Life Healthcare

summer / 2015

publishED in the interest of your health by

publishED in the interest of your health by LIFE HEALTHCARE

eat, play, love

SUMMER

• summer 2015

Delicious recipes Sun-smart tips HOLIDAY READS

plus

REBOOT YOUR WORKOUT IN 2016 The FACTS about pregnancy and diabetes 00_LIFE_COVERV2 (2).indd 1

DO GOOD, FEEL GREAT Your guide to giving 2015/11/17 2:14 PM

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Beyond the Blue PH51981 REV

No matter where you are this holiday season:

ed’s letter

Do you know your status?

Get screened in December – it’s World Aids Awareness Month

I M A G E an g i e laz ar o C O V E R I M A G E G r eats t o ck/ C o r b i s

Life is…

beautiful, says the movie of the same title, and never more so than when summer is waiting in the wings with its promise of long, sun-drenched days, balmy evenings and the collective joy of friends and family spending time together.

While the idyll of reconnecting with your loved ones and having a well-deserved holiday is one to savour, for many people it can be lonely and agonising, a topic Catriona Ross explores in ‘Surviving the Lonely Season’ on page 22. If you can relate to that feeling of isolation, this article is a must-read.

Where there’s summer, there’s sun, and the more intense the heat the greater your exposure to harmful UV rays, which is why sun safety is firmly on Life’s radar this month. Jamie Parker has compiled a comprehensive guide for the prevention, detection and treatment of skin cancer on page 32, and there are also tips on how to keep your little ones safe in and around water on page 42.

Before you dress the crayfish or serve the Christmas pudding (we have delicious recipes on page 52), spare a thought for all those less fortunate whose holiday might not be as abundant as yours. Volunteering is a great way to use your time in service to others and the emotional benefits are vast too (page 58).

As you launch into the new year, forget about making lofty promises (running a marathon, losing 20kg, cutting out dessert) and commit to implementing small changes every day that will have significant long-term payoffs. Health is about being able to enjoy your life and that’s the best resolution of all.

SAMANTHA PAGE, editor

life plus

THE SEPTEMBER 2015 ISSUE OF Life magazine, IS AVAILABLE AT www.lifehealthcare.co.za MAKING LIFE BETTER starts here

is brought to you by THE LIFE HEALTHCARE GROUP EDITORIAL Editor Samantha Page lifehealthcaremag@johnbrownmedia.com Art Director Nicky Cosgreave Managing Editor Estee Kershoff Copy Editor Raadiyah Abrahams Managing Editor (Life Healthcare Group) Tanya Bennetts editorial committee Yvonne Motsisi, Denis Scheublé, Dr Nilesh Patel, Lucy Balona (CANSA), Dr Adi Horak, Dr Vash Mungal-Singh (Heart and Stroke Foundation SA), Dr Steve Taylor, Janette Joubert, Dr Sharon Vasuthevan, Liesel van Oudenhove management Managing Director Lani Carstens Group General Manager Rebecca Smeda Group Account Director Joanne Peltz Account Manager Sumeera Dawood Production Director Nina Hendricks Financial Director Ruschda Ismail Business Development Director Warren Harding Human Resources Director Aashiqa Petersen

ADVERTISING Advertising Sales Manager Tessa Fenton-Wells tessa@tfwcc.net 021 761 2840; 082 320 0014 Production Production Co-ordinator Tessa Smith Reproduction Resolution Colour Printing Paarl Media Cape Life magazine, 2nd Floor, Block A, North Side, Black River Park, Fir Street, Observatory, 7925 / PostNet Suite #2, Private Bag X11, Mowbray, 7705 Email: lifehealthcaremag@johnbrownmedia.com Tel: 021 486 7600 Fax: 021 486 7614 www.johnbrownmedia.com For magazine-related queries, contact John Brown Media. Tel: 021 486 7600 Fax: 021 486 7614.

PostNet Suite #2, Private Bag X11, Mowbray 7705.

Life magazine is published by The Life Healthcare Group to provide patients, their families and the public with the most readable, interesting and relevant health and well-being journal available. Life is distributed quarterly to patients at all Life Healthcare hospitals and to private-sector doctors. It has a guaranteed print order of 90 000 per quarter, with an estimated readership of 240 000. Life can now also be read online.

Visit www.lifehealthcare.co.za Disclaimer: the opinions expressed by the authors of the articles published in this magazine do not necessarily reflect the views of The Life Healthcare Group Ltd or John Brown Media. The Life Healthcare Group Ltd or John Brown Media do not accept any responsibility for information given in the articles featured in Life magazine.

Endorsed by

LOOK OUT FOR LIFE PLUS BOXES IN OUR MAGAZINE FOR EXTRA INFORMATION AND HEALTH TIPS

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3059T GEN DPS Ad Healthcare Sum Dec 2015 P.indd 1

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THIS MONTH’S FOCUS … SAFE SUMMER FUN

Contents LIFE 01 LIFE IS…

A note from the editor

06 OVER TO YOU

Letters from our readers

10 LIFE NEWS

Medical innovations, what’s new at Life Healthcare and latest reads

14 GETTING FIT IN 2016

The days of straightforward gym are over. Here’s what you can look forward to in the new year

By Tracy Melass

16 PREGNANCY AND DIABETES

Gestational diabetes is more common than you think – find out how it can affect you and your baby

By Charlene Yared-West

19 ‘I HAD NO IDEA I WAS HAVING A STROKE’ Bonette Schmahl shares her physical and emotional recovery As told to Lynne Gidish

20 WHICH OIL IS BEST?

Confused by the variety of oil on the supermarket shelves? Here’s how to stock your cupboards with the healthiest options

By Catherine Eden

22 SURVIVING THE LONELY SEASON For some, the holidays are the time they feel most alone. If that’s you, hope and help are here

By Catriona Ross

24 WHAT’S YOUR EMOTIONAL IQ?

32

THE SUN RULES OF SUMMER

04

04_UPFRONT_Contents.indd 2

Take Life’s quiz, and evaluate your ability to perceive, control and evaluate your emotions

28 OFF TO THE MARKET WE GO

Forego the shopping malls and spend time in the great outdoors trawling markets and the yummiest foodie stalls

By Estee Kershoff

SUMMER 2015

2015/11/17 3:14 PM

eds letter

52

FESTIVE FARE

22

42

HOW TO SAVE YOURSELF FROM LONELINESS

KEEP YOUR KIDS SAFE IN WATER

HEALTH

CARE

32 Sun Smarts

50 No Bones About It

36 Greening Medicine

52 SISTER ACT

Have fun in the sun and decrease your risk of skin cancer

By Jamie Parker Life Hilton Private Hospital is leading the way in green yet technologically advanced healthcare

By Glynis Horning

40 The Right Prescription for You

What does a clinical pharmacist do and how do they help you heal?

By Vivian Warby

42 Winning Ways with Water If your little ones are in and around water, here’s how to keep them safe PLUS: What is dry drowning?

By Lisa Lazarus

45 Everybody’s Talking About … Vaping

Do e-cigarettes help or harm?

By Glynis Horning

47 DecodE Your Headache

The five most common headaches and how to get relief

How to maintain your frame and keep it healthy

By Charlene Yared-West MasterChef SA sisters Seline and Leandri van der Wat share delicious recipes for festive get-togethers

Which Oil is Best?

58 A Circle of Caring

Volunteering is the gift that keeps on giving. Here’s why you should give back

By Norma Young

59 The Handsome Man’s De Luxe Café

An excerpt from Alexander McCall Smith’s latest book

61 Life Healthcare Hero of the Month

Life Occupational Health nurse Sister Elsa Opperman

62 Mind Games

Take a break with our puzzles and crossword

64 An amplified existence The Eat, Pray, Love author on living creatively

By Elizabeth Gilbert

04_UPFRONT_Contents.indd 3

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LETTERS

OVER TO YOU We’d love to hear from you

WINNING LETTER

When life happens...

I am 40 years old and have always enjoyed good health, but something unexpected happened in my fourth decade.

I had a needle biopsy done on a weird lump in my breast.

Tests revealed that it could be malignant and I was booked for theatre the same day.

I’d planned on that being the end of it, but the doctor visited me that evening and prepared me for theatre the next day, pending further tests. I prayed the lump was a tumour and nothing more, but the results revealed it was cancer. I felt alone and thought it was the end. I burst into tears as I was rushed back into theatre.

An hour later it was over. My left breast was removed.

I looked around and saw my husband who was at a loss for words. The nurses were so comforting to my family and me. Their caring support and encouragement gave me the strength to say, ‘You can do this. Your six-year-old son and your husband need you to be strong’.

Three weeks later, I received news that the Ford EcoSport I had ordered before surgery was ready and waiting, and one month later I drove my new car.

As I take my next step and start chemotherapy, I want to thank everyone at Life Chatsmed Garden Hospital. You have helped and taken good care of me as I walk down this road towards good health.

Reshma Singh, Durban

PUTTING PATIENTS FIRST I would like to thank Life Rosepark for an outstanding effort to make me feel comfortable and to get me back on my feet. I was very impressed with the level of professionalism and personal attention to me, your patient.

EXCELLENCE IN ACTION My wife who, at the time of writing this letter, is approximately six months pregnant, was recently admitted to Life Midmed Hospital in Mpumalanga after severe and continuous vomiting.

After contacting her gynaecologist, whose receptionist Leticia was extremely helpful, I took her straight to the maternity ward. The entire process – including people from the admin staff to the admitting nurses – was painless and efficient.

During her stay, the nurses were extremely attentive, making their way around the wards during the shift handover to greet patients. In an overburdened healthcare system, to maintain this level of care is refreshing to say the least. Even the catering staff were friendly, patient and understanding of our dietary needs.

Compliments to Life Midmed Hospital; may you continue to excel.

Ayub Patel, Mpumalanga

THE GIFT OF DIGNITY Thank you to the nurses and staff at Life Bedford Gardens Hospital, especially Sister Susan and Sister Chantel, for making my aunt Wilma Gouws’ last day so comfortable and dignified. Her family are so comforted that she was receiving the best possible care when her prognosis was so poor. Life Bedford Gardens Hospital gave my aunt the chance to pass with dignity and that’s a special privilege.

Marlene Pienaar, Gauteng

TWEETS OF THANKS

I would like to express my thanks to the staff at the maternity ward at Life Dalview who have been supporting my daughter Alicia Dickson, who gave birth to my granddaughter Charlotte in August 2015. Thank you for your patience during this time, and for taking excellent care of my granddaughter, who is currently still in the neonatal ICU. It’s difficult to see the baby so vulnerable, but we know that your staff is giving her the best care. I know the maternity section is new so I commend your staff for their great work, and I trust you will continue this attentive service. Judith Dickson, via @HiHelen

Jay du Plessis, Bloemfontein

Win a wellness assessment worth R5 000 Wellness is no longer limited to an annual medical check-up.

Careways – South Africa’s leading provider of Employee Wellness Programmes and a subsidiary of the Life Healthcare Group – gives you access to a combination of medical, behavioural and risk-management interventions aimed at personal optimisation. Delivered by teams at seven Careways facilities in South Africa, the wellness assessment uses the following processes to help you meet your objectives: 06

06_UPFRONT_Letters.indd 2

• Evaluation of your current health/wellness profile • Defining realistic health/wellness goals • Identification of sustainable well-being behaviour change opportunities • Planning of lifestyle and behavioural interventions For more information, visit www.ewp4u.com Email your thoughts on life, health or care to lifehealthcaremag@johnbrownmedia.com and you could win.

SUMMER 2015

2015/11/17 2:21 PM

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2015/08/20 1:11 PM

LIFE

POWERFUL POMEGRANATES / TOP APPS / SALT AND KIDS’ HEALTH

‘And now let us believe in a long year that is given to us, new, untouched, full of things that have never been.’

i m a g e S gett y /gallo images

RAINER MARIA RILKE

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NEWS

i m a g e S th e li c ens i n g p r oj ec t, g et t y /ga llo i m ag es , I S TOC K

LIFE NEWS

Medical innovations and Life Healthcare news

Q

Should I be asking for cold-pressed juice?

Life says Celebrities swear by it, ardent gym-goers say it gives them a much-needed boost before and after a workout, but what are the facts? Conventional centrifugal juicers have spinning blades that dice fruit and veg, exposing them to heat and oxygen in the juicing process, both of which degrade nutrients, vitamins and minerals.

Juices from the supermarket have been pasteurised, which also involves heat, however, cold-pressed juices, as the name suggests, have been squeezed, so there’s no heat, and they must be refrigerated for a longer shelf life. Sound like the scales are tipped in favour of cold pressed? There are certainly processing benefits, but can your body absorb all the additional nutrients or do they simply pass through your gut? ‘We don’t have enough information to prove that either method is good or bad, and the added nutrients may or may not be useful,’ says Bhimu Patil, PhD, director of the Vegetable and Fruit Improvement Center at Texas A&M University. So in the meantime, keep eating fresh fruit and vegetables.

Source: www.globeandmail.com

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I M A G E S TH E LI C E N S I N G P R OJ EC T, G ET T Y /GA LLO I M AG E S , I S TO C K

SOUTH AFRICA HAS THE

LISTEN UP!

TRY IT OR

SKIP IT?

THE CLAIM: If you’ve overindulged at a party the night before, you should drink a Bloody Mary to help your body recover.

THE EXPERTS SAY: A virgin Mary is a much better choice. ‘The worst thing to do is have another drink,’ says Dr Charles Cutler, MD of Montgomery Hospital Medical Center in Pennsylvania, US. The truth is that you feel terrible because alcohol is toxic, explains Dr Cutler, and what you really need is to give your body a chance to recover. Replace the fluid you’ve lost with water, juice or a sports drink.

Diabetes has a wide variety of effects on the body, but most people are not aware that those living with diabetes may have a higher risk of developing hearing problems than those without the disease. ‘The ear needs an adequate blood supply to keep hearing intact, thus any thickening of capillary blood vessels in diabetes can cause a loss in hearing, says Life Groenkloof Hospital audiologist AnnaMarie Marais.

14 November was World Diabetes Day

SUPERFOOD

Pomegranates FOR THE HEALTH OF YOUR BODY • Ellagic acid: regenerates skin cells, protects collagen, guards against UV rays, prevents sun damage • Anthocycanidins: protect cells from oxidative and environmental stress and damage, protect DNA, boost body’s production of built-in antioxidants • Punicalagins: renews cells, increases microcirculation, and is effective in treating wrinkles

saltiest kids’ burgers Age 0–6 months 6–12 months 1–3 years 4–6 years 7–10 years 11+

Maximum Salt Intake/Day < 1g < 1g < 2g <3g < 5g < 6g

Most children relish the chance to have a burger and chips on the weekend, and while we know it’s not always the healthiest option, we don’t really know what’s in every meal. But a recent international survey carried out by World Action on Salt and Health (WASH) and endorsed by the Heart and Stroke Foundation South Africa (HSFSA) revealed staggering stats about the salt content in those meals.

Of the 37 countries surveyed globally, South Africa features among the top 10 countries for saltiest children’s fast food meals.

A kiddies chicken burger and a small packet of chips from a popular fast food chain contain 2.91g of salt – almost the entire daily salt intake recommended for children aged between four to six years.

The survey results are extremely relevant in South Africa where fast food intake is on the rise, with an estimated one in three adolescents consuming fast food three times a week. With South Africa’s meal ranking as the third saltiest, it’s clearly time we paid more attention to what is being sold and marketed to our children.

For more information, visit www.heartfoundation.co.za

Source: www.womenshealthmag.com/style /ingredient-lab-pomegranates

WWW.LIFEHEALTHCARE.CO.ZA

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bits & by tes

Tap into your health While your phone can sometimes be a distraction, you can learn to harness its power to promote healthy living. Here are three top apps for a better lifestyle.

Lumosity Mobile (FREE) Rating 4.5/5 stars (iPhone); 4/5 stars (Android) What it does Designed to improve cognitive abilities and give your brain a workout. It uses a series of challenging games to stimulate different parts of your brain, and you can track your progress.

A teenager has created an alternate way to help the visually impaired by inventing an open-source, cost-reduced DIY Braille printer. Shubham Banerjee, 13, combined his love of Lego and his desire to help others and created Braigo (Braille + Lego) for a school science fair in January 2014. Normally a Braille printer costs about $2 000 (± R27 000) but his invention has slashed the price to $350 (± R4 800). ‘I don’t really care about making money,’ he said in a recent interview. ‘I just care about the lives I’m potentially helping.’

His father added that Shubham wants to develop other products that will have a social impact. Although he’s just started high school, Shubham patented his printer and founded Braigo Labs, which microchip giant Intel has invested in to pay for staff and product design. ‘My end goal would probably be having most of the blind people … using my Braille printer.’ With an estimated 50 million people in the world legally blind, he’s sure to find a willing audience.

4 January is World Braille Day

61%

Finding the heart’s rhythm 12

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CODY (Free) Rating 4/5 stars (iPhone); 4/5 stars (Android) What it does This app is Facebook for fitness.

You can track your own progress, connect with new and old friends, share workouts and like and comment on your and others’ daily workout activity.

of us have been attracted to someone by their smile alone

Cardiac electrophysiology broadly refers to the science of interpreting, diagnosing and treating the electrical circuitry of the heart. Dr Kevin Michael, founder of the Heart Rhythm Management centre at Life Westville Hospital says ‘the Heart Rhythm Management centre has been erected to be more than a walk-in clinic – it also has facilities for virtual patient consultations and video conferencing. We now have a tangible unit in Durban, and a satellite electrophysiology programme that is a point of care to patients.’ Contact the Heart Rhythm Management centre at Life Westville Hospital on 031 251 6911.

i m a g e S g et t y /g a llo i m ag e s, ISTO C K, B R AIG O n e i l b a n e rj e e

Braille printer developed by 13-year-old

Moves (Free) Rating 3.5/5 stars (iPhone); 4/5 stars (Android) What it does Do you spend a lot of time sitting?

With Moves, you can track the distance you travel by bicycle and foot each day. The app tells you how many steps you’ve taken and how many calories you’ve eaten so you can chart your daily progress.

summer 2015

2015/11/17 2:28 PM

BOOKS

SHELF HELP The latest reads to nurture your mind, body and soul

MUST READ THE NEW RULES OF RUNNING

Five Steps to Run Faster and Longer for Life

I M A G E S G ET T Y /G A LLO I M AG E S, I ST O C K, B R A I G O N E I L B AN E RJ E E

By Vijay Vad, MD with Dave Allen

Dr Vijay Vad is a renowned sports medicine specialist and he has developed a book that will guide and support your running whether youâ&#x20AC;&#x2122;re trying to recover from injury, develop fitness or better your personal record. The New Rules of Running will make you a faster, healthier runner with an emphasis on prevention and recovery.

We are giving away two copies of The New Rules of Running.

Email lifehealthcaremag@ johnbrownmedia.com by 31 December to stand a chance of winning.

10_KNOWS_News.indd 5

THE LOW CARB SOLUTION FOR DIABETICS

By Vickie de Beer and Kath Megaw In 2008, Vickie de Beerâ&#x20AC;&#x2122;s son Lucca was diagnosed with type 1 diabetes. Along with dietician Kath Megaw, De Beer set about writing and compiling The Low Carb Solution for Diabetics (Quivertree) and in the process developed an arsenal of the most effective day-to-day strategies for practically dealing with diabetes. Part journey, part cookbook, part medical reference, the book is a guide, a shoulder to lean on and an invaluable support. Grouped seasonally and covering all the days of the week, The Low Carb Solution for Diabetics offers ideas for every meal of the day.

We are giving away two copies of The Low Carb Solution for Diabetics. Email lifehealthcaremag @johnbrownmedia.com by 31 December.

2015/11/17 2:30 PM

FIT FOR LIFE

GETTING FIT IN

2016 Whether you’re employing outlandish hybrid sports or a nostalgic nod to childhood activities to get fit, Tracy Melass says the days of straightforward gym are over

BOXING

There’s something very cinematic about boxing (we have Rocky to thank for that) and while you’re humming ‘Eye of the Tiger’ and lacing your gloves, you already start to feel stronger. You use your upper body muscles to throw punches, dip and dodge, and your quadriceps, hamstrings and glutes to lunge, plus you get to vent your frustrations, making boxing a truly effective holistic workout.

Pros • Promotes endurance and stamina • Excellent stress reliever 14

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SUMMER 2015

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I M A G E S G ET T Y /G A LLO I M AG E S

N

o one said gym would be fun all the time, but when you look forward to it as much as a root canal, something needs a revamp.

Couple this with dazzling technology and creativity, and each year fitness trends push exercise further beyond the boundaries of punishment and boredom.

Life has researched your options to present the five biggest exercise trends for 2016. Whether it’s kung fu-inspired moves, left jabs or pliés you’re after, the results speak for themselves.

fit for life

• Top cardio workout • Burns fat fast Cons • Risk of injury • Contact element not to everyone’s taste Feedback ‘Boxing provides the best all-over workout, perfectly balancing aerobic and anaerobic activity, and has amazing benefits for physical and psychological well-being,’ says Steve Burke, owner of The Armoury Boxing Club. www.armouryboxing.com

6

High-Intensity Interval Training (HIIT)

i m a g e S g etty/ g a llo imag e s

It’s easy to keep up a steady stride on the treadmill while watching CNN. This may increase your general knowledge, but will not get you fit. HIIT requires alternate bursts of intense with medium-level activity to boost fitness, metabolism and fat burning. Exercises feature a warm-up period, repetitions of high-intensity workouts separated by medium-intensity workouts, and a cool-down exercise.

Pros • Quick results • Burns fat fast • Creates lean muscle • Increases oxygen capacity Cons • Not suitable if you’re unfit or a beginner • Can be tough on your body and you’re more susceptible to injury Feedback ‘HIIT has the ability to improve both aerobic and anaerobic capacity in addition to having powerful fat-burning properties,’ says Luke Saner of Lander & Pursad Biokineticists. www.biokinetics-sportscience.co.za

Mixed martial arts (MMA)

Mixed martial arts (a hybrid which draws from a number of forms), is reportedly the fastest growing sport in the world.

Combining everything from ju-jitsu, Muay Tai and judo to tae kwan do and Krav Maga, MMA advocates holistic,

life plus

all-round fitness by engaging your muscle groups. It demands balance, explosive strength, speed, agility and flexibility, and improves mental and emotional health.

Pros •S trengthens core, muscles, bones, joints •E xcellent cardiovascular workout •M akes you more alert, engaged Cons •C ontact sport can cause injury •U ntrained ‘fitness’ instructors may not properly understand or teach the martial arts elements correctly Feedback ‘It’s about empowerment through self-development. People want to “learn and gain” – this is a new way to get into shape. They also like the social element of it and, crucially in SA right now, it gives people a way of defending themselves,’ says Fabian Langerman of Warriors of Faith. www.wfma.co.za

Ballet

Many little girls dream of becoming prima ballerinas, but never make it onto the stage. Well, there’s hope again – or at least super-toned legs – which is why it’s little wonder adult ballet is booming.

Ballet boosts strength throughout your body, from the small intrinsic muscles of your feet to the larger muscles of your back, glutes and calves. Repetition of certain exercises build strength in specific areas, most notably in the hip, lower leg, ankle and foot.

Pros •P romotes good posture •T ones body • Strengthens back and abdominal muscles Cons •L imited muscle-building benefits •B allerinas are often weak in their arms, hamstrings, quads Feedback ‘Not only will you tone and strengthen core muscles, you’ll also enhance coordination, balance, flexibility and posture. It’s a fantastic way to improve mental function too – ballet

Exercise before surgery ‘Exercise is an important part of rehabilitation. Muscle-strengthening exercise will speed up recovery, while general aerobic exercise improves the safety of the anaesthetic.

‘There are no specific exercises that are contraindicated prior to surgery. Your

Prehab

Worried about injuries? Prevention is always better than cure, which is why prehab should be included with your workout. Simply put, it’s a proactive approach to avoiding pain and injury. You will build strength and stability around your most vulnerable areas, and improve mobility, balance and joint function, decreasing the potential for injuries.

Pros •F ocus on core •F ocus on ability and stability •H elps prepare your body for surgery •P revents injury Cons •P rehab work can be time consuming Feedback ‘Prehab or prehabilitation training is very effective to prevent injuries, and can be important for those about to have surgery,’ says Durban-based biokineticist Debbie Wilson. n

condition, however, may not allow you to perform certain exercises.

‘I would recommend starting at least four weeks prior to surgery and continuing up until the day before the operation.

‘Focus on your needs. For example, for hip- and knee-replacement surgery,

14_KNOWS_Fit4Life.indd 3

is exercise for body and brain,’ says Evelyne Aregger Esterhuyse of Cape Ballet Centre. www.capeballetcentre.co.za

do specific exercises that focus on strengthening the thigh, hip flexors and hip abductors as well as core strengthening.’

Dr Marc Nortje, Cape Hip and Knee Practice, Life Orthopaedic Hospital, Life Vincent Pallotti Hospital www.capehipandknee.co.za www.lifehealthcare.co.za

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2015/11/18 12:56 PM

pregnancy and diabetes Being diagnosed with gestational diabetes might sound overwhelming at first, but the condition is more common than you may think. Charlene Yared-West finds out how you can protect your baby and you during pregnancy

G

estational diabetes only happens during pregnancy and affects about 18 of every 100 pregnant women. Even women who do not have pre-existing diabetes can experience the condition in pregnancy. So, what are the risks and how can they be overcome to ensure a healthy mom and baby throughout nine long months? Life spoke to Dr Bandile Masuku and Dr Gaontebale Matlhaga, two obstetrician-gynaecologists from Life Suikerbosrand Hospital.

What causes gestational diabetes?

Pregnancy can affect the way a woman’s body usually processes sugar. Under normal circumstances, explains Dr Matlhaga, food is ingested and digested, and glucose from the food enters the bloodstream. ‘In response to this increase of sugar in the blood, the pancreas releases the hormone insulin, which helps to move the sugars from your bloodstream and into your body’s cells, where it is used as energy,’ he says. ‘In pregnancy, however, the placenta produces pregnancy hormones, which impair the action of insulin, then automatically raises the blood sugar levels.’ As your pregnancy progresses and your baby grows, the placenta, he says, produces even more insulin-blocking 16

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e st

GROWING LIFE

hormones, creating a cycle of increased blood sugar levels. He adds that the condition is most common from around 20 weeks of pregnancy, but generally not earlier than that.

‘It isn’t always easy to notice signs or symptoms, which are non-specific, so they are usually picked up in a urine test, which is then followed up with a fasting blood test to ascertain if the woman has this condition,’ he says.

WHAT ARE THE DIFFERENT TYPES OF DIABETES?

• Diabetes mellitus, otherwise known as diabetes, is a metabolic condition involving uncontrolled high blood-sugar levels over a long period of time. Symptoms can include increased hunger and thirst, as well as frequent urination.

• Type 1 diabetes: This is an autoimmune disease, where the pancreas produces very little or no insulin. It is most common in people under the age of 20.

• Type 2 diabetes: This disorder is commonly found in people who gain weight as they get older, are obese or who have a sedentary lifestyle. The pancreas does not produce enough insulin, or the body does not use insulin properly.

It can be considered a lifestyle disease, which is usually triggered by little or no exercise and being overweight.

• Gestational diabetes: Occurs in pregnancy. The body cannot produce enough insulin due to weight gain and hormonal changes.

WHO IS AT RISK?

Any pregnant woman can develop gestational diabetes, but some are more at risk than others: • Women older than 25 • Women with polycystic ovary syndrome • Family or personal history and pre-pregnancy diabetes • Women with a body mass index of 30 or higher • Women who are black, of Indian origin or Asian • Women who have previously had gestational diabetes.

WHAT ARE THE COMPLICATIONS OF DEVELOPING GESTATIONAL DIABETES?

If left undiagnosed, the complications for mother and baby can be dire, explains Dr Masuku. ‘Babies are born with a high birth weight because of the extra glucose in the bloodstream, which crosses the placenta and triggers the baby’s own pancreas to make extra insulin – and this causes the growth rate to speed up. As a result, many babies with this condition, known as macrosomia, are born via caesarean because of their size,’ he says.

‘Preterm labour is also a risk, which means that the baby’s lungs are not fully developed and he or she will not be able to breathe on their own. In addition, babies can also develop low blood sugar because their insulin production is so high, which can also lead to seizures. As a result, the blood sugar levels in the baby must be closely monitored after birth to help normalise their blood sugar level.

Babies of mothers who have gestational diabetes also have an increased risk of developing obesity and type 2 diabetes later in life,’ Dr Masuku adds. Gestational diabetes can also increase the risk

Ntsako is managing her diabetes with a balanced diet and exercise

CASE STUDY

Ntsako Ndlovu

‘I was 30 weeks pregnant, on the highway and driving to work one winter’s morning in June, when I suddenly felt extremely hot, so I opened the car window. I felt terribly nauseous and started vomiting, so I moved over into the slow lane.

Luckily, I was close to the office, but the nausea wouldn’t go away and I started vomiting more. My colleague took me to hospital, where I was kept for observation. They measured my sugar levels, which were exceedingly high, and wouldn’t return to normal even that evening when the tests were repeated. It was decided to put me on insulin, which brought my levels back to normal. I also had to speak to a dietitian who advised me on diet and exercise. Diabetes is hereditary in my family; both my parents and sister have it, but I did not – and I thought I was having a healthy pregnancy; no morning sickness or nausea, I only had fatigue. It was very frustrating for me to have this condition and, of course, I was worried about the health of my baby. Thankfully, through diet and injectable insulin, I controlled my sugar levels well and my 4.5kg baby girl, Humelelani, was born on July 22 last year, via caesarean section. The gestational diabetes cleared after I had given birth, but after a health screening at work about a year later, it was determined that I had diabetes type 1, which I now manage with medication and a strict diet.’

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growing life

of high blood pressure and preeclampsia, which are also dangerous to mother and baby.

Furthermore, women with gestational diabetes also often develop future diabetes, whether in a future pregnancy or type 2 diabetes later in life.

Why is it challenging to FALL pregnant when you have diabetes?

PREPARING for pregnancy: consult your ob/gyn

‘It would be beneficial for all women who want to fall pregnant to see their obstetrician/gynaecologist before conception, for counselling

MEET OUR experts 18

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It’s important to gain control of blood sugar levels before pregnancy and to develop a plan, especially if they have diabetes as an existing condition. It is important to gain control of blood sugar levels before pregnancy, which can also help to avoid the onset of gestational diabetes,’ says Dr Masuku. ‘It is also more challenging for women who have pre-existing diabetes to fall pregnant, so a consultation can help to see where the problem is and also to create a programme, which includes dietary advice and exercise guidelines. It even helps if a woman can lose extra weight before conception to achieve a healthier pregnancy and lower her chances of getting gestational diabetes.’

Dr Gaontebale Onthatile Matlhaga is a specialist obstetrician and gynaecologist at Life Suikerbosrand Hospital. He has a special interest in minimal access gynaecological surgery and women’s health.

Managing the condition According to Dr Masuku, it can be psychologically challenging and inconvenient to be diagnosed with gestational diabetes, because of the lifestyle and dietary changes that come with the treatment strategy.

‘Daily checking of the sugar levels before and after meals, is necessary to make sure levels are within a healthy range,’ he says. ‘In addition, eating the right kinds of food in healthy portions is one of the best ways to control sugar levels and help to avoid weight gain.

Exercise also plays an important role and can help lower your blood sugar by encouraging your body to move glucose into your cells where it will be burned for energy – and less insulin will be necessary.’ He adds that if diet and exercise are not impacting your sugar level, medication might be necessary, which is assessed on an individual basis. ‘Medication in oral form and injectable insulin might be necessary to control the condition.’ n

i m a g e S g et t y /g a llo i m ag e s

Women suffering from type 1 or type 2 diabetes usually face challenges when trying to fall pregnant, as the ‘conception environment’ can be compromised, explains Dr Matlhago. Type 1 diabetes sufferers also tend to have higher incidences of miscarriage or have a baby born with a birth defect.

In a healthy person, food is digested with the help of the hormone insulin, but in diabetics, there are flaws in this metabolism system. Hormones and hormone production are an essential part of the reproductive process, especially for a person wanting to conceive, and diabetics have a compromised system of hormonal control. ‘In addition, diabetic men may also want to consult their doctor about problems that can arise, such as erectile dysfunction and damaged nerves, which can cause the sperm to enter the bladder during ejaculation, he adds.

Dr Bandile Masuku is an obstetrician and gynaecologist at Life Suikerbosrand Hospital. He’s also head clinician for the twin clinic at Chris Hani Baragwanath Hospital, and a keen teacher and researcher.

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FIRST PERSON

‘I HAD NO IDEA I WAS HAVING A STROKE’ In September 2013, 38-year-old Bonette Schmahl, a PA, went to work as usual despite feeling numbness on the right side of her body. She brushed off slight slurring and dizziness as ‘exhaustion’. By the time she realised something serious was happening, she was already paralysed…

I

had a very busy life and I knew I was run down. I’d just done a five-kilometre fun walk despite having a touch of the flu, and was pushing myself to get fit for summer, walking on a friend’s treadmill and taking diet tablets to help me lose a few kilos. My daughter and husband were both concerned about my speech that evening. I also felt a little dizzy and was surprised to discover that I couldn’t hold my left arm in the air while drying my hair. It was later, when I developed a blinding headache, I realised something was wrong and woke my husband. I was disorientated and unable to stand, and by the time we got to hospital I was completely paralysed down my left side.

My family was shocked to hear I’d had a stroke, but I was pretty much out of it.

It had come out of the blue: I was fit, young and healthy, had never smoked or drank alcohol, and there was no history of stroke in my family. After I was stabilised, I was transferred to the Life Rehabilitation Unit at Life Eugene Marais Hospital. By that stage, I knew what had happened and I was an emotional and physical wreck.

I couldn’t stop crying and gave my rehab team a hard time as I’m not a patient

LIFE PLUS

patient. I hated being an invalid who had to rely on others and I wanted everything fixed now. I’m fiercely independent and fought with them to do things on my own, until I found myself in surgery after a fall that tore the ligaments of my left foot.

That was the wake-up call I desperately needed. With the support of my family and the amazing doctors and staff, I learnt the tough life lesson that there’s no such thing as a quick fix – goodbye diet tablets – and that most things worth fighting for take time.

I had to learn to swallow my pride, and accept that recovery is a slow process and my journey to reclaim my life would be all about baby steps – physically and mentally – with lots of ups and downs.

I’ve raged against what’s happened to me and constantly blamed myself for ignoring the signs. But going back to work made a difference, while the support of family and friends got me through each day.

My focus right now is to regain the remaining 20% of strength on my left side, while respectfully listening to my body. I have a lot to live for, so for the first time ever, I’m doing my best to appreciate and enjoy, while allowing myself to heal. ■

Bonette’s story highlights that stroke in younger people does happen and symptoms should never be ignored, says Dr du Preez. If you’re not sure about symptoms, remember the acronym FAST. F: Fallen or drooping face, especially on one side. Ask the person to smile.

Something is wrong if he/she is unable to raise both corners of the mouth.

A: Check for ability to raise arms and keep them there. If one arm drifts downwards, something is wrong.

S: Slurred speech. Ask the person to repeat a simple phrase.

Bonette’s courage and determination is helping her heal

IN HER DOCTOR’S WORDS

According to Dr Sammy du Preez, a rehabilitation doctor at Life Eugene Marais Hospital, all Bonette’s medical tests revealed no apparent reason for her suffering a stroke. ‘She had no risk factors, such as hypertension, diabetes, clotting disease or high cholesterol, and was young, healthy, a non-smoker, on target weight and very active. She was, however, taking over-the-counter diet tablets that may have been a contributing factor, and using an oral contraceptive.

Despite the uncertainty about her health and future, she was highly motivated to participate in her rehabilitation programme and improved markedly. She had excellent family support. Her speech and facial paralysis recovered fully with therapy and she has regained movement in her left arm, although she’s still struggling with spasticity of her left hand. She’s returned to work, is caring for her family and participating in a full social life. She’s an excellent example to all stroke sufferers of what can be achieved with support, motivation and full participation in a rehabilitation programme.’

Check for the presence of strange or slurred words.

T: Impact of time. Seek immediate medical help if you notice any of the above symptoms, as it’s vital to be treated at a stroke unit/ emergency unit as soon as possible.

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t h e wa y w e e a t

Sunflower, olive, canola oil … the supermarket shelves groan with choice. But what’s the difference and how do you know which one to pick? By Catherine Eden

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Know your fats

‘Fat is an important dietary component,’ explains Tristie van der Spuy, a dietitian at Life Rosepark Hospital. ‘It makes food more palatable; it allows fat-soluble vitamins to be absorbed and it builds cell membranes. Up to 35% of your daily energy intake can come from equal portions of saturated, monounsaturated and polyunsaturated fats.’

Saturated fat was outlawed for years for its possible links to heart disease, but it is now known that a certain amount is necessary for good health. Oils that become solid at room temperature contain saturated fats and include palm kernel oil, coconut oil, ghee and butter. Monounsaturated oils are liquid at room temperature but start to solidify when chilled. These include extra-virgin olive oil, canola oil and peanut oil. Polyunsaturated fats (sunflower, corn and nut and seed oils) are liquid at all temperatures.

They are high in omega-6 fatty acids, which must be balanced by anti-inflammatory omega-3 fatty acids to create the correct ratio for health.

Cook with a stable oil

The oil you choose to cook with must be stable when heated to a high temperature. Saturated fats like butter and lard have made way for mono- and polyunsaturated vegetable oils, many of which, when 20

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Which oil is best?

ever have food choices been more hotly debated. The current arguments may leave you confused, but the positive spin-off has been to raise public awareness around nutrition: more and more of us are trying to find out what is in the food we eat so that we can make healthier decisions.

Oil is a kitchen staple, but faced with an ever-growing array of options, it’s hard to know which to choose. You’ll still need to do your homework before you buy, but here are a few things to consider.

heated, oxidise and become rancid with damaging consequences to your health. To counter this problem, a process called hydrogenation turns vegetable oils into solids and prevents them going rancid. Unfortunately, dangerous transfats are a by-product of this procedure, increasing your risk of developing breast cancer and heart disease. The bottom line is to choose cooking oil that has not been heated, hydrogenised or genetically modified.

The closer the oil is to the original plant (cold pressed), the better.

Olive oil

Olive oil is high in oleic acid, a monounsaturated fat, which makes it more stable than a polyunsaturated oil. It can be used at moderate temperatures, but should not be heated above 200°C or it may oxidise. ‘Extra-virgin olive oil is better than other vegetable oils because of its cold-pressed extraction technique and its rich mix of antioxidants,’ says Tristie van der Spuy. Ripe, unfiltered oil should have a rich, gold colour and a slightly cloudy appearance. Best used for drizzling over food or in salad dressings. It can also be used for a light stir-fry.

alternative to polyunsaturated vegetable oils as it is low in saturated fat, high in monounsaturates and a good source of omega-3 fatty acids, however, some critics are not convinced.

The Cancer Association of South Africa (CANSA) awarded its Seal of Recognition to canola oil that is produced from South African-grown GMO-free canola.

Linseed (flaxseed) Oil

This seed oil has a high omega-3 content and is considered something of a health food. It should be kept in the fridge and used sparingly in salad dressings. It should not be heated.

Others claim it is a wonder oil with many health benefits. In its favour is that it is very stable at high temperatures, so it can be used for roasting or frying too.

Palm and palm kernel oil

After coconut oil, these two oils are the most saturated of the vegetable oils. Unprocessed palm oil, which should be reddish in colour, is bursting with antioxidants and vitamins. It’s mostly used in the food industry as a replacement for hydrogenated oils in processed food, but palm oil can be used for cooking too. n

Coconut oil

As with olive oil, you need to know how your coconut oil has been produced. Look for certified organic varieties that have not been refined, bleached, hydrogenised or deodorised. Coconut oil is a highly saturated fat (92%) and is consequently frowned on by some.

Sunflower, corn and cotton seed oils These polyunsaturated oils are all very high in omega-6 fatty acids and very low in omega-3. They should not be used for cooking, frying or baking as their chemical structure changes at high temperatures.

Hybrid sunflowers, high in oleic acid, are more stable than traditional plants, but cold-pressed oil from these plants is hard to come by.

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Canola oil

Canola stands for Canada oil, which is where the plant was developed in the 1960s. They are a genetically modified form of the rapeseed plant, whose seeds contain a harmful substance called erucic acid. Canola has been bred to all but eliminate this substance, and is now widely promoted as a ‘heart-healthy’ all-purpose

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mind wise

surviving the lonely

season The festive season may promise good cheer, but for some it’s the loneliest time of the year. Help is available, says Catriona Ross

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I M A G E : B e t h S t u d e n b e r g / t h e l i c e n s i n g p r oj e c t. c o m

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treets are aglow with twinkling lights, shops are filled with glossy gifts and Christmas carols, and everyone’s excitedly discussing holiday plans.

It’s the best time of year, right? Not if you’re feeling lonely. ‘Although there isn’t an increase in the number of calls we receive over this period, we do see that the reasons for people calling are more linked to loneliness,’ says Cassey Chambers, operations director at SADAG, the South African Depression and Anxiety Group.

‘We also get calls from people who may be experiencing the festive season by themselves – having their first Christmas without the kids after a divorce, for example. It’s important for them to know that they aren’t alone, and they don’t have to suffer in silence.’

In reality, loneliness affects everyone at times, from orphaned children to the bereaved elderly.

‘Many people are lonely during the holidays,’ confirms Dr Hemant Nowbath, a psychiatrist at Life Mount Edgecombe Hospital in Durban.

Loneliness often results from unavoidable life changes: a bereavement, divorce, retrenchment, empty nest or estrangement from a family member.

(According to British charity StandAlone, one in five families experience estrangement.) ‘Everyone experiences loss at some stage, and a holiday without that loved one present,’ says Dr Nowbath.

Those who are physically isolated – living on their own, for instance – are equally vulnerable since ‘loneliness is fuelled by isolation’, adds

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Dr Marius Welgemoed, a psychiatrist at Life Groenkloof Hospital in Pretoria.

When loneliness leads to more

Festive season loneliness often presents with depression, fatigue, aches and pains, shifts in your sleep pattern along with low self-esteem and a lack of pleasure in life.

A spate of holiday-season loneliness may lead to something more serious, warns Dr Welgemoed. For those predisposed to a mood disorder, such as depression, it can precipitate the development of the disorder. Paradoxically, some people isolate themselves when they are feeling lonely, which can exacerbate the problem.

According to a new study by researchers at Brigham Young University, both feeling lonely and actually being socially isolated are potentially damaging. The subjective feeling of loneliness increased the risk of mortality by 26%, while social isolation and living alone increased it by 29% and 32% respectively.

I M A G E : B e t h S t u d e n be r g / t hel i c e n s i n g p r o j e c t . c o m

To cope, reach out

‘When you’re lonely, make emotional contact. You need someone to talk to, to share your emotions with,’ says Dr Welgemoed. Cultivate a social group that meets regularly, throughout the holidays, from friends to ballroom dancers to a Run/Walk for Life group, or consider volunteering (see ‘A Circle of Caring on page 58 for recommendations). ‘A group gives you a sense of belonging, and we all have a need to belong,’ notes Dr Nowbath.

And opt for real, regular contact, since reliance on social media for daily interaction can increase loneliness when you’re home alone for the holidays.

‘We’re so well-connected on the internet that we don’t connect to each other,’ notes Dr Nowbath. Instead of messaging friends for birthdays and special occasions or simply to say ‘hello’, pick up the phone.

meet OUR experts

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When a loved one has died or you’re apart from those you love, acknowledge and express your feelings – feeling sad is normal. Plan a response to well-meant inquiries like ‘What are you doing for Christmas Day?’ You could say, ‘I’m helping at a charity for the homeless’ or ‘I’ve decided not to go home this year’ or ‘I’m spending the day in my new flat’, recommends StandAlone. Should your feelings become severe, consult a professional, as you may require medication to help you through this time.

Starting a new tradition

If you spent the last festive season sad, try actively changing your pattern, Dr Nowbath recommends. Go to a friend’s house for Christmas Day; invite people over; go on a holiday.

Kate Finley*, 38, a media manager from Cape Town, broke her pattern.

‘We’d always had a big, traditional family get-together for Christmas, but some years after my dad died, I’d had a big fight with my brother and it was just me and my mom for Christmas for the first time, no kids, no grandparents. We were trying to plan a Christmas dinner at home but we decided to go out for a seafood dinner instead and splurge on prawns and lobster! We started our own tradition.’

This year, Kate is hosting Christmas lunch at her house with her newly adopted baby daughter. All the family is invited, including her brother and his family, with whom she has reconciled. ‘To others who are feeling lonely: it doesn’t stay like this forever. Life is about light and dark times,’ she says. ‘Do something completely different: be adventurous, treat yourself. Create new memories and traditions instead of trying to recreate what you had before.’ n *Name has been changed

For help, call SADAG on 0800 12 13 14

Dr Hemant Nowbath (left) is a psychiatrist in private practice at Life Mount Edgecombe Hospital, and Dr Marius Welgemoed is a psychiatrist at Life Groenkloof Hospital.

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life quiz

Read every statement carefully and indicate which option applies best to you and your feelings, attitudes, behaviours and life in general. After finishing the test, you can sum up your points using the scoring table and view the relevant results for you.

2. I run into obstacles that keep me from reaching my goals.

what’s your emotional iq?

Some researchers say emotional intelligence can be learnt and strengthened while others claim it’s inborn. Take our test to learn more

F

or decades, a great deal of emphasis has been put on certain aspects of intelligence, such as logical reasoning, maths skills, spatial skills and verbal skills. However, researchers were puzzled by the fact that while IQ could predict academic performance to a significant degree, and professional and personal success to some degree, there was something missing in the equation. Some of those with fabulous IQ scores were doing poorly in life – but why? They were wasting their potential by thinking, behaving and communicating in a way that hindered their chances to succeed. It was then theorised that one of the major missing variables in the success equation was emotional intelligence.

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A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false 3. Even when I do my best, I feel guilty about the things that were not done perfectly.

A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false 4. I am able to stop thinking about my problems.

A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false

A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false 7. When someone I care about is sad, I feel sad too.

A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false 8. Some people make me feel bad about myself, no matter what I do.

A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false 9. Everything I try to do ultimately ends in failure.

A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false

5. I am bored most of the time.

10. I am not satisfied with my work unless someone else praises it.

A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false

A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false

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i m a g e S g e t t y/ g al lo i m ag e s, I s to c k

A Completely true B Mostly true C Somewhat true/false D Mostly false E Completely false

6. I feel like I worry about things that other people don’t even think about.

C O P YR I G HT 2 01 5 – WWW. QUEE N D OM. C OM

1. When I mess up, I say self-deprecating things, such as ‘I am such a loser,’ ‘Stupid, stupid, stupid,’ or ‘I can’t do anything right’.

life quiz

s c o r in g yo u r s e lf

C O P Y R I G H T 2 0 15 – W W W. Q UEEN D O M. CO M

i m a g e S g et t y /g a l lo i mag e s , I s to c k

QUESTION 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

WHAT IS EIQ?

a 0 0 10 0 0 10 0 0 0 0

B 2 2 2 8 2 2 8 2 2 2

C 5 5 5 5 5 2 5 5 5 5

D 8 2 2 2 8 8 2 8 8 8

E 10 10 10 0 10 10 0 10 10 10

0–50

50–80

80–100

Your emotional intelligence will require some development.

On a positive note, awareness is a healthy first step towards improvement. Emotional intelligence can be improved with knowledge and practice.

Start by making a conscious effort to put yourself in other people’s shoes. Think about how your words or actions will affect others, and try to see the world from their point of view. Making it a point to pay attention to people – their words, facial expressions, body language – can teach you a lot about interaction, emotions, and human nature. While you certainly can’t fake empathy, you can increase your connection to other people by truly listening and trying to understand things from their perspective. You may also find it helpful to seek the guidance of a therapist or life coach to help you learn and practise more effective ways of dealing with your emotions and those of other people. The benefits of improving your EIQ will be numerous, including stronger relationships, a more successful career and personal happiness.

Overall, you are fairly skilled at understanding and dealing with emotions. This is likely evident in your ability to relate to others, express your needs and maintain a satisfactory level of emotional balance. Since your score is in the mid-range, however, you are not taking full advantage of your potential.

Try as much as possible to stay in touch with your feelings.

Pay attention to what triggers certain emotions and how you react. For example, when you’re upset, sad or angry, how does your body react? What are the signs? Learning to recognise how you respond to different sentiments can help you become more in tune with your emotions. If you are a little uneasy expressing your feelings, take small steps.

For positive feelings, start by expressing genuine compliments and then take it further to appreciation or gratitude. When you need to communicate a negative feeling, try writing down what you feel if you’re too intimidated to say it. Like any new skill, it will get easier with practice.

Your emotional intelligence is well developed. This means that you are able to express your feelings clearly and appropriately in a variety of emotionally charged situations, and are comfortable dealing with other people’s emotions as well. You own your emotions, both good and bad, and use them to guide your judgment, reasoning and decision-making.

Not only does your ability to deal with emotions benefit and enhance your relationships with others, it also allows you to create a better relationship with yourself. Continue to explore your inner self by making a list of your strengths and limitations, and ways in which you can improve in any weak areas. The more in touch you are with who you are, the better you will be able to understand and handle your emotions.

Likewise, when you need to deal with a touchy situation like an argument, always take a moment to ask yourself how you would feel if you were in the other person’s situation.

Remember, when it comes to emotions, awareness is key.

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In the late 1990’s, emotional intelligence (EIQ) was one of the hottest buzz-phrases in contemporary psychology. In the business world, it became a hot topic largely due to one author’s claim that a high EIQ was one of the best predictors of success in the workplace. In his 1995 book Emotional Intelligence: Why it Can Matter More than IQ, Daniel Goleman used an early definition by researcher Peter Salovey, which stated that the construct of EIQ includes knowing one’s emotions, emotional self-control, motivation and persistence, recognising emotions of others, and successfully handling relationships. Goleman made some very strong statements in his book, including the suggestion that EIQ is one of the main keys to success in life. He implied that emotional intelligence is at the root of many of life’s puzzles. Why are some smart people unsuccessful? Why do certain individuals strike out at others in a violent manner?

Why do some excel at managing people while others struggle? He hinted that EIQ was an answer to these mysteries, along with many of life’s other questions. n www.lifehealthcare.co.za

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OFF TO THE MARKET WE GO Whether you’re in search of paleo-friendly food, fresh organic vegetables or the best artisanal bread and beer, you’re guaranteed to find what you’re looking for at one of these local foodie markets.

By Estee Kershoff

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• Market on Main is a weekly market in Maboneng Precinct that trades in regional foods and fresh produce, as well as sweet treats, art and vintage clothing. It holds a night market on the first Thursday of every month, from 7pm to 11pm, and trades every Sunday from 10am to 3pm at Arts on Main. www.marketonmain.co.za • The Banting Food Market in Pretoria holds regular market days on the first Saturday of the month from 9am to 1pm at the Pretoria National Botanical Garden. Expect to find banting- and paleo-friendly food, such as pizza, sugar-free ice cream and even milk tart from a wide selection of superb suppliers. www.bantingmarketpretoria.co.za • The Neighbourgoods Market is held in a lively, inspiring spot in the heart of Joburg, stocked to the brim with fresh produce and creative wares. Look out for Tutto Food Co – the oldest food truck in Jozi – and Fine & Raw’s artisan organic raw chocolates. They trade every

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GAUTENG

JOURNEY

Saturday from 9am to 3pm, at 73 Juta Street, Braamfontein.

The Cape Town instalment is based at 373 Albert Road, Woodstock. www.neighbourgoodsmarket.co.za • Jozi Real Food Market is an outdoor farmers’ market supporting local small producers, and offers a wide selection of fruit, veggies and freshly baked goods.

You can also expect live music and entertainment. Visit every Saturday, 8:30am to 1pm, and bring your pets (they’ll welcome your four-legged friends), at Pirates Sports Club, 25 Braeside Avenue, Greenside.

• Bryanston Organic & Natural Market is Johannesburg’s original outdoor market. It sells locally produced, artisanal products and organic, natural, fresh produce, delicatessen foods and delicious baked items. They trade every Thursday and Saturday from 9am to 3pm, and start their Tuesday evening moonlight markets on 17 November to 22 December, from 5pm to 9pm. Find them at 40 Culross Road, Bryanston. www.bryanstonorganicmarket.co.za

i m a g e S gett y/ ga l lo i mage s , ga l lo i mage s/ AF P

WESTERN CAPE

• Root44 Market outside Stellenbosch is the perfect spot to gather with family or friends. Enjoy the wide selection of food on offer and sip on local wines and craft beers while stretching out on the shaded lawns listening to live music. Rain or shine, they’re open every Saturday and Sunday from 10am to 4pm at Audacia winery, corner of Annandale Road and the R44 between Stellenbosch and Somerset West. www.root44.co.za • The V&A Food Market offers delicious food – and superb shopping. Stop by to enjoy everything from sweet treats and bubble tea to delicious artisanal street food. Open daily from 10am to 7pm in the historical The Pumphouse building off Nobel Square at the V&A Waterfront. www.waterfrontfoodmarket.com • Earth Fair Market in Tokai has a variety of food and crafts. Operating out of the South Palms Centre on Wednesdays and Saturdays, the market moves outside and into the city centre on Thursdays, turning into a vibey open-air affair. Expect to find free-range meat, organic veggies, speciality breads and fresh fish. They trade on Saturdays

9am to 2pm and Wednesdays 3pm to 8:30pm at the South Palms Centre, 333 Main Road, Tokai; and every Thursday 11am to 3pm at Upper St George’s Mall in the CBD. www.earthfairmarket.co.za • The Palms Market is all about fresh food and farm-style produce with more than 40 food stalls, including Darling Gourmet Mushrooms, Stonehill Olives, Wayland’s Nguni Meats and Eureka Mills Bread. Visit every Saturday from 9am to 2pm at The Palms Décor and Lifestyle Centre, 145 Sir Lowry Road, Woodstock. www.palms.co.za

KWAZULU-NATAL

• I Heart Market pops up once a month on the Imbizo Lawns outside the Moses Mabhida Stadium. Go for the great vibe, local crafts and good food – best enjoyed picnic-style on the green grass. They trade on the first Saturday of every month, 9am to 2pm. www.iheartmarket.blogspot.co.za • Shongweni Farmers & Craft Market is a charming country market, which is perfect for the entire family, including Jock. Expect to find everything from traditional English sausage to delicious baked goods and artisanal cheese as well as Middle Eastern and Mediterranean specialities, such as baklava and falafel.

Trading hours are every Saturday, 6:30am to 10:30am, corner of Alveston and Kassier Roads, Shongweni. www.shongwenimarket.co.za • The Morning Trade, a weekly food market, is the perfect place at which to stock up on wholesome, fresh produce and meat for the week ahead. Visit Sundays, 8am to 1pm, at 15 Station Drive, Durban. www.themorningtrade.co.za • The Stables Lifestyle Market is an iconic Durban venue, offering a family and pet-friendly outing. There’s a wide variety of food to try, from Indian and Chinese to German and South African. These scrumptious eats as well as interesting wares are available every Sunday from 10am to 5pm, and Wednesdays and Fridays 6pm to 10pm, at 9 Jaco Jackson Drive, Durban. They’ll also be open 5:30pm to 10pm every evening from 11 December to 4 January. www.stableslifestylemarket.co.za n

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Gifts galore Looking for gift inspiration? Why not skip the bustling malls in favour of one of these local markets?

CAPE TOWN

Blaauwklippen Twilight Christmas Market The market offers an ideal opportunity to do some Christmas shopping with a wide variety of fashion, jewellery, lifestyle products and even something for your furry friends.

15 to 19 December, from 5pm to 10pm, Blaauwklippen Estate, Stellenbosch.

Kirstenbosch Craft Market Approximately 180 crafters sell original, hand-crafted goods of a very high quality. Proceeds from stall rentals go to the Development Fund for Kirstenbosch Gardens.

13 and 20 December, Stone Cottage grounds, corner of Kirstenbosh and Rhodes Drive, Newlands.

JOHANNESBURG

Kamersvol Geskenke Unique, creative gifts and a festive atmosphere will make your KAMERS experience unforgettable.

1–6 December, Open Window, Southdowns, Irene, Pretoria.

DURBAN

I Heart Christmas Market, The Christmas edition of this iconic Durban market promises entertainment, food and the perfect opportunity to support local designers and crafters.

7, 14 and 21 December, Imbizo Lawns, Moses Mabhida Stadium, Durban.

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ADVERTORIAL

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textiles is required. Since 2001, PrionTex has been manufacturing and supplying high-quality medical textiles for surgical drapes, gowns, procedure packs and decontamination suits to healthcare facilities locally and abroad. The proprietary laminate fabric we have created is strong and durable, absorbent, breathable yet impermeable to fluids, and provides a barrier against viruses and bacteria.

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PrionTex provides cost-effective and tailored solutions, which include consultations between surgeons and our company’s trained clinical team. Our products conform to the highest international standards and benchmark with the best in the world.

For more information or to schedule a consultation with PrionTex: Call 011 237 5900 or 021 797 1878 Visit www.priontex.com

• Cost-effective solutions • An environmentally responsible approach

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2015/11/17 2:00 PM

HEALTH

SUN SMARTS / LIFE HILTON’S GREEN HOSPITAL / E-CIGARETTES / WATER SAFETY FOR KIDS

‘In an age of speed, I began to think, nothing could be more invigorating than going slow.’

i m a g e S g e t t y /g a llo i m ag e s

Pico Iyer, The Art of Stillness

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Sun Smarts Sun exposure is the most preventable risk factor for all skin cancers, including melanoma. Hereâ&#x20AC;&#x2122;s how you can have fun in the sun and be safe. By Jamie Parker

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I

t’s summer, it’s the holidays, and there’s a good chance your plans include a lot of sunshine.

We all need some sun exposure in order to develop vitamin D, but the sun carries one important danger: exposure to its ultraviolet (UV) rays means an increase in your risk of skin cancer.

In 2010, the Cancer Association of South Africa published statistics indicating that skin cancer is the most common cancer in South Africa, with about 20 000 reported cases every year and 700 deaths. We also have the second highest incidence of skin cancer in the world after Australia – clearly South Africans aren’t protecting themselves adequately in the sun.

‘The simplest thing to remember about skin cancer and sun exposure, is that skin that changes colour is usually in trouble,’ says Dr Noufal Raboobee, dermatologist at Life Westville Hospital in Durban. ‘There is no such thing as a safe tan or protective tan – tanned skin is damaged skin. And it doesn’t matter whether you tan in the sun or on a sunbed, both increase your risk of skin cancer.’

Dr Raboobee says there are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma (although there are other, less common ones too). Basal and squamous cell carcinoma usually occur on sun-exposed areas of your body, and melanoma can develop

meet our expert

anywhere on your body, in otherwise normal skin or an existing mole that becomes cancerous.

‘Skin cancer forms when there are mutations in the DNA of skin cells,’ he says. ‘The mutations cause the cells to grow out of control, and they form a mass of cancer cells. The origin of the cell giving rise to the cancer determines its type, as well as your treatment options.’

The key with skin cancer is to act early – if you notice any changes to your skin that worry you, it’s best to err on the side of caution and see a dermatologist. Not all skin changes are caused by skin cancer, but it’s better to be safe.

‘Your dermatologist will look carefully at your skin to begin with,’ Dr Raboobee says, ‘but some further testing may be required. Usually, we do a biopsy, where we remove a sample of the suspicious skin for lab testing. This will tell us if it’s cancer or not. If we establish that it is cancer, total removal of the cancer is the main goal’.

Skin cancers like basal cell carcinoma rarely spread, so often the biopsy will remove the whole growth. But if you have a large squamous cell carcinoma or melanoma, your doctor may recommend further tests to determine the extent of the cancer. These could include testing nearby lymph nodes to see if the cancer has spread or not.

There are four stages of cancer: stage I means the cancer is small and contained

Know your ABCs It’s helpful to remember ABCDE when you’re checking your moles.

Get yourself checked out if you’re concerned about any of the below: • Asymmetry Appearance of one half is different to other.

• Border The edges are ragged, notched or blurred.

•C olour The colour of the mole isn’t uniform.

It’s mottled and there are shades of tan, brown and black. There may be dashes of red, white and blue.

• Diameter Any mole bigger than a pencil eraser needs to be checked out.

•E volution The size, shape, symptoms or surface of the mole have changed.

Itchiness, tenderness and bleeding are all signs that you need to see a doctor.

Dr Noufal Raboobee is an examiner for the Colleges of Medicine of South Africa, Faculty of Dermatology, and was a senior lecturer at the University of KwaZulu-Natal until 2014. He is presently the president of the Vitiligo Society of South Africa and a member of the International Vitiligo Working Group. His special interests include phototherapy, skin cancers, laser and surgical treatment of vitiligo and biologic treatment of psoriasis.

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Melanoma

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Skin cancer symptoms

Your best defence against skin cancer is prevention

1

Basal cell carcinoma • Usually on the face or neck • A waxy or pearly bump • A flat, flesh-coloured or brown scar-like lesion

2

3

Melanoma

• Most often appears on the face or trunk of men, and the lower legs of women • Can appear anywhere and affect anyone regardless of skin tone • A large brownish spot with darker speckles • A mole that changes in colour, size or feel, or that bleeds • A small lesion with an irregular border and portions that appear red, white, blue or blue-black Source: mayoclinic.com

Risk factors Factors that may increase your risk of skin cancer include: • Fair skin • A history of sunburn • Sunny or high-altitude climates • Moles • A family history of skin cancer • A personal history of skin cancer • A weakened immune system • Exposure to radiation

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to the area it began in, whereas stage IV means your cancer is advanced and has spread to other areas of the body. Once the stage has been established, your doctor will decide on the most appropriate course of treatment.

Your best defence against skin cancer is prevention, and there’s a lot you can do to protect yourself: 1. Avoid the sun during the middle of the day – between 11am and 2pm the sun is at its strongest. But don’t forget that even in winter or on a cloudy day, UV radiation still gets through.

2. Wear sunscreen every day of the year. Sunscreens aren’t perfect, but they do play a starring role in a good sun-protection programme.

3. Use a broad-spectrum sunscreen with SPF 20 or more, and reapply often, especially if you’re swimming or perspiring. Don’t forget the sensitive areas like your lips, the tips of your ears, and the back of your hands and neck.

4. Wear protective clothing. Dark, tightly woven clothing that covers your arms and legs, and a broad-brimmed hat will provide the best protection.

5. Look for sunglasses that block both types of UV radiation — UVA and UVB rays.

6. Avoid tanning beds.

7. Check your prescriptions. Be aware that some medicines, including antibiotics, can make your skin more sensitive to sunlight.

8. Examine your own skin at least once a month, with the aid of mirrors, for any changes. Include your palms, soles, spaces between your toes, your genital area and between your buttocks.

The skinny on sunscreens

When choosing a sunscreen, look for one with a sun protection factor (SPF) of between 20 and 50, and if your skin is fair (or very fair) go for larger numbers, preferably SPF 30–50. (Look out for the CANSA Seal of Recognition.)

Sunscreen needs to be liberally applied to all exposed skin at least 20 minutes before going into the sun. But that doesn’t mean you can apply and bake yourself to a crisp without a care in the world; it’s still wiser to stay in the shade whenever possible, and sunscreen needs to be reapplied every couple of hours.

Also be aware that the cream usually expires after two years, so that old bottle that’s been in the back of your cupboard should go straight into the bin.

Finally, look for a broad-spectrum sunscreen, which will protect your skin from both UVA and UVB rays. n

I M A G E S G E T T Y /g a llo I MAG ES , i s t o c k

Squamous cell carcinoma • Usually in areas like the face, ears and hands (except in darker-skinned people, where it can occur on areas not often exposed to the sun) • A firm, red nodule • A flat lesion with a scaly, crusted surface

summer 2015

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Choosing the right sunscreen Sunscreen is an important part of the prevention equation and finding the right one for your specific needs can be challenging. Here’s some help:

BEST FOR WATER SPORTS Island Tribe SPF 50 Clear Gel (100ml) provides maximum protection for water sports enthusiasts with up to four hours of water-resistant protection.

BEST FOR FULL BODY Eucerin Sun Lotion Extra Light SPF 50 (150ml) has a light, non-sticky formula that is easily absorbed.

This broad-spectrum defence is dermatologically tested and can be used on sensitive skin.

BEST FOR FACE EVERY DAY Natural Lab SPF 30 Face Cream (50ml) offers UVA and UVB protection for delicate skin on the face, neck and bust. The tinted lotion is light enough to be applied under make-up.

BEST FOR OILY SKIN Eucerin Sun Gel-Crème Oil Control Dry Touch SPF 50+ Face (50ml) is long-lasting with a matt finish to reduce shine.

The non-comedogenic reduces sun-induced hyperpigmentation.

BEST FOR ANTI-AGING Nivea Sun Anti-Age Face Sun Cream SPF 30 (50ml) moisturises skin while protecting it against premature ageing, fine lines and sun-induced wrinkles.

KIDS TIP

I M A G E S G E T T Y /G A LLO I M AG E S, I ST O C K

Opt for a sunscreen with a sun protection factor (SPF) of 30 or higher BEST FOR CHILDREN Nivea Sun Kids Moisturising Sun Spray SPF 50+, (300ml) is easily absorbed for immediate protection.

The convenient trigger allows for effortless application.

BEST FOR LIPS LipSano SPF 30 moisturises lips with lanolin, beeswax, vitamin E, shea butter and cocoa butter, while protecting against UVA and UVB rays. Also effective in treating cold sores.

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greening medicine

The new Life Hilton Private Hospital in the KZN Midlands is leading the way in green technologically advanced healthcare. Glynis Horning takes you on a tour

H

igh in the forested hills of Hilton, gateway to the lush sprawl of the KZN Midlands, stands a state-of-the-art hospital that exemplifies the global move to green. Its crisp lines may be painted the corporate red, white and blue of the Life Healthcare Group, but like its setting, a striking leaf design on the façade indicates its inner hue.

Hospitals exist to better human health and, today, that rests increasingly on environmental health. Theyâ&#x20AC;&#x2122;re energy- and resource-intensive

enterprises, and by reducing their carbon footprint through design and innovation, these establishments can help create health, economic and social benefits for people, says Indren Poovan, manager of the new Life Hilton Private Hospital, who has overseen its commissioning, building and marketing.

South African figures are hard to come by, however, in England, the National Health Service calculates its carbon footprint at 25 million tons of carbon dioxide equivalents a year.

Fortunately, some health leaders are now extending the Hippocratic Oath

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of abstaining to do harm beyond the doctor-patient relationship, to include environmental health.

Life Hilton Private Hospital is a multidisciplinary, 94-bed hospital with five operating theatres, maternity and paediatric units, and consulting suites for associated specialists. By providing these services to the burgeoning Midlands community and Pietermaritzburg, it can help reduce their transport footprint.

Other green benefits are apparent the moment patients arrive.

In the airy double-volume reception area, patients are greeted by local

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I N N O VA T I O N

photographer Alistair Cotton’s outsize landscapes of the Midlands and the Drakensberg beyond, visible through the hospital’s enormous windows.

Skylights here and throughout the building help reduce the need for lighting and are part of the ‘green scheme’ for the hospital, realised

by Life Healthcare’s engineering manager Andrew van de Water.

All lighting is the energy-efficient LED variety, activated by motion sensors that switch on when someone enters a room and off when they leave, he explains. Heat pumps with heat recovery from the air-conditioning units are used to provide hot water,

One of the maternity wards

For all its green considerations, however, Life Hilton Private Hospital’s focus is firmly on technological health advances for the best available patient care resulting in only a quarter of the electricity demand of traditional element-based hot-water systems.

What this means is that the hospital will use 890MWh less electricity per year to run. ‘That’s roughly equivalent to the requirements of 120 houses,’ says Van de Water.

Large windows are a feature not only in all public areas, including the hospital’s attractive Wiesenhof coffee shop, but in the medical wards, which are all semi-private or private and outward-facing for light and views. They have been built into the aesthetic of the 12-bed ICU and High Care ward, as well as the eight-station renal dialysis unit, 38

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where armchairs have been turned to take in the forest.

Cupboards and flooring in these sections are wood-effect vinyl for sterility but a natural feel, and this has been used to mark pause areas throughout the hospital where the gently curved corridors – another design measure to avoid a clinical feel – are set with sofas, potted succulents and orchids, and hung with botanical prints, encouraging patients and visitors to relax.

For all its green considerations, however, Life Hilton Private Hospital’s focus is firmly on technological health advances for the best available patient care, says Poovan.

‘When you design and build a hospital from scratch like this, you can think about what you want to achieve and implement advances optimally.’

Among those of which he and Van de Water are most proud, is the size of the hospital’s laminar flow operating theatres. Laminar airflow helps avoid surgical site infections by providing uniform, directional airflow that carries any bacteria floating in the air away from areas requiring sterility.

‘Our largest theatre is 74m2 and the smallest 57m2, significantly larger than the industry requirements,’ says Van de Water. ‘This allows surgeons to carry out complex and lengthy

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I M A G E G E T T Y /G A LLO I M AG E S

The paediatric ward

LIFE HEALTHCARE’S

Environmental policy

I M A G E G E T T Y /G A LLO I M AG E S

The intensive care unit with strategically positioned skylights

cases in comfort with all the extra equipment they bring. It also reduces the heat gain and clutter around the operating field, making for a more optimised operating area with, hopefully, improved clinical outcomes.’

He is now preparing for next year’s opening of a high-tech oncology unit supported by 11 oncologists, to feature a cutting-edge radio-oncology device – the Novalis Tx, which produces radiation to target tumours. ‘The Novalis Tx allows for far more accurate “shaping” of the radiation dose, reducing damage to “good” tissue,’ he explains.

‘This and other features allow for rapid treatment of tumours previously untreatable as patients had to be physically restrained to ensure that radiation hit exactly the right spot, and moving organs like the lungs were totally untreatable.’

The advance with which the hospital’s nursing manager Chantelle Coelho is most excited is the installation of one of the country’s biggest hazmat

(hazardous materials) showers at the hospital’s 24-hour emergency entrance.

‘Here anyone exposed to hazardous materials or suffering chemical burns can be rinsed down quickly and thoroughly before being taken to our emergency bays, which are fitted with the latest resuscitation equipment,’ she says.

A state-of-the-art MRI and CT scanner are nearby, and scans and X-rays can be brought up quickly on wall-mounted computer screens instead of printed as in the past, using chemicals. Waste chemicals and their containers are classified as hazardous waste and used to have to be stored and transported as such, Chantelle explains, adding to a hospital’s carbon footprint, so this is a positive green step too.

‘We’re all doing our bit for the environment,’ she says. ‘Nurses and staff use lifts only if we’re accompanying patients on trolleys, else it’s a rule that we take the stairs. It saves electricity – and helps keep us fit.’ ■

The Life Healthcare Group has committed to reduce its carbon intensity by 10% between 2013 and 2018 and has already achieved a 7.08% reduction.

• It has constituted a Group Environmental and Climate Change Forum to monitor its sustainability initiatives and impact.

• It has installed new metres at every facility, connected to the intranet for real-time energy and water monitoring.

• It is converting all conventional geysers to heat pump installations to save energy.

• It is introducing alternative lighting systems to save electricity.

• It has developed a ‘green by design’ policy setting a minimum standard for all mechanical and electrical installations, especially heating, ventilation and air-conditioning systems, which account for up to 60% of total energy consumption.

Life Hilton Private Hospital is the first new facility to be built in line with this policy.

FEATURES OF A GREEN HOSPITAL There is no global standard defining what a green and healthy hospital should be, but according to a discussion draft paper published by the World Health Organisation and the international Health Care Without Harm coalition, these include: 1. Energy efficiency 2. Green building design 3. Transport reduction/efficiency 4. Alternative energy generation 5. Waste reduction; chemical/ pharmaceutical management and disposal safety 6. Sustainably grown food for staff and patients 7. Water conservation

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As pharmacists start to play an active clinical role in your hospital care, Vivian Warby finds out exactly what their job entails

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i m a g e S g et t y /g a llo i m ag e s

the right prescription for you

GOOD MEDICINE

E

very day, Debbie Cruickshank starts her work day in the Intensive Care Unit on the fourth floor at Life The Glynnwood.

Accompanying the intensive care specialist on duty, she greets patients and then proceeds to run through the list of medication they are on. Unlike pharmacists who work in a pharmacy dispensing, Debbie is in the wards, hands on, ensuring that what patients have been prescribed will ultimately contribute to their best possible health outcome.

She is a clinical practice pharmacist, a field fast-gaining traction in South Africa. While many pharmacists have been providing this service for a while, the clinical pharmacy specialist’s registration is only now being finalised by the South African Pharmacy Council.

Debbie works directly with patients, doctors and other health professionals in the wards. This allows her to evaluate

worrying them. For example, are they in pain or experiencing nausea?

‘If patients aren’t able to speak to me, I phone their family and discuss with them.’

Debbie dispenses medication from the ward using the hospital’s computer programme. The prescription is picked up in the pharmacy by a pharmacist’s assistant under the supervision of a pharmacist and then delivered to the ward.

‘I check the medication at the patient’s bedside. I also go through it with the sister looking after the patient and ensure they’re familiar with all the medications and know how to administer them correctly.’

Debbie has to be available to the doctors she works with 24/7, even when she is not in the ward, in case they have queries or questions. ‘I chose pharmacy because I enjoy working with people, especially in an environment where I can help them.

The area of clinical pharmacy interests me because it allows me to help patients and use my knowledge of medicine.

‘Clinical practice pharmacists can work

I M A G E S G ET T Y /G A LLO I M AG E S

Being able to see the patient and speak to them provides me with a unique opportunity to understand all their needs and to treat them in a holistic way the prescription, as well as see the laboratory results and interact with the patient and others who are caring for them. Her focus is medication, and therefore she is able to help the doctor by checking this aspect of a patient’s treatment, she says.

After Debbie’s been on the fourth floor ICU, she proceeds to the third floor ICU and then finally to the paediatric ICU. ‘Paediatric ICU is special for me as, with children, doses of medicines are very important,’ says Debbie. One of the highlights, she says, is seeing the children recover. ‘Once they are feeling better, they’re happy to smile at everyone – this really makes my job rewarding.’

During her rounds, Debbie checks every aspect related to prescribed medication (see ‘Check-up’). ‘I also speak to patients to ensure there is nothing

in the wards or in ICU. I chose ICU because of the challenges. Here patients are more critically ill and generally have more medication, making it a greater challenge.

We also treat different types of patients – surgical, medical, cardiac, trauma, cancer and patients in renal failure.

‘I also enjoy working as part of the healthcare team – doctors, nurses, dieticians, physiotherapists – and seeing the benefit of teamwork for the patient.’

Working daily in ICU has its stresses and challenges, and Debbie says she tries to switch off when she goes home by working in her garden. ‘But, while the challenges are great in this profession, so are the rewards – seeing a critically ill patient recover against the odds and knowing you’re part of a team that made that happen is very rewarding,’ she says. ■

Check-up What is Debbie looking for when she does her rounds?

• Appropriateness of each medication prescribed • Patient allergies to ensure medication is safe to use • Dose and frequency prescribed • That there are no untreated conditions (Debbie also checks on patients’ chronic conditions) • That there are no interactions between medications prescribed • That there are no interactions between the medication prescribed and a patient’s chronic condition • That there are no adverse reactions to the medicine • A patient’s lab results – especially the renal (kidney) function.

This is because many medicines are excreted or eliminated by the kidneys and if there is any deterioration in this organ it may require a change in dose • The patient’s cultures to ensure that the antibiotics prescribed are appropriate, and also check the dose and duration of therapy of all antibiotics. This is part of the hospital Antimicrobial Stewardship Programme. Debbie is responsible for the hospital Antimicrobial Stewardship Campaign, which came about because of the problem of antibiotic resistance in South Africa and globally.

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I

winning ways with water Summer family time inevitably involves water, whether it’s swimming, water sports or just cooling down.

Lisa Lazarus presents some ideas to keep your kids safe 42

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Arrive Alive recommends that you: •S upervise bath time.

•D on’t rely on an older sibling to watch a younger one in the bath. If you are interrupted during bath time, wrap baby in a blanket and take him/her with you.

•D rain water from the tub immediately.

•A lways be within arm’s reach when infants or toddlers are playing near water.

•D on’t allow running on slippery surfaces near water.

•D on’t leave toys in the pool. A child can slip and fall in while reaching for one of them.

• I nstall fencing around a swimming pool – this is the best protection. (www.arrivealive.co.za/swimmingsafely-and-advice-to-preventdrowning has more tips.)

Teach your child to swim

Contrary to popular belief, children can actually be taught to swim from as young as six months, explains Eileen Xhakaza, mass participation manager at Swimming South Africa (swimsa.org).

‘At this age (up to about 12 months), the water feels natural and babies are comfortable,’ says Ross Johnston, coach at Swim4Life Swim School in Cape Town. Also, it’s easier to teach water adjustment and breath control before the ‘terrible twos’ hit. Children who begin at this young age are generally swimming on their own by the time they hit their second to third birthday.

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I M A G E S g e t t y /g a llo i m ag e s

t’s every parent’s nightmare: your child drowning.

Unfortunately, it’s not an irrational fear. In South Africa, more than one child drowns every day – a third under the age of 14. The Medical Research Council lists drowning as the third highest cause of accidental death in children under the age of five – with 60 to 90% of drownings taking place in residential pools.

Alarmingly, children younger than one are most likely to drown in bathtubs, buckets or toilets, states the Arrive Alive website, as all it takes is 2.5cm water and just 60 seconds. Though terrifying, drowning can be preventable.

THE BABY FILES

For this kind of success rate, however, you need to maintain consistency. One of the major factors preventing children becoming water safe quickly, explains Johnston, is the stop-start nature of the lessons: once the warm months finish, parents tend to pack up shop.

You can inculcate a positive experience of swimming by incorporating these tips from Johnston into your water routines: • Teach children to get their faces wet – a vital step for learning to swim – in the bath or shower, and make it fun by getting them to ‘teach’ a bath toy.

• Make playful connections. So when they bob under water, tell them to look for fish, dolphins, mermaids or swimming fairies.

• Use a mirror so children can see what they look like underwater.

• Sing familiar songs to relax your child as you hold and swim with them.

• Importantly, keep your fears under control as children pick up their parents’ insecurities.

I M A G E S G E T T Y/ GA LLO I M AG E S

DO YOUR SWIM SCHOOL HOMEWORK

When searching for a swimming school, check whether it has been certified

by Swimming South Africa (SSA), which includes accreditation for the instructors and safety in and around the pool. Xhakaza further recommends checking instructors’ qualifications, as well as asking about public indemnity and liability insurance.

Aquatics consultant Laura Slane explains that lessons for under-fives are generally aimed at adults, not kids.

Observe a lesson to see whether: • The instructor is teaching you how to handle your child in the water, how to get in and out water safely, about

MEET OUR EXPERT

water dangers and how to play games together in the pool.

• Classes are well-organised. The schedule should be consistent and include skill and play as well as information time.

• Children are not waiting more than ‘doing’.

• The instructor can handle difficult behaviour, such as misbehaviour or fear.

• Pool hygiene is maintained. Coach Johnston states that children who are not potty trained should be wearing swimming nappies. A good nose blow is ideal before jumping in. Swimming caps should be worn to keep hair out of eyes as well as goggles, if eyes are sensitive to chlorine.

SSA-ACCREDITED LEARN TO SWIM SCHOOLS Western Cape • Happy Dolphins Swim School www.happydolphinswimschool.co.za • Swim4Life www.swim4life.co.za Gauteng • Splashmates Swim School www.splashmates.co.za • Irenas Swim School www.swimirena.co.za National • Virgin Active www.virginactive.co.za/inside-ourclubs/swim For a full list, contact SSA. Visit www.swimsa.org, call 011 404 2480 or email services@swimsa.co.za

With learning to swim, patience is vital.

Some children pick it up quickly, whereas others can take a long time. But with positive reassurance, you’ll teach your child a vital skill to last a lifetime, and bring with it much delight. ■

Dr Muhammad Ashraf Ahmed is a specialist paediatrician at Life Fourways Hospital. He qualified at the University of Cape Town and has been a specialist paediatrician for 15 years. He works in the fields of acute paediatrics and neonatology. He has five children, including triplet boys.

Dry drowning Dry drowning, explains paediatrician Dr Muhammed Ahmed, is delayed drowning. A near-drowning victim may survive, but can die within 48 hours after the drowning experience, as a result of catastrophic damage done to the lungs by inhaled water.

This results in poor gaseous exchange/ventilation, i.e. entry of oxygen from the lungs into the blood stream and exit of carbon dioxide from the blood stream into the lungs.

Symptoms • Shortness of breath • Rapid breathing • Chest pain • Blue discoloration • Altered level of consciousness or coma • Seizures How should you treat a near-drowning or drowning experience?

• Seek medical care immediately • Observe and manage in hospital for at least 48 hours • Commence the ABCD assessment and management (Airway, Breathing, Circulation, Drugs) • Provide oxygen as soon as possible • Ventilate, if needed • Antibiotics, if pneumonia is suspected

Learn basic lifesaving skills, so you are able to administer first aid until medical help arrives.

WWW.LIFEHEALTHCARE.CO.ZA

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hot topic

Everybody’s Talking About...

version of vanilla), are known respiratory irritants, and researchers found e-cigarettes exposed users to twice the recommended limits.

There is concern too that flavourants – from bubblegum to chocolate and even pizza – are being used to market e-cigarettes to teenagers, along with trendy packaging and glamorous ads.

A study in the Journal of the American Medical Association showed teens who used e-cigarettes were three times more likely to smoke normal cigarettes than those who didn’t. ‘Users are likely to become addicted to nicotine and constantly crave more, which can ultimately lead to smoking combustible cigarettes with all the dangers,’ says Peter Ucko, director of the Tobacco, Alcohol and Gambling Advisory Advocacy and Action Group.

Vaping E-cigarettes are on the lips of guilty smokers and trend-conscious teens everywhere – but are they the safe alternative to tobacco products some claim? Glynis Horning reports

LEGALLY SPEAKING

I

n the 11 years since they’ve been launched, e-cigarettes have become a trendy electronic toy flaunted by celebrities, ostensibly safe and cool. Unlike ordinary cigarettes, these battery-operated devices do not contain tobacco – instead they carry a cartridge of nicotine and other liquids, which when activated by a heating element emit a vapour that’s inhaled.

But are they really safer than tobacco products?

And can they help smokers quit? With e-cigarettes now a billion-dollar industry set to outstrip tobacco product sales in 10 years, the debate rages…

FOR

Many medical experts consider e-cigarettes to be life savers. To Dr Derek Yach, executive director of the Vitality Institute and former executive director for Non-communicable Diseases and Mental Health of the WHO, it’s enough that they are free of the tar associated with tobacco’s most dangerous effects. Against the ‘undisputed damage of tobacco use on human health’, any potentially negative effects of e-cigarettes are likely to pale in comparison, he says. At an Electronic-cigarette Association of SA function in Cape Town this year, he urged doctors to recommend them to patients as an important quitting tool. ‘My concern, when tobacco is claiming six million lives a year, is the consequence of not using e-cigarettes,’ he said.

I M A G E G E T T Y /g a l lo I M AG E S

AGAINST

Opponents argue that some e-cigarette cartridges contain tobacco extract, and most contain nicotine, although at lower levels than tobacco cigarettes.

Dr Richard van Zyl-Smit of the University of Cape Town Lung Institute reports that nicotine can elevate heart rate and blood pressure, and possibly promote the growth of cancerous tumours. It’s addictive and harmful for the developing teenage brain – repeated exposure can impair the body’s ability to release its own natural pleasure-giving chemicals, so teens may crave more for the same effect, says Dr Johan Jordaan, a cardiothoracic surgeon at Life Rosepark Hospital.

Also, studies at Indiana University of Medicine suggest chemicals in e-cigarettes can damage lung tissue, lowering the lungs’ ability to prevent germs and other harmful substances entering the body. And a study in the journal Tobacco Control suggested flavourants safely ingested in food may be dangerous when heated and inhaled. Some, including vanillin (a synthetic

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As yet, vaping products appear to be in legal limbo and are available even to youngsters. ‘Under the Medicines and Related Substances Act, they’re classified as a schedule 3 drug and should only be bought with a prescription,’ says Dr Yussuf Saloojee, executive director of the National Council Against Smoking (NCAS). ‘But the manufacturers say the act only applies when they’re sold as a cessation aid, and not for recreational purposes.

I disagree with this interpretation but the issue has not been tested in the courts.’

However, the situation is expected to change soon. The Food and Drug Administration (FDA) in the US announced last year that it plans to extend its regulation of tobacco products to include e-cigarettes, and SA Health Minister Dr Aaron Motsoaledi has said that he intended to include e-cigarettes in the Tobacco Products Control Amendment Act, and to outlaw their use. ‘The whole thing must go. The whole concept of e-cigarettes is not in good taste,’ he said.

BOTTOM LINE?

There’s still no definitive evidence whether or not e-cigarettes cause long-term harm, but there are many reasons to be concerned that they may be found in future to increase heart and lung disease and cancer. Dr Saloojee says the NCAS stance is that e-cigarettes are not safe. ‘They may be less dangerous than cigarettes but they are still harmful. The best advice to smokers concerned about their health is not to smoke or vape.’ n

life plus

Would you like to stop smoking? Call Quit Line on 011 720 3145, or sign up for CANSA’s eKick Butt programme at www.ekickbutt.org.za

www.lifehealthcare.co.za

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A high salt diet is a key contributor to high blood pressure which is one of the leading causes for heart disease and stroke

<5g

You should eat no more than 5 g of salt per day – this is the same as one teaspoon and includes the salt that you add to your food as well as salt already found in foods

South Africans consume more than double the recommended amount of salt (6 – 11 g per day)

Half of the salt we eat is from salt added by manufacturers during the processing of foods

The other half of the salt we eat comes from salt we add during cooking and salt sprinkled on at the table

Bread is the single highest contributor to the total salt intake of South Africans

Salt is made up of two parts – sodium and chloride. Sodium is the part of salt that can increase your blood pressure when you eat too much of it

For more information visit www.saltwatch.co.za or call the Healthline 0860 1HEART (43278)

POWER OF FIVE

PAIN RELIEF

DECODE YOUR HEADACHE Identifying the kind of headache you have is the first step to treating it effectively. Here are the most common headaches, and what to do to get relief

I M A G E G R EATST O C K/ C O R B I S C O M P I L E D BY S AM A N TH A PAG E

1 2 3 4 5

MIGRAINE HEADACHE

TENSION HEADACHE

SINUS HEADACHE

CLUSTER HEADACHE

REBOUND HEADACHE

Feels like… an intense throbbing, typically on one side.

It comes with nausea, vomiting, sensitivity to light, and sometimes an aura (movement, light or speech disturbances) which is exacerbated by movement.

Feels like… a tight band around your head. The pain is a moderate, steady ache and often includes tenderness around the jaw, head, neck and scalp. This headache is often related to stress.

Feels like… your face is swollen due to the intense pressure in your cheeks and brow.

This is caused by inflamed sinus cavities and often includes pain and fever.

You can try According to the Mayo Clinic, over-the-counter (OTC) treatments like aspirin, ibuprofen and naproxen are usually sufficient, but if pain persists, consult your GP. Repeated use of OTC meds can cause rebound headaches.

You can try ‘The sinus headache caused by allergies is responsive to nasal decongestants and antihistamines,’ says Mark A. Zacharek, MD, of Henry Ford Hospital, US. Sinus headache is also treated with antibiotics.

Feels like… excruciating knife-like pain centred around one eye that can spread to other areas on the same side of the head.

It’s often accompanied by excessive sweating, watering eyes or a droopy eyelid, and sufferers feel agitated.

Feels like… a gentler form of the other headaches.

Generally occurs every day, improves with pain-relief medication, but returns once it wears off. Nausea and irritability often accompany it.

You can try ‘Doctors generally prescribe painkillers, anti-inflammatories and muscles relaxants,’ says Dr Robbie Potenza from the Wits University Donald Gordon Medical Centre.

You can try ‘Go to the emergency room of the nearest hospital and get some oxygen if it lasts longer than 20 minutes,’ suggests Jessica Ailani, a headache specialist at Georgetown University Medical Center.

You can try Rebound headaches are from the overuse of headache medication and worsen until you get proper treatment.

Discontinuing the medication or tapering the dose will lead to more easily controlled headaches.

WWW.LIFEHEALTHCARE.CO.ZA

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CARE

BONE HEALTH / RECIPES / HEALTHCARE HERO / VOLUNTEERING / SHORT STORY

‘Whenever you see someone being cared for and not forgotten about, their human spirit comes alive.’

i m a g e S getty / gallo i m ages

Sir Elton John

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N

ot many of us spare a thought for our hardworking skeletons. Until, of course, we experience a bone fracture. Only then do we realise how much we value each and every one of the 206 bones of the skeletal system.

Our bones provide protection just like body armour – the skull for the brain, as well as the spinal column and rib cage – keeping our essential organs safe. Bones also allow for body movement, are magnificent storehouses of minerals, such as calcium, and work as factories to produce blood cells. As we age, our bones change, break down, repair and rebuild themselves, which makes it a necessity to understand the ins and outs of optimising bone health.

Your bones are alive and changing

Osteoporosis and broken bones do not need to be a normal part of aging. You can take charge of your bone health and longevity, says Charlene Yared-West 50

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What is osteoporosis?

The body uses calcium to rebuild bones and 99% of the one kilogram of calcium in our bodies is located in the skeletal system. ‘If there’s a shortage of calcium in the body, there’s less building material available to the bones for rebuilding, repair and maintenance, which can mean more brittle, weaker and fragile bones, a condition known as osteoporosis. The word literally means “porous bone”,’ explains Dr Slade Vermaak, orthopaedic surgeon at Life Groenkloof Hospital. ‘Healthy bones can look like a honeycomb, but when you have osteoporosis, the holes in the spaces of the honeycomb comparison are much bigger. The bigger holes indicate that your bones have lost density or mass, which means that your bones are weaker and more likely to break as you age.’

Dr S Vermaak recommends going for a bone density test to assess your bone health.

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I M A G ES g a l l o / G E TT Y I M AG E S

no bones about it

Skeletons conjure up images of Halloween, where bones are dry and stiff. But, this idea couldn’t be further from the truth. Your frame is made of tough, healthy, living tissue. ‘When bones crack or fracture, they are able to recover through rebuilding themselves and are usually restored to their original strength,’ says Dr Duwayne Vermaak, an orthopaedic surgeon at Life Groenkloof Hospital. ‘However, the age and general health of the person must be taken into account (as this can affect the healing and regeneration process, which happens all the time) even when there is no injury.’ Dr D Vermaak points out that there are often little or no warning signs one can pick up on that could indicate a problem. ‘Bones don’t tell you much until it is too late, and then they break…. Only then does the patient seek advice, and in most cases some form of pain relief as fractures can be very painful,’ he says.

my health

Who is affected the most?

Worldwide, more than 200 million people have osteoporosis – one in three women and one in five men over the age of 50 will suffer from a fracture due to the disorder. An osteoporotic fracture occurs every three seconds, and by 2050, the worldwide incidence of hip fracture in men is projected to increase by 310% and by 240% in women. At the age of menopause, women experience a reduced level of oestrogen, which simultaneously causes a rapid reduction in their bone mass. In men, bone loss occurs around the age of 70 years old. Broken bones can occur anywhere in the body, but are most common in the wrists, spine and hips.

prevention is better than cure

Bone health begins in the womb, where good maternal nutrition ensures healthy development of the baby’s skeleton in utero, which continues into later life through living a healthy lifestyle and eating right, explains Dr S Vermaak. ‘The focus for children and adolescents is on building the maximum bone mass, which happens until the age of around 25, where about half of our bone mass is accumulated. Thereafter, as adults, the emphasis is on maintaining healthy bones and avoiding premature bone-mass loss, which can occur through unhealthy lifestyles.’ He goes on to say that gastrointestinal disorders also affect the nutrient absorption – especially calcium – in people of all ages and they can be at risk of bone disease, therefore, may need to supplement calcium and vitamin D. ‘When in doubt, consult your GP,’ adds Dr D Vermaak.

I M A G E S gallo / G E T T Y I M A G E S

How can you lower your risk of bone disease?

There are certain risk factors that increase a person’s susceptibility to bone disease. These are a sedentary lifestyle and poor nutrition, smoking and alcohol use. In addition, age is taken into account, previous injuries, body mass index and existing metabolic and health conditions, such as arthritis. ‘Smoking and alcohol use should be avoided as much as possible, and exercise, including muscle strengthening and weight

MEET OUR experts

bearing, is important for building strong, healthy bones. This applies to both men and women,’ says Dr S Vermaak. ‘A well-balanced diet cannot be emphasised enough – one high in calcium-rich foods, vitamin D, protein and other micronutrients like vitamin K, magnesium, zinc and carotenoids.

This can reduce the risk of osteoporosis.’

Are you getting enough calcium?

Six top tips to get bone healthy

1

Soak up the sun. Get 600 IU of vitamin D per day. Sunlight has become the enemy in the last few years, as consensus tells us to cover up with sunscreen… Also, young people spend less time outdoors, as computers, mobile phones and television take centre stage. All that’s required is 10 to 20 minutes of sun exposure on bare skin, outside of peak sunlight hours (before 10am and after 2pm), without sunscreen, while taking care not to burn.

Calculate your average daily calcium intake in three easy steps. Available online and on mobile devices. www.iofbone health.org/ calcium-calculator

2

Ensure sufficient calcium, vitamin D, protein and micronutrient intake daily.

Calcium: Milk, yoghurt, cheese, broccoli, dried figs, almonds, tofu Vitamin D: Salmon, sardines, tuna, shiitake, egg yolks Protein: Dairy products, meat, fish, poultry, lentils, beans, nuts Micronutrient: Green and leafy vegetables, cabbage, kale, liver, seeds, carrots, red peppers

Knowing your risk factors

3

Take the International Osteoporosis Foundation One-Minute Osteoporosis Risk Test to find out if you may have specific factors which place you at higher risk of osteoporosis and fractures. www.iofbonehealth. org/iof-one-minuteosteoporosis-risk-test

Avoid smoking and excessive alcohol and caffeine. If you love your coffee, or other caffeine-heavy beverages, drink less than four cups per day, as more than three cups could be associated with a 20% increase in the risk of osteoporotic fractures. And make sure you are getting enough calcium.

4 5 6

Include daily exercise and muscle strengthening into your regime.

Identify your risk factors.

Take prescribed medication if necessary. n

Dr Duwayne Vermaak is an orthopaedic and spine surgeon in a full-time practice at Life Groenkloof Hospital.

His interest and field of expertise is arthro-plasty focused on hip and knee surgery and sports injuries.

Dr Slade Vermaak is an orthopaedic and spine surgeon and consults and performs surgeries at Life Eugene Marais Hospital and Life Groenkloof Hospital.

He has a keen interest in deformity surgery.

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cook’s corner

Sister Act Two is better than one, and as foodie sisters Seline and Leandri van der Wat can attest, it also makes for much more creative fun in the kitchen. Here they share some recipes from their new cookbook – perfect for delicious family get-togethers this festive season

O

ur parents believed that one should explore, understand and know your own country before you start travelling overseas, and that’s what we did throughout our childhood. My husband, Jay, has had a different upbringing; his family has been trekking to the quaint seaside town of Lambert’s Bay for holidays for 30 years. Lambert’s Bay is on the West Coast of South Africa, which means the water is freezing, but perfect for crayfish! Jay has taught me to dive for crayfish and, with my legal permit in hand and kitted out in the thickest wetsuit ever, I have proudly brought home a few of these beautiful creatures. There is something magical about diving in freezing water for two hours to catch your own crayfish with your bare hands and then gently steaming and enjoying them while watching the ocean. The distinct tropical fruitiness of mango plays so well with the sweetness and texture of the crayfish. – Seline 52

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sUMMER 2015

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Steamed Crayfish with Curried Mango Sauce Serves 2

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cook’s corner

Steamed Crayfish with Curried Mango Sauce Serves 2 2 whole live crayfish 50g butter 1 small onion, finely chopped ½ clove garlic, finely chopped Salt and pepper to taste 5ml garam masala 2 ripe mangoes, peeled and chopped into small pieces 10ml lemon juice 1. Place the crayfish into a bucket of tap water for a few hours. The crayfish will slowly fall asleep as the oxygen content in the water is lower than in the ocean.

We have found that this is the most humane way to kill them. Cut a line straight down

the middle of each crayfish’s stomach with a pair of scissors to remove the black vein just under the shell.

2. Place the butter, onion and garlic in a saucepan and cook at a medium heat until the onions are translucent. Add a generous pinch of salt and pepper and the garam masala.

Cook gently for 1–2 minutes.

3. Add the mangoes and lemon juice to the saucepan and cook for a further 5 minutes until the mango is soft. Blend with a stick blender.

4. Place about 400ml boiling water in the bottom of a large saucepan. Place a grid above the steam and place the crayfish on the grid. Cover the pan and steam them for 8 minutes and then remove from the pan.

5. Serve warm or cold with the curried mango sauce.

Tomato Sorbet in a Cucumber Consommé with Rooibos-Pickled Melon Cucumber is very refreshing and therefore perfect for this palate cleanser.

Serves 6 as a palate cleanser.

For the tomato sorbet 2 gelatin leaves 2kg ripe tomatoes 100ml fresh apple juice 200g sugar 50ml liquid glucose 20g basil micro herbs For the cucumber consommé 2 English cucumbers 15ml fresh mint leaves 10ml lemon juice Zest of ½ lemon A pinch of salt For the rooibos-pickled melon 3 rooibos tea bags 150ml hot water 100ml winter melon (see step 3) 100ml watermelon (see step 3) 100ml sweet melon (see step 3) 80ml white sugar 150ml white wine vinegar 1. To make the tomato sorbet, bloom the gelatin leaves by placing them in a small bowl of ice water. Peel the tomatoes, cut them into quarters and remove all of the seeds. By the time you are done, you should have 1.5kg of tomato flesh.

Add a few more tomatoes if the weight is not correct.

Blend the tomato flesh and apple juice in a blender and then strain through a sieve into a mixing bowl. Place about 250ml of this tomato juice into a saucepan and heat with the sugar and liquid glucose. When

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the mixture starts to boil and the sugar has dissolved, add the bloomed gelatin leaves, discarding the water. Stir and then pour into the remaining tomato and apple juice in the mixing bowl. Place the bowl in the fridge until the mixture has cooled. Churn the mixture in an ice-cream machine until set and then place in a suitable container in the freezer to harden.

2. To make the cucumber consommé, juice the cucumbers and mint leaves in an electric juicer. Place a cheese or muslin cloth into a bowl large enough to contain the juiced cucumber, ensuring that the cloth hangs over the edges. Place the cucumber, lemon juice, lemon zest and salt in the bowl. Gather the cloth’s edges and tie up into a knot (or use string). Suspend the cloth above the bowl to allow the juices to drip through in their own time (this usually takes about 1 hour). Once all the liquid has dripped through, cover the mixing bowl and chill in the fridge.

3. To make the pickled melon, steep the rooibos tea bags in the hot water for 5 minutes.

In the meantime, remove any peel, seeds and/or pips from the 3 types of melon and cut the flesh into 1 cm cubes. You’ll need about 100ml of cubed flesh of each type. Combine the sugar, vinegar and rooibos tea (discard the tea bags) in a mixing bowl and add the melon cubes. Leave to pickle for 30 minutes in the fridge before straining and discarding the pickling liquid.

4. To plate, spoon a few tablespoons of the chilled pickled melon into the bottom of a glass and pour over a helping of the cucumber consommé.

Scoop a ball of tomato sorbet into the middle of the glass and top with basil micro herbs.

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cookâ&#x20AC;&#x2122;s corner

Polenta and Dukkah-Crusted Chicken Livers with Bulgur Wheat and Pomegranate Salad

Steamed Crayfish with Curried Mango Sauce Serves 2

Serves 4

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COOK’S CORNER

I M A G E S S EAN CALITZ AN D PE N G U I N R AN D O M H O U S E

Spiced Marshmallow Cake with Fruitcake Compote and Butterscotch Sauce

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SUMMER 2015

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Polenta and Dukkah-Crusted Chicken Livers with Bulgur Wheat and Pomegranate Salad

Spiced Marshmallow Cake with Fruitcake Compote and Butterscotch Sauce

Serves 4

Makes 1 × 20cm diameter cake

for the chicken livers 180ml polenta flour 60ml uncooked couscous 100ml grated Pecorino or Parmesan cheese 45ml dukkah 5ml salt A pinch of pepper 2 eggs 100g butter 50ml olive oil 400g chicken livers, cleaned of all sinew

i m a g e s S ean Calitz an d Pe n g u i n R an d o m H o u s e

for the bulgur wheat and pomegranate salad 200g bulgur wheat A handful of baby spinach leaves 100g pomegranate rubies 30ml honey 30ml olive oil 30ml balsamic vinegar Chopped fresh Italian flat-leaf parsley for garnishing Sea-salt flakes for garnishing 1. To make the chicken livers, mix the polenta flour, couscous, cheese, dukkah, salt and pepper.

Beat the eggs in a separate bowl.

2. Heat the butter and olive oil in a frying pan until foamy.

Pat dry chicken livers, then dip them in the egg and then in the polenta. Fry in the hot pan for 2 minutes per side until crispy, then drain on paper towel.

3. To make the salad, boil the bulgur wheat in 1 litre salted water for 8 minutes until cooked, then strain using a sieve.

Allow the bulgur to cool slightly.

4. Place the spinach leaves, pomegranate rubies and bulgur wheat in a bowl. Whisk together the honey, olive oil and balsamic vinegar and drizzle over the salad.

Toss to coat.

5. Arrange the chicken livers over the salad and garnish.

This is a great twist on the traditional Christmas cake.

The butterscotch complements the caramel notes in the cake, while the spiced marshmallow layers add a welcome lightness.

For the fruitcake compote 50g butter 80ml brandy 100g fresh berries plus 250g extra for serving ½ quantity fruitcake (you can use a store-bought cake) For the spiced marshmallow 690g and 80g castor sugar 25ml liquid glucose 280ml and 270ml water 30g powdered gelatin 105g egg whites 2ml mixed spice 2ml ground cinnamon A pinch of ground cloves For the butterscotch sauce 300g castor sugar 125ml cream 30ml butter A good pinch of salt 1. To make the fruitcake compote, melt the butter in the brandy in a saucepan.

Add the 100g berries and stew for 10 minutes.

Meanwhile, cut the fruitcake into 2cm cubes. Add these to the brandy mixture and cook for a further 5 minutes until the cake has absorbed all the liquid. Set aside to cool before assembling.

2. To make the spiced marshmallow, spray three 20cm diameter cake tins with non-stick cooking spray.

Making marshmallow requires doing three things concurrently, so make sure all your ingredients are weighed out and ready before

you start. The sugar mixture will take the longest to boil, but while you do that you will need to prepare your meringue and bloom your gelatin.

3. Combine the 690g castor sugar with the liquid glucose and the 280ml water in a saucepan. Bring this mixture up to exactly 127°C. While this boils, bloom the gelatin by sprinkling it over the 270ml water in a heatproof bowl.

Leave for 5 minutes, then microwave for 20 seconds.

Stir and microwave again if the gelatin has not yet dissolved (it will be clear and not grainy). Be careful as the mixture heats up very quickly and could boil over the sides of the bowl.

4. At the same time, place the egg whites in a stand mixer. When the sugar mixture reaches 118°C, start whisking the egg whites.

When the egg whites are at soft peak stage gradually sprinkle in the 80g castor sugar and spices. Continue beating until the mixture is thick and shiny. Keep the mixer running. By now the sugar mixture will probably be at the required 127°C. Remove from the heat, then gradually whisk in the melted gelatin. Work as quickly as possible so that the sugar mixture doesn’t cool below 118°C. If it does, just put it back on high heat for 20 seconds.

In a steady stream, add the sugar and gelatin mixture to the whipping egg whites. The mixture will become steamy and quite runny, but don’t worry;

just keep beating on high speed until it reaches room temperature. This usually takes 20–25 minutes.

5. Divide the mixture between the three prepared cake tins and smooth out the tops with a palette knife.

Leave to cool in the tins for a few hours until set and spongy.

6. Next, make the butterscotch sauce so that it can cool down before you assemble the cake.

Heat half the castor sugar in a wide saucepan. When that’s melted, add the rest of the sugar, wait 20 seconds and then start mixing with a wooden spoon to help the rest of the sugar melt (if you use a plastic spoon the plastic will melt into the sugar).

When the sugar is totally melted (190°C if you have a sugar thermometer), add the cream a little at a time while whisking. If you add it too fast the mixture will seize and turn solid. Once all the cream has been added, add the butter a knob at a time, stirring to incorporate.

7. To assemble the cake, remove the set marshmallow from the cake tins and place one onto a cake stand or plate. Spoon over half the compote, followed by a drizzle of butterscotch sauce. Repeat this process for the second layer and top with a final layer of marshmallow. Decorate with butterscotch sauce and fresh berries. n Recipes excerpted from Two (Struik Lifestyle) by Seline and Leandri van der Wat

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reach out

a circle of caring Whether it’s once off, to mark International Volunteer Day on 5 December or part of a regular commitment, volunteering really is the gift that keeps on giving.

By Norma Young

A surge of feel-good hormones

A study by the Corporation for National and Community Service reveals the science behind the lighter, happier emotions we often feel after doing good. In their survey, they discovered that people who volunteer generally have less stress. An increase in mental health was reported due to the personal sense of accomplishment, confirms the study. While challenging circumstances in the personal lives of volunteers might not change, a release of mood-boosting hormones like serotonin, oxytocin and endorphins does increase coping ability. ‘In the society in which we live, many people are under a large amount of work and family stress, which can impact on health and well-being,’ says Melinda Howlett, a psychologist based at Life Westville Hospital.

‘Management of stress levels is important.’

With a positive impact on mood and mental health, philanthropic acts hold great stress-management benefits for volunteers.

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OPPORTUNITIES FOR CAREER AND SKILLS DEVELOPMENT

Many of us have talents and interests that we’d like to include in our day-to-day work, but sometimes our formal job functions don’t have a wide enough scope. If you’ve been developing a graphic design skill that you can’t utilise in the office, volunteering to make posters or design a logo for an NGO could be a wonderful use of your ability. And it’s not just practical skills that you can exercise through volunteering. Overseeing a project can also develop your leadership skills. This sort of involvement – that calls on both your brain and heart – is valuable, and was referred to as the ‘next executive training ground’ in an article in Stanford Social Innovation Review. If you’re looking for opportunities to volunteer in a meaningful way, explore Life Healthcare’s Sizanani initiative. It has 76 projects across South Africa and Botswana. Many of the hospital and administrative staff are involved in volunteer work, but there’s no reason why friends, families and the local community can’t lend a helping hand too. You can also visit www.cansa.org to sign up as a volunteer in areas of cancer care and support, fundraising or administration.

APPRECIATION FOR NON-MATERIAL JOYS

Time is a commodity that seems to be in short supply for everybody. But a recent study in Harvard Business Review has delightful news: people who volunteer their time feel like they have more of it. Study author, Wharton School professor Cassie Mogilner, says: ‘The results show that giving your time to others can make you feel more “time affluent” and less time-constrained than wasting your time, spending it on yourself or even getting a windfall of free time’. n

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hile it shouldn’t be motivation to get involved in acts of service, it has been proven that volunteering can have a positive impact for both recipients and benefactors. Studies reveal that people who volunteer can experience rewards, such as improved mental and physical health.

They’re also likely to have a better perspective of their life and careers. Here are three benefits of philanthropy.

Would you like to volunteer? The GreaterGood South Africa Trust connects givers with good causes and activates the public to give responsibly through their evaluation, vetting and fund management. Visit greatergoodsa.co.za to find a cause you’d like to support.

sUMMER 2015

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SHORT STORY

HOLIDAY READ

THE

HANDSOME MAN’S DE LUXE CAFÉ

An adventurous romp through the streets of Botswana and Mma Ramotswe’s detective agency. It’s almost impossible to read even one page without smiling

CHAPTER ONE

The Women of Botswana Now Fly Aeroplanes Precious Ramotswe, creator and owner of the No. 1 Ladies’ Detective Agency, friend of those who needed help with the problems in their lives, and wife of that great garagiste, Mr. J.L.B. Matekoni, felt that there were, broadly speaking, two sorts of days. There were days on which nothing of any consequence took place – these were in a clear majority – and then there were those on which rather too much happened. On those uneventful days you might well wish that a bit more would happen; on days when too much occurred, you longed for life to become a bit quieter.

It had always been like that, she thought, and always would be. As her father, the late Obed Ramotswe, often said: there are always too many cattle or too few – never just the right number. As a child she had wondered what he meant by this; now she knew.

Both sorts of day started in much the same way, with the opening of her eyes to the familiar dappled pattern made by the morning sun on the ceiling above her bed, an indistinct dancing of light, faint at first, but gradually becoming stronger. This intrusion of the dawn came from the gap between the curtains – the gap that she always intended to do something about, but did not because there were more pressing domestic tasks and never enough time for everything you had to do. And as long as curtains did their main job, which was to prevent nosy people – unauthorised people, as Mma Makutsi would call them —

from looking into her bedroom without her permission, then she did not have to worry too much about their not meeting in the middle.

She woke up at more or less the same time each morning, thought for a while about getting up, and then rose, leaving Mr. J.L.B. Matekoni still deeply asleep on his side of the bed, dreaming about the sort of things that mechanics, and men in general, dream about. Women, she felt, should not enquire too closely as to what these things were, as they were not the sort of things that women liked very much — engines and football, and so on.

A friend had once said to her that men did not dream about things like that — that this was just what women wanted men to dream about, while men, in reality, dreamed about things that they would never reveal.

Mma Ramotswe doubted this. She had asked Mr. J.L.B. Matekoni one morning what he had dreamed about and he had replied: “the garage,” and if this were not proof enough, on another occasion, when she had woken him from the tossing and turning of a nightmare, he had replied to her question about the content of the bad dream by saying that it had all been to do with a seized-up gearbox. And then there was Puso, their foster child, who had told her that his dreams were about having a large dog that chased away the bullies at school, or about finding an old aeroplane in the back yard and fixing it so that it could fly, or about scoring a goal for Botswana in a soccer match against Zambia, with

the whole stadium rising to its feet and cheering him. That, she thought, settled that. Perhaps there were some men who dreamed about other things, but she felt that this was not the case for most men.

Once up and about, clasping her cup of freshly brewed red bush tea in her hand, she took a walk around the garden, savouring the freshness of the early morning air.

Some people said that the air in the morning had no smell; she thought they were wrong, for it smelled of so many things — of the acacia leaves that had been closed for the night and were now opening at the first touch of the morning sun; of a wood fire somewhere, just a hint of it; of the wind, and the breath that the wind had, which was dry and sweet, like the breath of cattle. It was while she was standing there that she decided whether the day would be

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short story

one in which things might happen; it had something to do with the way she felt when she considered the day ahead. And most of the time she was right, although sometimes, of course, she could be completely wrong.

On that particular morning as she walked past the mopipi tree she had planted at the front of the garden, she had a sudden feeling that the next few hours were going to be rather unusual.

It was not a disturbing premonition — not one of those feelings that one gets when one fears that something is going to go badly wrong — it was more a feeling that something interesting and out of the ordinary lay ahead.

She remarked on the fact to Mr. J.L.B. Matekoni as he sat at the kitchen table eating the brown maize porridge that he liked so much. Puso and his sister, Motholeli, had already eaten their breakfast and were in their rooms preparing to leave for school.

The school run that Mma Ramotswe had become so used to was now no longer necessary, as Puso was of an age to make his own way there — the school was not far away — and he was also able to help his sister with the wheelchair. This gave the children an independence that they both enjoyed, although departing on time could be a problem when Puso had some boyish task to complete — the catching of flying ants, for instance — or Motholeli had at the last minute to find another pair of cotton socks or locate a book that needed to be returned to the school library.

“I have a feeling,” announced Mma Ramotswe, “that this is going to be a busy day.”

Mr. J.L.B. Matekoni glanced up from his porridge. “Lots of letters to write? Bills to send out?”

Mma Ramotswe shook her head. “No, we’re up to date on all of those things, Rra. Mma Makutsi has been busy with her filing, too, and everything is put away.”

“Lots of clients to see, then?” He thought of his own day and imagined a line of driverless, impatient cars, each eager for his attention, their horns honking to attract his notice: cars, in his view, were quite capable of all the human emotions and failings, including a lack of patience or restraint.

Mma Ramotswe had looked at her diary just before leaving the office the previous day and had seen that it was largely empty. “No,” she answered. “There are no appointments with clients. Nothing this morning and nothing this afternoon, I think.”

He looked puzzled. “And yet it’s going to be a busy day?”

“I have that feeling. It’s difficult to say why, but I am sure that this will not be a quiet day.”

Mr. J.L.B. Matekoni smiled. People talked about the intuition of women, but he was not sure that he believed in it. How could women possibly know things that men did not know? Was their hearing more acute than men’s, so that they heard things that men missed — as dogs or cats might pick up frequencies audible only to them? He thought not. Or was their eyesight more acute, so that they saw clear details where men saw only indistinct blurs? Again, he thought not. What we knew, we knew from our senses, and the senses of women were no different from the senses of men.

The Handsome Man’s DeLuxe Café is published by Random House and is available at all good bookstores nationwide.

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OUR HERO

HERO OF THE MONTH

SISTER ELSA OPPERMAN A nurse’s enquiring mind traces the source of infection on a factory floor to bat droppings. By Melanie Farrell

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hen this month’s hero, Sister Elsa Opperman, a Life Occupational Health nurse, saw many patients with similar symptoms last year, she smelt a rat – or, rather, a bat.

‘I was overseeing a warehouse in Mpumalanga with about 450 workers.

During flu season some workers appeared again and again with what appeared to be severe flu symptoms.

‘I wanted to figure out why this was happening and did research, then a workplace inspection. I noticed there were birds roosting in the rafters, producing lots of droppings, and I also spotted bats. I researched bird and bat droppings and discovered a fungus is carried in it that causes a disease called histoplasmosis. Symptoms of histoplasmosis can be mistaken for a flu or cold.’

Sister Elsa contacted HR at the business and got the go-ahead to test all workers for histoplasma antibodies.

‘Three tested positive and when I compared their results with their occupations, it turned out they were part of the housekeeping team, so they were sweeping the factory floor.

I checked whether they had been exposed to chickens at home. They hadn’t been, and my conclusion was that the bird and bat droppings were harbouring histoplasmosis spores and this was causing their illness.’

MY MANTRA IS:

Yesterday is history, tomorrow is a mystery, today is the present, a gift, so make the most of it!

Sister Elsa’s medical detective work saves lives

Sister Elsa made appointments for affected workers with the National Institute for Occupational Health, where specialised tests were carried out to determine if they had histoplasmosis or only carried the antibody. It turned out the workers were healthy and didn’t show any signs of the disease – kudos to Sister Elsa for her medical detective work.

‘It’s not a rare condition, but people aren’t aware of the link between bird and bat droppings and transmission of the disease. If it develops, it can kill you.’

‘I love my job, because you have to be alert and aware of all possibilities. I work on my own, but in our field we offer primary healthcare as well as occupational health and safety tips. We help keep employees psychologically, emotionally and physically well. Occupational health nursing is very rewarding and a highly specialised field,’ says Sister Elsa. ‘My favourite part of my job is risk-based medical surveillance. Through this you determine if an employee is negatively affected by their job. The outcome of the tests also determines the effectiveness of personal protective equipment the employee has to wear, as well as their compliance in using it correctly.’

Sister Elsa, who only returned to nursing five years ago after working in business, received her occupational health nursing qualification last year.

‘I never thought I would make it because it’s so specialised,’ she laughs, ‘but here I am, doing what I love.’ ■ WWW.LIFEHEALTHCARE.CO.ZA

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puzzle this...

Test your mental agility with our brain-teasers

1 CROSSWORD PUZZLE 2 SUDOKU

26 Encased, in a way 30 Hockey venue 31 Picture puzzle 32 Geologic period 33 Sank, as billiard ball 35 ‘Hey, you!’

36 Twitches 37 Starbucks order 38 God 40 Harbor structure 42 U.N. workers’ grp.

43 Played a bat-and-ball game 48 Chap

ACROSS

1 ‘Family _____’ 5 Revlon rival 9 Scoundrel 12 Relaxation 13 Diner’s card 14 Wish otherwise 15 Grouped together 17 Coulter or Curry 18 Nevada city 19 Vile 21 Eco-friendly 24 Unuttered ‘alas’ 25 Incense 62

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49 Welsh vegetable 50 Protuberance 51 Type measures 52 Vortex 53 Animated figure DOWN

1 Shortest of the 12 (Abbr.)

2. Corn spike 3 ‘Born in the ____’ 4 Edict 5 Congregation’s cry 6 Kill a bill 7 Inseparable

8 Pests 9 It often involves a dummy 10 One of the kin 11 Say it isn’t so 16 Understanding 20 Census statistic 21 Stagehand 22 Puerto _______ 23 November events 24 Missile type 26 ‘West Side Story’ gang 27 Honest politician?

28 Formerly, formerly

29 Appointment 31 Honor Earth Day, in a way 34 DIY buy 35 Progenitor 37 Albanian money 38 It ain’t worth a nickel 39 Verve 40 Multi-coloured 41 Gross 44 Roulette bet 45 Additionally 46 Tokyo’s old name 47 Lair

i l l u s tr ati o n toby n e w s o m e. p r e s s/ magaz i n e f eatu r e s ( pt y )lt d

Difficulty level ***

summer 2015

2015/11/17 3:52 PM

MIND GAMES

3 WORD SLEUTH

4 BANANAGRAMS!

Find the hidden words in the diagram.

They run in all directions

Each of the three-letter groups below may be extended both on the right and the left to form a seven-letter word. Use the tiles above each group to fill in the blanks

Backpack Camper Canteen Camper Gorp Hiking

Insects Lantern Map Matches Scenery Swiss knife

Tent Trail Wildlife

Answers increase, underate, meantime

4

3 Spring:

2

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i llustrati on to by n e ws o m e. p r e ss /m ag az i n e f eatu r e s (p t y) ltd

solutions

www.lifehealthcare.co.za

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SOUL FOOD

AN AMPLIFIED EXISTENCE W

hen I talk about ‘creative living’ here, please understand that I am not necessarily talking about pursuing a life that is professionally or exclusively devoted to the arts. I’m not saying that you must become a poet who lives on a mountaintop in Greece, or that you must perform at Carnegie Hall, or that you must win the Palme d’Or at the Cannes Film Festival. No, when I refer to ‘creative living’ I am speaking more broadly. I’m talking about living a life that is driven more strongly by curiosity than by fear.

One of the coolest examples of creative living that I’ve seen in recent years, for instance, came from my friend Susan, who took up figure skating when she was 40 years old. To be more precise, she actually already knew how to skate. She had competed in figure skating as a child and had always loved it, but she’d quit the sport during adolescence when it became clear she didn’t have quite enough talent to be a champion. (Ah, lovely adolescence when the ‘talented’ are officially shunted off from the herd, thus putting the total burden of society’s creative dreams on the thin shoulders of a few select souls, while condemning everyone else to live a more commonplace, inspiration-free existence! What a system…)

For the next quarter of a century, my friend Susan did not skate. Then she turned 40. She was listless. She was restless. She felt drab and heavy. She did a little soul-searching, the way one does on the big birthdays. She asked herself when was the last time she’d felt truly 64

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She ignored the voice within her that told her she was being self-indulgent and preposterous to do this crazy thing.

light, joyous, and – yes – creative in her own skin. To her shock, she realised that it had been decades since she’d felt that way. In fact, the last time she’d experienced such feelings had been as a teenager, back when she was still figure skating.

She was appalled to discover that she had denied herself this life-affirming pursuit for so long, and she was curious to see if she still loved it.

So she followed her curiosity. She bought a pair of skates, found a rink, hired a coach. She ignored the voice within her that told her she was being self-indulgent and preposterous to do this crazy thing.

She just did it Three mornings a week, Susan awoke before dawn and, in that groggy hour before her demanding day job began, she skated. And yes, she loved it, as much as ever. She loved it even more than ever, perhaps, because now, as an adult, she finally had the perspective to appreciate the value of her own joy.

Skating made her feel alive and ageless. She stopped feeling like she was nothing more than a consumer, nothing more than the sum of her daily obligations and duties. She was making something of herself, making something with herself.

That’s what I call creative living.

And while the paths and outcomes of creative living will vary wildly from person to person, I can guarantee you this: A creative life is an amplified life. It’s a bigger life, a happier life, an expanded life, and a hell of a lot more interesting life.

Because creative living is where Big Magic will always abide. ■

IMAGE SUPPLIED

Eat, Pray, Love author Elizabeth Gilbert offers advice on living a life driven by curiosity not fear

SUMMER 2015

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