JAN MAR 2015
ISSUE 28
TT$35.00 US$5.99
®
THE CARIBBEAN HEALTH DIGEST
Are we ready? Pa allllia attiive ve Car are Un U nde derrsstta an nd d mor ore ab abou o t th this is ap pp prro pro oaacch thaatt imp th mpro rovve es tth es he q qu uaallity ity of it of liiffe. e. Hea He eal alth hy Pr Pro os sta tate te Te T en tth hin ng gs s me en n can an do to o mai aint ntaaiin prro p os sta sta tate te hea ealltth. Cu C ucumb ucu cumbe cu mb ber err- Fr Frui uit o uit orr Ve eg get etab able? le? le Callll it wh Ca Call hat at you ou wan ant nt b bu ut th ut the h the he eal alth th be b enefi ne efi fits ar are end dlless. es sss..
uhealthdigest.com
Founders
Sherine Mungal Stuart Fraser
Publisher
Eidetic Publishing
Editorial Director
Sherine Mungal
Managing Editor
Roslyn Carrington
Writers
Maia Hibben Vernon Khelawan Carol Quash Dr. Sara Ouellette Robert Taylor Sacha Fortuné David Fenton
Creative Director Design Project Coordinator Traffic Photography
Medical Advisory
Stuart Fraser Eidetic Cindy Singh Lorraine Biran shutterstock iStockPhoto Dr. Neil Singh
MBBS PG MSc
This information is of a general nature only and is not intended as a substitute for professional health advice and no person should act in reliance on any statement contained in the information provided and at all times should obtain s p e c i f i c a d v i c e f ro m a h e a l t h professional. Eidetic Publishing has made reasonable efforts to ensure that the health information contained herein is accurate and up to date. To the extent permitted by law, Eidetic Publishing, their employees, agents and advertisers accept no liability
(even if negligent) for any injury, loss or damage caused by reliance on any part of this information. U also contains information supplied by third parties. This information is identified with the name of the source and has been chosen for publication because we believe it to be reliable. To the extent permitted by law, Eidetic Publishing, their employees, agents and advertisers accept no liability (even if negligent) for any injury, loss or damage caused by reliance on any part of this information.
U The Caribbean Health Digest is published 4 times a year by Eidetic Publishing, Gaston Court, Gaston Street, Lange Park, Chaguanas, Trinidad & Tobago. Distribution is handled by Eidetic Limited.
Entire contents are copyright. Reproduction in part or whole is prohibited. Eidetic Publishing is in no way affiliated with companies or products covered in U. Produced and printed in Trinidad & Tobago.
12 Palliative Care Palliative care focuses on providing patients with relief from the symptoms, pain, physical stress, and mental stress of a serious illness, whatever the diagnosis, with the main goal being to improve the quality of life for both patient and family. Maia Hibben explores more in this article.
16 Medical Tourism In this feature article we look at Medical Tourism, one of the fastest economic growth areas globally, and how the Caribbean, specifically Trinidad and Tobago, can position itself to tap into this growing market.
22 Cool As A Cucumber If this fruit had a personality it would be described as nonchalant, easygoing, and one of the coolest customers around, but despite its unassuming appearance, cucumbers have the power to rehydrate and replenish daily vitamins, while eliminating toxins in our body.
24 Chia Seeds Once something new hits the scene and has health benefits, then we must bring it to our U readers as an option. Chia seeds are making its way into health food stores and kitchens and lunch kits everywhere, and has finally found a place inside our pages, just for U.
30 Vaccines The subject is more in the limelight now than it has been in the last decade and is creating quite a stir, too; in fact, it’s causing quite a controversy right now in the US as parents exercise their rights by choosing not to have their children vaccinated. Carol Quash explores the pros and cons of vaccination for certain diseases.
34 Prostate – What All Men Need to Know Dr. Sara Ouellette discusses in her article some very important facts that men ought to know, and shares with our readers ten tips on how to maintain a healthy prostate.
38 Medical Emergency BBC’s Health Correspondent, David Fenton, shares his experience on the sudden upsurge of medical emergency cases in the UK during what was recorded as one of the worst winters ever, and discusses what may have accounted for this increase in the need for medical emergency attention.
46 Body Transformation There is a psychology in every little thing we do, a reason behind why we do what we do, and the same applies to our bodies and how we approach keeping fit. This article explores the difference between Training and Transformation, and the role of motivation in the process.
Welcome to our 28th edition of U! Our cover story visually demonstrates a subject that has been bandied about for years in the Caribbean, particularly here in Trinidad and Tobago. To many, it’s two words that sound nice together, and which people seem to be using a lot these days. To others it may seem like an unattainable goal, because of all the bureaucracy that may be involved in the concept of Medical Tourism. To us in Trinidad and Tobago, yes, it is an opportunity to look at our healthcare sector as another avenue to generate revenue for our economy, but more importantly, it’s about the potential for our national community to receive a higher quality of patient care if we were to develop Medical Tourism within our healthcare sector, especially since accreditation is one of the main drivers that must be considered by healthcare facilities. In this, our Expo 2015 issue of U, we take the opportunity to highlight Medical Tourism as a matter of national interest and take it a step further by hosting the first of a series of seminars dedicated to discussing the area of accreditation, featuring the Joint Commission International (JCI), one of the world’s leaders in accreditation. The usual mix of informative, entertaining and educational content, put together by some of the best writers in the field, coupled with engaging design and a host of corporate partners, all made the cut for this issue. As always, our one wish is for you to read, learn and enjoy. Till next issue, be healthy and God bless.
SHERINE & STUART
FOUNDING EDITORS
TREATMENT
| PALLIATIVE CARE
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WRITTEN BY MAIA HIBBEN
PALLIATIVE CARE
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TREATMENT
what is palliative care? IT IS AN APPROACH THAT IMPROVES THE QUALITY OF LIFE OF PATIENTS AND THEIR FAMILIES FACING THE PROBLEMS ASSOCIATED WITH LIFE-THREATENING ILLNESS, THROUGH THE PREVENTION AND RELIEF OF SUFFERING BY MEANS OF EARLY IDENTIFICATION AND IMPECCABLE ASSESSMENT AND TREATMENT OF PAIN AND OTHER PROBLEMS, PHYSICAL, PSYCHOSOCIAL AND SPIRITUAL (WORLD HEALTH ORGANISATION). 13 | u
TREATMENT
| PALLIATIVE CARE
Palliative care is a relatively new area of medicine and is often confused with hospice care, which focuses on caring for someone at the end of their life. Palliative care, on the other hand, is involved from the initial diagnosis of a life-threatening illness, throughout the course of the illness, and right to the end of the patient’s life. Palliative care is not just about providing relief from pain and other distressing symptoms.
What sort of illnesses do you see in this area of medicine?
It takes a much more holistic approach to the patient’s needs; supporting the psychological, spiritual, and functional, as well as the physical. It supports the patient to live as actively as possible, as well as offering a support system to the patient’s family; helping them to cope and adjust to the reality of having a family member with a serious or terminal illness.
“Cancer is one of the leading causes of death worldwide, and in Trinidad and Tobago the incidence is increasing yearly. Trinidad has also seen a rise in diabetes, hypertension and heart disease, which may lead to renal and heart failure. Palliative care is now a vital form of supportive care treatment for all these patients. Doctors, especially oncologists, are privileged to access this type of care at different public and private facilities in Trinidad and Tobago.”
Administering palliative care can often be very difficult due to the complex nature of these illnesses. It is commonly administered by a team, which often includes doctors, nurses, physical therapists, pharmacists, spiritual leaders, dieticians, social workers and other specialists depending on the needs of the patient. This range of expertise coming together means they can address the wide variety of needs of the patient and their family. Palliative care can undoubtedly improve the quality of life, not just for the patient, but the whole family, and research suggests that it may also have a positive impact on the course and development of the illness. Until recently there was no formal palliative care or palliative care training available in Trinidad and Tobago. However, the Palliative Care Society of Trinidad and Tobago and the University of the West Indies recognised this growing need and created an MSc in Palliative Care. This September (2014) saw its first group of graduates from a range of healthcare backgrounds, and in order to find out more about this new area of medicine now available in Trinidad and Tobago, I spoke with one of these graduates, Dr. Nadya Watson (B.Sc., M.B.B.S, MSc Palliative Care Medicine).
Can you, in layman’s terms, explain what a palliative care specialist does? “The word palliative, simply put, means to comfort or support. Palliative care medicine is a holistic and multi-disciplinary approach to patient care. It relieves physical symptoms and stress caused by serious illnesses, improving patients' as well as their family’s quality of life.
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Patients can receive symptom management for issues such as pain, vomiting, nausea, decreased appetite, insomnia and constipation. Other aspects of care are also addressed such as advanced care planning, end-of-life issues, and the person’s social, spiritual and emotional needs.”
“Palliative medicine is available not only for cancer patients, but for any patient diagnosed with a terminal illness, such as renal failure, heart failure and Chronic Obstructive Pulmonary Disease (COPD)”.
Which illnesses do you most commonly see here in Trinidad?
Is palliative care only for the elderly? “These illnesses can be seen in all ages, from the very young child to the elderly. Palliative care has no age-related boundaries, as anyone can be diagnosed with a terminal illness.”
What inspired you or motivated you to study further in this area of medicine? “I became involved in palliative care after attending a two-day conference at Mt. Hope; the first palliative care conference in Trinidad. It took away the uncertainties I had as a physician when it came to managing severe pain and symptoms associated with these types of illnesses; and also lessened my insecurities when it came to breaking bad news to patients and families. Since then I started actively managing patients and completed my MSc in Palliative Care offered at UWI. I have not been more fulfilled since starting my career in medicine nine years ago. I have seen patients with severe pain and loss of hope regain that hope and quality of life that is deserving to all human beings.”
Why do you think it is important that there are palliative care services available in Trinidad? “With an increase in cancer and other lifestyle diseases in Trinidad, many families, even ones close to us, may become affected. If that were to be a member of your family, would you not want them to have the best quality of life and dignity at the end of life?” Trinidad can now offer this to many families, and in some instances at no cost. Caura has opened a new Palliative Care facility, offering a more multidisciplinary approach to caring for patients. Palliative care is sometimes confused with Hospice care, and because of this, late referrals are often submitted.
PALLIATIVE CARE
It is common for me to see patients with a life expectancy of 2-3 days. This common misconception leads to patients not benefiting from this valuable form of care. I am hoping that, if no other message is received, the public and other members of the medical profession understand that we can see referrals from onset of diagnosis.”
If you have a family member or friend with a serious terminal illness, and they would like to see a palliative care specialist, can they do this even though they may already be visiting a doctor and be on some kind of treatment plan? Of course, palliative care is available to any patient once they have been diagnosed with a terminal illness. As I mentioned, Caura has opened a Palliative Care Unit, offering this service to any citizen of Trinidad and Tobago. The St. James Radiotherapy Unit and San Fernando General Hospital also have very well organised palliative care clinics. Private care is also available to
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TREATMENT
many patients. Referrals must be written in order to join these units/clinics. These referrals can be written by the consultant responsible for these patients. All patients and their caregivers must give consent to a palliative care referral being done.
How can you access a Palliative Care Specialist in T&T? For further information, contact The Palliative Care Society of Trinidad and Tobago, or The Caura Hospital, Palliative Care Unit 662-2211. Dr Watson (Family Practitioner & Palliative Care Specialist) can be contacted at The Healthy Living Medical Practice – Vistabella 319-8955.
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MEDICAL
|
MEDI CAL TOU R IS M
Touri WRI WRIT RI TEN RIT E BY EN BY VER V NON N NO KHELA KH ELAWAN WAN AN N
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MEDICAL TOURISM IS NOW A SERIOUS PLAYER IN GLOBAL ECONOMICS, AND THERE HAS BEEN NOT-SO-QUIET TALK ABOUT TRINIDAD AND TOBAGO SEEKING TO PARTAKE OF THAT ECONOMIC PIE AS A MAJOR PART OF ITS DIVERSIFICATION THRUST.
ism
M E D I CA L TO UR I SM
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MEDICAL
FEATU RE
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MEDI CA L TOU R IS M
And why not?
The global value of medical tourism in 2010 was more than US $40 billion, and many developing countries are already benefitting from this new type of tourism, especially in Asia where Singapore and Thailand are estimated to receive somewhere in the vicinity of US $900 million per annum from medical tourism, with India and Malaysia growing quickly with earnings of US $333 million and US $400 million respectively.
Traditionally, Caribbean tourism meant people from colder climes coming to countries like ours, where sunshine abounds and the sandy beaches are usually quite close and constantly beckoning. Over time, the word, and possibly its connotation, has undergone some kind of metamorphosis, giving rise to the many types of tourism which exist today. The subsets include: sports, eco, religious, recreational and medical. So while medical tourism in its present incarnation is relatively new in some countries, moving around for health care is not. Centuries ago the Greeks travelled to the small territory in the Saronic Gulf, called Epidauria, which was the sanctuary of the healing god, Asklepios. In the early ages, visits to spa towns and sanatoriums could be considered an early form of medical tourism, which possibly in a different form still exists in the Caribbean. In the nature isle of Dominica, people visit to dip their bodies in that country’s famous sulphurr springs, which are supposed to have healing qualities. ote However, like most other countries which promote ild the medical tourism, Trinidad and Tobago has to build industry on the strength of its private health caree providers. The Trinidad and Tobago Coalition off Services Industries (TTCSI), in its draft National Strategy for Medical Tourism, showed there were 10 private hospitals in Trinidad and Tobago, and all are registered, byy law, with the Ministry of Health under the Private Hospitals ospitals Act. Capacity of these institutions is estimated at 39,900 patients annually, with estimated current utilisation ion of 31,000 per annum, indicating there is excess capacity. pacity.
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According to the Ministry of Health, Trinidad and nd Tobago has excellent capability and track record d
(higher than average success rates) in three of the main market segments for medical tourism – joint replacement, cardiac surgery and dentistry. However, when one looks at the word TOURISM carefully, one can see there is something of tourism in everything and which over time has gained considerable traction because of the ease and speed of travel today. The availability of motor cars, trains and buses has made even domestic tourism quite attractive, an activity which has been in vogue for a long time in the larger countries. Decades ago, people would travel from underdeveloped countries to major medical centres in First World countries seeking medical assistance that would have been unavailable in their homeland. Today, the converse applies. With high health care costs existing in the developed countries, the trend has changed, with people from the first world countries now travelling to third world countries for medical treatment. In spite of this, however, the original pattern still holds, but to a much lesser extent. Just as the competition for visitors to countries for recreation and leisure continues, so, too, is the competition becoming more intense as countries move strategically toward increasing their market share in the health tourism sector. Major players in this industry include Israel, India, Malaysia, South Korea, Turkey, Taiwan, Thailand, Singapore, and, closer to the English speaking Caribbean, Costa Rica, Mexico, and the United States, which still attracts many people from the Caribbean.
M E D I CA L TO URI SM
Based on statistics, there is an obvious question:
Why has medical Tourism become so attractive? Two main reasons prevail. Apart from the cost factor, there is also the complementary benefit of being able to visit and possibly enjoy the physical and cultural attributes of a different country. There are other factors which influence travel for health purposes, and these are standards and technology, because health institutions with state-of-the-art equipment and facilities would naturally attract greater numbers of patients. But the key to attracting foreign medical tourists, especially from the US market, is international accreditation such as Joint Commission International (JCI) or Trent. There are at present more than 255 JCI-accredited hospitals outside the Unites States, which is the same accreditation that more than 4,800 hospitals in the US receive. According to JCI surveys, patients’ experience and satisfaction at JCI-accredited hospitals abroad is generally more favourable than in the US. Surgical complication rates compare favourably, and cost savings on most surgical procedures can exceed 50—80 per cent of the US cost. It is not by accident, therefore, that the popular Trinidad-based health magazine, “U The Caribbean Health Digest”, desirous of being a positive influence in the development of medical tourism in Trinidad and Tobago,
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FEATURE
has made international accreditation an integral agenda item at its annual Health and Wellness Exposition at the Hyatt Regency Hotel in Port of Spain at the end of March, by securing the services of a senior consultant from the United States to speak on accreditation of health institutions. Dr. Thomas Kozlowski of the Joint Commission International (JCI), is presenting the first of a series of seminars aimed at making Trinidad and Tobago become more aware of the potential of medical tourism, titled “Medical Tourism: Are We Ready?”. The accreditation group, JCI, was formed in 1994 to provide international clients with education and consulting services. The importance of Joint Commission International resides in the fact that many international hospitals and other health institutions realise that obtaining international accreditation is a way to attract American patients. JCI is part of a global enterprise of dynamic, non-profit organisations that address dimensions of accreditation, quality care and patient safety. JCI identifies, measures and shares best practices in quality and patient safety with the world. Recently, international conferences and specialist seminars have become an important marketing tool for medical tourism, where health care professionals (doctors, specialists, consultants) gather to discuss new methodologies, new drug usage, and general improvements in health care procedures. Less than two years ago, Colombia, seeking to establish itself as a modern medical tourism centre, held the first annual meeting of “Advance in International Cardiovascular Medicine” in Medellin. This conference saw some of the world’s best cardiologists and clinicians gather for two days and discuss a broad range of cardiovascular topics, including practical and state-of-the-art management of Ischemic heart disease, structural heart disease, interventional and minimal invasive cardiovascular techniques and devices, and peripheral vascular disease and intervention. Regarded as a major milestone in medical tourism, the conference was a joint venture of Yale University in the United States, the University College of London in the United Kingdom, and the Cardio VID Clinic in Colombia, with the major focus being interventional therapeutics, clinical research and education. Trinidad and Tobago, therefore, is well positioned to explore medical tourism as a viable economic option. The TTCSI, in its draft national strategy, states that moving the sector forward would “require co-operation and actions by a broad range of stakeholders within the public and private sectors”. It also suggests there is need for “a strong supervisory and facilitation role for an APEX organisation that can co-ordinate and oversee implementation.” 19 | u
10 Things about
Medical Tourism
+ The top destinations for Medical Tourism in the world are Costa Rica, India, Israel, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey, United States
+ The top specialties for medical travelers are: 1. Cosmetic surgery 2. Dentistry (general, restorative, cosmetic) 3. Cardiovascular (angioplasty, CABG, transplants) 4. Orthopedics (joint and spine; sports medicine) 5. Cancer (often high-acuity or last resort) 6. Reproductive (fertility, IVF, women's health) 7. Weight loss (LAP-BAND, gastric bypass) 8. Scans, tests, health screenings and second opinions + An average of 1,200,000 Americans traveled outside the US for medical care in 2014 + The average medical tourist spends between US$3,500 - US$5,000 per visit + Trusted international accreditation has become one of the biggest drivers in the growth of the medical tourism market
+ With medical tourists almost 90% of patients or their companions engaged in tourism activities + 64% of patients that traveled abroad for care did not have health insurance + Nearly 80% of the demand for medical travel is driven by cost savings + Data from the Council for International Promotion of Costa Rica Medicine (PROMED) shows that in 2012, Costa Rica attracted nearly 50,000 medical tourists (mostly from the U.S. and Canada) and each one spent an average of $7,000. Close to half of these medical travelers were said to be dental, followed by orthopedics, weight loss surgeries, gynecology and plastic surgery. Medical tourism generated some $338 million in revenue for the country that year, PROMED reported
FRUIT
| CUCUMBER- FRUIT OR VEGETABLE?
WRITTEN BY CAROL QUASH
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The debate on whether the cucumber is a fruit or a vegetable has been going on for as long as 'the chicken or the egg' contention. The Website dictionary, reference.com, defines a fruit as, “Any product of plant growth useful to humans and animals,” technically classifying the cucumber as a fruit. The same dictionary, however, defines a vegetable as, “Any plant whose fruit, seeds, roots, tubers, bulbs, stems, leaves, or flower parts are used as food,” also technically placing the cucumber into the vegetable family. Thus the war rages on. But amid it all you can stay cool as a cucumber, for in spite of the arguments, two things are certain – cucumbers are delicious and are exceedingly good for you.
CUCUMBER- FRUIT OR VEGETABLE?
Scientifically known as the Cucumis sativus, the cucumber is a botanical relative of the melon and the squash. It is reputed to have originated in Western Asia and parts of the Middle East. Cucumbers come in a wide variety of colours, sizes, shapes and textures, and are classified into two major groups.
SLICING
– This type may have thick or thin skins and is good for slicing. It is typically oblong and elongated, with dark green skin and is harvested for consumption in fresh form.
PICKLING –
Very firm, crisp, small and mild tasting, this type is harvested before it is completely ripe for eventual pickling – preserving in a liquid.
Cucumbers contain valuable antioxidant nutrients such as beta-carotene, Vitamin C and manganese. They also contain a number of flavonoid antioxidants such a luteolin, apigenin, kaempferol and quercetin. And according to naturalnews.com, they are also a good source of vitamin K, potassium, magnesium, iron, calcium and some B vitamins, most of which are found in the skin of the fruit/vegetable. Studies published in Nutrition, Metabolism and Cardiovascular Diseases in 2010 and in Nutrition and Cancer in 2013 identify cucumbers as a rich source of pinoresinol, lariciresinol and secoisolariciresinol – three lignans that have been proven to help in the reduction of the risk of cardiovascular diseases and certain types of cancers. Most commonly used in salads, this unassuming fruit/vegetable does not stop there when it comes to working to keep the body in good health. According to the Mayo Clinic, researchers have identified a hormone in cucumbers that can assist with production of insulin by the pancreas — good news for diabetic patients. In addition, studies have shown that they help lower cholesterol levels, regulate blood pressure, help with digestion, cure hangovers and fight bad breath. And because of the fact that they are 96% water, they are ideal in the treatment of dehydration and for flushing toxins out of the body. It must be noted, however, that no amount of cucumbers can replace the need to consume six to eight glasses of water a day. But while cucumbers work wonders on the inside of the body, beauty professionals have tapped into their therapeutic components to work magic on the outside of the body, too. We have all heard of how this wonder fruit/vegetable uses its natural ascorbic acid and caffeic acid to remove under-eye water retention and puffiness with just two slices in a few minutes. But did you know it
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FRUIT
can help the skin heal from sunburn, inflammation, and eczema? Or that it can help in the reduction of cellulite if eaten and used topically? It's no wonder that the little green fruit/vegetable can be found in almost any beauty product — creams, lotions, shampoos, masks, scrubs, cleansers, toners, you name it. So the next time you are challenged to give your opinion on whether the main ingredient in cucumber salad, “mother-in-law” hot sauce, or cucumber chow is a fruit or vegetable, keep calm and enjoy your cucumber.
BASIC CUCUMBER MASK (For all skin types) WHAT DO YOU NEED: Cucumber (how surprising!) METHOD • Allow the cucumber to chill in the refrigerator for a few hours • Slice and place on the dry skin, or grate the cucumber and apply to the skin • Another option is blend the cucumber and spread the paste gently and evenly with your fingertips on your clean face and neck. Keep the eye area clear • Lie down, relax and leave the mask on for 30 minutes • Wash it off with cold water; pat your skin dry with a clean towel • Apply a moisturiser
WATERMELON-CUCUMBER HANGOVER CURE (serves 4) INGREDIENTS • 2 cups (300g) cubed watermelon • 1⁄2 cup (75g) peeled and sliced cucumber, any variety • 2 tablespoons fresh lime juice • 1⁄4 teaspoon salt • 6 fresh mint leaves, plus more for garnish • 1 litre water • Ice, for serving
PREPARATION
1. Combine the watermelon, cucumber, lime juice, salt, and mint in a blender and blend until smooth. 2. Strain the mixture through a fine-mesh sieve, pressing to release all the liquid. 3. Into a tall glass filled with ice, pour 1⁄2 cup (125 ml) of the watermelon mixture and top with 1⁄2 cup (125 ml) or more of the water.
Sip slowly until you’ve recovered. Have another glass if you need it. Store any remaining cooler covered in the refrigerator for up to one day. Stir well before drinking. 23 | u
FOOD
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B ENEFITS O F C HIA S E E DS
Superfoods
Chia S WRITTEN BY MAIA HIBBEN
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Chia seeds have recently burst onto the health food scene, creating a wave of chia fanaticism. They have been dubbed “the miracle seed”, “the dieter’s dream” and “the running food”. But what are Chia seeds? And are they the ‘superfood’ they are cracked up to be?
B E N E F I T S O F C H I A SE E D S
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FOOD
Seeds 25 | u
FOOD
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B ENEFITS O F C HIA S E E DS
C
hia, or Salvia hispanica L, is a member of the mint family, native to Guatemala, Mexico, and other Central and South American countries. As with quinoa, chia seeds are only now becoming commonplace on the shelves of our groceries, but they have been used by ancient cultures for hundreds of years. They were widely used by the Maya and the Aztecs, and historians believe the seeds were as important to these cultures as maize. It was, without doubt, a staple food source for the Aztec people, and they revered it enough to use it for religious ceremonies and medicinal purposes. Chia is the Mayan word for ‘strength’, and this does suggest that these ancient peoples believed chia seeds held important health benefits. The Maya would grind chia seeds into flour, press them for oil, and drink them mixed with water. They considered these seeds magical due to their ability to increase stamina and energy for long periods of time. Modern day researchers, who studied its use within ancient cultures, believe that it was the main source of nourishment and energy for these tribes when they ran for extreme distances in the difficult terrain of the jungle; this has fuelled its popularity with modern endurance runners, who sometimes consume the seeds as they run.
So is there any truth in any of these claims? The seeds, which come in either white, brown or black, although tiny, appear to pack a great nutritional punch. High in fibre, omega-3s, calcium, protein, antioxidants and other essential vitamins and minerals, yet low in cholesterol with potential weight loss benefits; it really does seem that it has earned its name as ‘the miracle seed’!
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Although there are limited human trials, as with much food research, anecdotal evidence does suggest chia's positive health effects include boosting energy, stabilizing blood sugar, aiding digestion, and lowering cholesterol.
What's in 100 g of chia? • Protein: 20.7 g • Fat: 32.8 g • Carbohydrate: 41.8 g (of which fibre is 41.2 g) • Calcium: 714 mg • Iron: 16.4 mg • Niacin (B3): 613 mg • Thiamine (B1): 0.18 mg • Riboflavin (B2): 0.04 mg SOURCE: Nutritional Science Research Institute
So here are the top 10 reasons adding chia seeds to your diet could benefit your health. Pack in your fibre Just a 28 g or 1 oz serving of chia has 11 g of dietary fibre — about a third of the recommended daily intake for adults. Adding some chia to your diet is an easy way to make sure you're getting a good amount of fibre, which is important for digestive health and weight loss.
Get your omega-3s Chia seeds are a concentrated sources of omega-3 fatty acids; surprisingly, they actually have more omega-3s than salmon! Omega-3s are critical for brain health, and chia contains 5 g per 28 g or 1 oz serving.
Stronger teeth and bones A serving of chia seeds has 18% of the recommended daily intake of calcium, which puts you well on your way to maintaining bone and oral health, and
B E N E F I T S O F C H I A SE E D S
Don't forget manganese
Boost heart health
Although manganese isn't a well-known nutrient, it's important for our health: it's good for your bones and helps your body use other essential nutrients like biotin and thiamine. One serving of chia seeds, or 28 g, has 30% of your recommended intake of this mineral.
Studies have shown that chia seeds can improve blood pressure and increase healthy cholesterol while lowering bad cholesterol. Great news for our old tickers!
Plenty of phosphorus
Combat diabetes
With 27% of your daily value for phosphorus, chia seeds also help you maintain healthy bones and teeth. Phosphorus is also used by the body to synthesize protein for cell and tissue growth and repair.
Chia is being studied as a potential natural treatment for type-2 diabetes because of its ability to slow down digestion. The gelatinous coating chia seeds develops when exposed to liquids can also prevent blood sugar spikes.
Stock up on protein Chia seeds also make a great source of protein, especially if you are vegetarian, and they don’t have any cholesterol. One 28 g serving of these super seeds has 4.4 g of protein, nearly 10% of your recommended daily value.
Trim the fat Chia seeds absorb up to 12 times their weight and expand in your stomach, making you feel full, and curbing your appetite. Chia seeds help reduce your caloric intake by filling you up and helping lower the energy density of certain foods.
Get Full. Faster. Tryptophan, the amino acid found in turkey, is also found in chia seeds, and is popularly known as the amino acid which makes you sleepy. As well as the urge to nap, it also helps regulate appetite and sleep, and improve mood.
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FOOD
How can you eat chia? Here are some quick and simple suggestions… • Mix it with other nuts and seeds to make a quick, high energy, on-the-go snack • Sprinkle over your salads • Add to couscous, quinoa and rice dishes • Stir it in to bread and cake mixes • Mix it in with your oats, breakfast cereal or yoghurt • Add it to your smoothies and juices With its mild nutty flavour it can be added to almost anything or simply eaten alone. It seems that the ancient cultures of Central America have been proved correct in their belief in the ‘strength’ of the chia seed, and have provided us with yet another ’superfood’ to improve our diets and overall health. Although no one seed, grain, fruit, or vegetable will ever be a true miracle food — requiring us to consume no other food source — chia seeds are certainly a small, versatile and hugely nutritious addition to our diets.
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MEDICINE
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B IO LO GICAL ATTAC K : ONE S HOT AT A T I M E
BIOLOGICAL
ATTACK ONE SHOT AT A TIME WRITTEN BY
CAROL QUASH
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The surge in the number of cases of measles across Europe, central Asia, and the United States last year and into this year has raised serious concerns worldwide. "When we consider that over the past two decades we have seen a reduction of 96 percent in the number of measles cases in the European region, and that we are just a step away from eliminating the disease, we are taken aback by these numbers. We must collectively respond, without further delay, to close immunization gaps. It is unacceptable that, after the last 50 years' efforts to make safe and effective vaccines available, measles continues to cost lives, money and time," Dr. Zsuzsanna Jakab, the World Health Organization (WHO) regional director for Europe, tells the BBC.
BIOLOGICAL ATTACK: ONE SHOT AT A TIME
The 22,000 plus cases of measles may have stemmed from the refusal by a growing number of parents to have their children immunized for religious or personal reasons. "It's going like wildfire," Dr. Carol Baker, executive director of the Center for Vaccine Awareness and Research at Texas Children's Hospital in Houston, US tells
HealthDay. "Measles is a really terrible disease. You have fever for a week, your eyes hurt so bad you have to stay in a dark room, and you don't even ask to go outside and play because you're so sick, even if you have uncomplicated measles." But measles is just one of the many diseases that people, especially children, need to be vaccinated against.
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MEDICINE
WHO defines a vaccine as a biological preparation that improves immunity to a particular disease. In 2012 the 194 member states of the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP), a framework to help prevent millions of deaths by 2020 by creating equitable access to existing vaccines for people worldwide.
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MEDICINE
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B IO LO GICAL ATTAC K : ONE S HOT AT A T I M E
But how does a vaccine really work? The immune system is the body's natural defence against germs that cause infections. When they enter the body, these germs are fought off by the antibodies created by the white blood cells. Even after the body has healed, the antibodies stay in the bloodstream, keeping a look out for those specific invaders. If they re-appear, the antibodies spring into action to protect and prevent the body from becoming infected again. A vaccine is made out of a weakened version of viruses or bacteria that cause a specific disease. When the vaccine is introduced, the immune system reacts just as it would in the case of a real infection. In other words, the vaccine tricks the body into thinking it is being attacked by germs, and the antibodies fight back, thus building an immunity to the disease. While some vaccines, such as Mumps Measles Rubella (MMR), can provide protection for a lifetime, others such as tetanus require booster shots. The influenza vaccine is needed annually, as the viruses that cause the flu tend to mutate, making existing antibodies ineffective. Newborn babies develop an immunity to some infections as a result of antibodies that are passed on from mother to child. This immunity, however, only lasts for the first few months of life.
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Over the years, a number of concerns have been raised by parents regarding having their children vaccinated. The WHO has compiled the following about some of the myths and facts about vaccination.
MYTH 1
Better hygiene and sanitation will make diseases disappear – vaccines are not necessary. FALSE
FACT 1
The diseases we can vaccinate against will return if we stop vaccination programmes. While better hygiene, hand washing and clean water help protect people from infectious diseases, many infections can spread regardless of how clean we are.
MYTH 2
Vaccines have several damaging and long-term side-effects that are yet unknown. Vaccination can even be fatal. FALSE
FACT 2
Vaccines are very safe. Most vaccine reactions are usually minor and temporary, such as a sore arm or mild fever. Very serious health events are extremely rare and are carefully monitored and investigated. You are far more likely to be seriously injured by a vaccine-preventable disease than by a vaccine. While any serious injury or death caused by vaccines is one too many, the benefits of vaccination greatly outweigh the risk, and many, many more injuries and deaths would occur without vaccines.
MYTH 3
The combined vaccine against diphtheria, tetanus and pertussis (whooping cough) and the vaccine against poliomyelitis cause Sudden Infant Death Syndrome (SIDS). FALSE
FACT 3
There is no causal link between the administering of the vaccines and sudden infant death; however, these vaccines are administered at a time when babies can suffer SIDS. In other words, the SIDS deaths are co-incidental to vaccination and would have occurred even if no vaccinations had been given. It is important to remember that these four diseases are life-threatening and babies who are not vaccinated against them are at serious risk of death or serious disability.
BIOLOGICAL ATTACK: ONE SHOT AT A TIME
MYTH 4
Vaccine-preventable diseases are almost eradicated in my country, so there is no reason to be vaccinated. FALSE
FACT 4
Although vaccine-preventable diseases have become uncommon in many countries, the infectious agents that cause them continue to circulate. In a highly inter-connected world, these agents can cross geographical borders and infect anyone who is not protected. So two key reasons to get vaccinated are to protect ourselves and to protect those around us. Successful vaccination programmes, like successful societies, depend on the cooperation of every individual to ensure the good of all.
MYTH 5
Vaccine-preventable childhood illnesses are just an unfortunate fact of life. FALSE
FACT 5
Vaccine-preventable diseases do not have to be ‘facts of life’. Illnesses such as measles, mumps and rubella are serious and can lead to severe complications in both children and adults. Failure to vaccinate against these diseases leaves children unnecessarily vulnerable.
MYTH 6
Giving a child more than one vaccine at a time can increase the risk of harmful side-effects, which can overload the child’s immune system. FALSE
FACT 6
Scientific evidence shows that giving several vaccines at the same time has no adverse effect on a child’s immune system. Children are exposed to several hundred foreign substances that trigger an immune response every day. The simple act of eating food introduces new antigens into the body, and numerous bacteria live in the mouth and nose. A child is exposed to far more antigens from a common cold or sore throat than they are from vaccines. Key advantages of having several vaccines at once are fewer clinic visits, which saves time and money, and children are more likely to complete the recommended vaccinations on schedule. Also, when it is possible to have a combined vaccination, e.g. for measles, mumps and rubella, that means fewer injections.
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MYTH 7
Influenza is just a nuisance, and the vaccine isn’t very effective. FALSE
FACT 7
Influenza is much more than a nuisance. It is a serious disease that kills 300 000 –500 000 people worldwide every year. Pregnant women, small children, elderly people with poor health and anyone with a chronic condition, like asthma or heart disease, are at higher risk for severe infection and death. Vaccinating pregnant women has the added benefit of protecting their newborns (there is currently no vaccine for babies under six months). Vaccination is the best way to reduce your chances of severe flu and of spreading it to others.
MYTH 8
It is better to be immunized through disease than through vaccines. FALSE
FACT 8
Vaccines interact with the immune system to produce an immune response similar to that produced by the natural infection, but they do not cause the disease or put the immunized person at risk of its potential complications. In contrast, the price paid for getting immunity through natural infection might be mental retardation from Haemophilus influenza type b (Hib), birth defects from rubella, liver cancer from hepatitis B virus, or death from measles.
MYTH 9
Vaccines cause autism. FALSE
FACT 9
The 1998 study which raised concerns about a possible link between the measles-mumps-rubella (MMR) vaccine and autism was later found to be seriously flawed, and the paper has been retracted by the journal that published it. Unfortunately, its publication set off a panic that led to dropping immunization rates, and subsequent outbreaks of these diseases. There is no evidence of a link between MMR vaccine and autism or autistic disorders.
Iff you opt to get your children h ld vaccinated, d your d doctor willll provide guidance on the immunization schedule. 33 | u
HEALTH
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WHAT AL L ME N NE E D TO K NOW AB OU T T H E P R O STAT E
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SNAP !
W H AT A LL M E N N E E D TO KN OW A B O UT T H E P R O STAT E
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WHAT ALL MEN NEED
TO KNOW ABOUT
THE PROSTATE 10 THINGS YOU CAN DO TODAY TO KEEP YOUR PROSTATE HEALTHY
WRITTEN BY SARA OUELLETTE, CNP Certified Holistic Nutritionist and Fitness Consultant
PROSTATE CANCER IS THE SECOND MOST FREQUENTLY DIAGNOSED CANCER IN THE WORLD, AND IT IS A SERIOUS HEALTH PROBLEM IN THE CARIBBEAN, WITH HIGH INCIDENCE AND MORTALITY RATES AFFECTING A PREDOMINANTLY BLACK POPULATION. WHY IS THIS SO, AND WHAT CAN BE DONE TO REDUCE THE MORBIDITY AND MORTALITY ASSOCIATED WITH PROSTATE CANCER IN THE CARIBBEAN? As a Certified Holistic Nutritionist, I strongly believe in the power of prevention. Prevention means making positive changes in regards to what we have control over, before disease sets in. Quite simply, active holistic surveillance empowers you to take your health into your own hands.
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HEALTH
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WHAT AL L ME N NE E D TO K NOW AB OU T T H E P R O STAT E
GET YOUR H2O The closer you are to the equator, the more water you need. This increases with your activity level. If you get thirsty, you’ve waited too long. Thirst is a sign that you are already dehydrated. Start your morning with a glass of water, sip some throughout the day, and have another glass before bed. Another good indication that you are well hydrated is if your urine runs clear. Urine should never be bright yellow or brown (unless you are taking vitamins). Drink up! Anyone with an enlarged prostate should consume plenty of water and other healthy fluids (herbal tea, fresh vegetable juice, etc.) to flush the bladder. Avoid the three nasties; alcohol (especially beer), caffeine, and sugary, processed drinks. All of these have an adverse effect on the way testosterone is metabolized and cleared from the body, which can contribute the prostate problems.
ZINC-A-DINK-ADOO Every male needs zinc. 50% of men with prostate cancer are deficient in this important mineral. This is bad news, because the prostate tissues are highly dependent on zinc to maintain their health. Zinc boosts a male’s testosterone, and prevents testosterone from converting to oestrogen. That alone should convince you! But more importantly, zinc protects the prostate. Good levels of zinc promote lower levels of oestrogen and prolactin, which reduces the risk of prostate disease. For my scientists, here is the low down; zinc prevents the formation of dihydrotestosterone (DHT), a very potent testosterone. When testosterone levels decline, as men age, the prostate gland converts testosterone to DHT. DHT breaks down testosterone, causing a range of problems, including prostate enlargement, potentially prostate cancer and even male baldness!
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You can get zinc by consuming foods like raw pumpkin seeds, sunflower seeds, pecans, and cashews, Brazil nuts, pine nuts, macadamia nuts, sesame seeds, coconuts, organic spinach, spirulina, seaweeds (sea moss, kelp, nori) and oysters. A healthy snack could include some trail mix consisting of at least ¼ cup of raw pumpkin seeds and dried fruit. There you have your daily dose of zinc!
WELCOME SELENIUM Selenium’s highest concentration in the body is in the reproductive organs. A potent antioxidant, it is found in nuts—especially raw Brazil nuts—seeds, mushrooms (shiitake and crimini), seafood, some meats, fish, wheat bran, wheat germ, oats and brown rice. Selenium protects DNA and the nervous system. It also preserves cells.
BUMP UP THE LYCOPENE Lycopene, a carotenoid pigment found in such foods as tomatoes, tomato products, red grapefruits and watermelons, appears to reduce the risk of prostate cancer. Cooking may release more of the lycopene in tomatoes (especially in cast iron pans); so tomato-based pasta sauces and soups may be especially beneficial. Having tomatoes with extra virgin olive oil also helps. Lycopene is fat-soluble, so it is better absorbed when eaten with a little fat. When I say tomatoes, I mean red, juicy, ripe local tomatoes! Not those white looking, unripe tomatoes we sometimes find in store-bought salads or subs. The pigment should be very bright red, inside and out of the tomato.
GET SOME SUNSHINE We all know that getting a sunburn is bad for us, but recently, there has been so much hype about covering up from the sun, wearing sunblock, using sunglasses or staying indoors. Now we are not getting enough sun! Back in the day, we used to spend more time outdoors. Now, with our busy careers and electronics, we hardly see the sun! We head to work before sunrise, stay in a poorly ventilated, florescent-lit offices, and head back home after the sun has set. Vitamin D is produced by your skin in response to exposure to ultraviolet radiation from natural sunlight. The healing rays of natural sunlight cannot penetrate glass. So you don't generate vitamin D when sitting in your car, office or home. It is nearly impossible to get adequate amounts of vitamin D from your diet. Vitamin D is good for prostate health, as well as to prevent all sorts of cancers. People with dark skin pigmentation may need more exposure to sunlight than fair-skinned people do to generate the same amount of vitamin D. That's why prostate cancer is epidemic among black men — it's a simple, but widespread, sunlight deficiency. There is also increasing evidence that vitamin D promotes resistance to infections. Inflammation, especially combined with a lack of vitamin D, may encourage cancer to develop. Get your sunshine. Just 15 minutes of daily sun exposure can increase your vitamin D to a healthy level.
W H AT A LL M E N N E E D TO KN OW A B O UT T H E P R O STAT E
SEEK BUSH Two common herbs have been shown to improve prostate health. The first is saw palmetto, known for its positive effects on the prostate. Research has found that it hinders the conversion of testosterone to DHT, and may increase testosterone levels. Maca, a herb (or so called “superfood” root), more popularly known for its aphrodisiac qualities, has been found to be beneficial for sufferers of prostate cancer, and is being further researched as a possible preventative measure. Maca is well known for its ability to bring equilibrium to the body’s hormone levels. Since the prostate is one of the organs most affected by hormones, it also benefits a lot from maca’s influence. By effectively keeping hormone levels stable, maca mitigates most of the changes in the body’s physiology, retaining the ‘youth’ of the prostate. Do your research, and consult a qualified holistic practitioner before you decide to supplement with any herb.
GET YOUR ANTIOXIDANTS Consume plenty of fresh whole foods that come from nature and that are rich in antioxidants, like fresh vegetables and fruits, raw nuts and seeds, as well as herbs and spices. A herbal tea that is associated with reduced prostate cancer risk is green tea (or white tea); it contains antioxidants known as catechins, which may help fight prostate cancer.
BREATHE AND RELAX It’s not news that stress can have a significant negative impact on your health, including prostate health. Stress can impair the ability of the immune system to fight illness. Some experts believe that, just as people tighten their neck or shoulder muscles when they are stressed, men unknowingly focus some stress on their pelvic floor muscles. Chronic tightening of the pelvic floor muscles may be a cause of prostatitis (infection of the prostate), or contribute to the development of an enlarged prostate. Stress can also lower zinc levels, and a zinc deficiency can cause prostate problems. Men can utilize stress management techniques to help them both acknowledge and address the impact of stress on prostate health, whether they have a current condition or not. Techniques can take a variety of forms, including psychotherapy, group therapy, meditation, guided visualization, deep breathing, self-hypnosis, exercise, nature walks — whatever helps an individual release stress and maintain a sense of calm and balance.
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GET MOVING Physical activity is important for general health and wellbeing. It can help increase circulation, decrease inflammation, and promote a healthy weight. All which may reduce the risk of prostate cancer. Physical activity can also help to slow down the growth of prostate cancer. A well-rounded exercise program that includes resistance and cardiovascular exercise, as well as stretching, delivers solid health benefits.
REDUCE YOUR TOXIC LOAD It is quite possible that the tremendous increase of prostate cancer reflects the ever-increasing exposure of toxic compounds. A diet rich in whole foods, with as little processing and chemicals as possible, may help prevent prostate cancer. Lemon and water every morning on an empty stomach is an effective way to aid the body in detoxification. Also, be cautious of hormone disruptors. They are synthetic chemicals that cause hormonal activity similar to oestrogen, or alter the hormone’s effects. Avoid pesticides, herbicides, and fungicides, food stored in plastic containers (especially when microwaved), body creams with parabens, cologne, sunblock, etc. The prostate is very susceptible to radiation damage as well. Avoid unnecessary radiation. Do not sleep with electronics close to your head. Males who keep their cell phones attached to their belt or in pockets (close to the prostate), have shown to have a higher risk of developing prostate conditions.
LOOK AT THE BIG PICTURE The importance of a healthy diet and lifestyle cannot be overstated. To function properly, the reproductive system requires the proper nutrients, some sunshine, a bit of exercise, and time to recover. Deficiencies can impair hormone function and contribute to prostate problems, and an excess of toxins can do the same. When possible, eat organic food. Focus on quality and not quantity. Do your best at living a healthy balanced life, including all aspects of the picture. That is living holistically. The key to prevention is gaining knowledge and making your health a priority. Treat your body well.
Sara is a Certified Holistic Nutritionist and Fitness Consultant. She is the founder and owner of Beyond Vitality, a holistic health, nutrition and fitness consulting practice in Trinidad & Tobago. You can find out more about Sara by visiting www.beyondvitality.com or by “liking” the Beyond Vitality Facebook page. 37 | u
MEDICAL
| THE REAL EMERGENCY, IN EMERGENCY MEDICINE
The real
Emergency,
in Emergency
Medicine. WRITTEN BY DAVID FENTON
Television loves Emergency Medicine. I can’t count the number of films, dramas, and programmes that I have seen with people being blue-lighted to hospital with life-threatening ailments, to be saved, resuscitated (or sometimes not) by scrub teams of nurses and doctors — usually looking perfectly turned out and rather handsome, or beautiful, depending on your point of view. It’s no surprise, because Emergency Medicine can be dramatic, stressful, life or death stuff.
Well, perhaps.
Over Christmas and New Year’s, almost all our hospitals failed that target. Some were struggling to see 70% of patients on time. And the problem isn’t just the dire emergencies who are coming in; it’s the elderly, the infirm and those with long-term chronic conditions who suddenly take a turn for the worse who are appearing on the hospital doorstep, often because they don’t know where else to go.
This year, the Emergency departments of all our major hospitals in England have had one of the worst winters on record. And when I say worst, I am not talking about the weather. I am referring to the sheer number of patients who are having to be seen and treated.
One doctor told me: ‘We can cope with trauma victims, the car crashes and heart attacks — but it’s the sheer number of very sick elderly patients, often with respiratory problems, who are putting extra pressure on the system. It’s not their fault, but that’s the way it is.’
But the reality for most hospitals is actually very different in Trinidad and Tobago, and indeed, around the world. After all, emergencies are emergencies, aren’t they?
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Our Emergency departments, like many, have target times to meet. That’s four hours from the time you walk in to when your treatment starts. The Government wants 95% of all patients to be seen within this time, and that is just not happening.
THE REAL EMERGENCY, IN EMERGENCY MEDICINE
In January, I spent the day at one hard-pressed hospital in Poole, a town on the south coast of England with about the same-sized population as Laventille. Over the holiday period, the wards were full, there were no spare beds and sick patients were still arriving at the Emergency department. They can’t be turned away, but they can’t easily be admitted, either. The result: patients were having to wait on trolleys in the corridors, ambulances with patients still on board were queueing outside, and there were a lot of very stressed doctors and nurses. And it wasn’t just the medical teams feeling the heat. Things were so busy at this hospital they had to put out an appeal for secretaries, porters, post-room workers and employees from other parts of the hospital to come in on their days off to help out. Not with treating patients, of course, but with simple administration tasks and fetching and carrying.
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‘Generally speaking, a busy trauma ward is not a nice place to be if you are a frail, elderly patient, perhaps suffering from dementia, who has a long-term condition. It can be confusing for people, and, of course very stressful.’ Some hospitals are now running their own ‘senior citizen’ emergency rooms, where elderly people are separated off and treated in a quieter, less frenetic environment. But these tend to be people with non-life threatening injuries, likes minor falls. Elsewhere, much work is being done to treat more of these patients in their own homes — and to head off the emergency before it happens. Special teams of community consultants, nurses and physiotherapists are being established to identify the 100 most frequent Emergency Service users in their area, and to go out and give them special attention to make sure they are managing their conditions correctly and don’t take a sudden nosedive.
So, why have things got so bad? One problem was that this year a new strain of winter flu developed, which wasn’t affected by the seasonal flu jab. As a result, Emergency rooms were swamped by patients with existing lung and chest problems, brought low by an unexpected flu virus. In some hospitals, nearly 50% of all flu cases had this new strain. Over two weeks in January, 28,000 people died from the virus, or complications caused by it — about a third more than usual. Others took weeks to recover. But there is another, more deep-rooted problem to do with society as a whole. And that is that we are all living longer. Now, clearly, that’s a good thing. But if there is a downside to longevity, it is the threat of poor health. Medical science allows us to cope with many long term conditions and still live relatively healthy lives, but if those conditions are not managed well they can very quickly descend into a full-blown emergency. And this is the problem with many of the patients now turning up at our Emergency Departments. ‘It’s very difficult to know what to do with these kinds of patients,’ one consultant told me. ‘Clearly they are very ill, but equally they probably shouldn’t be in an Emergency Department.’
Another problem, which is also oddly a great benefit, is that all Emergency departments are very visible. They are open 24 hours a day, 365 days a year, and they are free to use by everyone (at least in the UK). Anyone can just walk in the front door, sit down and wait to be treated. Consequently, ED is often the first port of call for worried parents whose child has had a bump or graze, or anyone with a little cough or sniffle that’s been bugging them for a week or two. No one gets turned away. In some ways, that is the beauty of the system, but it is also a great burden. A lot of work is now being done to ‘persuade’ people to think twice before going to their local Emergency Department. Is it really an Emergency? Do you have a life-threatening condition? Have you had a serious accident? If not, go to your doctor or a pharmacist. Of course, the problem is that some patients feel their stubbed toe or their bleeding finger IS an emergency. To be fair, those people are in a minority. Most just want reassurance that their ailment is not something life-threatening and can indeed be treated by their local doctor. This is the way it has always been for Emergency departments, and changing the habits of a lifetime is not going to be easy, but it will be necessary if the NHS is to cope with the increasing demands being placed upon it.
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Joint Commission International (JCI)
JCI provides a premier set of international standards for patient-centered care The Earth is home to more than 7 billion people and its population increases by approximately 200,000 people a day. That growth translates into millions of daily patient care encounters, spanning births and chronic disease care to lifesaving surgeries and organ transplants. As patient needs expand, health care is poised on the cusp of change. New technology, breakthrough drugs, disease prevention strategies, a knowledge-based workforce – all of these contribute to a transformed arena where progress is made yet risks multiply. In the face of accelerated change, achieving and maintaining the highest quality and safety standards remains a top priority. With regional offices and advisory councils in the Americas, Europe, the Middle East, and Asia-Pacific, Joint Commission International (JCI) understands and helps meet the needs of diverse health care organizations in more than 100 countries. Due to the expertise and scope of its international team, JCI is uniquely positioned to adapt international leading practices to the delivery of local care.
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Every year hundreds of organizations apply for JCI accreditation in their
pursuit of high-quality outcomes and patient-centered care. More than 700 organizations have achieved Joint Commission International accreditation and earned the Gold Seal of Approval® in quality and patient safety and thereby enhancing their status among patients within competitive markets. Only JCI provides a premier set of international standards. A prestigious international committee develops the standards that JCI implements, while regional advisory councils —guided by experts—ensure local and cultural relevance. JCI’s standards and accreditation programs are accredited by the International Society for Quality in Health Care (ISQua), demonstrating that JCI meets the highest international benchmarks for accreditation entities. JCI also provides high-value, cost-effective services to organizations of all sizes and at every stage in their quality improvement journey. JCI consultants take part in engagements ranging from improving medication safety and using tracers and mock surveys to enhancing performance and conducting targeted gap analyses of high-risk areas. In addition to working with individual providers, JCI also
collaborates with ministries of health, public health agencies, government agencies, and others to evaluate and improve patient care throughout entire continents. Whether serving as an accrediting body, providing education programs to health care professionals, or helping to develop standards and evaluation methodologies, JCI’s goal is to make health care safer throughout the world.
Joint Commission International (JCI) was established in 1994 as a division of Joint Commission Resources, Inc. (JCR), a wholly controlled, not-for-profit affiliate of The Joint Commission. Through international accreditation and certification, advisory services, publications and education programs, JCI extends The Joint Commission’s mission worldwide by helping improve the quality of patient care. JCI works with international health care organizations, public health agencies, health ministries, and others in more than 100 countries. Please visit http://www.jointcommissioninternationa l.org for more information.
HEALTH
|
THE PSYC HOLOGY OF B ODY TR ANS FOR M AT I O N
W TEN BY WRIT
ROBERT ERT TAYLO L R & SA ACHA CH FO ORTU R NÉ É
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FITNESS: FOR SOME IT IS A LIFESTYLE; FOR OTHERS IT IS AN EVEER-ELUSIVE GOAL. SO WHAT MAKES THE DIFFER RENCE BETWEEN N THOSE WHO CAN SUSTAIN CHANGE, AND THOSE WHO WILL ALWAYS FEEL ESTRANGED FROM THE NEW BODY THEY HAVE CREATED AND REVERT TO THEIR OLD, COMFORTABLE WAYS?
THE PSYCHOLOGY OF BODY TRANSFORMATION
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HEALTH
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THE PSYC HOLOGY OF B ODY TR ANS FOR M AT I O N
TRAINING VS. TRANSFORMING The most frustrating thing for a body transformation expert to hear is that someone wants to ‘lose weight’ or ‘tone up’. Training is a continuous, ongoing practice that can be done with or without a concrete short-term or long-term goal. For those who do not require a major change, ‘training’ is sufficient. However, when you aim big and decide that you want to go from point A to point B where there is quite a significant gap, you do not need a personal trainer but a body transformation expert. Some may be able to carry through on their own without one – but it will be a long road ahead.
Will Julie, after her reunion, go back to her old ways? Will Bob, when he meets a woman and settles down into a relationship, still stay as fit as he was when he was single? Or will it be a wake-up call for Mike, who — when faced with certain death — decides to make a change once and for all?
Your gym pals will cheer you on for that last heavy-duty squat, but they will not be there when you open the fridge after your training session and feel to devour everything in sight!
The fact is, all of these persons can succeed in maintaining beyond the point of reaching the primary goal. The question is… who is the most motivated?
Transformation is a precarious business, so having that level of support is crucial if you want to succeed.
CONNECT WITH YOUR EMOTIONS
UNDERSTANDING MOTIVATION WHY do you want to transform your body? The more powerful your reason, the harder you will work at your goal. If it is a short -term goal, acknowledge this. Let’s examine possible scenarios with three friends: Julie, Jason and Mike. Julie has an upcoming 20-year high school reunion, and after a lifetime of being obese, she
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wants to prove to her high school friends that she is in charge of her life and her body. Jason has just been through a bitter divorce, and suddenly at the age of 45 he finds himself on the dating market again. Mike’s doctor informed him that if he does not lose half of his current body weight, he will become so dangerously obese that he will need to undergo a surgery to reduce the size of his stomach.
How you look makes a huge difference in the way you conduct life. Are you comfortable applying for a new job, where others do not know you and will be faced with your body as their first impression of your capabilities? Are you confident to approach a ‘cutie’ if the two of you lock eyes across a room? When you shop for clothes, can you quickly grab your size, or do you need to try on a dozen options in your fluctuating ‘size range’ and ensure that nothing is jiggling or bulging where it shouldn’t?
One does not simply get up one day and decide to be a fitness god or goddess. You have to prepare mentally and emotionally. You have to prove yourself equal to and worthy of it; that you’re willing to go the distance; that you’re able to face it with the strength, grit, and determination required; and that you will not bail out at the first sign of trouble. If it sounds scary… it is. It is supposed to be.
SITUATIONAL VS. DISPOSITIONAL BARRIERS The reason many don’t attain their goals can be situational or dispositional. FINANCES: A common situational factor is budget constraints. Large quantities of fish and lean meats are pricey, whereas fast food is dirt cheap; it appears that the system is built to counteract our best intentions! However, those who ‘cry poor’ are often the ones that find themselves in every party, eat out often, wear the best clothes, and drop loads of money on highly visible purchases like a new car. Now, no one is telling you not to enjoy yourself and live your life… but you have to understand that sacrifice is essential if you want to live your life in the body you want. If you truly do not have the finances, this does not mean that you should give up… only that you need to get creative. Look into planting provisions and vegetables or rearing small livestock, or research dietary alternatives and exercises that can be done at home.
THE PSYCHOLOGY OF BODY TRANSFORMATION
TIME: Another situational factor is time. The reality of some jobs (e.g. medical profession, shift workers, or upper management) will mean that fitness may fall by the wayside as a day-to-day priority. Again, for some, it will be easy to say “I don’t have time for that,” when they clearly have time to do just about everything else under the sun except that. If time really is a serious issue, however, it can be a little tricky to circumnavigate. But some time is always better than no time. There are ways to squeeze in a high-intensity workout into just a half-hour. Are you willing to get up earlier, or go to sleep later? Can you suggest a gym or even a single item of equipment be procured for your office, so that you can combine a work meeting with a friend into a chat while you both walk on a treadmill? Time is limited only if your imagination permits it. PERSONALITY: This is the key dispositional factor that affects just about everyone along the course of their path. Self-doubt and laziness go hand in hand with failure. “I was never good at sports, and my genetics are messed up, so why bother…” or “Carnival is over, why do I need to still go to the gym…” or “I tried this before and it didn’t work for me…” or even simply: “I really like food…” We have heard it all before. Half-hearted attempts and excuses are part of human nature. You cannot, however, expect transformation if your mind is not ready for it.
A family member: “But girl… you drop so much weight, like you disappearing!” Or even worse, your significant other: “But oh gosh, baby, I miss your curves!” What lies behind the gentle teasing from loved ones can be a myriad of things — it may be genuine concern, but more likely it may be doubt or insecurity on their part. A significant other, for example, may be worried when your fitness level drastically surpasses his or her own — it can trigger anxiety that (1) you may no longer be satisfied with his/her own level of fitness (2) you will be getting much more attention from the opposite sex, or even simply (3) your interests have gone out of sync with each other and he/she can no longer relate. Greatness comes with consequences – when your body changes, your perceived identity changes. There might be more attention from the opposite sex, more subtle rivalry with your friends/colleagues of the same sex, or even quite simply ‘haters’ who are not pleased that you have been able to achieve what they cannot. It is easy to fall back into your old ways when you have all the negative energy surrounding you, but remember: your feeling uneasy and unhealthy serves a purpose. It allows you to avoid facing deep-rooted fears, encounter ongoing obstacles, open those old wounds, and make those crucial sacrifices.
THE CONSEQUENCES OF TRANSFORMATION
CONCLUSION And, once you DO circumvent all the evils of dispositional and situational factors and DO achieve a significant body transformation… How often do you hear… A friend: “You looking too hard, boy…”
Many may be wondering why diet and exercise have hardly been mentioned, but this is intentional. Designing a regimen is easy. However, the law of individual
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HEALTH
differences means that “what works for you, will not necessarily work for me” – and you must appreciate that. You cannot afford to get discouraged when friends are losing weight more rapidly than you while using the same regimen; and you cannot and must not lose heart when you do not hit the goals you set for yourself. If you are truly ready to embark upon a long-term body transformation, there is a psychological aspect of motivation and understanding how to use your “why” as fuel to achieve your goal. You can achieve anything through troubleshooting your transformation process. If you stay motivated and driven, eventually you will figure out a solution. Spend time being introspective and figuring out why you want to achieve a specific body transformation goal. Surround yourself with like-minded people, rather than those who only have passive-aggressive (or fully aggressive!) negative comments to throw your way. Even if you do not have the budget or the desire for a paid transformation expert, seek out a mentor who has gone through a similar body transformation process – you may not even need ‘advice’ per se, but simply to be in the presence of positivity. Finally, be prepared to lose friends if your new fitness regimen does not agree with their lifestyle you once enjoyed. Be prepared to hold your ground and tell your loved ones that you have made a decision to change, and either they get on board (join you) or at least get the picture (accept you). So in closing… stay motivated, and most importantly: get started!
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THE NEXT U April to June
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