bestseller that came about by chance. “One of the girls on the team was making me a cup of tea with whatever she could find lying around: mountain tea, thyme, rose hips and peppermint. It was delicious, so we decided to keep it.” If you’re in downtown Athens, stop by the shop near the Acropolis (19 Erechthiou), or get in touch beforehand (hello@ daphnisandchloe.com) to arrange a mini-tasting session.

BRANDS IN BLOOM Dynamic Greek companies combine the country’s unique botanical resources with its rich traditions and strong science base to produce excellent cosmetics and nutritional supplements.

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Friends since their schooldays, Yota Pavlaki, Sophia Stathatou and Eleni Vafiadi were enjoying successful careers in marketing, advertising, research and botany when they decided in late 2013 to create a product line that would marry tradition with innovation. With help from a master tea blender, they launched a line of five herbal infusions, using 24 herbs and flowers such as hibiscus, jasmine and rose. The blends – Energy, Relax, Detox, Harmony, Light and Lean – are made from cocktails of Greek herbs like Cretan dittany, sage, mountain tea, lemon verbena, lime flowers, chamomile and pennyroyal, most of them harvested by hand in the wild. They are available in pyramidshaped tea bags in attractive, colorful packages at selected stores. The company also sells a limited quantity in the US and the rest of Europe.

BEVER AGES

KROCUS KOZANIS PRODUCTS www.krocuskozanis.com

Even though saffron has been cultivated in the area around the northern Greek village of Krokos for more than three centuries, research into its multiple beneficial properties did not start in earnest until 25 years ago, as scientists sought a cure for thrombosis. Until then, Kozani saffron was mostly used in cooking for its discreet aroma and distinguished flavor, and as an additive in the local tsipouro to give the spirit a rich golden color and a more complex bouquet. To really appreciate this fine product, you should visit the fields when they’re in bloom in October – truly a sight to behold. Everything about saffron is labor-intensive: from its cultivation to the collection of the golden stigmas, which is done by hand. Requiring 150,000 flowers to produce one kilogram of saffron, it’s hardly surprising that it is known as “the gold that grows in Greece.” Kozani’s saffron has received protected designation of origin (PDO) status and it is used by Krocus Kozanis – a partnership between the local saffron cooperative and the Korres cosmetics company – to produce nine fine beverages, available in organic and conventional versions. Blended with mint and lemongrass, cinnamon and cloves, green tea, ginger and licorice, or rosemary and thyme, the saffron gives us a wonderful tea that is packed with goodness. H E A LT H 2 017- 2 018

NUTRITION

Liquid Gold and a Great Healer It tastes good and has no negative side effects. Extra virgin olive oil is the perfect comestible and drug rolled into one, the ultimate superfood. BY L I SA R A DI NOVSKY

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STYLING: TINA WEBB - PHOTO: GEORGE DRAKOPOULOS

NUTRITION

“Let food be thy medicine and medicine be thy food” – Hippocrates

he ancient Greeks had it right. Homer, the author of The Iliad and The Odyssey, referred to olive oil as “liquid gold.” Hippocrates, the physician known as the father of Western medicine, called it “the great healer” and prescribed it for 60 medical conditions. Dioscorides, another doctor, was one of the first to recognize that the healthiest olive oils were the fresh oils extracted from certain varieties of unripe olives – a fact recently confirmed by scientists, whose studies have also added to the long list of olive oil’s health benefits. According to myth, in a competition to become the patron of an as-yet unnamed city, the goddess Athena beat Poseidon when it was judged by the city’s residents that her gift to humanity, the olive tree, was more impressive than the sea god’s

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not-so thirst-quenching salty spring. Thus the city of Athens acquired its name and its patron goddess, along with the trees that have been prized for their tasty and nutritious fruit ever since. In real life, according to food historian Mariana Kavroulaki, ancient Greeks “selected the olive tree because it was reliable, long-lasting, and very fertile.Olives were used as food and as fuel; the oil was a basic product in lighting, medicine, diet, and cosmetics, and the export of the oil was of great economic importance.” Olive oil has been a widely consumed and highly desirable commodity for millennia, because “Greeks realized from very early on just how essential olive oil was to both their daily lives and their economy,” bringing them both wealth and good health. In fact, olive oil has played an integral part in the Greek diet

and Greek healthcare for millennia. It’s no coincidence that Mediterranean populations tend to live longer and suffer less from heart disease, high blood pressure and stroke than North Americans and northern Europeans. This observation has inspired great interest in the Mediterranean diet, particularly olive oil, one of its main components. Hundreds of studies have explored olive oil’s health benefits over the last six decades, ever since Ancel Keys initiated his famous Seven Countries Study in the 1950s. Mary M. Flynn, PhD, RD, a Brown University professor and dietician at the Miriam Hospital in Rhode Island, explains that there is a “common misperception that the health benefits of olive oil are due to the monounsaturated fat content,” which is often viewed as being healthier than

Harvesting organically grown “Koroneiki” and “Athinoelia” olives to produce the award-winning Maleas Organic Extra Virgin Olive Oil near Cape Maleas in Laconia, Peloponnese.

NUTRITION

saturated fat and trans fat. However, olive oil offers far more than that, according to Flynn: “Studies done in animals and in test tubes have shown that the phenols in olive oil have amazing health benefits, such as selectively killing cancer cells, decreasing inflammation as much as ibuprofen will, and inhibiting tumor growth.” In 2012, the European Food Safety Authority (EFSA) approved the following claim: “olive oil polyphenols contribute to the protection of blood lipids from oxidative stress.” University of Athens professor Prokopios Magiatis explains that this “means protection of LDL cholesterol from oxidation and consequently protection from heart attack and stroke.” The EFSA limited the health claim to certain polyphenols, including oleacein and oleocanthal, and to olive oils that contain a particular amount of them. We need antioxidants to avoid excessive damage from oxidative stress, which has also been linked to illnesses such as chronic fatigue syndrome, fibromyalgia, diabetes, Alzheimer’s disease, Parkinson’s disease, atherosclerosis and cancer. Sci-

entific studies suggest that some olive oil polyphenols, including oleacein and oleocanthal, can help us avoid this damage and help prevent these diseases. Much of the recent research on olive oil has focused on the contribution of polyphenols, which are antimicrobial and anti-inflammatory as well as antioxidants. Extra virgin olive oil (EVOO) is the type of olive oil that tends to be richest in polyphenols; it is unrefined, and refining destroys many of the healthy compounds. (The amount and type of polyphenols varies from one EVOO to another, and virgin olive oil also contains smaller amounts of them.) Extra virgin oil is, therefore, recommended for those seeking maximum health benefits. Oleocanthal, a polyphenol found only in some types of olive oil, has actually been compared to a common medication. One day in 2005, American scientist Gary Beauchamp tasted a freshly pressed EVOO and noticed a peppery stinging sensation in his throat very similar to a feeling he had when consuming a solution of the non-steroidal anti-inflammato-

There are more than 80 varieties of olives in Greece, but the majority of the country’s extra-virgin olive oil comes from PDO Kalamata olives, probably the best known Greek olive.

ry drug ibuprofen. Further investigation led to the groundbreaking discovery that oleocanthal also has similar anti-inflammatory effects to the drug. This is significant since many diseases, including cancer, heart disease, metabolic syndrome, diabetes, Alzheimer’s and arthritis, are associated with chronic inflammation. High-phenolic EVOO has been shown to reduce the blood clotting and narrowing of arteries that can lead to cardiovascular diseases, and oleocanthal has even killed cancer cells in test tubes, without harming healthy cells. Having studied olive oil from a pharmaceutical perspective for 16 years, Prof Magiatis explains that the combination of Greek olive varieties with Greece’s unique climate and soil type can produce “olive oil with increased levels of specific phenolic ingredients like oleocanthal H E A LT H 2 017- 2 018

Extra virgin olive oil tasting.

It is no coincidence that Mediterranean peoples tend to live longer and suffer less from heart disease, high blood pressure and stroke than North Americans and northern Europeans.

and oleacein – something that we don’t find often in the major varieties” of other leading olive oil producing countries. “Moreover,” Magiatis continues, “in Greece, there are numerous olive mills, and the production per farmer is small, so most producers are able to take personal care of the oil they make. For this reason, most of the oil produced is not only extra virgin but also high phenolic.” In other words, Greek extra virgin tends to be especially healthy – so healthy that some Greek entrepreneurs are packaging their extra-high phenolic extra virgin in medicine bottles, while others have enclosed their product in vitamin-like capsules. Flynn believes the many health benefits of extra virgin olive oil make it “more medicine than food, and it is a delicious medicine.” She finds it “hard to emphasize just one of the many health benefits 58

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of olive oil,” but is especially impressed by its ability to improve insulin sensitivity. “This means that use of olive oil daily will make insulin work better... [leading to] lower blood levels of both insulin and glucose” and, consequently, a lower risk of heart disease and cancer of the breast, prostate, pancreas, and leukemia. This is because excess insulin and glucose make the body more susceptible to those diseases. A recent clinical study went so far as to compare extra virgin olive oil with a statin drug, checking their ability to lower lipids in people with type 2 diabetes. While the statin was more effective, extra virgin had significant effects, without the negative side effects of the drug. Some do worry that consuming even healthy fat such as that in EVOO will lead to weight gain. However, Flynn and others have

observed that olive oil can actually help us lose weight and maintain a healthy weight, since the fat in it leaves us satisfied enough to stop eating and keeps us feeling full longer. Flynn adds that EVOO “is an economical food that makes your meal, and especially vegetables, taste better, and it will improve your health. A meal of two tablespoons of olive oil, vegetables and a starch is much less expensive, and certainly healthier, than one that contains even an average amount of meat.” (Most discussions on the health benefits of olive oil call for two to three tablespoons of extra virgin olive oil per day, in place of other fats.) Some argue that it’s best to consume olive oil raw, to prevent nutrients being damaged by heat, and it may be true that this is the best way to get the full benefits of extra virgin. On the other hand, extra virgin olive oil may also be the healthiest fat to cook with, especially since preparing certain vegetables with it seems to make them even more nutritious by increasing their polyphenol content. Olive oil also improves our ability to digest and absorb plant carotenoids, which are thought to be anticarcinogenic. Meats, too, can become healthier when marinated and cooked with olive oil, thanks to its antioxidants. Olive oil’s high smoke point is unlikely to be reached during normal home cooking. Even frying with it may be fine, and preferable to frying in other oils, since a Spanish study conducted over an 11year period on over 40,000 adults found that regular consumption of foods fried in olive oil did not increase their risk of heart disease. And that’s not all; rich in vitamin E, an antioxidant that helps boost the immune system, EVOO has also been shown to help decrease the risk of high triglyceride levels, depression, osteoporosis and high blood pressure. As Magiatis reminds us, “used in place of animal fat, [EVOO] is useful for the control of cholesterol levels. This is also an official EU-[and US Food and Drug Administration]-approved health claim.”

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GREEK SUPERFOODS

They can be found everywhere, from delis to pharmacies, conveniently packed and easy to carry back home. And theyâ&#x20AC;&#x2122;re the most beneficial gifts from Greece you can offer yourself and those you love. BY Ta s sou l a E p ta k i l i / F OO D S T Y LI N G : T I N A W E B B / P H O T OS : G E O R G E D R AKOPOULOS

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regano adds the familiar fragrance to a Greek salad, but it also provides relief for a sore throat. Olive oil is an essential component of Greek cuisine, but it’s medicinal, too. Honey is a sweetener that also contains more than 180 nutrients. Ancient Greek gastronomy, the ancestor of the food culture of Rome, is the source from which many features of European diet and cuisine are derived. But that’s not all. Ever since antiquity, the Greeks have not only sought to satisfy their hunger or to find enjoyment in foods. Many foods were used to prevent or treat a number of health conditions.

Trahana According to gastronomic history, modern-day trahana has evolved from a porridge-like mixture of milk and wheat eaten by the ancient Greeks and Romans. The noted gourmet and recipe collector Apicius (1st c. AD) refers to this food substance as tractae. In Byzantium, it was popular as tragos or traganos. In the past, it was a practical method for using up leftover milk and was critical to a family’s survival – trahana could be stored for more than a year in a cool place. Trahana is made with fresh milk that has soured, to which wheat is added. The wheat can range from coarse to fine – Cretan xinohontros, for example, uses coarse wheat. Trahana is rich in carbohydrates and is also a source of fiber, which aids intestinal health. The lactobacilli in the sour milk have a beneficial effect on the digestive tract, too. Trahana contains protein, magnesium, iron, phosphorus and calcium in a form which the body can easily absorb. It also has carotenoids, such as lutein, a powerful antioxidant that works to prevent the harmful effects of free radicals, thus helping to maintain healthy eyes, skin and heart. Trahana can be made into a thin or thick soup, and is low in calories (100 calories/100g). In recent years, many chefs have enriched the classic trahana soup recipe with bits of meat and vegetables or fish. It can be added to savory pie fillings or used in stuffed vegetables or grape-leaf dolmades instead of rice.

Olives and olive oil A plant native to Greece, the olive tree was being cultivated in the Aegean as far back as 2000 BC. The olive and its precious oil have been omnipresent components of Greek life ever since: in the diet, in religion, in mythology, in medicine, in literature and in art. Olive oil was particularly important at the palaces of Knossos, Mycenae and Nestor (Pylos). It was a key ingredient in most cooking, used in bread-making and even eaten with bread for a light meal. However, it also had important uses beyond cooking; it served as a fuel, as a cosmetic and as a medicine (60 medicinal uses are referenced in the Hippocratic Corpus). The olive tree was endowed with rich symbolism as well: it was the sacred tree of the goddess Athena, and its branches were used to make the kotinos, a crown given as a trophy to Olympic champions. The mainstay of the Mediterranean diet to this day, olive oil is critical to good

health. It is ideal for the heart and prevents blood clots. Its polyphenols reduce bad LDL cholesterol and increase good HDL cholesterol. Its cancer-fighting and anti-aging actions derive from its valuable antioxidants (flavonoids), vitamin E, provitamin A, minerals and trace elements. It helps to regulate glucose levels in diabetes, plays a key role in central nervous system development, and also aids in the normal function of the digestive system, decreasing the possibility of ulcers and improving intestinal tract motility. “But why Greek olive oil?” you may ask. Well, first of all, because of its unique flavor. Secondly, because more and more research is confirming that olive oil produced in Greece is higher in polyphenol content – polyphenols are the precious chemical compounds that promise to rid us of many health problems – than those produced in other parts of Europe.

More and more research is confirming that olive oil produced in Greece is higher in polyphenol content – polyphenols are the precious chemical compounds that promise to rid us of many health problems.

Sage Its official botanical name is in fact Salvia officinalis, which is partly derived from the Latin verb salvare, meaning “save,” and alludes to its therapeutic properties. The ancient Greeks used its fresh leaves to treat wounds and snake bites, and as a drink to enhance female fertility. As a beverage, sage-infused “Greek tea,” as the French call it, or “Greek sprout” for the Chinese, remains popular to this day, either on its own or combined with other aromatic herbs. Sage is also associated with some less scientific benefits. In Syros, for example, they say it exorcises gossip. You will often find little bunches of it hanging outside homes. A beneficial herb, sage has anti-catarrhal properties (for asthma, bronchitis and coughs), as well as anti-fungal and anti-infective action (for flu, gingivitis and insect bites). It is an effective antispasmodic (in cases of dysmenorrhea) and healing agent. Its broader effects include stimulating the nervous system, improving memory and boosting blood circulation, while its antioxidants act against free radicals. H E A LT H 2 017- 2 018

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Anthotyro According to Greek mythology, knowledge of cheese-making was gifted to humans by the gods of Olympus through Aristeas, son of Apollo. There are references to cheese products in the writings of Aristotle and in the comedies of Aristophanes, while Homer famously referred to them in the Odyssey as well, citing the production of cheese from goat’s and sheep’s milk by the one-eyed Cyclops Polyphemus who was eventually blinded by Odysseus. Could this cheese have been anthotyro? It is quite possible. Soft, white and rind-less, anthotyro is made in most regions of Greece from whey (left over from making another type of cheese) and the addition of sheep’s or goat’s milk, or a combination of the two. Lightly salted, it combines a pleasant rich flavor with high nutritional value. It provides all of the substances that dairy products offer (protein, calcium, potassium, phosphorus), but contains less fat (it is not high in cholesterol content) and is just 200 calories/100g. Compare that to 470/100g calories for graviera cheese, 420/100g calories for kefalotyri, and 350 calories/100g for feta. Anthotyro is served as a side dish with meals, used in savory pies and salads or as a spread on bread. It pairs deliciously with fresh fruit and nuts, and makes an excellent dessert when topped with honey.

Rusks, particularly those made with barley (which thrives better in the Greek climate than wheat), are considered a key ingredient of a healthy and balanced diet.

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Dried figs The ancient Greeks considered figs a luxury, with a quantifiable economic value that lent prestige to those who could consume them. But they were also a special delicacy. There was a word – sykoskopos – that referred to someone who brought news of where syka (figs) were to be found; there was also the term sykofantis, used for the person who revealed their illegal trafficking. It was not uncommon in Attic comedies to see the impoverished protagonists dreaming of buying wine and dried figs as soon as they could find a little money. In classical times, figs were eaten fresh as an appetizer, and were usually salted. In dried form, they accompanied the wine served at symposia. The leaves of the fig tree were soaked in brine to remove the bitterness and were then used to prepare

foods similar to modern-day dolmades. The nutritional value of figs, particularly dried ones, is indisputable. Rich in natural fiber (which stimulates intestinal motility), they help in weight control because they enhance the feeling of satiety. They are one of the best sources of potassium, which regulates blood pressure and boosts ligament health: just half a cup provides 300mg. They also contain magnesium, which is important for the function of the nervous system, for metabolism and for bone health. Surprisingly, they contain more calcium than milk does. You can add chopped dried figs to milk or yogurt along with your favorite breakfast cereal, eat them together with white cheeses, or try them on their own as a snack.

Stamnagathi These greens are a variety of wild chicory (Cichorium spinosum), and have a bitter flavor. They are a key element of Cretan cuisine. The Greek name originates from an old habit the Cretans had of placing these greens over the mouth of the water jars to keep bugs out of the water. The Stamnagathi plant is a source of dietary fiber, antioxidants, iron, calcium, potassium and vitamins A, C and E, and beta-carotene. It is an excellent tonic and diuretic; it helps to detoxify the liver and has slightly cathartic properties. The ancient Greeks considered it medicinal. The greens can eaten raw with a lemon or vinegar and olive oil dressing, boiled on their own, or cooked together with lamb or goat. They can also be pickled after parboiling. Barley rusks The ancient name for rusks was dipyritis artos, meaning “twice-baked bread.” Rusks have been a staple of the Greek diet since before refrigeration or preservatives, when a way of keeping bread for as long as possible was needed. Rusks, particularly those made with barley (which thrives better in the Greek climate than wheat), are considered a key ingredient of a healthy and balanced diet. They are a good source of vitamin B complex, selenium, potassium, calcium, phosphorus, silicon (which helps to rebuild and protect bones), chromium (for better control of glucose levels in

diabetes) and dietary fiber (especially beta-glucan, linked to lower cholesterol). They also aid in better intestinal and liver function and help reduce cellulitis. It should also be noted that barley contains less gluten than wheat. So, why not try replacing your breakfast toast with barley rusks? Alternatively, you can also replace commercial breakfast cereals, which contain a high level of hidden sugars, with boiled barley, honey and cold milk. And remember that, because their low moisture content eliminates the risk of microbial spoilage, rusks do not contain preservatives, either.

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1. Extra virgin olive oil 2. Anthotyro 3. Anchovies 4. Stamnagathi 5. Dried figs 6. Barley rusks

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Honey The history of apiculture, or beekeeping, in Greece goes back thousands of years. Excavations at Phaistos uncovered ceramic beehives from the Minoan era (3400 BC). Hippocrates, the father of medicine, recommended honey to all his patients. Honey, eaten with bread, was the main food for Pythagoras and his followers. Frequently, the libations to the gods included honey with wine and milk, while ambrosia, the food of the immortals, was said to contain royal jelly. In classical times, desserts with honey were very popular, including honey pies called melitoutta to plakountes, which also had sesame seeds and spices. With more than 180 nutrients, honey is a food of high nutritional value. It is an excellent source of carbohydrates, antioxidants, vitamin B complex, trace elements and minerals (calcium, magnesium, zinc, iron, copper) essential for keeping the body in balance and contributing to everything from bone strength to metabolism. It has a lower glycemic index than sugar. In other words, in small quantities, it is even suitable for people with diabetes. The great biodiversity of the Greek land – 1,300 endemic plants and an exceptional variety of flowers, herbs and trees – also affects the quality of the honey produced in Greece: it is far superior in flavor, aroma and density than honey from other countries.

With more than 180 nutrients, honey is a food of high nutritional value. It is an excellent source of carbohydrates, antioxidants, vitamin B complex, trace elements and minerals.

Tahini Closely tied to Christian fasting, tahini, the paste made from roasted sesame seeds, re-entered the Greeks’ diet through migrants from Asia Minor who carried with them the knowledge of how to make it and its cousin, halva, from their lost homelands. It has the delicious essence of roasted nuts and the rich flavor of its precious oil. One spoonful of tahini, particularly whole grain, is the perfect dietary supplement. First, the fatty acids it contains are mainly monounsaturated and polyunsaturated: these are fatty acids which raise the level of good cholesterol (HDL) that protects the heart. It is rich in high-quality proteins, vitamin B complex (which regulates the synthesis of several

hormones, among other things), calcium (acts against osteoporosis), iron (for physical and mental well-being), potassium, zinc (fortifies the immune system), phosphorus, magnesium (relieves stress and migraines), manganese and copper (reduces joint pain). It also contains selenium, which is one of the weapons in the body’s defensive arsenal against oxidative stress. Tahini is the ideal topping for breakfast (try bread with tahini and honey). It goes well with sweet flavors (honey or chocolate), with tangy lemon and with garlic, pepper, pulses and salads (it makes a great dressing). It can also be used in soups, pies, cookies and hummus.

Moustalevria In the days when there was no sugar, or it was hard to come by, homemakers made full use of everything the Greek soil gave them to expand their cooking repertoire. This is how moustalevria was born. The exact date of that birth is not known. We do know it is a dessert that dates back to antiquity; during the Byzantine period, it was called moustopita and was made with flour and boiled grape must. That is more or less the recipe that survives today, though it is now embellished with nuts and cinnamon. Moustalevria is a highly nutritious food, thanks to the raw material – grape must – which provides a large quantity of antioxidants. With the addition of walnuts, almonds, cinnamon and sesame seeds, it is enriched even further, not only in flavor but also in nutrients. Sesame seeds are rich in amino acids, minerals, trace elements and calcium. Cinnamon improves glucose levels in the blood, while walnuts and almonds provide valuable omega-3 fatty acids, antioxidants and phytosterols. What’s more, all this comes with zero fat. Traditional yoghurt Yoghurt has always held a special place on the Greek table, although it is in fact widely consumed throughout the southeastern Mediterranean. The ancient Greeks called it oxygala, and they had a particular liking for it. French explorer Pierre Belon (1517-1564) wrote, “The Greeks and Turks have oxygala, a type of sour milk which they carry in fabric bags hanging off the side of their animals. Though it is quite watery, it stays in the bag without spilling.” There’s been a lot of milk under the bridge since then. Nowadays, as the food industry endeavors to offer products with long shelf lives, most yoghurt is processed at temperatures high enough to prevent the growth of unwanted microorganisms. However,

this means that beneficial live bacteria are also eliminated and yoghurt loses a large part of its nutritional value. Traditional Greek yoghurt, the one with the skin on the surface, it made from cow’s or sheep’s milk and contains valuable bacteria which have a positive effect on the entire digestive tract. These bacteria include the Lactobaccilus, which research has shown to have cancer-fighting properties. In addition, yoghurt enhances digestion, provides all of the nutrients of milk (protein, carbohydrates, fats, calcium, phosphorus, vitamin B complex and others), and can often be consumed by people who are lactose-intolerant. It is, indeed, an allround superfood! H E A LT H 2 017- 2 018

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Oregano The ancient Greeks held it to be a symbol of joy: it was used to make wedding crowns. But they also knew of its therapeutic value and used it as a drink to treat poisoning, diarrhea and colic, or externally to relieve skin inflammation. Arcadia and Tenedos are famous for producing oregano. Until a few decades ago, Cretan folk medicine used oregano leaves fried in olive oil to make a poultice for back pain, and oregano oil offered relief for toothache. Oregano grows practically everywhere in Greece. Fresh or dried, it adds beneficial properties along with its characteristic fragrance to many dishes. Rich in vitamin C, it also contains calcium, magnesium, zinc, iron, potassium, copper, boron, manganese and vitamin A. The essential oil of Greek oregano is considered the best in the world, as recent studies have shown it to have the highest content in carvacrol and thymol, both of which have powerful antioxidant and cancer-fighting properties. It has antibiotic and antiseptic properties as well. Oregano can relieve intestinal upsets and abdominal pain; it exhibits stimulatory, sudorific and anti-asthmatic effects; it is used to treat flu, colds, gingivitis and sore throat (in a gargling solution). Amazingly, oregano demonstrates 42 times greater antioxidant action than apples, 30 times greater than potatoes and 12 times greater than oranges.

Kozani Crocus is good for the digestive tract, boosts the metabolism and improves memory and overall brain function.

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Kozani Crocus ...or saffron, is probably the result of efforts to tame the wild Crocus cartwrightianus in ancient Greece, as the plant appears frequently in Crete’s Minoan-era frescoes and pottery, as well as in a fresco from the prehistoric settlement of Akrotiri in Santorini depicting a woman collecting the flowers. Saffron was widely used in medicine – the ancient Greeks drank it in a tisane to cure sleeplessness and hangovers. Today, Kozani’s saffron is one of the most expensive spices in the world (it takes more than 150,000 flowers to produce one kilogram of the stuff) and is very sought-after for its subtle aroma and flavor, its properties as a coloring agent and its health benefits. Saffron contains

vitamins A, C and B complex, as well as iron, calcium, magnesium, potassium and lycopene, which is known to help prevent cancer. It also has powerful antioxidant and anti-aging properties, as its carotenoids protect cells from free radicals. It is good for the digestive tract, boosts the metabolism and improves memory and overall brain function. In addition, it helps fight anxiety and acts as a mood elevator. A mere pinch is enough to give food a rich yellow color, a subtle tang and plenty of aroma. It goes particularly well with rice, pasta, white meat and fish; it is used in salads and soups; and it is also used in sweets. It can be found in powder or thread form and as a tea.

Santorini fava Traces of stored crops and seeds found at Akrotiri indicate that a local species of vetchling, Lathyrus clymenum, was cultivated exclusively on Santorini for more than 3,500 years. Dioscorides, a famed 1st c. AD physician and botanist, distinguished the plant that provided the specific fava from its relatives in other regions. The particularities of the Santorini soil, the climatic conditions and, strangely enough, the lack of water combine to create a unique product with a velvety texture and sweet flavor. Rich in protein (20 percent) and carbohydrates (65 percent), the local fava is an excellent source of vitamin B1, iron, copper, phosphorus, potassium and magnesium. Its high fiber content makes it ideal for maintaining normal levels of glucose and cholesterol in the blood, for promoting the proper function of the digestive system and for preventing cancer of the large intestine. And it’s just 85 calories/100g. The fava is served in pureed form with lemon juice, oregano and olive oil, and sometimes with chopped onion and capers or with tomatoes and olives. You might also see it in salads, made into patties or even served with seafood such as octopus or anchovies. Mastic from Chios The mastic tree was particularly popular with the ancient Greeks: its shoots were pickled and eaten as appetizers, while its “tears,” the well-known mastic resin, were chewed to clean the teeth and freshen the breath. These tears were also used to flavor wine. The tree, Pistacia lentiscus Chia, does not grow anywhere in Greece but Chios; even there, it’s only found in the south of the island. Prescriptions based on mastic can be found in medical texts dating from late antiquity, when it was already considered beneficial. Present studies have confirmed this. Its antioxidant extracts prevent atherosclerotic plaque from forming on artery walls. Its polyphenols reduce

glucose and cholesterol levels in the blood. Regular use of mastic limits the formation of dental plaque. It helps prevent and treat diseases of the digestive system. It ‘s an all-purpose substance; a powerful anti-inflammatory, an analgesic, a cough suppressant, an appetite stimulant, an astringent and a diuretic. Today, mastic has many uses: in cooking, as a spice mainly for meat and fish, and for ice cream, spoon sweets and cookies; in mastic liqueur and ouzo, drunk as an aperitif or added to foods while simmering; and in cosmetics. Often made into chewing gum, the resin can be found in a variety of other forms: powders, crystals, mastic water or an essential oil.

reviving ancient grains Over the past decade, the seeds of a small revolution have been sown: Greece has seen the revival of ancient food crops as modern â&#x20AC;&#x153;superfoods.â&#x20AC;?

INFO Information courtesy of Antonis Kafatos, Professor Emeritus of Preventive Medicine and Nutrition at the Univeristy of Crete. H E A LT H 2 017- 2 018

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EAT REAL

The cuisine of Greece is rooted in simple, traditional foodstuffs bursting with flavor and nutrition. B Y D ia n e K o c h ila s

t was warm and the color of seduction itself, pure red. When my Aunt Mary cut it open with her small, dull, serrated knife, on the stone slab of a table right outside her kitchen door, goats gently bleating nearby, I could smell its perfect scent, light as the breeze. My first real tomato. I was reluctant to eat it but, goaded on, I did, at first a little frightened by the thin juice and sticky seeds on my lips and by its thick leathery skin and fleshy pulp. I was forever transformed. Ikaria. Summer of ’72. My love affair with this country and its cuisine began then and there, unbeknownst to my 12-year-old psyche. That was the summer I discovered food. Real food. Cut from vines, picked from trees, plucked off straw in coops, snapped from stalks. Comforting food placidly swimming in olive oil, punctuated with sharp oregano and crunchy salt. That was the summer I discovered the Greek diet although, back then, the term was not yet in use. Goats were everywhere, and we ate them. It was, however, years later before I dared milk one; to this day I am awed by the process, such a yin and yang. How, from this cranky mammal’s soft grey wrinkled teats, using just the right kind of pressure, which takes time to hone, you get that hard stream of warm white milk. Soft-hard, feminine-masculine, ancient-modern. This is Greece eternal, my life lesson in contrasts and the untold but palpable balance that is in evidence all over this country’s stunning natural landscape. More than four decades later, battered by a crisis of Herculean proportions, beaten but breathing, Greece and its food still seduce. The land is giving and many people have returned to it, to revive their lives and livelihoods. Many others, of course, have left in droves for distant shores, moving in free markets to work but just as likely fettered by what in Greek is called nostos, a yearning to return home, the root of our English word “nostal-

01. Diane Kochilas, a Greek food guru and writer, buys fresh vegetables and fruit from a farmer’s market. | 02. Xinomavro is northern Greece’s unrivaled wine variety (Boutaris Estate, Yiannakohori, Naoussa). | 03. When making a pie, sprinkling the dough with flour is necessary. | 04. Portrait of an elderly couple in Ikaria, a Blue Zone island, known for the highest percentage of 90-year-olds on the planet. | 05. Delectable shrimp stew cooked by the monks on Mt Athos. | 06. Fresh Greek ingredients ready for use in making the classic chicken in wine sauce. | 07. Rustic bread, feta cheese and olives make up the most common and delicious of Greek snacks.

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gia” and, tellingly, the root of the Greek word for “delicious.” Delicious home. That is always how I think of Greece – the vantage point of my perspective is forever the Greek table, and all that happens around it.

REGIONAL CUISINES The more one delves into the origins of Greek food and lore, the more one becomes entangled in the web of this country’s long, complex history. Greece has always been a crossroads between East and West. It has endured conquests and has absorbed whole populations from neighboring lands. Much of its history is one of migrations and resettlements. Most migrations, of course, were forced upon the Greeks, whether by threats such as pirates, earthquakes, Ottoman Turks and others, or by economic hardship, a recurring catalyst and one we are seeing today. Greece’s sinuous history has played itself out on her table. The cuisine is a rich amalgam of ancient, Byzantine, Balkan, Turkish, English and other influences, all fused into the terrain of the country itself. Geography and climate, more than anything else, have dictated what people in different regions of Greece cultivated and consumed throughout history. For the most part, even the modern Greek table overflows with ancient foods; the same basic ingredients have sustained Greeks since prehistoric times. Among them are the olive and its oil, of course, but there are also grains, such as barley and wheat; pulses, such as lentils, peas, chickpeas and broad beans; wild herbs and greens; game, such as wild birds and rabbits; snails; sesame, honey, nuts, and certain fruits. Goats and sheep have long provided milk, cheese, festive meats, and various household necessities such as wool or the goatskin bags still made on Ikaria, called filaki. Pork, a meat that divides the Mediterranean between Christian and Judeo-Muslim culinary traditions, has always been an important meat in Greece. Indeed, even today on the Aegean islands, the hoirosfagia, or “pig-slaughtering” custom, is alive and well. Taking place around the holidays, the family ritual is reason for a feast, and showcases the skills necessary for butchering the animal so that every last scrap is used. It has always been my belief that the regional cooking of Greece can be divided into three main “arteries”: mountain cooking (shepherd traditions), island cuisine (born from the thrifty cooking of the Aegean), and the urbane, fragrant cuisines of the Greeks of Asia Minor (as well as of the Italian aristocracy whose historic presence in parts of the Aegean and Ionian left a most aromatic mark on local tables). One could argue that Crete, almost a country unto itself, naturally blessed with a fecund landscape and host over the centuries to Venetian and Turkish invaders as well as to Greeks fleeing Asia Minor, is in a category all its own. As one moves from one corner of Greece to another, distinct regional cuisines emerge. The Peloponnese, for example, thanks to the copious amount of excellent olive oil that is produced throughout the region, is home to some of the best and simplest one-pot vegetable and bean stews in Greece. Oranges, lemons, and olives flavor the local cuisine. Pork is a local passion, so much 70

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01. Cretan pies with greens accompanied by traditional tsikoudia, a grape-based pomace brandy. 02. Returning from grazing at the end of the day (Trifylia, Kyparissia). 03. A cook from Epirus is making filo for a pie – the trademark dish of the region. 04. Picking olives the oldfashioned way, by hand (Argolis). 03 04

05. The Tsantalis vineyard on the “Holy Mountain” of Athos in Halkidiki.

Greece’s sinuous history has played itself out on her table. The cuisine is a rich amalgam of ancient, Byzantine, Balkan, Turkish, English and other influences, all fused into the terrain of the country itself.

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so that on weekends all over Messinia one can find roast pork, or gourounopoula, sold even at roadside stands. There are commonalities between the cooking of the Peloponnese and some of the culinary traditions of the Ionian, on the western coast of Greece, but the cooking of the Ionian Islands has also been shaped by hundreds of years of Venetian presence. Some foods have Italian names to this day. Heading north through Roumeli (central Greece) and Epirus, the land is so imposing, mountainous and dense, that the local cuisine is greatly defined by it. This is shepherds’ domain, where wild greens, meats, dairy and savory pies make up the mainstay of local food traditions. Thessaly, the great plain and wheat belt of Greece, is a kind of bridge for all the cooking traditions of the mainland, combining Macedonian traditions with shepherds’ ways, and both of those with the region’s unique geography of coastline, flat open expanses and lush mountains. In Macedonia and Thrace to the north, the cooking is spicier than elsewhere in Greece. All manner of peppers define the flavor palette. Cabbage and leeks are the most important vegetables. The kitchen is a reflection of the land, of local and Balkan influences, and of the rich, fragrant foods that Greece’s Asia Minor refugees brought with them en masse in 1922, when hundreds of thousands resettled in the area. The Aegean is a different story. For the most part, Greek island cooking is sparse and simple, and all of Aegean cuisine culminates in the great traditions of the Cretan table – one of the best examples of a unified, perfect, seasonal and varied Mediterranean cuisine.

COMMON THREADS Regardless of the region, however, connections run deep throughout all of Greek cuisine. To this day, our culinary traditions are living traditions, something reinforced, at least to my mind, every time I visit a laiki (farmers’ market) in my Athens neighborhood. Here, one sees the Mediterranean Diet and the Greek Diet in practice. The markets are a potpourri of all that is in season at any given time of year, and this adherence to seasonality, to the laws of nature, so to speak, is probably the one defining value of all of Greek cooking. These street markets are a living example of something else as well, equally important and often overlooked: the importance of plant-based foods in the Greek tradition. Long before it became fashionable to think about vegetarianism, Greeks had been practicing a kind of selective vegetarian-based cooking rooted in the fasting traditions of the Greek Orthodox Church. To follow the fast – and many people, including myself, still do – one basically goes off all animal products for almost half the year. It’s the ultimate detox diet, time-tested, healthy and delicious.

01. The old traditional Greek café is still a meeting place, especially in the villages (Mani). | 02. Sage grows everywhere in Greece and is a popular herbal tea during the winter months. | 03. Snails have been a part of Crete’s food history for millennia. | 04. Sotiris Lymberopoulos, a modern-day forager, supplies gourmet restaurants with wild greens through his successful company Radiki. | 05. A traditional bakery in Aeropoli (Mani). | 06. Eggs with smoked ham preserved in fat.

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IKARIA Plant-based cooking, seemingly anathema to contemporary Greeks, who do, indeed, love their animal protein, is one of the secrets to what just might be the perfect living example of the traditional Mediterranean diet in action, that of the island of Ikaria. Ikaria was catapulted to fame a few years ago as a Blue Zone, one of a handful of places on the planet where people live an extraordinarily long time. One main factor for this must be their diet, along with a lifestyle that includes strong communal ties and a resistance to the pressures of the clock. For my most recent book, “Ikaria: Lessons on Food, Life and Longevity from the Greek Island Where People Forget to Die,” I talked to many old people on the island (my ancestral home, too) about what they ate growing up. What I discovered was that it wasn’t so much what people ate a generation or two ago, but what they didn’t eat. Food was not nearly as plentiful then as it is now and they didn’t eat very much at all. It was a dearth of food, rather than the types of foods, which seems to have defined their diet. Equally important, of course, is the quality of food. On Ikaria, and I dare say in many parts of Greece, people consume very little processed food. Most people on the island grow at least some of their own food and many still forage for wild foods, such as seasonal greens, herbs, and mushrooms. Farm animals are either grazed or eat the family leftovers, not a diet of processed animal feed. Olive oil flows in copious amounts (as it does all over Greece, which has the highest per capita consumption in the world). The food people consume is very fresh; it’s packed with nutrients and free of pesticides. Herbs, not only as flavoring agents but also dried for tea, are a major part of the Ikarian diet. Indeed, the folk pharmacopoeia on the island is alive and well. “Why do you need penicillin when you have sage, garlic and honey?” an 85-year-old friend asked, referencing the cold medicine of yore. Pulses, whole grains, garden vegetables (fresh in season but also dried – and known as tsifia), foraged wild foods, fish, some game and some meat were the mainstays of the diet. Meat was scarce, so much so that to this day there is a tradition in the villages of Raches called mnimosyno. That’s the word for memorial service in Greek. On Ikaria, it refers to the communal Easter meal to which everyone who can contribute, and anyone who wants to can partake in. It was a way to ensure that even the poorest islanders got a little meat at least once a year. Ikaria is still a place where life is simple, and slow. People there have an appreciation for the kinds of things money can’t buy – good company, friends, family, and shared meals. Most people make their own wine and it flows freely, enabling islanders to also live uninhibitedly, loosened up and unstressed. It is a place where the Mediterranean Diet of 50 years ago still flourishes, as does a culture that frowns upon material wealth and its stressful pursuit. Maybe these long-living islanders are onto something all Greeks knew instinctively a generation or two ago: that eating fresh seasonal food (mostly plants) prepared simply, consumed with wine and shared with friends and family is what a healthy diet is all about. 74

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01. A beekeeper sells his thyme honey in the village of Anopoli on Crete. 02. Cooking food in olive oilbased sauces is very common in Greek cuisine. This is okra with tomatoes and mizithra, a soft white cheese. 03. The “flower of salt” (fleur de sel) is handpicked from rocky cavities by the coast. (East Mani).

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04. Traditional festivals are a beautiful expression of Greek culture (Ikaria). 05. A vendor stacks his tomatoes at a stall in an open air market in Athens. 06. Fishermen on the islands sell their catch of the day early every morning. (Mykonos).

ABOUT THE AUTHOR

Diane Kochilas is a chef and award-winning cookbook author. She is the host of the cooking/travel series My Greek Kitchen, which aired across the US on PBS in September 2017. Together with her husband, Vassilis Stenos, she runs the Glorious Greek Kitchen cooking school every spring and summer on the island of Ikaria.

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Feeling Healthy and Whole Treating your mind, spirit, and body as one in a natural setting at one of Greece’s holistic health retreats is an experience you’ll want to repeat. B Y P a u l i n a B j ö r k K a p s a l i s / P H O T O S D I M I T RIS V LAIK O S

Finding peace of mind at the Re-Green Ecoculture Center in Seliana, in Achaia, Peloponnese.

RECHARGE

id you know that you can direct the movement of your coccyx? And that when you do, it makes you feel taller? Walking around a retreat center in the little village of Seliana, in the northern Peloponnese, I felt as tall as the trees. I had been awakened by the bells from one of those remote little churches one never sees but always hears. The air still carried a chill; only the tops of the mountains around me were painted gold by the rising sun, but the animals were awake. For the first time in my life, I saw a pig stretching its legs, and I was grateful there would be no bacon on my breakfast plate. It was day three of a Biomatic Anatomy retreat held at Re-Green Ecoculture Center (re-green.gr), on a weekend I had signed up for with zero knowledge of the subject and without any previous experience of anything remotely similar. We were detoxing, impulse dancing, doing yoga, humming songs together in the tiny sweat lodge, and learning about our bodies. It was a program as varied as the group of people attending it, but somehow, it tied together. English was our language of choice, but non-verbal communication between participants was encouraged. “Oneness” was a term that kept coming up during the classes, where, surrounded by nature, we worked in pairs, aiming to better understand our skeletal structure and the mechanics of breathing. The night before, after enjoying a dinner of vegetable curry, gluten-free bread and salad with ingredients just picked from the garden, we had made a fire. Gathered around it, people laughed and sang. We hadn’t talked about our bodies being one with nature, but it was the palpable lesson of the day. Health retreats take place all around Greece, all year round. They’re visited by about as many foreigners as Greeks. In the summer, the islands provide the perfect setting for those who believe in the healing powers of the sea. You can do yoga in the water, on a paddleboard, 78

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Christos and Flery, the owners of Re-Green, gave up successful careers to live closer to nature.

Man’s best friends also find happy refuge at the eco-culture center.

Energy-boosting fresh vegetable juices and granola bars are served between classes.

The food is prepared using vegetables from the retreat’s organic garden.

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on the beach or on the deck of a private sailing boat. In the winter, most retreats are held in mountain villages. Apostolia Papadamaki, owner of The Happiness Retreat (thehappinessretreat.gr) who was leading this group in Seliana, even arranges retreats in the center of Athens, where participants are encouraged to touch historic monuments. Most retreat activities, however, take place far from the city and place emphasis on natural surroundings. The reason to do them in Greece, most agree, is that there are very few places in the world where you can experience such variations in landscape concentrated in one area. But nature isn’t the only reason that holistic health retreats have based themselves in Greece. In fact, the approach was born here. It dates back to the Pythagorians, who believed that wellbeing depended on a perfect balance of the body’s fluids, and that imbalance was caused by bad habits and the environment in which we live. Hippocrates and his followers also believed that there has to be equilibrium between a person and their environment in order for them to have internal harmony. This, I learned, is the essence of the holistic approach. Holistic living includes avoiding big cities, living in harmony with nature (especially in terms of diet), and exercising mind, spirit, and body. By looking at yourself as a whole, you can avoid illness rather than just treating parts of your body where symptoms of illness appear. Even just adopting the lifestyle for a few days or weeks at one of the holistic health retreats in Greece will make you feel healthier, stronger and, if you’re lucky, even taller (I feel I grew half an inch). As I headed towards the main building for another homegrown, organic meal that morning in Seliana, I felt far more present than I usually feel when on vacation. I noticed the hurried movements of the chickens in the coop, I was aware of all my joints, I was belly -breathing and I could hear the sound of the nearby waterfall. All stress was gone. I was healthy; I was whole. 80

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Apostolia Papadamaki studied movement and spirituality for 20 years before developing the Biomatic Anatomy method.

You’ll get to learn a lot about fungi, too!

Lunch time at the retreat.

Unity and giving and receiving are important parts of holistic living.

In the garden.

Salads, hummus and freshly-baked bread make for a satisfying meal. H E A LT H 2 017- 2 018

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Alternative escapes

Greece is just the place to heal and strengthen your inner self

ZANTE FITNESS RETREATS Professional yoga instructor Panagiota Ntozi runs various holistic health retreats on the island of Zakynthos, where all classes are held outdoors. She bases one of her retreats, the Detoxifying Hippocratic Lifestyle Yoga Retreat, on what she learned about the ancient Greeks as a student. “There are texts from back then illustrating stretching and breathing exercises,” she says, and she combines those exercises with yoga and latenight cardio walks. Other great options are the Aerial Yoga Retreat, where beginners and more advanced practitioners use silk hammocks to take part in anti-gravity yoga, and the Reiki Mindfulness Meditation and Yoga Retreat, which focuses on self-healing. No matter which one you choose, you can expect wonderful hospitality (Ntozi greets her participants with complimentary welcome packages filled with healthy local treats) and gorgeous views of the sea from the hills of Zakynthos. INFO:

www.zantefitnessretreats.com

SKYROS HOLISTIC HOLIDAYS At the Skyros Center, maybe the oldest alternative vacation health center in Europe, you can design a retreat that suits you by picking from activities and classes such as psychotherapy, windsurfing, reflexology, abseiling, yoga, massage, music, dance, comedy and tai chi. It’s a mix that may seem random, but it’s all aimed at caring for the body as a whole. About three-quarters of the participants are from the UK, but the retreats are loved by people from all over Europe. Owner Yiannis Andricopoulos had the ancient Greeks in mind when he founded the center. Inspired by how “the whole for the Greeks was more than the sum of its parts,” he created a center where participants get to nurture body, mind and spirit. The island of Skyros in the Sporades offers beautiful surroundings for your tailored retreat. Choose between two locations on Skyros: the villa and huts at Atsitsa Bay or the facility on the outskirts of the island’s main village. INFO:

www. skyros.com

YOGALEXIA International yoga teacher and raw food chef Alexia Kulterer, who runs Yogalexia from Vienna, arranges “yogacruising” retreats on a larga private yacht in the southern Dodecanese. She believes that exercise and meditation in the crystal-clear bays of the small islands are perfect for making participants forget about regular city life. “Moving your body in nature is the best way to rejuvenate and heal. We are often looking for all kinds of remedies to cure some disease or illness, when actually, nature can heal it all,” she says. Participants agree: Angela Strauss from Vienna claims that the “breathtaking sunrises, the nurturing sounds of the ocean and the abundance of fresh, authentic and healthy Greek food,” in combination with the exercise, helped her find what she describes as her “natural self.” Yogalexia offers a week-long holistic package of movement, breathing exercises, sunrise meditation, two yoga classes per day and healthy vegetarian food from the onboard chef (because, as Kulterer puts it, “when you meditate more, you find a better connection to your inner wisdom. Automatically, you want to eat healthier, too”). Hiking excursions and sightseeing on the islands take place, too, and all this comes with plenty of rest in splendid settings. Waking up to the sound of the waves and spending all day in close connection to beautiful nature will keep you relaxed all week long. INFO:

www. yogalexia.at

BY LOOKING AT YOURSELF AS A WHOLE, YOU CAN AVOID ILLNESS RATHER THAN JUST TREATING PARTS OF YOUR BODY WHERE SYMPTOMS OF ILLNESS APPEAR 82

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Â© DIMITRIS VLAIKOS, PERIKLES MERAKOS, GETTY IMAGES/IDEAL IMAGE

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Harmony in the Hills Pristine nature, fresh air, great food, authentic experiences and plenty of history: here are three destinations for getaways that reinvigorate body and soul. By Olga Ch a r a mi & L i na K a peta n iou

Left to right: The dense forests of Tsagarada are interspersed with churches and aristocratic homes. The Bridge of Kleidonia in Zagori is the end point of the rafting route on the Voidomatis River. The bucolic landscape outside the village of Dimitsana. H E A LT H 2 017- 2 018

01. Rafting on the gentle currents of the Voidomatis River. | 02. Aristi is one of the most beautiful and well-developed villages of Zagori.

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Epirus: Zagori 400k from Athens

In Ioannina’s Zagorochoria region, one of Greece’s most special destinations, manmade structures like villages, bridges and cobbled streets blend harmoniously into their breathtaking natural surroundings. Historical background: The period from the 17th to the 19th century was of vital importance to this area. During that time, although Greece was under Ottoman rule, Zagori enjoyed a special tax status and autonomy. As a result, trade flourished, bringing the wealth that helped the area acquire its unique architectural character. Those were also the days when the renowned Vikogiatri – folk healers – used creams (still used today) made from the therapeutic herbs of the 86

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Vikos Gorge to treat ailments. The landscape: The area features two rivers – the Voidomatis, one of the cleanest and coldest in Europe, and the fast-flowing Aoos; the imposing Mt Tymfi, many of whose peaks are over 2,000m tall; Drakolimni, one of the three alpine lakes of the Pindus mountain range, nestled at an elevation of 2,050m; and the Vikos Gorge, one of the deepest in the world (1,200m), which is complemented by the Vikaki and several other gorges.

This stunning landscape – in which rocks, water and lush vegetation alternate and colors change with the seasons – is also home to dozens of stone-built traditional settlements. The area is at the heart of the Vikos-Aoos National Forest – a UNESCO Global Geopark – which, in turn, makes up a section of the Northern Pindus National Park. Climate: Heavy rains fill the streams and rivers, waters the earth and increases humidity. The winters are harsh, with a lot of snow; summers are relatively cool with intermittent rain. Until the 19th century, many of the area’s inhabitants – mainly stockbreeders – would adjust their lifestyles according to the weather, moving to the lowlands every autumn. Activities: You can enjoy rafting on the Voidomatis River year-round, or on the demanding Aoos River – but this only in winter months, and only for the more experienced. There is also canyoning in the gorges, mountain biking, river trekking along the Voidomatis and snowshoeing (Trekking Hellas, Tel. (+30) 694.475.0009, (+30) 26510.717.03, www.trekking. gr). Some of the most beautiful trails in Greece (many accessible only in the sum-

03. Hiking in the area of Spitalia, in Monodendri, with a view of the Vikos Gorge. | 04. The path that leads to Oxia, another site with a stunning view of the Vikos Gorge. 06

05. Walking by the Voidomatis River, next to the bridge of Aristi. | 06. Beverages made with local herbs together with homemade desserts at Sterna in Megalo Papigo.

mer) are located here as well, including one that runs along the Vikos Gorge and another that ascends to Lake Drakolimni, on Mt Tymfi. In the winter, you can walk around the village of Kapesovo, set out on the stone skales (stepped cobbled roads) or take the Voidomatis Trail. For yoga in nature and wellness treatments, contact the Aristi Mountain Resort (Tel. (+30) 26530.413.30, www.aristi.eu). Food: Local fare often includes wild mushrooms and herbs; restorative (porridgy) trachanas and soups; almost any kind of pie you could think of; organic

vegetables from privately owned gardens; and dairy and meat products from local stockbreeders. Zagorian cuisine reflects a wise frugality that makes the most of nature’s ingredients and one’s own produce. Opt for Astra (Tel. (+30) 26530.421.08) in Megalo Papigo; Thoukydidis (Tel. (+30) 697.998.3798) in Kapesovo; or the Salvia restaurant (Tel. (+30) 26530.413.30) at the Aristi Mountain Resort. For local sweets and for drinks prepared from wild herbs, try Sterna in Megalo Papigo (Tel. (+30) 697.720.2817). Inspiration: A tour of some of the 46

Zagorian villages is a lesson in architecture. Secular buildings, mansions and churches all feature interlocking stone construction and slate roofs. Other evidence of the renowned artistry of the craftsmen of the 18th and 19th centuries are the little cobbled roads, the skales, and the exquisite stone bridges (around 100 of them) that span rivers and streams. Megalo Papigo, Aristi, Kato Pedina, Kipi, Vitsa and Monodendri are some of the villages where tourism is more developed, while Dilofo, Koukouli and Kapesovo retain a more authentic charm. H E A LT H 2 017- 2 018

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The Peloponnese: Arcadia 200k from Athens

There’s so much to do in this history-packed corner of Greece: visits to significant historical monuments, hikes on Mt Mainalo or in the Lousios Gorge, strolls through stone-built villages, and more.

and supplied the revolutionaries with gunpowder from the 14 gunpowder mills in Dimitsana. The landscape: Mt Mainalo (1,981m), with its forest of Greek fir (Abies cephalonica) and its alpine meadows with plentiful herbs, dominates an area that includes monasteries, watermills and bridges, as well as the Lousios and Alfeios rivers, with their plane trees, olive trees and wild fruit trees. In the midst of this stand picturesque villages such as Karytaina, Stemnitsa, Dimitsana and, higher up, Vytina. Climate: Summers are cool and winters are dry but with snow; humidity is low (except in the gorges). The area consti03

01. The forests around Mainalos are ideal for hiking and mountain biking. 02. Aristocratic Stemnitsa, surrounded by rich vegetation. 03. You will find choice dairy products at Tsatsouli in Vytina.

04. Jewelry-making at the Stemnitsa Silver and Goldsmithery School. 05. A fulling mill, an installation once used for washing textiles, at the highly educational Open-Air Water Power Museum in Dimitsana.

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Myths and history: According to myth, this was where Arcas, the primogenitor of the Arcadians, once reigned. It was in the waters of the Lousios River that the newborn Zeus bathed. The god Pan, a symbol of bucolic life who charmed intellectuals and influenced the art of the Renaissance, was worshiped in the area’s mountains as well. In antiquity, it was home to one of the most renowned asclepieia (healing site) – that of Ancient Gortys, near the village of Karytaina. In more recent times, highland Arcadia was one of the epicenters of the 1821 War of Independence. The area produced military leaders and religious patriarchs, was the location of “underground” schools

Power Museum (Tel. (+30) 27950.316.30, www.piop.gr), on the outskirts of Dimitsana, is well worth a visit. There, you can see how a fulling mill, a flour mill, a raki still and a tannery are all powered by water. In Stemnitsa, visit the local Folklore Museum (Tel. (+30) 27950.812.52), which has displays on traditional homes and occupations. Stemnitsa is also the location of the Silver and Goldsmithery School (Tel. (+30) 27950.815.14), which organizes workshops, too. For seminars on cooking, contact the Mpelleiko guesthouse (Tel. (+30) 27950.812.86, mpelleiko.gr). In Elati, if you’re interested in workshops on painting and wood carving, call Christos Simopoulos (Tel. (+30) 697.702.2173). In Karytaina, take a walk around the Frankish castle and all the way to the stone bridges on the Alfeios River. © DIONYSIS KOURIS

gr), mountain biking, ATVs and 4X4s in Vytina (Explore Mainalo, Tel. (+30) 693.816.9580, www.explore-mainalo. gr) and skiing at the Mainalo Ski Center. Food: Handmade pasta, mushrooms, herbs and wild greens, local dairy products and meat are the basis of Arcadian cuisine. Try local recipes featuring products from their own farm and garden, as well as homemade bread, at the taverna Zerzova (Tel. (+30) 27950.317.53), located in the village of Panaghia, and at the taverna Stemnitsa (Tel. (+30) 27950.813.71) in the village of the same name, which also offers family-produced meats and local cheeses. When in Vytina, shop for dairy products at Tsatsoulis, for pasta and other products at Palea Agora and go for the honey at Liaropoulos. Inspiration: The Open-Air Water

tutes an ideal environment for those with respiratory conditions. It’s no coincidence that Vytina had two functioning sanatoriums until the 1940s, and that this Arcadian resort village appeared very quickly on the tourist map. Activities: Follow the trail leading to the Lousios Gorge; it begins in Dimitsana and ends in Ancient Gortyna (Gortys), a four-hour hike. For a shorter walk, opt for the section that links the three historic monasteries of the gorge – the Nea Moni Filosofou (17th century), the ruined Palea Moni Filosofou (said to have operated as a underground school during the Greek War of Independence) and the Prodromou Monastery (16th century). More experienced hikers might want to take on the 75k Menalon Trail, certified by the European Ramblers’ Association, which runs from Stemnitsa to Lagadia. The hike takes five days to complete, with accommodation in a different village every night (menalontrail.eu). Other activities in the wider area include horseback riding in Elati (Christos Simopoulos, Tel. (+30) 697.702.2173), rafting on the Lousios and Alfeios rivers (Trekking Hellas, Tel. (+30) 27910.259.78, www.trekking.

The Prodromou Monastery, built into the rock face of the Lousios Gorge. H E A LT H 2 017- 2 018

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Thessaly: Pilio 350k from Athens

No less than 70 picturesque villages and stunning settlements are yours to explore on Pilio, a mountainous peninsula with lush vegetation that runs all the way down the sea. Myths and history: Mt Pilio appears in a lot of myths – and how could it not, being the summer residence of the Olympian gods and the legendary homeland of the half-man, half-horse Centaurs? The wisest – and most famous – of all of the Centaurs was Chiron, who possessed much knowledge, including much of a scientific nature. He was believed to have been a healer himself, using many of the herbs that grow on Mt Pilio to treat ailments. His list of students included Achilles, Theseus and Asclepius – the god of medicine. To this day, Chiron remains a symbol of inner peace and tranquility, and of theart of healing. The landscape: Rising between two bodies of water – the Pagasetic Gulf and the Aegean Sea – Mt Pilio occupies almost 90

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the entire northern half of the regional unit of Magnisia. Dense forests of beech, walnut, oak, chestnut and other trees compose heavenly landscapes, while views of the sea – especially from the eastern side of the mountain – are astounding. Climate: Coastal, lowland and highland villages are all to be found on Pilio. Its most famous villages are those built highest up. Even though the mountain rises abruptly from the sea and its highest peak stands at only 1,624m, winter brings heavy snowfalls, and a ski center operates in the village of Hania. In summer, the lush vegetation keeps the area cool – but also humid. Activities: You can enjoy Pilio ‘s natural bounty while staying at the Amanita guesthouse (Tsagarada, Tel. (+30) 24260.

01. The village of Pinakates is one of the prettiest in Pilio, its small size notwithstanding. 02. A longtime mushroom expert, Filaretos Psimenos is the owner of the guesthouse Amanita. 03. One of the stone bridges in Tsagarada.

497.07, www.amanita.gr). Its owners have created a small organic garden in which they cultivate seasonal vegetables, fruit trees and herbs (many of them medicinal) that are representative of what grows locally. In hands-on seminars, you can get to know the herbs of Pilio and learn how they’re used in cooking. The same folk also organize forays in search of mushrooms, and teach visitors how to identify them – later, the harvest is cooked and enjoyed collectively! The whole of Pilio is hiker heaven. Be sure to walk from Damouchari Beach to Tsagarada, from Kissos to Mouresi and from there on to Aghios Ioannis. Hikes are organized by companies like Hike Away in Pelion (Tsagarada, Tel. (+30) 24260.497.24) and Bike or Hike (Portaria, Tel. (+30) 698.209.9620, www. bikeorhike.gr), which also offers cycling rides. Food: Mt Pilio is abundantly fertile and fruitful – wild mushrooms and greens, apples, walnuts and chestnuts are just some of what grows here. Head to Zagora to sample the protected designation of origin (PDO) apples grown by the agricultural cooperative Zagorin; while there, be sure to try the “honey of the Centaurs,” which is what they call the petimezi (mo-

You can try stews and other dishes made with local meat in the taverna Meintani in Zagora.

The village square in Vyzitsa.

lasses-like syrup) they make from their apples. The taverna Paradeisos (Tel. (+30) 24260.492.09) in Tsagarada serves up traditional dishes prepared using local ingredients, while at the taverna Meintani (Tel. (+30 ) 24260.226.26) in Zagora you can try local greens and meats, and pies made with handmade filo pastry. Inspiration: The Church of the Archangels (Pammegiston Taxiarchon) in Milies, built in 1741, is well worth a visit, both for its murals (among these is one depicting the Zodiac Circle, titled “The Vain Life of the Illusory World”) and for

its amazing acoustics, boosted by the 48 urns placed upside-down in its domes. Another unforgettable experience is a ride on the narrow-gauge Pilio train from Ano Lechonia to Milies. The line, laid in 1903, is among the narrowest in the world – a mere 60cm wide. The supervisor of the construction project was Evaristo de Chirico, father of the famed painter Giorgio de Chirico, who lived in Greece and depicted railways in some of his paintings. The 15k route takes 90 minutes to complete. (For more info, Tel. (+30) 24210.397.23) H E A LT H 2 017- 2 018

Â© CLAIRY MOUSTAFELLOU

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Fountains of Life

A short narrative on a long healing tradition, from ancient water worship to the most recent natural spa revival. BY M a r i a C ov e ou

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Surrounded by breathtaking scenery, Pozar Hot Springs in Pella, northern Greece, feature a variety of pools both private and public.

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Vouliagmeni Lake, a year-round natural thermal spa of particular beauty, is located just 25k south of the center of Athens.

ith about 750 locations of natural curative resources, most of which are water-related, Greece could be described as a paradise of healing spas. Still, most remain undeveloped: only 45 springs have been officially recognized so far, while recognition of another 70 is pending. Meanwhile, few of them have onsite lodgings. Over the last few years, as holistic medicine has once again become a topic of discussion for the scientific community, there has been rekindled interest in developing these springs by creating high-end hydrotherapy facilities and hotels that focus on balneotherapy, not only as a treatment for specific ailments, illnesses and injuries, but also to promote general wellbeing. The Greeks were among the first to discover the beneficial properties of water. They used it not only for cleanliness 94

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and therapy, but also for relaxation. At first, unable to understand the actual curative capability of water, they (like other ancient people, such as the Egyptians, Babylonians, Persians and Indians) simply worshiped it as a deity and ascribed supernatural and magical powers to it. Early Greek texts and myths confirm this: Achilles, for instance, was invincible because his mother, Thetis, dipped him as a baby in the magical waters of the River Styx. As she held him by his heel, it remained the one vulnerable spot – his Achilles heel – which became the target of Paris’ arrow in the Trojan War. Heracles, another legendary hero, regained his strength after completing each feat by bathing in the hot springs at Thermopylae, which the god Hephaestus had created for him at the behest of the goddess Athena. As we learn from Homer’s epics, Greeks of this period also used water

for personal hygiene. They welcomed visitors by serving them water as a gesture of hospitality, and by inviting them to wash in their home’s tub, called the asaminthos. Their love of water was passed down over the centuries to their descendants, who created the first public baths. The balaneia, so-called because of their acorn-shaped dome (balanos in ancient Greek means “acorn”), were available for warm or cold bathing, or for steam baths in the special chamber called the pyriaterio. This was heated either by a furnace or by steam coming through the floor. Most balaneia were built near the gymnasiums and wrestling schools where athletes trained, but they also attracted citizens who wished to meet and discuss philosophy while relaxing in the waters. And, during Greek winters, there were more than a few of the less well-off who frequented the baths for warmth. For the

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Thermae Sylla Spa & Wellness Hotel, in Edipsos, uses thermal spring water that gushes up from depths reaching 3,000 meters.

Athenians, both hot and cold baths were an indicator of civilization and a part of everyday life. On the other hand, the Spartans and Macedonians, both fierce warrior tribes, preferred cold waters and avoided the balaneia, where they believed the heat just made one soft. The Spartans made an exception for the pyriaterio, which they used to work up a sweat before diving into the ice-cold waters of the River Eurotas to toughen themselves up. During the 6th and 5th centuries BC, the ancient Greeks used healing water for the first time in medicine, as practiced then, at the Asclepieia. These were both places of worship and healing centers dedicated to the god Asclepius. Treatment included washing, hot or cold baths, diet, exercise and entertainment. Most Asclepieia were conveniently located next to water sources (thermal springs,

rivers or the sea) and in areas of particular natural beauty. Since nature was associated with the divine and was therefore miraculous, it was considered to be an essential component of treatment. The foundation of holistic medicine had been laid, but it was Hippocrates (460-370 BC) who established its scientific basis. He separated treatment from

religion and instead linked it to ecology, rationally propounding that the environment and climate could have a beneficial effect in the treatment of patients. He was the first to study the sources of water and to classify it as potable, saline or sea water, where the “saline” water was actually mineral spring water. He spoke of the effect of cold and hot baths on

For the Athenians, both hot and cold baths were an indicator of civilization and a part of everyday life. On the other hand, the Spartans and Macedonians, both fierce warrior tribes, believed hot water made one soft.

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Popular for almost a century, the coastal town of Loutraki boasts modern facilities which complement its natural springs.

the human body and investigated conditions for which curative waters might be indicated. The Romans inherited Hippocrates’ knowledge of hydrotherapy and applied it to the treatment of many diseases. The Greek physician Galen, who lived in Rome in the 2nd c. AD, contributed greatly to continuing the Hippocratic hydrotherapy tradition. Among other things, he classified springs according to the temperature and the chemical content of their water, while also documenting numerous therapeutic indications. As great fans of Greek baths, the Romans copied the idea and named them “balnea,” from the Greek balaneia. With advancements in plumbing systems and a greater abundance of water, the Roman baths surpassed the Greek ones and evolved into impressive bathing facilities, the so-called thermae. They reached their peak initially as recreational centers and led to the establishment of the early spa towns, before 96

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becoming identified with opulence and debauchery, then ultimately declining after the fall of the empire. In the Byzantine period, the clergy initially fought against the baths, as the Christian ethic was diametrically opposed to the orgies that were supposedly taking place in the spa towns. However, the bath tradition was so deeply rooted in the lives of most citizens that the church ultimately had to accept it. A visit to the baths then became an important social event for the Byzantines, particularly those of the upper classes. In Greece, hydrotherapy essentially disappeared after the end of the Byzantine era, though the Turkish conquerors in turn made good use of the existing Byzantine baths. They turned them into the Turkish hammami, and thus such steam baths came to be known – wrongly, some may argue – as Turkish. By the mid-19th c., as thermalism was gaining popularity in Europe, the springs in Greece, which had just been liberated

from the Turks, began to get attention as well. The first to take an interest in them was Ioannis Kapodistrias, the governor of the newly formed Greek nation. He formed a scientific committee to analyze and assess the thermal springs, particularly those in Ypati, Edipsos and Kythnos. In 1835, a Bavarian scientist named Xavier Landerer, the personal pharmacist of King Otto of Greece, published the first positive findings. Queen Amalia made Kythnos popular with her visits for balneotherapy and, in 1845, the first modern Greek public bathing facility was built there. By 1935, many of the areas with springs that were also near the sea had grown into important spa destinations, achieving the same standards as leading European spas. The towns of Loutraki and Edipsos, among others, were at their peak in the interwar period, as they began to attract members of the upper middle class. By the 1950s, many spa towns would come to feature

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well-marketed hotels and resorts with restaurants and even casinos, thus creating a tourism product that the recently established Greek National Tourism Organization (GNTO) could now export. In the meantime, however, growing faith in conventional medicine and pharmaceuticals had impinged upon the popularity of spas. The Greek spa towns enjoyed one last period of glory in the 1960s and 70s, as the new middle class began to vacation there, taking advantage of their proximity to the sea. Naturally, spas were no longer a high-priority treatment option and were only used incidentally by those preferring cosmopolitan beaches. Thus,

they gradually came to be used only by the elderly, and their use came to be associated primarily with cures for illnesses. In this way, spas came to be regarded as destinations for the old and the ill. In fact, no matter where in Greece you travel, you’ll come across thermal springs, often with only basic facilities but with fanatic grey-haired supporters as well; you shouldn’t hesitate to join these enthusiastic individuals in the ancient practice of balneotherapy. If, however, you’re more interested in higher-end facilities, there are now a number of luxurious hydrotherapy resorts supplied by the same thermal springs that have long invited visitors to experience the healing aspect of Greece.

MIRAGGIO THERMAL SPA RESORT

scientific background

One of the steps taken during the process of officially recognizing a thermal spring is an analysis of the chemical composition of the water. Springs are characterized by what they contain: sodium chloride; hydrogen sulfide; carbon; iron; radon; or any combination of the above. They are also classified on the basis of temperature: cold (<20°C), cool (20°-35°C), medium-warm (35°50°C) and hot (>50°C). For different medical conditions, different mineral contents are indicated. Medical conditions may include disorders of the musculoskeletal, nervous, respiratory, cardiovascular, hematopoietic, gastro-intestinal and urinary systems, as well as dermatological, gynecological, endocrinological, otolaryngological and periodontal conditions. Hydrotherapy is used in thermal medicine as an adjunct to conventional medical treatment and is distinguished as either external (balneotherapy, mud treatments), internal (inhalation and waterdrinking therapies) or thalassotherapy (using seawater). Treatment is applied under a doctor’s supervision, with an established time duration per session and a prescribed overall length of treatment period to achieve the maximum therapeutic result.

KRINIDES MUD BATHS

INFO

The scientific details used for this article originate from the Greek-language publication Medical Tourism-Thermal Spa Tourism-Thermalism (2014) by Konstantinos Kouskoukis, Dermatology Professor, President of the Hellenic Academy of Thermal Medicine – Lawyer; and from the Institute of Geology & Mineral Exploration (IGME). H E A LT H 2 017- 2 018

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Best spots for a soak © ACHILEAS SAVVOPOULOS

Natural springs with excellent healing properties and facilities to match

KRINIDES MUD BATHS Originally a Byzantine-era spa, the village of Krinides was deserted after the 1923 GreekTurkish population exchange and gradually became a mudflat. It is said that a sick buffalo was left here by its owner for the wolves to devour, only to be spotted ten days later fully recovered and grazing the fields; this was how the thermal properties of the mud were discovered. Nowadays, the Krinides Mud Baths, located 3km west of the village, ranks as Greece’s most popular mud therapy spa. Guests here first visit the center’s doctor, take a five-minute thermal shower to clean the skin and then immerse themselves in the mud for 20 minutes. The cycle concludes with a second thermal shower, the only thing capable of washing off the Krinides mud. water type: Cool, metallic,

alkaline, calcareous, magnesiumbearing, acidic, carbonated.

HELPS WITH: Musculoskeletal

and nervous system disorders, gynecological conditions, skin conditions, cosmetic mud therapy.

INFO: Krinides, Kavala

(147k north-east of Thessaloniki) Tel. (+30) 2510.516.162 • Open June-October • www.pilotherapia.gr •

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THERMAE PLATYSTOMOU RESORT & SPA The spa at Platystomo in the prefecture of Fthiotida is located close to the village of Makrakomi, at the southern foot of Mount Othrys. Construction work initiated in 1929 to develop the spa (which opened in 1933) led to the discovery of the ruins of baths dating back to the Roman era, confirming the use of the region’s two thermometallic springs in ancient times. The four-star hotel Thermae Platystomou Resort and Spa, located amid a richly vegetated and privately owned 78-hectare expanse, utilizes the thermal waters in its two indoor swimming pools. water type: Cool, high alkaline, medium sulfur presence. HELPS WITH: Musculoskeletal, respiratory and nervous system disorders, skin conditions, gynecological conditions. INFO: Loutra Platystomou,

Makrakomi (246k north-west of Athens) • Tel. (+30) 2236.022.510 • www.platystomo.gr/en

VOULIAGMENI LAKE Vouliagmeni Lake, located in the heart of the Athens Riviera, is a spot of particular natural beauty. It features water stemming from sources between 50 and 100 meters deep at temperatures ranging between 22°-29°C, which makes the spot a year-round thermal spa. From a distance, the lake’s water looks black; this is the result of dark-colored seaweed and a layer of mud that has formed on the lake bottom. The lake flows into the sea, which means the lake water has a brackish taste. Small Garra rufa (or doctor fish), native to the lake’s waters, promise visitors a unique exfoliation experience by ridding the skin’s outermost surface of dead skin cells. water type: Cool, metallic, alkaline, chlorinated. HELPS WITH: Musculoskeletal

system disorders, skin conditions.

INFO: Vouliagmeni

(25k south of central Athens) Tel. (+30) 210.896.2237 • www.limnivouliagmenis.gr/en •

MIRAGGIO THERMAL SPA RESORT The thermal waters from the spring in Kanistro, on the Kassandra peninsula of Halkidiki, supply the Myrthia Thermal Spa at the brand new Miraggio Thermal Spa Resort, an ultra-luxury facility. Located amid a rich green landscape in front of a 500m-long beach, the ultra-modern, two-level, 3,000sq.m. wellness center offers both thermal and sea water for reinvigorating and cosmetic purposes in four different pools, each maintaining a different water temperature. water type: Cool, metallic, chlorinated, brominated and highly carbonated. HELPS WITH: Musculoskeletal and nervous system disorders, peripheral vascular conditions, skin conditions. INFO: Kanistro, Paliouri

(123k south of Thessaloniki) Tel. (+30) 2374.440.000 • Open April-October • www.miraggio.gr/en •

HYDROTHER APY

POZAR SPA Located in the prefecture of Pella, northern Greece, at the foot of Mount Voras (Kaimaktsalan), 500m above sea level. Thermal waters here were being used during the era of Alexander the Great through the Roman and Byzantine periods. They retain a temperature of 37°C, which is how the spa got its name, Pozar, which means “beneath the fire” in Slavic. The verdant area around the spa features an impressive ravine. The Toplitsa River, a thermal river formed by hot water springs that gush out at elevations of 360-390m above sea level, flows through the ravine. At the site, there is an old hydrotherapy center featuring 48 private baths, two indoor pools and two small hamam facilities, as well as a modern hydrotherapy center with eight 6-person pools. A 50m swimming pool is located on a specially designed plateau and visitors may also enjoy the small thermal waterfalls along the river. water type: Medium-warm temperature, metallic, acidic. HELPS WITH: Musculoskeletal

and nervous system disorders, gynecological conditions, skin conditions.

INFO: Loutraki, Aridea

(110k north-west of Thessaloniki) • Tel. (+30) 2384.091.300 • www.loutrapozar.com.gr/en

LOUTRAKI THERMAL SPA The ancient Greek historian Xenophon has written that Spartan soldiers would use the thermal springs of the ancient city of Thermes, believed to be today’s Loutraki in the prefecture of Corinth, for relaxation and reinvigoration following their battles. The first organized spa here was launched in 1855, and in the early 20th century, Loutraki became Greece’s first spa destination. This seaside town, which also features a casino and is linked to Athens by train, is still regarded as the country’s main spa therapy destination, while many prominent figures have visited the facilities known today as the Loutraki Thermal Spa. The complex was renovated in 2009, at which time the original 1934 building was joined to a new, larger structure housing modern facilities for spa therapy and thalassotherapy. water type: Cool, metallic, alkaline, chlorinated, hydrosulfuric. HELPS WITH: Musculoskeletal

and nervous system disorders, skin conditions, gynecological conditions.

INFO: 24 G. Lekka, Loutraki (81k west of Athens) Tel. (+30) 2744.062.186 • www.loutrakispa.gr •

THERMAE SYLLA SPA & WELLNESS HOTEL Edipsos is one of the most renowned spa resort towns of modern Greece. Its thermal springs gush up from depths of as much as 3,000 meters at temperatures reaching 75°-85 °C. The best-known of these springs, the Thermae Sylla, was named after the Roman general Sylla (AKA Sulla), who, according to the historian Plutarch, suffered from a case of gout while in Athens in 84 BC and traveled here for relief. Nowadays, this spring’s waters (35°-50°C) are channeled to the five-star Thermae Sylla Spa & Wellness Hotel. Established in 1897 and revamped in 1999, the hotel is equipped with a spa that was further upgraded in 2012 to feature facilities for thermal therapy and thalassotherapy. Additional water (the temperature of which can be as high as 85°C) from the EOT (Greek National Tourism Organization) Springs is also used here. water type: Medium-warm,

metallic, alkaline, chlorinated.

HELPS WITH: Musculoskeletal and nervous system disorders, skin conditions, gynecological conditions, as well as cosmetic use. INFO: 2 Posidonos,

Edipsos, Northern Evia (184k north-west of Athens) • Tel. (+30) 2226.060.100 • www.thermaesylla.gr/en

GALINI WELLNESS SPA & RESORT Back in the early 20th century, Kamena Vourla in the prefecture of Fthiotida, was home to nothing more than swampland. However, the area possessed many thermal springs which prompted its development as a spa town. Today, the spa at the five-star Galini Wellness Spa & Resort, a facility covering 3,000sq.m., offers visitors both indoor and outdoor swimming pools, filled with thermal waters from the region, and a separate indoor swimming pool filled with sea water for thalassotherapy, as well as specialized therapies based on the use of its thermal waters. These are thought to be among the few in Greece that, thanks to the presence of radon, exhibit radioactive properties. water type: Medium-warm, metallic, acidic, chlorinated, mildly carbonated, mildly hydrosulfuric, medium radon presence. HELPS WITH: Musculoskeletal, nervous system disorders, skin conditions, gynecological conditions. INFO: 5 Ger. Vasiliadi,

Kamena Vourla (175k north-west of Athens) • Tel. (+30) 2235.080.501-6 • Open April-October • www.mitsishotels.com/hotels/ galini-resort/

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Sharing the Greek Path to Wellbeing Thousands of years ago, the Greeks discovered new ways of thinking and being. It’s high time to revisit these concepts, and to teach them to others. B Y A L E X PAT TA KO S P h D & E L A I N E DU N D O N *

n chasing “the good life,” many of us sacrifice our relationships, our health and our sanity, and still find ourselves with lives and work that bring us little fulfillment. But while our lives may seem complex, the solution to this challenge is actually quite simple. We just need to follow the path the Greeks have laid out for us! What we find fascinating is that the ancient Greeks were leaders in holistic thinking – viewing the world from an integrated point of view, not just looking at the parts or events of our lives as being separate. They believed that nothing and no one was separate, that everything was connected. They were ahead of their time with their insights into the integration of body, mind, and spirit. (Much later, the body and mind were viewed as separate entities, leading to what we believe are many of the issues we face in the pursuit of well-being today.)

“Man is a social animal.”

– Aristotle

CONNECT MEANINGFULLY WITH OTHERS Aristotle believed that we are gregarious beings who flourish in groups or communities. Importantly, it is our nature to belong. Today, we live in a global world but, despite our social media connectivity, our emailing and our texting, research has shown that many people feel increasingly alienated. Depression, anxiety, and addiction are all on the rise, leading to a general decline in well-being. A related challenge we face today is that, instead of relying on those we know for the necessities of life, we’re dependent on strangers and institutions for our survival. We don’t barter with neighbors, or even know where our food comes from; instead, we shop at supermarkets. We don’t depend on others for information or advice; we turn to the Internet. At the same time, we’re also more independent; rather than borrow things from our neighbors, we simply buy our own. Instead of asking others to help us, we do the chore ourselves or hire professionals. What have we lost? Have we tried so hard to be self-sufficient that we have cut ourselves off from each other? Ancient and modern Greeks have much to share about connecting meaningfully with others. They teach us that we’re all important participants in the different “villages” in our lives, whether that village is our family, our friends or coworkers, or a larger organization. Greeks teach us to extend hospitality to others and always include them – “there is always room for one more.” 100

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ABOUT THE AUTHORS

Alex Pattakos, Ph.D., and Elaine Dundon are founders of the Global Meaning Institute (www. GlobalMeaningInstitute. com) and authors of the award-winning book, The OPA! Way: Finding Joy & Meaning In Everyday Life & Work (available in English and Greek) in which they share their formula for finding deeper meaning in our lives and work, drawing on ancient philosophy, mythology, traditional village life and modern-day Greek culture.

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“We should look for someone to eat and drink with before looking for something to eat and drink.” – Epicurus

Sharing and caring Throughout Greece, building relationships through conversation is an integral part of daily activity. Stopping to greet others acknowledges their presence – their human existence – and tells them they’re an important part of the “village.” It’s about the conversation and the connection. The cashier in the local grocery store in the town of Chania, Crete, engaged in a long conversation with a young woman in front of us in line; she takes an interest in her customers as people, not just as business transactions. Every interaction is an opportunity to strengthen or weaken connections with others. In no small way, the depth of our lives depends on the depth of our relationships with others. This is an important part of the Greek way of living.

“The sun is new each day.” – Heraclitus

EMBRACE LIFE WITH zest The ancient Greeks taught us that life is short and ever-changing. Importantly, the need to embrace the fullness of life – all its ups and downs, joys and sorrows – with gusto and an appreciation for being alive is built into the Greek DNA. Indeed, to be “enthusiastic” about life means, literally, to manifest the spirit within! Greece could lead the world in teaching a holistic approach to well-being. Taking good care of spirit, mind, and body is ingrained in the culture. Greeks know that life is about energy, and well-being is about keeping this important life energy flowing. We can all adopt the essence of the Hippocratic Oath, to “do no harm,” by replacing inactivity, excessive stress, overeating and eating poor quality foods, with healthier choices. In times of crisis and undue stress, where we are struggling or lacking fulfillment, we need to go back to the basics in life and search for sources of true meaning and well-being. As Heraclitus taught us, the sun is new each day. Every day is a new chance to connect meaningfully with others, find a deeper purpose, and embrace life fully. It’s a new opportunity to follow the Greek path to well-being. 102

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“I am not alone in my fear, nor alone in my hope, nor alone in my shouting.”

– N i k o s Ka z an t z a k i s ( a u t h o r , Z o r b a t h e G r e e k )

Questions and answers The famous Greek saying “Know thyself” is inscribed on a plaque above the entrance to the Temple of Apollo at Delphi, a sacred place where ancient Greeks came to seek guidance. Their questions were answered by Pythia, the priestess of the Greek god Apollo, but her answers were usually cryptic and open to interpretation. Once the visitor received an answer from Pythia, the challenge was what to do with the answer. Should they blindly follow her advice, believing they had received “the answer,” or was the inscription “Know thyself” a warning to decide the validity of the answer for oneself? In his speech defending himself at his trial, Socrates described how he would, like Heraclitus, go within and listen to his inner voice to discover the “right” thing to do. His approach was clearly metaphysical; he combined logic and reason with intuition, consulting what we refer to as his “inner oracle.” Like Socrates, the challenge for many of us is whether to trust our inner oracle, our sense of inner knowing, or whether to allow ourselves to be swayed by others.

“There is one life for each of us: our own.” – Euripides

be true to yourself The ancient Greeks taught us to always act in accordance with our true nature. In the final analysis, the greatest challenge in our life is to discover and embrace our core essence. Many people tend to focus on what job or career they think they should have, or how they might define their overall purpose in life. However, in actuality, a truly meaningful life starts from, remains engaged with, and, ultimately, returns to one’s core essence … awakening our true selves by connecting with whom we really are. The Greeks taught us that if we drift away from our authentic selves, perhaps by focusing on achieving or acquiring “external things” instead of focusing on our true purpose, we will never realize our highest potential. They believed that the end goal of life is evdemonia, a concept involving deep fulfillment, inner and outer prosperity, and being of service to others.

P R E S E N TAT I O N

IT’S BEEN A WHILE SINCE YOU PAMPERED YOURSELF... Aldemar Resorts introduce you the Elements All In, an original program that offers guests a unique combination of luxury and wellness, affording a wide range of premium choices and privileges

Aldemar Resorts is one of the leading hotel chains in Greece. With a total bed capacity of 5,500 and 1,800 employees, it is recognized as one of the most dynamic businesses in the Greek hospitality industry. Aldemar’s portfolio includes eight deluxe resorts, in Crete, Rhodes and the western Peloponnese, as well as two world-acclaimed thalasso and spa centers, in Crete and the Peloponnese. The world of Aldemar Resorts is one that combines luxury and relaxation, providing guests with a unique and memorable experience, complemented by genuine hospitality and an unmatched quality of service. As Alexandros Angelopoulos, Aldemar’s vice-president, says: “Our focus is always on the traveler; we have to understand and satisfy their wishes. As increasingly more and more peo-

ple choose to live healthier and more active lives, we have to be able to offer them such a lifestyle during their vacations. With the Elements All In program, we are in a position to offer guests five-star luxury on an all-inclusive basis, ensuring an indulgent and wholesome vacation experience.” The Elements All In program offers guests a unique combination of luxury and wellness, affording a wide range of premium choices and privileges, along with sophisticated pleasures on land and water: from elegant accommodation and fine-dining choices, including customized menus and gastronomic specialties, to exceptional thalasso and spa treatments and exciting water sports. Elements All In is available at both the Royal Mare Resort in Crete and the Royal Olympian Resort in the Peloponnese.

www.aldemar-resorts.gr

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LIFESAVER Georgios Papanikolaou, who developed the still-unsurpassed method for the detection of cervical cancer, is rightly regarded as one of the most brilliant scientific minds of the 20th century. BY El ena K iour ktsi

f we wanted to trace Georgios Papanikolaou’s life on a map, we’d start our line at his birthplace, Kymi in Evia, and then run it through Athens, the German cities of Jena, Freiburg and Munich, and then down to sunny Monaco. It would briefly pause during the Balkan Wars, during which Papanikolaou fought, only to move on to New York before finally stopping at Miami. This geographical exercise would prove that for Papanikolaou the researcher, the world had no borders. Millions of women are grateful to him for the test he discovered and presented for the first time in 1928. He was 45 years old at the time, and the medical community was initially skeptical about him and his work. Nearly a century has now passed, and there is still no sign of a better, more modern method for the prevention of cervical cancer. And yet, Georgios Papanikolaou almost didn’t become a doctor. He was born May 13, 1883, the second son and third child of the Nikolaos Papanikolaou a doctor popular enough to be elected Mayor and subsequently a Member of the Parliament. According to the tradition of those times, the firstborn son had to follow his father’s career. But as his older brother chose law, Georgios, who was already showing a particular inclination towards medicine, took up the responsibility instead. 104

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Â© GETTY IMAGES/IDEAL IMAGE

Georgios Papanikolaou, seen where he nearly always was: by his microscope, examining a slide. New York City, 1958.

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To this day, the Pap Test is used worldwide for the diagnosis of cervical cancer, precancerous dysplasia and other cytological diseases of the female reproductive system.

With his beloved wife, Machi, and a group of students.

After primary school, Georgios left for Athens where he started learning French, a language considered a necessary skill for young Greek gentlemen. Leaning towards music, he also studied violin for eight years at the Lautner School of Music. In 1898, aged only 15, he managed to get into the School of Medicine of the National and Kapodistrian University of Athens. During his university years, he formed strong friendships with other students, including Dimitris Glinos and Alexandros Delmouzos from the School of Philosophy. They were dedicated to the demotic movement, an attempt to make the demotic, colloquial Greek the predominant language in place of the cultivated imitation of Ancient Greek known as katharevousa. In these matters and others, Glinos and Delmouzos influenced Papanikolaou.

philosophical thought Having finished school, Papanikolaou returned to Kymi under the influence of the new ideological movements and philosophical theories of the early 20th century and withdrew to his birthplace to cultivate the land, read philosophy and 106

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biology and occupy himself with language and demoticism. He was influenced by the theories of Kant, Nietzsche, Schopenhauer and Goethe, and by Ernst Haeckel’s book “The Riddle of the Universe.”

Nevertheless, scientific research still fascinated him. Knowing this, his father sent Georgios to Germany for further studies in 1907. For three years, he studied Biology and Zoology, first in Jena, then Freiburg and finally Munich, from where he acquired his PhD. This “German period” of his life was full of explorations and discoveries, and it was during this time that Papanikolaou decided that research and biology would be the twin purposes of his life. He wrote to his father: “I am no longer a dreamer. Science snatched me out of Nietzsche’s hands. I’ve got my feet on the ground.”

Scientific Odyssey When he returned to Greece in 1910, Papanikolaou realized that the conditions were not favorable to his plans for the future. He married the educated and open-minded Andromachi – or Machi, as he called her – Mavrogenous (a descendant of the Mavrogenous family who made

history fighting against the Ottomans in the Greek War Of Independence). Right after their marriage, he decided to leave Greece again. He clarified his position to his parents, explaining that his “ideal in life was neither to become rich, nor to live happily, but to work, act, create and do something worthy of a man who’s moral and strong.” The young married man’s first stop was at the Oceanographic Institute of Monaco. In 1911, he took part in a scientific expedition in Prince Albert’s oceanographic vessel L’Hirodelle. A year later, during the Balkan Wars (1912-1913), he was conscripted into the army as an Assistant Medical Reserve and returned to Greece. During this time, he met a number of compatriots who had previously migrated to America and were now back in Greece voluntarily, to fight. From conversations with them, he began to form the opinion that the New World was the place where the conditions for scientific research were at their best. On October 19, 1913, Georgios Papanikolaou, together with his wife, disembarked in New York. The couple initially faced serious financial difficulties.

PIONEER

At the beginning, they lived in a single room on 116th Street and both worked at Gimbels Department Store. He sold carpets and, in the evenings, played the violin in various restaurants, while she sewed buttons for five dollars a week. However, although poor and seemingly unknown, Papanikolaou overcame the difficulties quickly. He found work as a journalist for the Greek paper Atlantis and was later recruited by the New York Hospital, having been recommended by Professor Thomas Hunt Morgan of Columbia University. Dr Morgan knew Papanikolaou from Germany and appreciated his work. Finally, in October 1914, he started working at Cornell University where he would remain for the next 47 years. Two months later, his wife Machi joined him as his technician.

the Pap test The 1920s were the most productive but also the most difficult years of his efforts. The experimental stage of his research began with vaginal smears from actual guinea pigs. The results were encouraging. Shortly afterwards, Papanikolaou began to experiment on vaginal smears from his own wife and, eventually, female patients at a hospital affiliated with Cornell. When he identified cancerous cells in a sample from a woman with cervical cancer, he confessed that it was one of the most staggering experiences of his scientific career. The first clinical trials proved the diagnostic value of cytological examination of smears. This work became the cornerstone that established his method for the timely diagnosis of cervical cancer. In 1928, he made his first announcement titled “New Diagnosis of Cancer.” It was first received with doubt by the American medical community. He, however, was absolutely confident about its value and continued his research with greater zeal. Thanks to his perseverance, Dr Pap’s pioneering cytodiagnostic method became both accepted and internationally known under the medical abbreviation Pap test. To this day, it is used worldwide for the diagnosis of cervical cancer, precancerous dysplasia and other cytological diseases of the female reproductive system.

The epilogUE in Miami Papanikolaou worked relentlessly for almost half a century at Cornell. He didn’t take any vacations, apart from one short scientific trip to Europe where he slipped in his hometown Kymi as the final stop. In 1961, despite the fact that he was 78 years old, he decided to leave New York and settle in Miami. He planned to undertake the organization and management of the Miami Cancer Institute. However, he did not have the chance to inaugurate the Institute himself; he died suddenly of a heart attack on February 19, 1962. The Institute was renamed Papanicolaou Cancer Research Institute. Throughout his career, the great researcher and scientist kept unbreakable bonds with Greece and maintained his interest in Greek politics and the various intellectual and social movements in the country. His wife continued his work in Miami until her death in 1982. She believed that one is born a scientist and that research comes to fruition only inside labs. For this reason, she said, “There was no other option for me but to follow him inside the lab, making his way of life mine.” She was so devoted to him that she decided not to have children in order to always be by him. She said that she never regretted it.

Sons of Hippocrates Eight Greek scientists who changed the course of modern medicine

The Nobel Prize that wasn’t

Papanikolaou’s bibliography consists of 158 articles and five scientific books. The most prominent of them is the famous Atlas of Exfoliative Cytology. The book is a milestone not only in the science of cytology, but also in the medical bibliography of the 20th century as a whole. Even though he never received a Nobel Prize (although he was nominated twice), he was awarded many medical prizes, both during his life and posthumously.

Machi Papanikolaou spent half a century in the laboratory, by her husband’s side. H E A LT H 2 017- 2 018

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BRILLIANT MINDS Greek physicians are renowned not only as research scientists of the highest international caliber but also as excellent health practitioners. Whatâ&#x20AC;&#x2122;s so special about them? Here, three of the nationâ&#x20AC;&#x2122;s leading medical figures talk about education, flexibility under pressure, the empathetic bond with the patient and other factors that make for a remarkable history of healing. B y K at e rina B ak o y ianni

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THANOS DIMOPOULOS Rector, National and Kapodistrian University of Athens. Professor of Therapeutic Hematology-Oncology. Better lucky than good,” Thanos Dimopoulos says, referring to how he became one of the most widely recognized researchers worldwide. He attributes his “luck” to a specific meeting. While training in hematology at the University of Texas MD Anderson Cancer Center in 1989, he happened to meet a leading figure in the field of plasma cell dyscrasias, Dr Raymond Alexanian, who asked him to join his research staff. Now, 28 years later, the Department of Clinical Therapeutics he heads at Alexandra Hospital in Athens is among the 10 most important research centers in the world working on multiple myeloma, a cancer that mainly affects bones and kidney function. Collaborating with major universities in Europe and the US (under ISO certification standards and US Food and Drug Administration controls), Prof Dimopoulos and the university doctors on his team take part in a large number of research studies and publications. His patients in Greece have access to new pharmaceutical substances much earlier, within a regulated framework, once an innovative medicine is approved. What sets Greek physicians apart from their colleagues in Europe and the US? The way in which students are selected for admission to the country’s medical schools is very important. Incoming students are so exceptional and of such high standard that, even with its inherent challenges, medical training in Greece, which may be lacking in comparison to many British or American universities, ultimately prepares our graduates for very good careers. And not just in Greece, but in other countries, as about 30 percent of graduates emigrate each year. Aside from that, I believe that we Greeks are smart, adaptive and sensitive, and are particularly skilled at developing interpersonal relationships. These attributes are very important for a doctor. What can Greek medicine offer the rest of the world and the citizens of other countries? Cancer-fighting care in Greece is at quite a high level, despite the economic difficulties the country faces. A significant number of patients are enrolled in clinical studies, and access to innovative medicines is better – because they’re approved by the social insurance funds – than even the access that patients in the UK often have. We have quite a few patients from other countries (in the Balkans, Italy and Cyprus) who come for clinical studies that haven’t been activated in their country. The care provided here is of very good quality as well. There are doctors working in our hospitals at great personal sacrifice. I hope that, as we exit the crisis, medical infrastructure will be developed in areas of particular tourist interest to stimulate medical tourism. Important steps are already being taken in this area as regards in vitro fertilization or reconstructive plastic surgery. The same could be done for kidney disease patients who can only vacation in areas with access to dialysis. As the world’s population ages, more and more elderly people with medical conditions from Europe and America will be looking to travel to places with proper medical services. And it’s possible that some of them could stay even longer and choose Greece as their permanent or semi-permanent residence.

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we Greeks are smart, adaptive and sensitive, and are particularly skilled at developing interpersonal relationships. These attributes are very important for a doctor.

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GEORGE CHROUSOS Chairman of the First Department of Pediatrics at the Athens University Medical School.

eorge Chrousos is the most cited clinical pediatrician or endocrinologist in the world and one of the most frequently cited scientists internationally, according to the Institute for Scientific Information. His research has focused on the hypothalamic-pituitary-adrenal (HPA) axis and he has done extensive studies on the neuroendocrine alterations associated with mood disorders, sleep, pain perception and immune function. He returned to Greece from the US in 2001, but even today, the research he conducted during the years he served as the chief of the Pediatric and Reproductive Endocrinology Branch of the National Institute of Child Health and Human Development in Bethesda, Maryland, is a point of reference in diagnosing and treating HPA axis-related diseases, such as Cushing’s syndrome and Addison’s disease. Dr Chrousos is continuing his research as professor and head of the Department of Pediatrics of Aghia Sofia Children’s Hospital, which he says is a “battlefield” some days. The hospital receives pediatric cases from throughout metropolitan Athens, as well as many severe cases from the rest of Greece. This ensures his access to a large sample for researching childhood stress, obesity or post-traumatic stress disorder, as well as diseases which rarely affect the pediatric population. Any rare and interesting conditions that cannot be investigated in his own endocrinological laboratories – mainly due to cost issues – are transferred to the National Institutes of Health in the US, where his former students now hold senior positions.

What sets Greek physicians apart from their colleagues in Europe and the US? A great number of Greek doctors have received excellent undergraduate training in Greece, and outstanding postgraduate training in other countries such as the US, UK and Germany. That’s why we’re in great demand outside our own country. It’s also impressive that the public hospitals in Greece continue to provide high quality care despite the country’s economic problems and staff shortages. It’s a good thing that Greek doctors are intelligent and alert. They’re able to discern which patients may be at higher risk and to pay more attention to those individuals. In my opinion, we do not have a lot of unfortunate medical incidents, as we often see in other countries. We are very careful with our patients.

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Greece could become a center for medical studies and research on an international level and a place to provide medical treatment to foreign patients.

What can Greek medicine offer the rest of the world and the citizens of other countries? First of all, it’s still relatively easy for someone to conduct clinical research in Greece, and Greek physicians are very good at accurately diagnosing their patients, which is very important both for the patient and for medical research. Things are much more difficult in the US because of the increasing bureaucracy associated with clinical research. They have instituted committees upon committees for clinical trials, and it is becoming more and more difficult to get approval for a protocol to investigate a new case or drug. I believe the future of medicine in Greece lies in developing international medical training and medical tourism. We have a wonderful climate, beautiful beaches and mountains, and a very good reputation abroad as doctors. With its highly trained scientific personnel, Greece could become a center for medical studies and research on an international level and a place to provide medical treatment to foreign patients. In other words, it could become the Boston or Florida of Europe. Even now, if a tourist experiences a medical problem with a child, it’s a good idea to come to the Children’s Hospital, where they will receive excellent care. But our private hospitals also provide excellent medical care. Many couples are already coming here from abroad for infertility testing and in vitro fertilization, but we could expand into other areas as well: we could have physiotherapy and rehabilitation centers, geriatric centers, or centers for research and innovation. At the same time, we should work under the banner of returning to a healthy lifestyle and universal humanistic values. There have been countless studies that show that the happiest and healthiest people are those with values and virtues. As Aristotle said in his eulogy at Plato’s funeral, the latter was “the first of mortals [who] clearly revealed, by his own life and by the methods of his words, how to be happy is to be good.”

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ELIAS PANAGIOTOPOULOS Professor of Orthopedics at the University of Patra and director of the Rehabilitation Clinic for Patients with Spinal Cord Injury, the only one of its kind in Greece

he greatest source of satisfaction for a doctor, Prof Elias Panagiotopoulos says, is to see a patient again after a certain period of time and to not recognize him or her: to see such a dramatically different person – one who is content, creative and integrated into society. The Rehabilitation Clinic for Patients with Spinal Cord Injury – where many of these transformations take place – had been a dream for many years, but the project stalled due to lack of funding. About 10 years ago, a private donor, a shipbuilder originally from Patra, decided to take on the project of designing and building the clinic and to provide all of the funding. The result is a model, 2,500-square meter clinic which has become a center for training young physicians at undergraduate and postgraduate level, and for developing innovative research on the rehabilitation of patients with spinal cord injuries. The goal is for Greece to become a pioneer in providing holistic care to help reintegrate patients with spinal cord injury into society. “We had a 23-year-old patient, who had been injured in a car accident, in the hospital for seven years, with complete quadriplegia and a tracheostomy,” Prof Panagiotopoulos recalls. “Discharging him was out of the question because no one could take over his care. At the new clinic, he learned to manage his disability, his carers were trained and, within two years, he was able to move in with his family, buy a car and develop a social life.” Aside from providing holistic care to patients with spinal cord injury, the clinic also specializes in medical problems associated with the aging population, problems that are expected to increasingly burden healthcare systems globally in the coming years. These include osteoporosis, sarcopenia and fall-related injuries. In fact, the clinic is part of the EU’s Advantage Program focused on preventing falls and on responding to frailty-related conditions in the elderly.

What sets Greek physicians apart from their colleagues in Europe and the US? With globalization, access to continuing education is more or less uniform; we draw information from the same sources. I would say that what makes Greek doctors different is that they are reluctant to adopt protocols, in contrast to colleagues in the rest of Europe and in the US. That may be a negative thing, but it does have some positive aspects because it can sharpen understanding and encourage critical thought. Questioning is the first step to innovation. Greeks have a particular proclivity for medicine and the humanities. The truth is that our society pushes young people in this direction, in contrast to other European countries where young people opt to follow careers in other fields, such as technology or economics. What can Greek medicine offer the rest of the world and the citizens of other countries? Right now, Greece meets all the conditions for great achievements in the field of medicine, including exceptionally well-trained personnel, tradition and “creative questioning.” And now, the area of medical tourism, where the country’s potential is truly huge, is also expanding through a number of initiatives, including the efforts of the Panhellenic Medical Association. I am optimistic about the future of medicine in Greece and I hope that many of the Greek doctors now on staff at major hospitals abroad will return to their home country.

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Greeks have a particular proclivity for medicine and the humanities. our society pushes young people in this direction, in contrast to other European countries where young people opt to follow careers in fields such as technology or economics.

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S P E C I A LT I E S

The Seven Pillars of Medical Tourism

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Greece is making its mark on the medical tourism map by offering innovative, high-quality services at competitive costs. B Y A L E X A N D R A T Z AV E L L A / M ar i a C o ve o u / N ata s h a blat s i o u

THE “DA VINCI” REVOLUTION GREECE BOASTS ONE OF THE TOP ROBOTIC SURGERY TEAMS IN THE WORLD The revolution of robotic surgery has one of its strongest frontlines in Greece and its achievements here are being recognized by the international medical community. Doctors from Europe and the Middle East who want to learn the specialization of the future, as well as patients from many countries, are buying tickets to Greece. As soon as the patient is asleep on the surgical table, the robot awakens. The super-fine ends, or “fingers,” of its articulated arms enter the body through a tiny incision and, with very precise moves, they locate and remove the diseased gallbladder. Obviously, the robot doesn’t have a mind of its own. It serves the surgeon, seated in front of a computer console and looking at an enlarged, 3D version of the surgical site. The commands (given by the surgeon by means of control levers) are executed by the robot. The cholecystectomy can be completed within 40 minutes, almost bloodlessly. The patient recovers quickly with minimum discomfort, no pain, often without any complications and with only the tiniest scar just a few millimeters long. This isn’t a scene from a sci-fi film, but everyday practice in some of the most modern hospitals in the world. Back in 2006, Greece became the first southeast European country to acquire Da Vinci Si HD, the first FDA-approved robotic surgery system. Da Vinci is still used by the top 50 hospitals in America and is employed by five major hospitals in Athens and one in Thessaloniki. In Greece, it is mostly used in urological operations,

As soon as the patient is asleep on the surgical table, robot “fingers” enter the body through a tiny incision and, with very precise moves, locate and remove the diseased gallbladder. H E A LT H 2 017- 2 018

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particularly prostate, kidney and cyst procedures. However, when we speak about the Greek revolution in robotic surgery, we are referring specifically to general surgery, a medical specialty in which the country excels at an international level. In 2011, Intuitive Surgical, which designs and builds Da Vinci Si HD, chose a Greek hospital and the team of an internationally acclaimed surgeon to start applying single-site robotic surgery in operations that have only recently started taking place in Spain, Italy and Germany. The doctor was the “father” of robotic surgery in Greece, Konstantinos M. Konstantinidis. He is Adjunct Professor of Surgery at Ohio State University, President of the South Eastern European Robotic Surgery Society, and heads the Department of General, Laparoscopic, Bariatric and Robotic Surgery at Athens Medical Centre. The hospital specializes in robotic surgery, and he is one of only a few doctors in the world whose experience covers such a broad spectrum of the field. “Robotic surgery is the successor of laparoscopy and my team applies it, having performed 15,000 laparoscopic surgeries,” Konstantinidis notes. “Imagine what this number really means, taking into account that a surgeon is considered experienced once they’ve carried out 200 operations.” By means of 3D video streaming, the international scientific community watches operations taking place at the ultra-modern facilities of Athens Medical Center. Some of these are unprecedented in medical history: single-site robotic cholecystectomy in pregnant women, robotic pancreatectomy (Whipple procedure and distal pancreatectomy), robotic nephrectomy in a seven-year-old child with malignant hypertension, robotic spleen cyst removal in a nine-year-old child. “We have reached the point where, for the first time internationally, we can operate on pregnant women during their 27th, 28th and 31st weeks. With an incision just 1.5 centimeters long, we carry out hernia operations on pregnant women and they are discharged the following day,” the Greek surgeon says. Twenty-five years ago, he was the first to establish a department of laparoscopic surgery and laser applications in Greece, even though he had only just returned from his studies in America. His team was the first to operate using the Da Vinci robotic surgery system. Today, the team uses an advanced 4th generation model. After receiving numerous accolades, they now attend leading national and international

scientific meetings, such as the International Robotic Surgery Conference and the European Association of Urology Meeting, where their advanced techniques are discussed with great interest. Among the honors and awards they have received is the Award for the Successful Organization of International Robotic Surgery Meeting “MIRA” in 2011. Many of Konstantinidis’ operations have become case studies; one of them being the robotic removal of a scalpel that had broken inside a patient’s body during diaphragmatic hernia repair surgery. “We are the most experienced in Europe in the Whipple procedure, specifically in cases of pancreatic cancer,” he mentions. “They are the most difficult, dangerous and lengthy surgeries. They take 8-12 hours because we remove a large part of the stomach.” Greek doctors who learned about robotic surgery by participating in his team, first as observers and then as active members, are now on successful career paths at leading hospitals in Athens. In his role as Proctor for Intuitive Surgical, Konstantinidis supervises doctors from all across Europe, guiding them in their first steps in robotic surgery. “Some of them visit Greece to observe operations. Recently, we were visited by 20 professors of medicine from Russia. We receive doctors from all around the world.” Very often, surgeries are broadcast live to 50-60 countries. “If I operate on a woman during her eighth month of pregnancy, removing the gallbladder through an incision, my colleagues from all around the world want to see it. This is why I share it with them. Difficult operations are followed by clarifications and telementoring.” Spearheaded by Konstantinidis’ team, the Athens Medical Center is now leading efforts to conquer markets such as China and the Arab world, with the aim of developing medical tourism in Greece. Hundreds of patients from places such as Israel, Libya, Qatar, Dubai, the UK and Russia are coming to Greece to undergo robotic surgery. Some of the most common robotic surgeries are for gynecological issues, gastroesophageal reflux syndrome, diaphragmatic hernia, colon cancer, stomach cancer, cholecystectomy and hernia. “Our experience is vast, and the future is bright,” says Konstantinidis. “We are being spurred on by technology! We are part of a huge scientific experience. Greece has both the scientific training and suitable facilities to become the leader in robotic surgery on an international level.”

“Robotic surgery is the successor of laparoscopy and my team applies it, having performed 15,000 laparoscopic surgeries. Imagine what this number really means, taking into account that a surgeon is considered experienced once they’ve carried out 200 operations.”

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ÂŠ DIAMANTIS MANTIS

By means of 3D video streaming, the international scientific community watches Dr Konstantinos M. Konstantinidis perform his operations in Greece. Some of these are unprecedented in medical history. H E A LT H 2 017- 2 018

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In Vitro Fertilization (IVF) MANY OPTIONS, HIGH SUCCESS RATES

Year after year, more and more couples from Europe, the USA, Canada and Australia are placing their trust in medical professionals in Greece to help them realize their dream of childbearing. Greece’s IVF legislation, one of the most progressive, is one of the main reasons why couples choose Greece as a destination. Greek legislation allows anonymous and voluntary egg donation; the transfer of more than one embryo – depending on the age of the woman who’s going to bear the pregnancy; embryo, egg and sperm freezing; prenatal checks; and surrogacy. The fact that, in Greece, women up to the age of 50 are given the chance to become mothers is another factor in the development of IVF-related medical tourism. Greek IVF units operate under license from the Greek National Authority of Assisted Reproduction which monitors whether legal requirements are being met and whether they are working in accordance with Greek and European regulatory frameworks. Recently, the authority launched a program of detailed checks, both to reassure IVF candidates that they will receive secure and reliable service and to get a clearer picture of the current situation in the field of assisted reproduction in Greece. To date, 40 IVF units (and five cryopreservation banks) have met the requirements and are licenced. These units apply best

practices and are staffed with trained specialist doctors and excellent personnel. They offer advanced services at a cost many times lower than in the rest of Europe. Each one of these units has developed a “full-package” offer and is ready to assist couples with the financial aspects of the process. While most clinics are located in Athens and Thessaloniki, there are pioneering units on islands and in smaller cities like Larissa. A large unit in Crete, for example, has received roughly 200 couples from European, African and North American countries, as well as from places as distant as Australia and Sri Lanka. The couples remain on the island from 7 to 45 days in order to complete their treatment, combining their stay with a holiday. “The high percentages of pregnancies achieved in Greece, a country that ranks first internationally in many different areas relating to IVF, are also due to a reason that’s not medical: the country’s bioclimate. The sun and the quality of life on the islands, where the couples stay, improve well-being and boost positivity,” said Dr Konstantinos Pantos, secretary-general of the Hellenic Society for Reproductive Medicine and a member of the Medical Tourism Committee of Athens Medical Association, during his speech on IVF at the Medical Tourism Conference held in New York on October 29-30, 2016.

Information courtesy of Dr Aristidis Antsaklis, professor of Obstetrics and Gynecology at the University of Athens and president of the Greek National Authority of Assisted Reproduction.

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Physical Medicine & Rehabilitation A WIDE RANGE OF SERVICES IN AN IDEAL ENVIRONMENT Physical Medicine and Rehabilitation is that field of medicine which aims to restore and enhance the functional ability and quality of life of those who have suffered strokes, traumatic injuries and acute illness, or are suffering from various chronic diseases, disorders, or post-operative conditions. Such rehabilitation entails interdisciplinary care to achieve improved health and deliver the higher quality of life that comes with that improvement. Thanks to state subsidies, Greece has experienced a surge of growth in this field since 2000, with many private rehabilitation and recovery centers being established around the country, most of them in the regions of Macedonia and Thessaly. They offer top-notch facilities staffed with highly competent and experienced doctors, therapists and nurses, implementing well-established techniques, as well as new clinical innovations, all supported by cutting-edge medical and rehabilitation equipment. Greek rehabilitation centers also stand out for their competitive prices. For a 30-day neu-

ro-rehabilitation all-inclusive package, for example, an in-patient should, according to the Union of Rehabilitation Centers of Greece (EKAE), expect to spend around €9,900. This price includes use of the center’s facilities and rehabilitation services, full-board accommodation, transfers to and from the airport, special diet menus, laundry and ironing services, and much more. There are currently 19 major private rehabilitation centers in Greece, all following internationally recognized protocols. Their rehabilitation programs take into account patients’ individual needs and combine a wide range of services from the different specialties available: physiotherapy, hydrotherapy, occupational therapy, speech therapy, psychological support, nutrition and dietetics. State-of the art facilities, exceptional services and outstanding medical experience, powered by great prices and assisted by the Mediterranean climate and diet as well as the famed Greek hospitality, make Greece an ideal recovery spot for natives and foreigners alike.

Information courtesy of the Union of Rehabilitation Centers Greece (EKAE) and Dr Christos Goumas, Physiatrist and Scientific Director of the physical rehabilitation center Euromedica-Arogi of Thessaloniki. H E A LT H 2 017- 2 018

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Ophthalmology NEW ADVANCED SURGICAL TECHNIQUES

Ophthalmology is the field of medicine that deals with the anatomy, physiology and diseases of the eye. It is one of the major specialties on offer in the context of medical tourism. Technological progress in this field, along with new advanced surgical techniques, have made it possible for almost all surgical procedures in ophthalmology (approx. 90 percent) to be performed without the need for hospitalization. This means it is even easier nowadays for patients to seek medical services in countries other than their own and to combine an opthalmological procedure with a vacation. Medical centers and clinics in Greece typically include an ophthalmology department, but most medical tourists seeking out ophthalmic procedures are likely to opt for one of the country’s day clinics, established under new laws in 2014. They boast cutting-edge equipment alongside expert ophthalmologists, opticians, optometrists and nurses, and can perform surgical procedures that require only a few hours of post-operative hos-

pitalization. Their rates are quite competitive compared to those in other countries, making Greece one of the top destinations for ophthalmic treatments. Among the standard procedures on offer in Greek day clinics are excimer laser refractive surgery for the correction of myopia, hyperopia and astigmatism; cataract and glaucoma surgery; and treatment for age-related macular degeneration and for diabetic retinopathy. Some medical tourists may also seek out oculoplastic interventions, performed to correct an injury or done simply for esthetic purposes. According to a recent study, Greece could attract at least 100,000 medical tourists, in particular from the EU, southeastern Europe, Russia, the Middle East, the US and China within the next five years, and up to 400,000 patients within a decade. Greece’s high-standard services in ophthalmology could play an important role in shaping the country’s future as a medical destination.

Information courtesy of Andreas Tourmouzis, ophthalmic surgeon and medical director at Athens Ophthalmic Day Clinic.

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Dental Tourism

Exceptional standards at lower costs

In recent years, a number of Greek dental clinics have become part of a dynamic branch of medical tourism, attracting not only Greeks living overseas who return for treatment but also patients from other countries, chiefly the UK, Belgium and Russia. The largest dental centers in this category are private and operate in Athens and Thessaloniki; there are less than a dozen of them, and they offer high-quality services at costs up to 50 percent lower than similar clinics in Europe and the US. Equipped with the very latest infrastructure (including advanced laser technology, robotic dentistry devices and dental microscopes) and enjoying both international recognition and quality-of-service certification to ISO standards, these centers offer the highest quality dental care at an affordable cost. There’s even a clinic for children with special needs, which has earned a fine international reputation by successfully undertaking even the most difficult dental cases.

In addition to the actual treatment, the cost package that you are offered by these clinics may include transfers to and from the airport, accommodation at a good hotel, special arrangements for accompanying persons, and provisions for covering additional expenses in cases where more days are needed than those originally scheduled. And, of course, there will also be time for sightseeing and excursions. Treatment is generally of short duration, thanks to the simultaneous provision of care to the patient by a number of specialists. The clinics are manned by dental practitioners representing up to 10 different fields, including oral and maxillofacial surgeons, cosmetic dentists, implantologists and periodontists. Most of the dentists and other specialists at these centers have completed post-graduate training abroad, often in Scandinavia, North America or Australia, and many are dental care “veterans,” with experience spanning four decades, who also collaborate with medical schools in Greece.

Information courtesy of the Athens Dental Tourism Cluster. H E A LT H 2 017- 2 018

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DIALYSIS

A user-friendly DESTINATION FOR KIDNEY PATIENTS Every other year, kidney patients undergoing blood dialysis at Liège University Hospital take their vacation in Irakleio. They don’t choose it just because of the beautiful beaches, the amazing sights and the Mediterranean cuisine. After all, they couldn’t enjoy any of these if a hemodialysis unit didn’t operate there. Every two days, these tourists visit the local unit for blood dialysis, a process necessary to keep them alive. In Greece, hemodialysis tourists began appearing a few years after the first private Greek hemodialysis unit opened in a Cretan hospital in 2000. Nowadays, there are 62 active private units in the country. With specifications meeting European standards, they are ISO 9000 and 9001 certified, which ensures quality. Over the past 15 years, these units have attracted more than 20,000 foreign kidney patients; English, Dutch, Germans, Danes, Swedes, Italians and Belgians, as well as a few Americans and Australians. They prefer the Greek sun and the cheaper prices that Greece offers them over its main competitors, Spain and Turkey. Some come for a few days, others arrive during the off-season and remain for roughly five to six months. They often stay in popular tourist cities and islands, within or near the hemodialysis units. Using their accommodation as a base, they take short cruises and trips. Crete, Santorini, Rhodes, Kalamata and Meteora have all invested heavily in hemodialysis units, becoming key players in the medical tourism industry. “What did you do to her that improved her condition so

much?” asks a Swiss doctor about his patient who returned home in much better shape after her trip to Irakleio. “The difference wasn’t in the dialysis method; the standards are the same as those followed elsewhere in Europe. It was the Greek climate, the good food, the sun and the sea that changed the mental well-being of this kidney patient,” says Nick Stathoglou, General Manager of MESOGEIOS Dialysis Centers, a medical group that, apart from its facilities in Crete, also has units in Athens, Kalamata, Halkida and Serres. In just 17 years, these centers have received more than 9,000 patients, most of them traveling with chaperones. For the most part, these private Greek hemodialysis units offer advanced medical services and, in addition to nephrologists, are also staffed with specialists such as cardiologists, pulmonologists and urologists; many also collaborate with social workers, psychologists and nutritionists. The units are usually linked to large public hospitals and are equipped with modern medical facilities in attractive surroundings. Some of them remind you more of hotels than clinics, with libraries as well as dialysis suites. On the other hand, if patients ask about sightseeing tours or other organized activities, they might be disappointed in the options on offer. There’s still a lot of room for improvement in creating medical tourism packages. However, most units are happy to handle simpler logistical matters such as transfers and accommodation for foreign patients. They also offer friendly prices to their patients’ chaperones.

Information courtesy of Nick Stathoglou, General Manager of the MESOGEIOS Dialysis Centers Group.

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PLASTIC SURGERY

World-class standards of beauty augmentation

Safety, lower costs, spectacular esthetic results, a great environment enhanced by the well-known pleasant climate of Greece, the possibility of short vacations in the Greek islands and the vibrant culture found in today’s Greece are only some of the compelling reasons someone should come to Greece to beautify him/herself and to look younger. Most Greek plastic surgeons have been trained at internationally accredited centers worldwide and have acquired the valuable experience needed for excellent performance in the medical tourism field. Some of the Greek plastic surgery clinics have ISO and TEMOS accreditation and are already renowned for both their international clientele and the high levels of after-treatment patient satisfaction they achieve. The most popular esthetic plastic surgery operation in southern Europe is breast augmentation, followed by facial fillers and botox, liposuction and gluteoplasty, and other esthetic treatments. For every procedure, there are specific mandatory pre-operative and the post-operative steps. Before any surgical operation or beautifying procedure is performed, a

thorough discussion takes place with the patient. All details are reviewed, a medical history is taken and full preoperative clinical-laboratory tests are carried out to ensure the patient’s good health. All surgical operations take place in a fully equipped medical clinic in the presence of an experienced anesthesiologist. That way, the patient is taken to the operating room in complete tranquility. Post-operative instructions (and medication, when necessary) are given after each treatment. Depending on the procedure/operation, the patient remains in Greece from one to 15 days. Office procedures do not require post-operative follow-up. For one-day clinic procedures like liposuction, breast augmentation (2+1 triple-plane or 2+2 quadru-plane), the patient will usually be able to travel on the second or the third post-operative day. With more complex surgical operations, such as facelifts, the doctors will probably need at least 10 days for post-operative treatment. One of the best ways one can find out about esthetic plastic surgery in Greece is through social media, where many doctors have a significant professional presence.

Information courtesy of Ioannis Lyras MD, Director – 2nd Clinic for Plastic Surgery of Henry Dunant Hospital Center and Honorary Consul of Brazil in Greece. H E A LT H 2 017- 2 018

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INTERVIEW

PROMOTING GREECE AS A HEALTH DESTINATION

GEORGIOS STAMATIOU ELITOUR is the Greek Medical Tourism Council, founded by the largest private healthcare providers in the country. The president of its board of directors firmly believes that Greece can become a significant player in the healthcare tourism market.

This coming spring, Athens will be hosting the prestigious IMTJ Medical Travel Summit 2018, an event that gathers the world’s leading industry professionals and key opinion leaders to share their insights and experiences regarding medical tourism, as well as to debate the challenges faced by this developing sector. The summit could not take place at a more opportune time for a country that is trying to break into the competitive medical tourism market. And who better to offer its support to the event than ELITOUR, the Greek Medical Tourism Council, an NGO whose mission since 2013 has been to promote Greece as a medical tourism destination by highlighting the country’s great possibilities and strengths? “Greece possesses a plethora of inherent advantages, such as a high-quality infrastructure of private hospitals, highly skilled doctors, expert medical staff, high-end tourist facilities and natural beauty, all of which give it a competitive edge that could allow it to become a significant player in the healthcare tourism market, as long as the private and public sectors work systemati-

cally towards that goal,” explains Georgios Stamatiou, president of ELITOUR’s board of directors. ELITOUR was, in fact, the first private body to systematically promote Greece as a health tourism destination. It was founded by the largest private healthcare providers in the country, creating a cluster of companies that cover the whole spectrum of medical tourism throughout Greece. It is comprised of more than 50 members, including hospitals, clinics, airlines, insurance companies, travel agencies, facilitators, hotels, advertising companies, business consultants and certification bodies. “ELITOUR is a very important reference point for anyone looking to receive medical services in Greece,” notes Stamatiou. “It offers useful information on and personalized assistance for all available medical treatments.” As for the practical aspects of a medical trip to Greece, Stamatiou notes that there are specially trained facilitators that can help patients organize everything. Moreover, there are many certified health providers in Greece with both the experience and the resources to handle such trips.

INFO 37-39 Kifisias, Athens, Tel. (+30) 210.638.3925 • info@elitour.org • www.elitour.org 126

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health M E D ICAL BRIEF

the doctors are in

Distinguished specialists share some of the latest developments in fields ranging from cosmetic surgery to minimally invasive arthroplasty and from dentistry to IVF treatment. Illustration by Philippos Avramides

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MEDICAL BRIEF

opthalmology

Melanopsin: How sunlight and deep blues help us feel better Many people experience Seasonal Affective Disorder, or SAD, a feeling of depression which occurs when winter approaches and the days become darker.

Iordanis Chatziangelidis

is an ophthalmologist specializing in medical retina and a fellow of the European Board of Ophthalmology. The title of this article may be a bit unusual, but I would like to share some knowledge that I believe might lead to some changes in the scope of ophthamology. Melanopsin was the first subject I was assigned to research at Northwestern University, Chicago. Unfortunately, the energy used by the experimental two-photon microscope meant that conducting research on a human subject was off-limits. Nevertheless, an extensive amount of research is being done into the relatively new area of retinal ganglion cells, which contain melanopsin. The retina is the organ which acts as the sensor for the human eye. It works just like film or a charge-coupled device (CCD) in a camera. This sensor consists of many layers; different cells which perform different functions. The two types of photoreceptors – the ones for color perception are called cones (because of their conical shape) and those which can see in twilight and distinguish between levels on the grayscale are called rods (because of their rod-like shape) – and the ganglion cells, which are the first to “filter” the information before passing it along to the brain, are the cells that form the optic nerve. The photo receptors perceive light. They contain substances which react to light and which send signals, electric pulses, to activate a second type of cell, the ganglion cells, whose job is to further transmit

the signal. With this in mind, it was a major suprise to find that there was a substance capable of detecting light in ganglion cells as well. We know that this substance, melanopsin, is activated by light of a wavelength between 420nm and 450nm, otherwise known as deep blue. Those ganglion cells are scattered in the periphery of the retina and they are not part of the vision function, but they are a part of three other important functions. The first is the regulation of the circadian rhythm, the biological regulation of the body for the perception of day and night. The second is their participation in the pupillary light reflex controlling the dilation of the pupil in the dark. The third, which concerns me most here, has to do with mood. We have discovered a link between the luminosity of the environment and mood. In fact, many people experience Seasonal Affective Disorder, or SAD, a feeling of depression which occurs when winter approaches and the days become darker. Light therapy can help in cases of SAD. The treatment involves exposure to very bright artificial light, for a few minutes every day, and can be combined with medication to boost its efficacy. I believe that the reason why “life is good in Greece” and why Greeks smile so much has less to do with philosophy and history and more to do with the light, the sky and the sea: the deep blue. In any case, you should always wear your sunglasses.

we have discovered a link between the luminosity of the environment and mood.

•

www.eyesee.today • fb.com/eyesee.today

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MEDICAL BRIEF

ORTHOPEDICS

THE FUTURE OF HIP and KNEE ARTHROPLASTY Minimally invasive techniques, using biologically fixed implants and a state-of-the-art navigating system, ensure patients full mobility in record time.

New ALMIS technique in hip arthroplasty

ALMIS is a new technique for hip arthroplasty. Anesthesia is usually dorsal and the patient can listen to music during surgery. A small incision is made in the side of the thigh; this does not extend to the vastus externus muscle and its vessels. The gluteus minimus tendon is temporarily elevated and, in most cases, no external rotator muscles excision is needed. The skin is closed using the bio-absorbable technique, so no stitches need to be removed. Normally, the main part of the surgery takes less than an hour to complete, and the patient can get up and walk within two or three hours. There is no need for a bladder catheter to be used as a blood transfusion is not required in most cases. Normally, patients then need to remain in hospital for one to two days before they can resume their normal life, including any physical activity they wish. A new type of biologically fixed, threaded acetabular implants, short or “mini” titanium biologically fixed anti-rotation stems, are used (without screws or acrylic cement) in order to diminish bone destruction, in much the same way as modern titanium teeth implants. There is no need for complex and time-consuming navigation or for “robotic” systems, because the position of the implants is adapted to the individual needs of each patient.

Personalized knee arthroplasty and the “mini” navigating System Perseus

The clinic uses the modern personalized Signature or OneFit knee arthroplasty system to

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Nikolaos Christodoulou MD PhD Chairman of Orthopedic Surgery, Athens medical group

perform knee arthroplasties. A pre-operative, three-dimensional rendering of all knee defects is created, based on CT or MRI scans. A minimally invasive procedure, it does not affect the healthy anatomical elements, namely the medial vastus muscle, collateral ligaments, popliteus tendon or posterior cruciate ligament. The procedure includes the realignment of the leg and a balancing of the knee to minimize any future need for implants. It does not, however, involve traumatic, long inter-canal guides or complex and time-consuming navigation, or any “robotic” systems. Instead, the “mini” intraoperative navigating Perseus system can be used to control the mechanical axis of the leg and the center of the leg rotation without damaging the femoral canal.

A modern Approach to foot deformities

THE new, minimally invasive technique used to correct foot deformities correction ALLOWS PATIENTS TO WALK LATER THE SAME DAY.

A new, minimally invasive technique is used to correct simple or complex foot deformities, including hallux valgus, metatarsalgia, hammer toes, clubfoot, flat feet, pes cavus and heel problems. Only a local anesthesia is required, usually just in the lower extremities. For hallux valgus, only a small incision in the foot is required. Following the procedure, the skin is closed using the bio-absorbable technique, so no stitches need to be removed. Fixation is achieved using bio-absorbable materials. The adductor tendon is not sectioned in most cases in order to avoid anterior arch instability. Patients can walk later the same day, using special light footwear for protection.

Athens Medical Group/Iatriko Psychikou Clinic 1 Andersen, Neo Psychiko, Athens, Greece • www.christodoulou-n.gr The publishers of the magazine are not responsible for the content of this article

MEDICAL BRIEF

ANDROLOGY

TREAT YOUR PROSTATE AND IMPROVE YOUR LIFE A novel treatment protocol makes it possible to solve the problem of chronic prostatitis and various other issues affecting the prostate without surgery.

Dr Pavlos Georgiadis, one of the leading specialists worldwide for Chronic Prostatitis (CP)/Chronic Pelvic Pain Syndrome (CPPS), has over 20 years of experience in successfully treating CP patients. He received his degree in General Medicine from UMF Iasi in 1988 and his specialized degree in Urology from the University of Athens in 1993. He has received training in ultrasound, x-ray diagnosis of the urogenital system, transrectal ultrasonography, biopsy of the prostate gland, and prostate neurology and urodynamics at the NMTS hospital. In addition, Dr Georgiadis has been trained in Laparoscopic and Robotic Surgery in Urology at the European Institute of Telesurgery, University of Strasbourg in France.

Dr PAVLOS GEORGIADIS

M.D., SURGEON UROLOGIST – ANDROLOGIST PhD - UNIVERSITY OF ATHENS

“FREE YOUR PROSTATE, FREE YOUR LIFE”

With Dr Georgiadis’ novel treatment protocol, the problem of chronic prostatitis and various other issues affecting the prostate can now be solved without surgery. Microbes are almost always the main cause of inflammation in the prostate. During chronic inflammation of the prostate, the following changes occur: • Hardening of the prostate gland (the organ starts to malfunction) • Erectile dysfunction • Urination issues • Infertility (or reduced fertility) • Enlargement of the prostate (hypertrophy) • Potential cancerous tissue generation in the prostate

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The method of Dr Georgiadis addresses the prostate issue from a completely different angle, focusing on the root cause before gradually treating the complications.

Traditionally, this condition has been treated superficially; for the most part, patients have been prescribed oral antibiotics for a period ranging up to a month (with limited and temporary improvement) and have suffered relapsing symptoms (due to more resistant microbes), ultimately leading to partial or full surgical removal of the prostate gland. The method of Dr Georgiadis addresses this prostate issue from a completely different angle; he focuses instead on the root cause, before gradually treating the complications. More specifically, his protocol focuses on and succeeds in: • Radical elimination of the microbes. • Releasing the vessels and nerves of the prostate gland. • Reducing the size of the prostate (up to 60%). • Returning the affected tissue to its natural state and thus alleviating the patient’s symptoms.

Treatment Protocol

igorous and frequent specialized prostatic R pressures for a variable period of time, depending on the individual patient. • Tailored oral antibiotics, taken in combination with the prostatic pressures, after targeted EPS and semen examinations. • Injections of antibiotics directly into the prostate gland. The success rate of this approach ranges between 96%-98%. For further details and patient testimonies, visit the website www.georgiadis-urology.com. •

39 Asklipiou, Athens • Tel: (+30) 210.363.2377 • e-mail: georgiadis.urology@gmail.com

The publishers of the magazine are not responsible for the content of this article

MEDICAL BRIEF

MINIMALLY INVASIVE SPINAL SURGERY

Endoscopic discectomy: Successful treatment of more than 300 patients A procedure performed with local anesthesia and sedation has revolutionized the surgical treatment of spinal problems

STELIOS KAPETANAKIS MD, FRCS, PhD

Orthopaedic Surgeon – Spinal Surgeon, Assistant Professor in D.U.Th, Director of Orthopaedics Clinic, Minimal Invasive Spine Surgery, Athens Medical Center, Head of Spine Clinic and Deformities, European Inter-balkan Medical Center

Endoscopic discectomy is a relatively new technique of disc-hernia and lateral-stenosis treatment, which is accompanied by a lower complication rate and increased tissue preservation. The medical teams of the Athens Medical Center in Marousi and the European InterBalkan Medical Center in Thessaloniki, under Medical Director Stylianos N. Kapetanakis, have successfully treated more than 300 patients over the last two and a half years. This technique applies not only to patients who suffer from disc herniation but also to patients who have undergone surgical treatments like open discectomy and micro-discectomy and have not experienced the expected results. Elderly patients and patients with neurological diseases and multiple sclerosis can also be treated with endoscopic discectomy with excellent results. In addition, endoscopic discectomy is suitable for patients facing chronic diseases leading to respiratory failure (for ex-

ample, severe chronic obstructive pulmonary disease) and heart failure. All these patients are considered either too high-risk or cannot take the general anesthesia required for conventional surgical methods. Performing an endoscopic discectomy with local anesthesia and sedation has revolutionized the surgical treatment of spinal problems, as the patient is able to walk some 30 minutes after the operation and is fit for discharge five hours later. Dr Kapetanakis is a globally respected spine leader in MISS techniques, an official instructor in endoscopic surgery and a faculty member of the German company Joimax, a leading developer and marketer of complete systems for endoscopic minimally invasive spinal surgery. He has published his surgical results in more than 60 scientific papers. He also received an award at the Eurospine Annual European Congress in Dublin at 2017.

the patient is able to walk some 30 minutes after the operation and is fit for discharge five hours later.

INFO: Athens: +30 210 6862167 • Thessaloniki: +30 2311 289109 • Website: www.stylianoskapetanakis.gr • E-mail Address: spineklinik@gmail.gr The publishers of the magazine are not responsible for the content of this article

MEDICAL BRIEF

VASCULAR SURGERY

A formidable disease of the past made easy The evolution of treatment for Abdominal Aortic Aneurysm from ancient Greek techniques to innovative synthetic graft implantation through the femoral artery.

An aneurysm is defined as a localized dilation of an artery. The word derives from the Greek aneurysma which means “widening.” Abdominal aortic aneurysms are usually the degenerative result of aging. They occur in approximately 5% of the population over 60 years old. The threat of aneurysm rupture and death increases in proportion to the aneurysm’s diameter and is the main indication for elective treatment. Antyllus, a Greek surgeon of the 2nd century AD, described the types of aneurysms and was the first to perform the procedure of ligation (tying-up) in an attempt to treat them. Antyllus’ procedure was not always successful and often led to death, but it continued to be used until the 19th century. After the long era of ligation, new treatments were developed. In the first half of the 20th century, one widespread method was to induce thrombosis of the aneurysms by intraluminal wiring (the endovascular approach) or to wrap the aneurysm wall with skin grafts or cellophane in order to prevent rupture. However, operative results remained unsatisfactory. In December 1948, the physicist Albert Einstein was admitted to hospital at the age of 69 suffering from upper abdominal pain and a pulsating mass. Dr. Rudolph Nissen, famous for his operation to prevent esophageal reflux, performed an exploratory laparotomy only to find a mass abdominal aortic aneurysm. He wrapped the anterior wall of the aneurysm with polythene cellophane to produce fibrosis and reinforce the aortic wall to prevent rupture. Five years after surgery, Einstein collapsed from aneurysm rupture. He refused redo surgery and died. In March 1951 in Paris, Dr Charles Dubost performed the first successful resection of an abdominal aortic aneurysm

Chris Klonaris, MD

Associate Professor in Vascular Surgery National & Kapodistrian University of Athens

Offering many advantages and reducing operative risk, endovascular techniques have rapidly evolved and provide a first-line treatment for many patients.

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E-mail Address: chklonaris@gmail.com

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with graft replacement. However, the use of homografts as an aortic substitute was shortlived due to problems associated with their preservation, availability and degeneration. The next major innovation was the development of prosthetic grafts as an artificial substitute for the aorta. In 1952, at Columbia Presbyterian Hospital in New York, Dr Arthur B. Voorhees first reported the successful use of vinyon-N grafts. Although this material didn’t prove to be ideal, the concept became established and introduced a new era of aortic aneurysm surgery. Soon after, other materials such as nylon and teflon were tested. In 1954, collaboration between Dr Michael E. DeBakey and the textile engineer Professor Thomas Edman resulted in the development of the knitted Dacron synthetic graft, which is still in use today. During the second half of the 20th century, accumulated experience in and improvements to this “modern” technique – along with progress in anesthesia, careful preoperative evaluation, patient monitoring and postoperative management – made the elective procedure relatively safe, with a failure rate of 2% or less. In 1991, Dr Juan Parodi reported the feasibility of synthetic graft implantation through the femoral artery, thereby eliminating the need for laparotomy and initiating the current endovascular era in the treatment of abdominal aneurysms. Offering many advantages and reducing risk, endovascular techniques have rapidly evolved to provide a first-line treatment for many patients. Both conventional open and endovascular repair are in practice today. Careful selection of patient clinical status and aneurysm morphology are determinants of the most suitable choice.

MEDICAL BRIEF

DENTISTRY

Tips to prevent and deal with toothache This unpleasant experience does not have to ruin your day, your weekend, a business trip or meeting or, even worse, your holidays.

Dr Constantinos Laghios D.D.S.,M.S. Advanced Dental Center

Everyone wants to feel good, look good and be healthy. Today, with our extremely fast pace of life, this presents more of a challenge than ever. Toothache, along with earache, is one of the most unbearable pains. A great number of people will experience the thoroughly unpleasant sensation of toothache at some time. This misfortune, however, does not have to ruin your day, your weekend, your business trip or meeting or, even worse, your vacation. A sore tooth, or one that is very sensitive to hot or cold, might indicate the existence of caries under a filling, or even a cracked tooth. These teeth are likely to become even more painful in the future. It’s a good idea to check them clinically, with digital x-rays and, more importantly, with a dental operating microscope; this can help your dentist detect cracks or decay in hard-to-see areas. In some cases, sensitive teeth just need to be desensitized with a sealant. A feeling of heaviness or light numbness in the mouth may indicate inflammation. This should be checked, even if the symptoms are transient or mild. Fillings or teeth that have broken, even if they don’t hurt and even if they broke some time ago, need to be examined as well.

Sometimes, the early symptoms of toothache may be just a slight discomfort while biting or when teeth come into contact with one another. If the pain can be described as “throbbing,” you should take a painkiller. If the pain originates from deep down near the roots and it feels as if the tooth is “erupting” in the mouth, or if the gums are swollen, there’s a good chance that we are dealing with an abscess. This requires antibiotics accompanied by painkillers. The first dose of antibiotics should be double, because this way they work faster. It is important to remember that antibiotics need a couple of days to take effect. The next step is a visit to a dentist for endodontic or periodontal treatment. As health practitioners, our first aim is to prevent mouth diseases and deliver successful results to our patients, each and every time. Above all, we must offer our patients the chance to have the mouth they want by including all specialties in the treatment plan. Today, we have advanced techniques that allow for early diagnosis of diseases in our patients. With the help of digital radiography, lasers, microscopes, new-generation composites and CAD/CAM ceramics, dentistry has become painless, fast and esthetically effective.

As health practitioners, our first aim is to prevent mouth diseases and deliver success to our patients each and every time.

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Plastic surgery

AN HONEST APPROACH TO BEAUTY

Patients can experience all the beauty and warmth of the country, while taking the opportunity to undergo any cosmetic surgery desired at high-end medical centers that produce impressive results. Dr Ioannis Lyras is the director of a plastic surgery clinic in a modern, fully equipped hospital in Athens. He learned a great deal about plastic surgery while working as an assistant to Prof Ivo Pitanguy at the Carlos Chagas Postgraduate Medical Institute, in Rio De Janeiro, Brazil. Plastic surgery is now very common and Greece, especially Athens, can boast some of the most renowned experts in the world and certainly the most acclaimed in southern Europe. With the excellent, all-year-round Greek climate, the patient can experience all the beauty and warmth of the country, while taking the opportunity to undergo any cosmetic surgery desired at high-end medical centers that produce impressive results. Dr Lyrasâ&#x20AC;&#x2122; clinic provides patients with high-quality services at all levels, starting with a detailed pre-operative consultation

with the chief surgeon and his team. All those involved work in perfect coordination, from the stage of comprehensive pre-operative examinations that ensure a safe outcome to the excellent post-operative monitoring for as long as it is necessary. Combined with a comfortable stay in a modern clinic, the entire process will always be remembered as a pleasant experience, since all operations are performed safely, painlessly and with amazing results. The newest medical sector of the clinic is one dedicated to esthetic endocrinology, directed by Dr Pari Rapti-Lyra. Plastic surgery has the power to change oneâ&#x20AC;&#x2122;s life by increasing self-confidence and generating admiration from others. According to Dr Lyras, the honest approach is the one that always wins. As he explains, the people who visit him expect nothing less than an open and frank consultation and the best possible

solution to whatever issue concerns them. This is exactly what they receive from him and his team. Dr Lyras knows from his years of experience that even a minor procedure will make his patients feel happier. And so it does. The doctor realized early on in his career that plastic surgery could be described as sculpture for the 21st century. It is the field of medicine that reflects on each one of us differently, depending on our own personality and needs. Believing in team work, Dr Lyras has assembled a group of specialists to treat the patient as a whole. His extensive beauty services include aesthetic, reconstructive and laser plastic surgery procedures, with the use of classic techniques and a variety of new, yet repeatedly tested, and highly satisfactory, approaches that include:

MEDICAL BRIEF

Face value: Face lifting, face and neck mini-lifts, aesthetic and functional rhinoplasty (nose and septum corrections), blepharoplasty (eyelid surgery), otoplasty (ear corrections), threading (provisory mini-face lift) and injectable aesthetic therapies (fillers). Body work: Breast enlargement, breast reduction, breast lift, breast reconstruction, gynaecomastia solutions, body contouring and lipoaspiration (liposuction), classical and new (mini) abdominoplasty, skin needling for resurfacing and skin tightening. Laser and radiofrequency treatments for varicose veins and capillaries, acne, melasma and hypertrichosis. Laser treatments for skin resurfacing and laser lipolysis and correction of flaccidity in the areas of the inner thighs, arms, neck and back are also available in Dr Lyras’ clinic. Introducing Dr Lyras

Plastic surgeon Ioannis Lyras MD

1993: “Victor Spina” Official Scientific Prize of the Brazilian Society for Plastic Surgery for his original research on wound healing in the presence of medical foreign bodies (silicone and polyurethane implants) 2003: Honorary member of the Greek section of the International Committee of Aesthetics and Cosmetology (Cidesco) 2004: Registered as medical assessor for plastic surgery for the law courts of Athens and Piraeus 2006: Appointed honorary consul for the Federal Republic of Brazil in Piraeus, Greece

2006: Gusi Peace Prize for Medicine (plastic surgery). 2008 and 2012: Elected member of the board of directors (treasurer) of the Consular Corps in Greece as honorary consul of Brazil in Piraeus (terms 2008-2010 and 2012-2014) 2010: Medal of Honor from the International Federation of Consular Corps Associations (FICAC) for his consular activities 2016: Elected member of the board of directors of the Hellenic Society of Reconstructive and Aesthetic Plastic Surgery Association (HESPRAS)

With years of experience in the field along with his inexhaustible sources of inspiration, Dr Ioannis Lyras is the recipient of many awards, honors and memberships, including:

Director of the 2nd Clinic for Plastic Surgery of Henry Dunant General Hospital, Athens. Honorary Consul of Brazil in Piraeus / www.ioannislyras.gr

2017: Friend of the Brazilian Navy award. During his career, Dr Lyras has participated in countless medical congresses, seminars, debates and continuing-education events and has given speeches and seminars in Europe. Dr Lyras has contributed greatly to charity work, has an array of scientific publications to his name and in 2009 published his first book, titled The Secret of Brazilian Beauty, in order to share the principles and methods of plastic surgery with the public.

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esthetic endocrinologY

Medical thermalism in Greece

The historic spa town of Loutraki, with its thermal springs, has been attracting health visitors since ancient times.

reece is one of the most popular travel destinations in the world. Throughout the year, people from all over come to enjoy its natural beauty, the Mediterranean cuisine and Greek warmth and hospitality. Of course, tourism is nothing new for Greece. Along with its striking natural beauty, the country is also endowed with many springs, whose therapeutic properties, known since ancient times, attracted travelers from as far away as Rome.

Ancient Greek mythology contains many references to the miraculous therapeutic attributes of springs. The belief of the ancients in the therapeutic qualities of these waters is apparent in their tendency to build infirmaries (asklipieio) near such thermal sources from as early as the 5th century BC. Ancient thermal facilities have been discovered in Knossos, Phaistos, Tiryns, Mycenae and Nestorâ&#x20AC;&#x2122;s Palace in Pylos (Peloponnese), indicating that the use of thermal springs was popular even before the Trojan war.

Herodotus often mentions and recommends thermal therapy in his writings, while Hippocrates posited a number of diseases for which thermal therapy was indicated. In the Homeric era, the bathing tub was called an asaminthos and was made of wood or marble. Bathers spread oil (most probably olive oil) perfumed with rose petals on their bodies after bathing. In the Roman era, Greek doctors, following Hippocrates, took great interest in hydrotherapy. Today, natural mineral resources are scat-

MEDICAL BRIEF

tered all over the country. The water of these springs differs from common water either in terms of temperature or in the presence of minerals and other compounds with beneficial properties. There are springs that combine thermal properties and minerals; these are the ones used in therapeutic treatment or spa hydrotherapy, also known as thermalism. It is common knowledge that hydrotherapy is effective for the treatment of many afflictions, including hormonal imbalances. Hydrotherapy falls into two categories. Internal therapy includes drinking therapy, inhalation therapy and lavages (oral, nasal and gynecological). External therapy, on the other hand, includes baths, jet showers, hydro massage, hydrokinesotherapy, balneotherapy and kinesotherapy on afflicted parts of the body. As president of the First Mediterranean Congress of Thermal Medicine in 2006 and in 2007, I spoke on thermalism in Greece at the World Federation of Hydrotherapy and Climatotherapy (FEMTEC) congress. In addition, I’ve organized congresses on Thermal Medicine and a number of global conferences on esthetics (CIDESCO). Endocrinology is the science which I’ve been serving for many years, and for a number of those years I’ve been dealing with esthetic endocrinology as well. Medical thermalism is a complementary therapy, and my hometown of Loutraki has been known for its important thermal springs since ancient times. Its excellent water is highly recommended for drinking therapy, ideal for dealing with uric acid deposition, kidney stones, gallstones, minor hepatitic deficiency and hyposthenic indigestion. Balneotherapy, also available in Loutraki, can be used to treat chronic rheumatic disorders, muscle and joint pain, chronic rheumatoid arthritis, skin inflammation and gynecological disorders.

dr pari rapti - lyra endocrinologist

It is common knowledge that hydrotherapy is particularly effective for the treatment of many afflictions, including hormonal imbalances.

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www.rapti.gr

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MEDICAL BRIEF

physiotherapy

THE POWER OF THE PUMP A non-invasive and completely painless therapy for a wide range of musculoskeletal problems.

The diamagnetic pump represents an important technological advancement in the field of non-invasive rehabilitation medicine. It works by generating high-intensity super-pulsed magnetic fields (2 tesla) and low-frequency magnetic fields (7 Hz) which act on different biological tissues. Diamagnetism is a kind of magnetism wherein materials oppose the direction of their molecular components against applied magnetic fields, receiving a repulsive force. Diamagnetism is a property, for their nature, of body fluids, cell structures and substructures and many pharmacological molecules. This property enables very quick, effective and selective biological effects, that mean non-invasive and nonpainful applications. Every pathology evolves in a specific way and therapies for these pathologies need to be adjusted in order to remain effective. Diamagnetic therapy allows for such adjustments to be made according to the anatomical and pathological phase of cell damage that the patient is undergoing. Furthermore, it allows for real-time inspection of the reaction of tissue to these stimulation processes. Diamagnetic therapy, also called MDA (Molecular Diamagnetic Acceleration), is: • A non-invasive and completely painless therapy. • A therapy adaptable to the developing complexities of the pathology. • An intervention technique applicable just after the trauma or in the pre- and/or post-operative phases. • A technique allowing intervention on the damaged skin, e.g. bed sores, diabetic foot, postoperative wounds, without requiring direct contact with the skin. • A technique allowing intervention in the case of extended immobilization, despite

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the presence of bandaging, braces or plaster cast, without requiring direct contact with the skin. • A technique used to administer drugs without the use of needles which has huge advantages for the patient in terms of both comfort and convenience. The device acts in three ways.

Theofanis Th. Mountzouris Physiotherapist

1. Molecular implant. To obtain the substances delivery with the diamagnetic pump, the repulsive character of the diamagnetic substances is exploded. 2. Movement of body fluids. The Diamagnetic Pump uses magnetic fields with an intensity of about 2 tesla to trigger the movement of the diamagnetic components that exist in the tissue, allowing for fluid removal. 3. Endogenous stimulation. The magnetic field variations are the different frequencies provided by diamagnetic pump act on the recharging of the cell membrane potential. AILMENTS & CONDITIONS TREATED WITH THE DIAMAGNETIC PUMP

DIAMAGNETIC THERAPY allows for real-time inspection of the reaction of tissue to these stimulation processes.

Arthrosis Periarteritis Sciatic neuralgia, low-back pain, herniated disk Contractures, muscular lesions, fibromyalgia Cutaneous contusions Muscular contusions Tendinous and articular contusions Bony contusions Distortions I, II & III Carpal tunnel Bursitis Cruralgia Pubalgia Epicondylitis Tendinitis.

Physiotherapy Center Physiof 62 Salaminos Av., Keratsini, Piraeus • Tel: (+30) 210.400.9621, Mob: (+30) 693.401.0713 • www.physiof.gr

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MEDICAL BRIEF

PREVENTION

good health in the golden YEARS It’s never too early and it’s certainly never too late to start aging well. What is well-aging?

It’s a multidisciplinary approach that draws on research into the aging process in order to develop a treatment strategy based on preventive medicine. The goal is to improve quality of life and increase overall vitality.

What is anti-aging medicine?

Tests for telomerase length and modification potential. A revolutionary method using spectrophotometry to detect, directly and in real-time, the bioavailability of trace elements and the presence of heavy metal intoxication. AGEs Test, looking at advanced glycation end-products. (In human nutrition and biology, advanced glycation end products, or AGEs, are substances that can be a factor in the development or worsening of many degenerative diseases, such as diabetes, atherosclerosis, chronic renal failure, and Alzheimer’s disease.)

It is a wellness-oriented model of advanced preventative medicine. Its focus is to prevent degenerative diseases with a view to extending lifespan and, more importantly, prolonging the length of time that one is able to live independently and productively. Advanced evidence-based treatment protocols are used to overcome ELEANA dysfunction and disease. An individualized PAPACHARALAMBOUS program is created to treat any underlying Health Services Manager conditions and to optimize overall health and Health and Well-Aging Specialist wellbeing. This encompasses annual checkCEO Orthobiotiki Preventive Medical Center ups, proper nutrition and supplementation, bioidentical hormone replacement therapy, IV therapies, exercise and measures that deliver stress relief. Hundreds of scientific research studies clearly prove that such modest interventions significantly impact health in old age. Many of these interventions also increase patient lifespan.

well-aging and wellness: What is the difference?

Well-aging adopts a more comprehensive approach, based on scientific and medical insights, than wellness, which mainly offers treatments designed to meet specific individual needs. After determining the biological age of the individual by carrying out a clinical examination (check-up), a program is created and appropriate therapeutic measures are formulated.

What tests does Orthobiotiki offer?

The center administers a number of different tests that detect and document the current health status of the individual. None of these tests is painful or invasive. InBody Scan: Body mass and composition analysis, by segments. FRAS Test for the presence of free radicals and antioxidants. Digestive system examinations. EKG to measure metabolism at rest, under stress and after exertion. DNA Analysis to assist in dietary coaching.

how can well-aging BE APPLIED?

Applications vary. Our team motivates and supports clients in efforts to achieve a healthy lifestyle. Special attention is paid to a healthy diet with supplements (dietary supplements, IV treatments and vitamins). Likewise, we work to reduce or eliminate alcohol consumption and smoking, and encourage the adoption of a proper fitness program and of stress reduction through relaxation. Beauty is also an issue which we approach professionally.

When should you start?

Biologically, the human aging process begins after an individual reaches maturity, which means it begins between the age of 20 and 30. This is when it’s recommended that people start with early prevention, and learn correct lifestyle modifications; doing this is more important than ever because, in the Western world, life expectancy is increasing steadily. In order to live well during the extra years that are “gained” by this increase, people should take early health precautions. At “Orthobiotiki,’’ we strive to make all your years meaningful and enjoyable: that is how we understand our purpose. In any case, it’s never too early and it’s certainly never too late to start aging well.

On the beauty front

A wide range of beauty issues can be handled at the center: these include varicose veins, sagging necks, frown lines and sun spots. We draw on a full range of scientific knowhow to offer you a number of solutions, including cosmetic injections such as Aqualyx, botox, prp (platelet-rich plasma) and mesotherapy, all administered upon your request by our specialists.

At “Orthobiotiki,’’ we strive to make all your years meaningful and enjoyable: that is how we understand our purpose.

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ORTHOBIOTIKI PREVENTIVE MEDICAL CENTER 3-5 Sorou, Marousi, Athens • Tel: (+30) 210.323.0000 • email: info@orthobiotiki.com

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MEDICAL BRIEF

fertility

The newest advances in ivf treatment Monitoring of ivf pregnancies Innovations in modern medical science can help overcome the consequences of female infertility and make motherhood possible for a greater number of women.

New advancements in IVF

Preimplantation Genetic Screening (PGS) using Next Generation Sequencing (NGS) Preimplantation Genetic Screening (PGS) allows for the identification of euploid embryos prior to transfer for IVF, in order to avoid implanting aneuploid embryos. This genetic testing decreases the risk of miscarriage; pregnancy success rates rise to 70-80% when genetically sound embryos are transferred. Using NGS, even more accurate results are achieved, and it is less costly for the patient, which is very important nowadays. New cryopreservation methods with vitrification Vitrification is a new freezing method that enables the transfer of cryopreserved embryos and that has comparable or better success rates than fresh embryo transfer. Vitrification allows us to use frozen embryos, without any hesitation, in the following complex cases: A. Ovarian hyperstimulation syndrome: if we suspect this syndrome, we use the freezeall method and proceed to freezing all of the embryos. After we treat the hyperstimulation, we carry out the embryo transfer. b. Freezing after the PGS takes place, as mentioned above, in blastocyst, and transferring genetically healthy embryos during the next cycle, after we have received the preimplantation screening results. c. Oocyte cryopreservation: the vitrification technique has been very helpful in producing more viable embryos and in raising the pregnancy success rates after egg freezing. Oocyte cryopreservation is now a choice for young women who for any number of reasons do not wish to procreate at a young age and prefer to use their frozen eggs later. Natural cycles and mild stimulation protocols These techniques help women who don’t want to or, for medical reasons, can’t undergo standard ovarian stimulation treatments.

a. In natural cycles, we receive the egg during the natural cycle of the woman, after having monitored it via ultrasound from the 6th day of the cycle. This way, we can potentially transfer one or more embryos without the need for stimulation medication. b. Mild stimulation protocols. These involve using low dosages of advanced medicines to produce a reasonable number of eggs. For particular patients, this has higher pregnancy success rates than ordinary stimulation protocols.

Dr theocharis papageorgiou

MD, Obstetrician/Gynecologist Associate Professor, University of Athens Associate at IASO Maternity Hospital Associate at Embryogenesis IVF – Assisted Conception Unit

Vitrification is a new freezing method that has comparable or better success rates than fresh embryo transfer.

INFO: 16 Karneadou, Kolonaki • www.tpapageorgiou.gr The publishers of the magazine are not responsible for the content of this article

Monitoring of IVF pregnancies

IVF pregnancies need to be more closely monitored than ordinary pregnancies, due to the patient’s advanced maternal age. Patients should be given both standard and molecular tests for thrombophilia and, if needed, referred to a haematologist who specializes in thrombophilia, to determine if anticoagulant treatment is advisable. Frequent cardiac monitoring – at least twice during pregnancy with an electrocardiogram and heart ultrasound – should take place, and a detailed cardiological history must be taken. Glucose levels should be monitored, and the glucose curve should be checked by a diabetologist who can suggest treatment and a special diet if necessary. There must be frequent laboratory tests as well as obstetric ultrasounds (e.g. frequent uterine cervical length measuring) so as to diagnose and treat pregnancy complications promptly, both for the pregnant woman and the foetus. It is important that patients avoid overexertion and take frequent rest intervals. Of course, there’s no need to overcompensate, either. If all of the above instructions are followed, the pregnancy should be pleasant and stressfree, and run to full term smoothly.

MEDICAL BRIEF

ENT

REVOLUTIONIZING LARYNGEAL SURGERY Laser treatments are an incredible medical weapon when dealing with benign conditions and the early stages of pharynx and larynx malignancies.

Anatoli Pataridou ENT, Head and Neck Surgeon

What could be hiding behind hoarseness?

Laser treatment

While a hoarse voice may sound attractive to some people, it can also be a cause for medical concern. The larynx, the organ that produces the human voice, participates in three major bodily functions: vocalization, swallowing and breathing. The main anatomical component of the larynx consists of the vocal cords: two white membranes that oscillate and touch each other to produce a loud and clear voice.

Voice quality

Any infection of the pharynx, the larynx or even the nose can affect voice quality, thus resulting in hoarseness. A frequent condition affecting patients is acid reflux, which can cause a chemically induced type of laryngitis, sometimes impairing voice quality. The same goes for smoking (active and passive), air conditioning, the inhalation of irritants and many other external factors. Additionally, talking loudly, particularly in noisy venues, can damage the vocal cords, resulting in hoarseness, dry cough and other symptoms, such as voice crack and globus sensation. The most common vocal cord disorders are polyps, cysts, nodules, Reinkeâ&#x20AC;&#x2122;s edema, granulomas and, more rarely, cancer.

Surgery can be performed using either standard techniques or various laser procedures, which are a lot less traumatic for the sensitive mucosa of the vocal cords. Laser treatments have revolutionized laryngeal surgery because they allow for the pathology, be it benign or malignant depending on the stage of the disease, to be removed without external incisions. Laser is used on many benign conditions such as cysts, polyps, Reinkeâ&#x20AC;&#x2122;s edema, vocal papillomas, vocal fold paresis and benign tumors, but it has also radically changed the treatment of pharynx-larynx-hypopharynx malignancies. An important advantage of laser treatment when dealing with cancer is that the surgeon can perform a fast-track biopsy and, depending on the results, opt to proceed with immediate removal. The use of laser ensures optimal healing, so swallowing and vocalization are not affected particularly. It deters edema, thus averting the need for a tracheotomy, and also reduces the risk of bleeding. The surgery is performed under general anesthesia and with the use of a specialized tracheal tube. The laser device is connected to a surgical microscope and a specialized microcontroller allows us to select the parameters for the beam, depending on the particularities of the spot we need to approach.

An important advantage of laser treatment when dealing with cancer is that the surgeon can perform a fast-track biopsy and opt to proceed with immediate removal.

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MEDICAL BRIEF

rethymno medical assistance

quality care on hand in crete Rethymno is a popular destination for visitors from around the world, and caring for their health needs is the responsibility of the island’s highly qualified medical professionals.

Forty thousand patients and 13 years of experience have given Rethymno Medical Assistance (RMA) the depth of experience to deal with the challenges of the new era in tourism. We offer high-quality, hassle-free and personalized medical services for all kind of emergencies in the field of tourism medical services, from common allergies to heart attacks. A tourist destination ought to provide a variety of services, including international patient management. Despite the unprecedented crisis in Greece, the tourism industry is growing dynamically and making a crucial contribution to the economy. Statistics indicate steady growth in international arrivals. Moreover, much of this increase applies to vacationers over the age of 55. In themselves, those figures underline the need to be able to deal with all types of medical cases, ranging from potentially life-threatening incidents to simple ones such as asthma attacks, colds or sunburn. Providing medical care to tourists requires good organizational skills, particularly in light of these patients’ high expectations. The public health system cannot provide these visitors efficient access to its services or meet their standards. In that crucial regard, we are the first line of response for emergencies in the tourist areas

Dr Emmanouil Tzagarakis General Practitioner (GP), family doctor

on the island during the high season. We are fully prepared to deal with any situation that might arise. RMA is staffed with highly experienced healthcare professionals, both in terms of our medical and paramedical staff. We provide primary healthcare and medical tourism services of the highest standard in and around Rethymno, Crete. We are certified by the German organization Temos, ensuring that medical services are consistent, sufficient and meet international quality standards. Tourists expect quick and effective services in a comfortable environment that they can trust, an important factor for anyone who is ill and away from home. We offer: • T rained and qualified multilingual medical personnel • 2 4/7 services in the patient’s place of residence • Blood analysis tests • X -rays (from August 2018) • Bioresonance treatments and consulting • F riendly, helpful and efficient administraive staff • Links to secondary healthcare • C ollaboration with all international travel insurance and medical assistance companies • A network of colleagues throughout Crete

We are certified by the German organization Temos, ensuring that medical services are consistent, sufficient and meet international quality standards.

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• 75 Adelianos Kampos, 74110, Rethymno, Crete Tel. (+30) 28310.713.00 • www.rethymnomedicalassistance.com • Email: info@rma.gr

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