U The Caribbean Health Digest - Issue 29

APR JUN 2015

ISSUE 29

TT TT T$ $35 5..00 5 00 US$5. $5 $5 5..99 99

®

THE CARIBBEAN HEALTH DIGEST

Rehabilitative care for heart patients A way to enjoy a healthy future.

Food security in Caribbean households Dr. Caludette Mitchell takes a look at food security in the Caribbean Tamarind A delicately sweet and tangy fruit packed with anti oxidants. uh u hea ealt lthd dig ge es stt..co com

Founders

Sherine Mungal Stuart Fraser

Publisher

Eidetic Publishing

Editorial Director

Sherine Mungal

Managing Editor

Roslyn Carrington

Writers

Our Intention candles are hand-poured purposefully crafted to inspire your senses.

We use blends of only one hundred percent pure therapeutic essential oils in combinations that have been researched and proven to soothe, calm and relax.

Assembled using all natural soy wax which are free for all toxins and wicks constructed from natural, cotton threads and contains no lead, zinc or other metals.

Healing Blend Lavender • Eucalyptus • Sage Purify your mind and body with the healing candle. The essential oils of lavender and refreshing eucalyptus soothe the body while reducing physical and mental fatigue. Combined with sage, the “sacred herb,” anxiety can be relieved and euphoria can ensue.

Detoxify, energize and release what doesn’t serve you any longer.

Prosperity Blend Cinnamon • Bergamot • Petitgrain The prosperity candle will release negativity to create and receive abundance with the aromatic blend of cinnamon, bergamot and petitgrain essential oils. This spicy blend is grounding and powerful to welcome success and a sense of stability.

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Gratitude Blend White Spruce • Rosewood A comforting blend of white spruce and rosewood essentials oils. The gratitude candle is a great gesture of giving thanks to someone special or to light when one wants to honor their blessings in their own life. Take a few moments every day to feel what you are most grateful for and it will shift your energy immediately to a place of peace and joy.

Creative Director Design Project Coordinator Traffic Photography

Medical Advisory

Maia Hibben Carol Quash Dr. Claudette Mitchell Kerry Grant Lylah Persad Nasser Khan David Fenton

Stuart Fraser Eidetic Cindy Singh Lorraine Biran shutterstock iStockPhoto Dr. Neil Singh

MBBS PG MSc

Healthy Blend Eucalyptus • Basil • Lemongrass These inviting smells of basil and refreshing orange will delight your sense of health and well-being. Feel confident in your healthy decisions in life to stay energized and focused with this invigorating blend of neroli, basil and lemongrass essential oils.

Clarity Blend Litsea Cubeba • Peppermint The cleansing fragrance of this clarity candle will clear your mind while stimulating and energizing your mood.

The essential oil of litsea cubeba, combined with refreshing peppermint oil will increase your concentration and help uncover solutions in times of fatigue or stress.

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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.

Miami Cardiac & Vascular Institute at Baptist Health South Florida has been advancing care for over 25 years by pioneering treatments of heart and vascular conditions. Now with a $100 million expansion and integration of services at over 25 locations, you and your loved ones can experience the most trusted cardiovascular care in the region from some of the most renowned physicians in the United States.

Learn more at BaptistHealth.net/Heart

786-596-2373 | International@BaptistHealth.net

12 An Empowering Approach to Mental Health Care in T&T There’s no question that any history of mental illness can leave a person with a lifelong stigma.

This article focuses on a young group of mental health care professionals who understand the challenges associated with this, and are now providing a new approach to mental health care.

16 Teenaged Stroke When we hear the word stroke, we assume that it must be associated with an elderly or mature person. The reality is that younger people can also suffer strokes, and David Fenton looks at the case of a teenager who suffered a severe stroke, and discusses causes and treatment options.

20 Getting to the Heart of the Matter Cardiac conditions can range from mild to extreme, but either way must be taken seriously. Rehabilitative care plays a critical role in managing and even preventing serious heart conditions. In this article, the Caribbean Cardiac Rehabilitation and Wellness Centre discusses the benefits of rehabilitative care with our writer Carol Quash.

24 Food Security in Caribbean Households In this article, Dr. Claudette Mitchell takes a look at the issue of food security in the Caribbean, some of the factors that may contribute, and how it can all affect our nutrition.

28 How Mixed Martial Arts Training Improves All Some martial arts can be traced as far back as the early 1500s, and are used in many cultures around the world today for many reasons, be they self-defence, competition, or physical health and fitness. Sensei Kerry Grant has been producing some of the nation’s top mixed martial artists, and shares the secrets to his success.

30 Irritable Bowel Syndrome (IBS) IBS is a pretty common term these days, but how many of us know exactly what it means?

Our writer, Lylah Persad, gives an account of her experience and shares how you can take control of this condition.

38 The Versatile Tamarind aka Tambran Even if you didn’t know what this fruit looked like, you must as least know that it’s the base for one of the Caribbean’s most popular treats, the tamarind ball. This tangy, sweet fruit is also quite nutritious and packed with medicinal benefits.

42 Therapy Works The challenges families face when special needs children are in the picture are sometimes overwhelming. Therapy Works is an organization dedicated to working with these children and their families through every stage of therapy and treatment. Maia Hibben shares the story of the incredible team of people.

Welcome to our 29th edition of U! Straight out of another hugely successful Health and Wellness Exposition, and we are on the ball again, putting things in place to bring you another issue of U. This time around we wanted to bring to the fore some of the incredible individuals and organizations that were a part of our Exposition 2015, as we were so impressed by how committed they are to raise the level of health and healthcare in Trinidad and Tobago.

In the first of these featured articles, we share the vision and passion of a family that is committed to working with cardiac patients at every level to rehabilitate them through their Caribbean Cardiac Rehabilitation and Wellness Center.

We were equally moved by the group of young mental healthcare professionals from ExecuCare, and have shared their profile and services in our article on Mental Health.

And, finally, from our Expo offering we have to tout the success of Sensei Kerry Grant and his Mixed Martial Arts Club by featuring them in the fitness article. The support and life demonstrations have been a part of our Expo for the five years.

Our U29 cover story examines a very serious subject, one that may surprise you; David Fenton looks at the case of a teenager in Britain who suffered a stroke, a cause for concern, given that strokes have traditionally been associated with much older people.

The tamarind fruit may leave a tangy taste in your mouth, but the health benefits certainly compensate for that.

Just some of what’s in store for your reading pleasure, plus much more.

Healthy reading!

SHERINE & STUART

FOUNDING EDITORS

MIND

| EXECU-CARE: AN EMPOWERING APPROACH TO MENTAL HEALTH CARE IN T&T

An Empowering Approach to Mental Health Care in T&T 12 | u

WRITTEN BY MAIA HIBBEN

EXECU-CARE: AN EMPOWERING APPROACH TO MENTAL HEALTH CARE IN T&T

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MIND

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MIND

| EXECU-CARE: AN EMPOWERING APPROACH TO MENTAL HEALTH CARE IN T&T

The mental health sector in Trinidad and Tobago is, unfortunately, still considerably fragmented. It is an area of health services that sees very little of the national health budget, and the public system is under significant strain in terms of space and resources. And yet, it is not all about money and resources; it is also about attitude, education, and, most crucially, about breaking down the stigma that still hangs like a dark cloud over mental health issues. But stigma is a sticky thing and not so easily removed; St Ann’s Hospital is perhaps the most notable example of this — it seems stigma is stuck to St Ann’s like ‘lagley’.

Yet on my journey within T&T’s mental health services I have met many dedicated professionals who have a real passion for their work, a desire to improve services, and who provide a high level of care to their patients, discrediting the myths and rumours and filling me with a renewed faith. I recently had the pleasure of meeting with one such individual who has found an innovative way to provide mental health services in T&T. Richard Allen has been a psychiatric nurse based at St Ann’s Hospital for the past 8 years. Thus he sees and understands, better than most, the stigma of St Ann’s, and, more importantly, the impact it has on patients and their families.

For most people, St Ann’s Hospital is the last resort, and this inevitably means people are compromising their health, or the health of their loved one, because of the reputation, fear and stigma attached to the hospital. This, Richard tells me, was one of the main drives behind the creation of Execu-Care, a comprehensive private mental health service that comes to you.

Execu-Care began in 2009, with the Execu-Care brand being established in 2013 by Richard Allen and Riguel Forgenie.

They aim to provide quality, holistic, client-centred and goal-orientated private mental health services to T&T. “We understand that each person is an individual with unique health needs that are influenced by physiological, biopsychosocial, socioeconomic, cultural and spiritual factors. Everyone is entitled to respect, dignity, privacy and confidentiality in a holistic and therapeutic setting.”

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Richard and other likeminded colleagues at St Ann’s Hospital recognised the need for an alternative option, a new approach to providing mental health services, a service that was free from stigma, that did not compromise confidentiality, and was safe and secure for the patient and the family.

The team currently consists of 6 members whose expertise covers psychiatry, psychology, nursing and nutrition and diet.

Unlike employing the services of mental health professionals where you would go to visit them, Execu-Care is a service that comes to you. Once the call is made, the psychiatric nurses and the house officer will attend and assess the mental state of the client, examine the options, and an immediate time frame is drawn up.

Depending on the outcome of this initial assessment, the consultant psychiatrist may also be called upon, and if need be the client may be privately hospitalised. If this happens, the psychiatric nurses accompany the person to hospital where they care for them 24/7 until they are discharged. Once home, the client would continue to be managed and monitored by the team. Richard explains that currently the majority of their call-outs are to respond to crisis situations, so their main objective is to stabilise the client and ensure they are not a risk to themselves, or their family.

Once the client is stable, the other expertise in the team comes into play. The psychologist conducts detailed assessments of the client and creates a plan of individually tailored psychotherapeutic tools that can be used. In a similar fashion, the nutritional advisor assesses the diet of the client and provides advice as to what diet and lifestyle choices will need to be made to improve the health and wellbeing of the client.

These services are not in themselves unusual, and you could access all of them, albeit individually, both in the public and private healthcare systems. What is unique about Execu-Care is that these services come to you and they work together to look at the client holistically — mind, body and soul; thereby striving to provide the best balance between these elements.

Mental illness is never black or white, and what works for one often will not work for another. Having this level of individualised care and treatment is providing something truly special and desperately needed.

Another important aspect to the role of the team is to provide support and education to the family. Because the team comes to them, in the comfort of their home, the family members and the client are deeply involved in the whole process. This, according to Richard, is crucial and they encourage the client and the family to be involved.

EXECU-CARE: AN EMPOWERING APPROACH TO MENTAL HEALTH CARE IN T&T

“It is an opportunity for them to learn about the symptoms, the condition, and how it can be recognised and managed.

Helping families understand puts them in a better position to help their loved one and also helps to reduce their stress, as they are better equipped to deal with the problems they face.”

Execu-Care was one of the new exhibitors at this year’s U Health Expo, and Richard indicates that one of their goals for the future is to host their own Mental Health Fairs, bringing education and knowledge-building to communities across the country. They also aim to purchase a vehicle which would be equipped similarly to an ambulance, but that would be private and unmarked — ensuring anonymity and comfort. This would be used to accompany those clients who may need hospitalization to a facility of their choice.

What Execu-Care is doing is providing a new approach to mental health care — one that is rooted in seeing the person as an individual and not an illness. But more significantly, Execu-Care is empowering people with mental illness and their families.

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MIND

They are giving them the dedicated attention their problems deserve and teaching families how to understand and support one another in the often turbulent journey they face. This is the very essence of community mental health care!

THE EXECU-CARE TEAM • Dr Dominic Nwokolo – Consultant Psychiatrist and Senior Medical Officer • Dr Chinwe Ezeokoli – House Officer • Mr. Richard Allen – Psychiatric Nurse • Mr Riguel Forgenie – Psychiatric Nurse • Mr. James Harper – Nutritional Advisor • Mr. Swayne-Leo Hosein-Cadogan – Forensic Psychologist

37B Mission Road, San Juan, Trinidad and Tobago Tel 1868-728-CARE (2273) Email execucare1@gmail.com or visit us on facebook.com/ExecuCareForYou 15 | u

FEATU RE

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TEENAGE D S TR OK E

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TEENAGED

T E E N AGE D ST RO KE

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FEATURE

WRITTEN BY DAVID FENTON

DAVID FENTON LOOKS AT HOW STROKES ARE AFFECTING YOUNGER PEOPLE MORE THAN EVER BEFORE — INCLUDING SOME IN THEIR TEENS — AND HOW A NEW PROCEDURE MIGHT HELP.

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FEATU RE

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TEENAGE D S TR OK E

T

wo days after celebrating his 18th

was wrong — Ben was having a stroke, just days

birthday, Ben was convinced he had the

after his 18th birthday.’

world’s worst hangover: the fever, the

sweats, and the symptoms just wouldn’t go away.

In the UK, 18 is the age at which you are legally

A stroke is a medical emergency. It happens when

allowed to drink alcohol, and teenagers often push

a clot blocks a blood vessel and starves part of

the boat out when celebrating. But in Ben’s case,

the brain of oxygen. Often it causes paralysis or

it wasn’t an excess of beer at all — in fact, it was

lack of speech. Sometimes it can be fatal. 24

something much more dangerous, and potentially

hours later, Ben woke up in Intensive Care,

fatal. When his symptoms failed to improve, he

unaware that he had undergone a major

went to his doctor and then to hospital, where he

operation. ‘I don’t remember very much about it

was diagnosed with a blood clot on his heart.

at all,’ he told me. ‘One minute I was talking to my mum and reaching over to pull out my phone charger plug and the next thing I knew I was

For the teenager and his family, it was a terrible

waking up in Intensive Care. I didn’t feel anything,

shock … but worse was to come. Ben was given a

but my arm just went completely limp, and then I

blood thinning infusion, because there was a high

must have blacked out.’

risk that the clot might suddenly break up and pass around his body, potentially blocking an artery.

Then, while he was sitting in his hospital bed

The clot had lodged in the main artery that

talking to his family, that is exactly what happened.

supplies the left side of Ben’s brain. Within minutes he was whisked to a specialist stroke unit, and then to a neurological centre at Southampton

‘One minute he was on the ward trying to get his

General hospital, where surgeons used a new

TV working, and the next thing he was having a

technique to remove the clot.

stroke!’ said his mother, Deborah. ‘It was four

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o’clock in the afternoon and I was just leaving. He stood up to see me out, and as he did that his

The procedure, a type of thrombectomy using a

body froze. It was like he was paralysed in freeze

stent, was performed by consultant

frame. I asked him if he was ok, but he didn’t

neuroradiologist Dr Jason Macdonald. ‘If there is

speak or move. His face had no expression and he

a large clot in an artery, blood thinning drugs have

just looked lost. I screamed to the nurses and they

only about a 10% chance of actually clearing it.

were at Ben’s side in seconds, but I knew what

But this procedure allows us to get at the whole

T E E N AGE D ST RO KE

clot, and hopefully remove it completely,’ he said.

told me. ‘High blood pressure, lack of exercise,

‘We go in through the groin, passing a catheter up

obesity and things like diabetes. It’s no different;

through the neck, and then either put a stent in to

it’s just that we are seeing the effects at a much

remove the clot, which is what I did with Ben, or

younger age.

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FEATURE

aspirate it, which basically means sucking it out.

‘What this does is to open up the blood supply again and stop the brain downstream of the clot from dying.’

‘I’d say that over the past 15 years we have seen a 25% increase in the number of stroke patients under the age of 45.’ But Ben was a fit and seemingly

Last year the hospital performed eight of these

healthy young man. His stroke was caused by a

procedures on patients, because as yet very few

hidden heart condition, which no one knew he had.

specialists are trained to do it. But perhaps 300 patients a year might benefit from it. The shocking thing about Ben’s stroke, of course, was

He remained in hospital for six weeks after his

that he was just 18 years old when it happened.

operation, learning to walk again and to speak.

But the number of younger people suffering

The stroke had disabled the right side of his body.

strokes is increasing, according to specialists at

‘Standing up the first time was the hardest,’ he said.

the Queen Alexandra Hospital in Portsmouth.

‘It took me about seven days before I cracked it. You would never have thought standing up would be so difficult, but every time I tried I just felt sick and dizzy

One doctor told me: ‘It used to be quite unusual

and my body felt the weight of 100 bricks!’

to see people in their thirties and forties with strokes, but we get it all the time now. It’s a fairly regular thing to see working age people coming in

That was last year, and when I saw him a few

with often very serious strokes. It can be devastating,

weeks ago — just after his 19th birthday — Ben

not just for them but for their families, too.’

was back at college, where he is training to be a car mechanic, and doing very well. So how to avoid getting a stroke in the first place? ’I tell my

So what is behind it? Why are more young people

patients that the secret to avoiding strokes is very

having strokes? Could it be something to do with

simple,’ said one specialist. ‘In fact, I tell them it’s

our modern lifestyle, stress at work, bad diet?

as simple as four words: Eat less, Move more!’

‘Often young people get a stroke for exactly the

Advice which I am sure many of us would do well

same reason as older people do,’ the specialist

to consider….

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HEALTH

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CARIB B EA N CA R DIAC R E HA B IL ITATION & W E LLN E SS C E N T R E : GE T T I N G TO T H E H E A RT O F T H E M AT TER

WRITTEN BY

CAROL QUASH

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Heart disease refers to any type of disorder that affects the heart, disorders which, if not treated, could be fatal. The World Health Organisation (WHO) names heart disease as the leading cause of death in the UK, USA, Canada and Australia. Some of the more common heart diseases include coronary artery disease, irregular heartbeat (arrhythmias), congenital heart defects, weak heart muscles (cardiomyopathy), heart valve problems, heart infections, and cardiovascular disease.

CARIB B EAN CARDI AC R E HA B IL ITATION & W E L L NESS C E N T RE : GE T T I N G TO T H E H E A R T O F T H E M AT T E R

T

reatment for heart disease may include lifestyle changes, medicines, medical and surgical procedures, and cardiac rehabilitation — such as the type that is offered by the Caribbean Cardiac Rehabilitation & Wellness Centre in Valsayn North.

The one-year-old facility boasts well qualified staff and top of the line equipment, so rehab patients get the treatment they need, and then some. “It is a family and friends-oriented business, with a team of focused people, all sharing one common goal.

We are the only specialised Cardiac Rehabilitation Phase II clinic in Trinidad and Tobago, and we take it to heart (no pun intended),” director and exercise specialist Fiad Mohammed tells U. The Cardiac Rehabilitation Phase II programme refers to the transitional phase of cardiac rehabilitation after a patient leaves the hospital.

Among its goals are: • Making a smooth transition from hospital to home • Taking proper care of yourself after leaving the hospital, including taking care of surgical incisions • Getting stronger and being more active But although the centre focuses mainly on rehabilitation, it also places great emphasis on prevention of heart disease with activities that help keep the body healthy and fit. “We specialise in Cardiac Rehabilitation Phase II. But we also offer natural weight loss, nutritional counselling, aqua therapy, yoga, Zumba, spin, body toning and sculpting,” Mohammed outlines. He says patients can feel comfortable in the hands of the facility's experienced and dedicated nurses, cardiologists, nutritionists, therapists, exercise and wellness specialists, and accident and emergency personnel.

Rehab clinic is held on Tuesdays, Thursdays and Saturdays. Patients are usually required to participate in 12 sessions per month.

“On an average day we welcome all our cardiac patients, make sure they are feeling well and are comfortable. Then we assign a cardiac rehabilitation specialist to them, who exercises them based on a cardiologist-approved workout. A nurse walks the floor and continuously monitors

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HEALTH

their blood pressure, heart rate and oxygen. So in one hour, a cardiac patient comes in for a cardiac rehabilitation session: everything is done in one hour. Simultaneously, we have clients who come in throughout the day for the weight loss workouts.”

Mohammed does his work passionately because he knows only too well the challenges that heart disease can create for the patient and their family, and the devastation it can cause when treatment does not produce the desired results. “Both my father and my wife's father died from heart disease.

This was mainly due to the lack of proper heart care and knowledge of heart disease back then.

Therefore my wife and I are prone to heart disease.

But it doesn’t just stop there. Our children can also be affected by this. This is our future. Taking care of ourselves now is a step towards a prosperous future.”

But a family history is not the only risk factor when it comes to heart disease. Some other common risk factors include • smoking • high blood pressure • high blood cholesterol • diabetes • poor diet • age • ethnicity • lack of exercise • obesity • stress • poor hygiene (some viral and bacterial infections can affect the heart) And as more people become informed about cardiac rehabilitation and its life saving effects, Mohammed says the Caribbean Cardiac Rehabilitation & Wellness Centre team will soon be opening new facilities nationwide. “The future is fruitful and near. There's no better feeling when you can wake up every morning knowing you are doing your part in helping someone stop suffering from this epidemic of heart disease. We plan to have clinics throughout the country, making cardiac rehabilitation more convenient for the people of Trinidad and Tobago. The more people learn about us, the more lives we get to help save.”

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O 1

THINGS ABOUT

STROKES

Stroke is the third most common cause of death, after cancer and ischemic heart disease.

Stroke is the most prominent cause of physical deformity Its incidence is accelerating in developing countries due to unhealthy lifestyles.

2/3 of stroke victims are above 60 years old.

1/5 of the victims die within a month of its occurrence. Half the survivors become physically deformed.

Damage in the left side of the brain may result in paralysis of the right side of the body; damage on the right side, paralyzes the left side.

Hypertension accounts for 30-50% of stroke risk.

Patients with diabetes mellitus are 2-3 times more predisposed to stroke.

Stroke can occur due to a disruption in blood supply or due to blood vessel damage.

FAST is an acronym that can help you remember the signs of a stroke and what to do. "F" stands for face. Is your face drooping on one side when you smile? "A" stands for arms. Raise both arms and notice if one arm falls. "S" stands for speech. Is your speech slurred? "T" stands for time. If detected early because of the warning signs, prevention is possible.

FOOD

| FOOD SECURITY IN CARIBBEAN HOUSEHOLDS

food s in Caribbean Households

WRITTEN BY CLAUDETTE MITCHELL, PH.D., RD, ASSISTANT PROFESSOR, UNIVERSITY OF THE SOUTHERN CARIBBEAN,

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SCHOOL OF EDUCATION AND HUMAN SCIENCES

FOOD SECURITY IN CARIBBEAN HOUSEHOLDS

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FOOD

ecurity 25 | u

FOOD

| FOOD SECURITY IN CARIBBEAN HOUSEHOLDS You will agree that all persons should have access to sufficient food to maintain his or her health. To achieve this outcome, the World Food Summit 1996 emphasizes that all individuals should have physical, social, and economic access to an adequate supply of food that is safe and nutritious, meeting their dietary needs and food preferences, for an active, healthy lifestyle. Therefore, food security in households is critical to maintaining nutritional status. The three pillars for food security include: (a) food availability: adequate quantities of food available consistently; (b) food access: sufficient resources made available to obtain appropriate foods for a healthy diet; and (c) food utilization: appropriate use based on knowledge of nutrition, adequate water and sanitation (Dowlath).

At the local and regional levels, food security in the Caribbean is negatively impacted by challenges such as natural disasters (hurricanes, floods, and droughts), agricultural policies, and the decrease in agricultural products, perhaps due to some farmers moving away from the land, or others opting to plant crops on a smaller scale. Whatever the challenge, it can have a major effect on the entire population and the economy of that country.

What can possibly happen during food insecurity?

Being able to provide for yourself and your family can be a matter of concern for many persons, and some individuals may find it difficult, frustrating or even challenging. People who are food insecure might appear to be undernourished due to the physical unavailability of nutritious food, coupled with the lack of social or economic access to adequate food and/or inadequate food consumption and utilization.

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As a result, the Food and Agricultural Organization (2000) indicated that the dietary intakes of these individuals might fall below the minimum calorie requirements, and they might exhibit physical symptoms due to energy and nutrient deficits because of unbalanced diets. Also, their bodies may show signs of the inability to use food effectively because of infection or disease.

Therefore, failure to resolve these issues can probably not only result in nutrient deficiencies among persons within families who may be at different stages of the life cycle, e.g. infant, school-aged child, adolescent, adult, pregnant and/or lactating mothers, and the elderly; but also contribute to chronic non-communicable diseases.

Lovendal et al. (2007) supported this view; they documented that the question of food security precedes that of energy intake. Adequate nutrition provided through a balanced diet can aid a person’s nutritional status. In some middle-income countries, there is a shift in the challenge from food security, considering insufficient energy consumption, to that of balanced diet. The focus here is placed on maintaining nutritional health and preventing diseases.

FOOD SECURITY IN CARIBBEAN HOUSEHOLDS

Some factors affecting food security in households…

Several contributory factors affecting food security include, but are not limited to, food availability, accessibility, consumption and/or utilization, socioeconomic status, and number of persons within households both at the local and regional levels. This, along with increases in population growth, economic crisis (falling oil prices), demand for supply followed by a decrease in food production, not enough support for farmers and/or the agricultural sector, an increase in food importation, are major issues.

From this brief overview, you can observe that adequate nutrition for every member of the household goes beyond having knowledge of nutrition and meal planning; but, these impending factors mentioned can pose a challenge to the maintenance of nutritional status. Moreover, throughout the region, environmental factors may also affect food production, sourcing and prices, thereby impacting food security (Henry & Ballayram, 2008).

The rising cost of food may cause some families to experience inadequate dietary intakes because a lesser quantity of goods can be purchased.

Therefore, a link exists between food prices and food security. The increase in food prices can impact both the consumers and farmers. You can sometimes find that farmers may adopt risk-reducing strategies, such as shifting to more stable and lower value crops, reducing investments in new technologies, or reducing use of purchase inputs. This, of course, can result in inefficient levels of investments and/or resource allocation, and may perhaps reduce competition within the agricultural sector (Lovendal et al. 2007).

Also, additional factors such as poverty, insufficient funds and/or the lack of income, and reduced access to resources continue to threaten food security. Poverty, nutrition and health status are inter-related. Constrains of poverty tend to affect both quantity and nutritional quality of foods selected and consumed, leading to hunger and malnutrition (Ballayram & Henry, 2008).

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Making changes…

Given this information, discussions on food security should be held not only within households; but at another level among other significant stakeholders such as farmers, community representatives, and government officials to address the aforementioned factors that might occur, affecting an adequate food supply.

Moreover, Ballayram and Henry (2008) documented that countries should establish national and nutritional goals which form an essential component of National Food Policies, National Plans of Action for Food and Nutrition Security, and committees at the government and community levels, with the aim of improving food security within households. The key focus is the development of efficient systems for agriculture and food and nutrition to ensure delivery of adequate and appropriate quantities of food to low-income and vulnerable groups within the population.

From this, therefore, you can observe that resolving food security issues involves a multidisciplinary approach, bringing together several groups such as local farmers, community representatives, families, policy makers, and business organizations.

A few helpful hints…

To ensure the provision of adequate nutrition, meal managers can be taught the nutritional value of local produce, smart grocery shopping, and how to prepare local foods in a variety of ways.

Due to the association between an unhealthy diet and disease, the meal managers may limit the purchase of foods low in dietary fibre, high in fat, sugar, and salt.

Families, communities, and schools should be encouraged to grow some of their local produce by making kitchen gardens on a small scale or by cultivating large plots of land; this, of course, can help to somewhat sustain their food supply, and can also bring a sense of satisfaction and joy.

Remember: Food security is critical to maintaining nutritional status and should be given top priority.

REFERENCES + Dowlath Samaroo. Sustainable Agriculture and Food Security for Trinidad and Tobago, Are we on the Right Track?

+ Ballayram & Henry Fitzroy. Food Security – I. Cajanus The Caribbean Food and Nutrition Institute. Vol 41, No 2, 2008.

+ Lovendal et al. Food Prices and Food Security in Trinidad and Tobago.

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ESA Working Paper No. 07-27, September 2007.

FITNESS

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MI XED MA R TIA L AR TS TR AINING IMP R OV E S A LL- A R O UN D H E A LT H A N D F I T N E SS

HOW MIXED MARTIAL ARTS TRAINING IMPROVES ALL-AROUND HEALTH AND FITNESS WRITTEN BY

KERRY GRANT

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THE SOUTHERN WARRIORS OF MIXED MARTIAL ARTS IS A PREMIER MMA CLUB LOCATED IN SOUTH TRINIDAD, AND IS WELL KNOWN THROUGHOUT THE CARIBBEAN FOR PRODUCING SOME OF THE NATION’S TOP MIXED MARTIAL ARTISTS FOR THE PAST SEVEN YEARS.

MIXED MARTIAL ARTS TRAINING IMPROVES ALL-AROUND HEALTH AND FITNESS

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ome of their best known members include Seon Adhar, ranked number one in the Caribbean in the fly and bantam weight categories, and also a double gold medallist at the 2014 Sambo Pan Am Championship; and Sherisse Subero, ranked as the Caribbean’s top female MMA fighter in her weight class and who was the first female from the Caribbean to medal in an international Sambo event. There is also Kerron Parris, an undefeated heavyweight fighter, who ranks number one in the Caribbean.

Sensei Kerry Grant, owner and head instructor of the combat club, insists that having a healthy lifestyle contributes to the success of his athletes. The program that they follow is very strict. To be an outstanding athlete, for example, they must follow a healthy nutritional and exercise regime.

Their breakfast includes oats, grains, tuna and eggs, with the occasional toasted slices of wheat bread, while lunch is a more complex carbohydrate menu, such as ground provisions. This is followed by certain fruits such as bananas,

which contain potassium, which helps with the restoration of tired muscles and reduces the risk of muscle cramps. Most times, the dinner menu is very light, containing mostly vegetable soups, mixed vegetable salads or very high protein shakes.

The importance of sleep should never be overlooked, for most of the body’s tissue and muscle repair goes on during sleep.

Having healthy muscles and ligament tissues are extremely important to mixed martial arts fighters. Therefore, a maximum of ten hours’ sleep is recommended, with a minimum of eight hours.

Mixed martial artists are skilled, physically and mentally fit athletes. Besides having a balanced healthy sleep and nutritional plan, they must undergo a high performance physical training program. This program is designed to build strong muscle tissue as well as build and sustain healthy, positive minds. Spending two to three hours for four days a week at the gym, coupled with a four-hour skills training program, helps these elite men and women

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FITNESS

to relieve stress and contributes to a healthy cardio-vascular and aerobic system.

When one goes through the MMA training process successfully, their outlook on all aspects of life is tremendously improved. They gleam with self-confidence, which carries over into positive thinking skills, and changes the way they interact with others. It means more than just having a well-shaped body; a healthy way of life is obtained and maintained.

“We are not ordinary people” is the Southern Warriors of Mixed Martial Arts mantra and motto.

They are constantly challenged and encouraged by Sensei Kerry Grant to live beyond the norm, train better than the best to be the best. The environment that he creates for his athletes is one of discipline and an overall healthy way of life.

Living the life of a mixed martial artist is indeed challenging, but to Sensei Kerry Grant and his team of Southern Warriors, it is a life of health worth living. The club is located at 165 Southern Main Road Marabella, obliquely opposite the Marabella Police Station.

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DISORDER

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IRRI TA B L E B OW E L SY NDR OME

Irritable Irr table Bowel Syndrome

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WRITTEN BY LYLAH PERSAD

IRRITABLE BOWEL SYNDROME

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rritable Bowel Syndrome — how often do you hear that? Or of someone with IBS? Me neither ... until last Christmas. I visited my doctor, (which has become a habit since spending time in the hospital for dehydration, which I discussed in my last article). I’d been feeling bloated and gassy and irritable... although of course, around Christmas time, it could be blamed on gluttony, as the food is so good.

As I sat there, a young doctor — not my regular doctor — came in and started repeating my symptoms to me: • Gas • Cramps • Abdominal pain • Bloating • Sometimes bowel movement seems to be incomplete.

• Irregular bowel movement — meaning diarrhoea sometimes, and, at other times, constipation

My doctor got up, closed the door, and then went on: “IBS is a chronic disorder which affects the large intestine (colon), preventing it from operating the way it should." (Chronic means a condition can be treated but not cured, and is long term.)

She continued, "There are muscles that line the walls of the alimentary canal, which contract and relax, allowing the smooth flow of food from the stomach, through the intestines, to the rectum.

But with IBS, the contractions are stronger and last longer than normal, causing gas, bloating and diarrhoea. In some instances, it is the complete opposite, with weak intestinal contractions, slowing the passage of food and leading to hard, dry stools.”

Then, to my relief, she added, “You won't have to go to the hospital, but we can prescribe something to treat it."

She asked if I had mucus in my stool, but I was constipated and gassy at the time, so I said no, in hopes I wouldn't have to provide a sample. We sat talking for a while, and she took out a textbook/manual and seemed to be looking up my symptoms.

That seemed pretty much like what was happening with me, and which seemed to have been happening to me since the passing of my grandmother years ago. As I absorbed the information, it seemed that every time I was stressed, I'd have bouts of diarrhoea or constipation, with lots of abdominal pain and excessive flatulence (gas).

She asked questions, like: Have I been under any stress lately? Do I have an allergy to any foods? Do I eat on time, drink lots of fluids, get enough rest, etc.? When do I notice the symptoms; is it before or after meals? Do I have any mental illnesses, or have family that do/did? Was I on my menstrual period?

And the questions went on. Has it been consistently this way for the past 3 months? In my case, it had been years.

For years, I've been experiencing these symptoms, but not continuously. I assumed it was because of my bad eating habits and being very picky; I was hardly ever hungry, but would eat anyway; not thinking of these being symptoms of a chronic ailment. I never addressed the problem, but just trusted it to go away. So I’m sharing this information in case you have been feeling like I did.

We spoke for a while, then she went through her manual, looked at me, and said, "OK, Ms. Persad, it appears that you have Irritable Bowel Syndrome (IIBS). It’s not commonly reported, but all the symptoms point to that.”

Symptoms of IBS include: Pain or discomfort in your abdomen.

Pains may feel like cramping, and improve after a bowel movement • Changes in how often you have bowel movements or how your stools look

I soaked it in for a bit, thinking that I needed more liquids since my dehydration episode. I said, "Well, that's not so bad, right? And I don't need to go to the hospital again?"

You may have IBS if • You’ve had the above symptoms at least three times a month, for the past 3 months

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DISORDER

• Your symptoms started at least 6 months ago People with IBS may have diarrhoea, constipation, or both. Some symptoms appear soon after eating a meal.

Important to note: “Normal” bowel function varies from person to person, and ranges from as many as three stools a day to as few as three a week. You really have to know your body and how it functions before diagnosing and treating your symptoms yourself. If you are unsure, always consult your physician.

You control signs and symptoms of IBS by • Managing stress • Watching your diet and observing when you experience abnormality • Eating on time • Getting sufficient rest • Exercise • Having lots of fluids Who is likely to be at risk for IBS? • People who have a history of physical or sexual abuse or other psychological trauma • People who have other conditions such as depression, migraines, etc.

• Women, who are two times more likely to experience it • Persons in their teens or 20s to 40s • People who have panic disorder or other psychological conditions • People who have a family history of IBS On the upside, IBS is NOT a lifethreatening condition. It would not cause permanent damage to the intestines, or cause colon or any other forms of cancer.

I won't give advice on medication or what was prescribed for ME, because there is no ONE cause for Irritable Bowel Syndrome, so there is no ONE treatment for everyone. If you've been having irregular bowel movements, accompanied by any of the symptoms listed in this article, don't be ashamed; go visit your doctor, because it can make for a healthier U!

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FEATU RE

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U 2015 EXPO

RECAP

M E D I CA L TO UR I SM SE M I N A R

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FEATURE

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FEATU RE

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U 2015 EXPO

U 2015 E X P O

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FEATURE

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FEATU RE

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U 2015 EXPO

E XP O B O OT H W I N N E R S

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FEATURE

1

4

2

3

5

Expo Booth Winners: 1

Most Creative Booth Design Trinidad and Tobago Cancer Society (Sponsored by: Phoenix Park Gas Processors Ltd.)

2

Most Popular Booth

Nestlé Trinidad and Tobago Ltd.

3

Most Innovative Booth

4

Most Friendly Staff

5

Most Productive Booth

Caribbean Cardiac Rehabilitation and Wellness Centre

St. Augustine Medical Laboratory

To all our exhibitors and patrons for being a part of the

U Health and Wellness Exposition 2015.

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Thank U!

ISD Health Solutions Ltd.

FRUIT

| THE VERSATILE TAMARIND AKA TAMBRAN

THE WRITTEN BY NASSER KHAN

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Tamarind, or tambran as it is OFTEN called, is a leguminous tree in the family Fabaceae, but still considered a fruit. Probably indigenous to tropical Africa, it has been cultivated for so long on the Indian subcontinent that it is sometimes also reported to be indigenous there.

THE VERSATILE TAMARIND AKA TAMBRAN

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FRUIT

aka Tambran

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FRUIT

| THE VERSATILE TAMARIND AKA TAMBRAN

There are different types of tamarind fruit in terms of size and taste, ranging from acid to sweet. The fruit has a cover, sometimes called a pod, 12 to 15 cm (3 to 6 inches) in length, with a hard, though brittle, brown shell, and a fleshy, juicy, acidulous pulp. This edible, pod-like fruit is used extensively in cuisines around the world, especially in savoury dishes.

The pulp can be eaten fresh and is also widely consumed in a variety of products such as jams, jellies, nectar, confections, syrup, chutneys, wine, beverages, oils, dyes, lacquers, varnish and pharmaceuticals/herbal medicines. It is a vital ingredient in Worcestershire sauce. The leaves and flowers are cooked or used in making teas, while the wood/lumber can be used in making furniture. Other uses include traditional medicine and metal polish. The ripened fruit tends to become sweeter and less sour (acidic) as it matures. The fruit can be stored for long periods without spoilage.

A tambran ball is as traditionally Caribbean as one can get.

Our taste buds have all probably experienced this ubiquitous and delicious treat, best described as having a sweet-sour -sometimes-peppery taste. In times gone by, in primary school, eating a tambran ball during school recess was a go-to snack. It was that or preserved fruit, a tough choice for your penny!

Tamarind chutney is popular and is made by soaking tamarind pods, squeezing the pulp, mixing it with cane sugar and spices and cooking it down. This makes an excellent sauce for pholourie, a popular T&T Indian delicacy.

Tamarind's natural acidity makes it a great marinade for meat, because the acid can break down and tenderize tougher cuts. Marinated overnight in a tamarind-tinged liquid, beef becomes succulent and tender.

Tamarind is not cultivated on a wide scale in the West Indies as a commercial crop, but it is in several parts of world. It is a tree that has great economic potential since every part of the tree, from the root to the flowers, can be utilized.

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Raw tamarind is high in several B vitamins, as well as iron, magnesium, and potassium — all vital to human health. Each 100 grams of tamarind contains 36% of the thiamine, 35% of the iron, 23% of magnesium and 16% of the phosphorus recommended for a day's worth of nutrition.

Other prominent nutrients include niacin, calcium, vitamin C, copper, and pyridoxine. Its nutritional content is as follows, per 100 grams: calcium 54 mg; iron 1 mg; potassium 781 mg; sodium 28 mg; Vit A 5 mg; thiamine 0.43 mg; riboflavin 0.04 mg; niacin 1.9 mg; Vit C 6 mg.

As most ancient foods do, tamarind has a long history of medicinal uses. The medicinal uses and claims of the tamarind are numerous. Many involve easing stomach discomfort, aiding digestion, and use as a laxative. Tamarind preparations are used for fevers, sore throat, rheumatism, inflammation, and sunstroke. Dried or boiled tamarind leaves and flowers are made into poultices for swollen joints, sprains, boils, haemorrhoids, and conjunctivitis. The fruit is the subject of many studies relating to claims of a host of medicinal benefits.

The pulp has been official in the British and American and most other pharmacopoeias, and some 200,000 lbs (90,000 kg) of the shelled fruits have been annually imported into the United States for the medicinal trade.

Tamarind preparations are universally recognized as laxatives and to reduce intestinal gas. Alone, or in combination with lime juice, honey, milk, dates, spices or camphor, the pulp is considered effective as a digestive, even for elephants, and as a remedy for biliousness and bile disorders, and to prevent scurvy. In native practice, the pulp is used in a gargle for sore throat and, mixed with salt, as a liniment for rheumatism. It is, further, administered to alleviate sunstroke, Datura poisoning, and alcoholic intoxication.

The pulp is said to aid the restoration of sensation in cases of paralysis. The fruit shells are burned and reduced to an alkaline ash which enters into medicinal formulas. The bark of the tree is regarded as an effective astringent, tonic and febrifuge (fever reducer). Fried with salt and pulverized to an ash, it is given as a remedy for indigestion and colic. A decoction is used in cases of gingivitis and asthma and eye inflammations; and lotions and poultices made from the bark are applied on open sores and caterpillar rashes. The powdered seeds are made into a paste for drawing boils and, with or without cumin seeds and palm sugar, are prescribed for chronic diarrhoea and dysentery. An infusion of the roots is believed to have curative value in chest complaints and is an ingredient in prescriptions for leprosy.

THE VERSATILE TAMARIND AKA TAMBRAN

TAMARIND BALL RECIPE

TAMARIND SAUCE RECIPE

Ingredients:

Ingredients:

1 1/2 lb. brown sugar, approximately; 1 lb tamarind pulp; 3 Tbsp. flour (optional); pepper to taste (about 2 tsp.); salt to taste (about 1/4 tsp.).

1 cup tamarind pulp; 2 leaves chadon beni (cilantro); 2 cloves garlic (grated); 1 Tbsp. pepper (or to taste); 1 Tbsp. brown sugar; 1/2 tsp. salt; 1/2 cup of water.

Method:

Method:

Place about 1 lb of the cleaned tamarind pulp in a large bowl. Add salt and pepper to taste, along with sugar.

Knead in the ingredients while separating the seeds.

Sprinkle a very little water over the tamarind to moisten it a bit. According to how sour the tamarind is, more sugar may have to be used. Let taste be your guide. (This step is optional): Add the flour (this helps the mixture to bind better). Knead the flour into the tamarind. If necessary, add salt to adjust taste. Roll into balls — about 2 inches in diameter. In a separate plate or bowl, pour some sugar and roll the tamarind ball in it. Store in the refrigerator or in a cool area.

Shell about 7 or 8 tamarinds and separate the seeds.

Add about 1/2 cup of water to the tamarind.

Squeeze the tamarind to separate.

Add all other ingredients.

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FRUIT

A delicious tamarind drink (tamarinade or tambranade) is made by boiling tamarind pods, removing the pulp, straining the water, and adding sugar…add ice and enjoy! To access and remove the pulp: remove the outer shell and pull the pulp out. Try to remove the stringy fibres that hold them together. You can remove the seeds or not.

Many tamarind recipes, from simple to complex, are available on the Internet for those desiring a fresh, unique culinary opportunity.

NOTE: Information for this article was obtained from various sources including the Ministry of Food Production library in Trinidad and from the World Wide Web.

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TREATMENT

| THER AP Y WOR K S

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Therapy Works

T H E RA P Y WO R KS

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TREATMENT

Having a child with special needs can be a challenging journey for parents, siblings, and the whole family. They may find emotional regulation, social interactions and relationship building, hard.

They may find communicating as you or I do difficult and exhausting. Having access to a range of high-level therapeutic services is critical to their emotional and physical development. It can help them learn to adapt and grow in our fast paced, demanding society and, crucially, improve their quality of life.

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TREATMENT

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THERA P Y WOR K S

Recently I met with Speech and Language Pathologist, Robyn Edwards, and Occupational Therapist (OT), Sara Stephens (Co-Directors), who have combined their talents and many years of experience to provide just such a service; through their clinic, Therapy Works, located in St James, Trinidad. Their mission is to provide holistic, therapeutic services to effectively treat the whole client — their mind, body and soul, while also providing the necessary support to the families on the long and winding road of caring for someone with special needs.

Their vision grew from the recognition that families struggle to access all the services their child needs and that being able to provide these services in one space would be of huge benefit to these families. Clients, both adult and children, often need various kinds of therapy together, yet there are few clinics in Trinidad and Tobago which provide services in an integrated environment, in the same space. Therapy Works provides a much needed ‘one-stop shop’; a multi-disciplinary therapy clinic which aims to provide holistic and client centred care.

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They currently offer 3 types of therapy. Speech language therapy, which is the treatment of speech and communication disorders. It may include physical exercises to strengthen the muscles used in speech (oral-motor work), speech drills to improve clarity, or sound

production practice to improve articulation. Occupational therapy, which uses purposeful and meaningful activities to help individuals be as independent as possible with their occupations, which for a child may include attention, basic self-care skills, sitting in a chair at school, handwriting, helping out around the home, interacting with peers, and, most importantly, play! And art therapy, which is an expressive psychotherapy that uses the process of art making to improve a person's mental, physical or emotional well-being. The team specialises in treating children, although services are available to individuals of all ages seeking therapeutic support.

Bringing all these therapeutic services under one roof is not the only element that sets Therapy Works aside from the rest. This highly trained team are exactly that – A TEAM. They are not a group of professionals working in the same field, or operating as standalone therapists in the same building — they are a team that work closely together to tailor therapy plans to each individual’s needs.

The team consists of three occupational therapists (Sara Stephens, Jeanna Sabga-Aboud and Shivani Maynard); two speech and language pathologists (Robyn Edwards & Charlotte Edghill); one art therapist (Kristy Anatol), together with their dedicated office manager (Frances Edwards).

Both Robyn and Sara believe that the team’s excellent communication skills and their ability to function dynamically together is key to their success in serving the children they see, holistically.

Another unique element that Therapy Works provides is joint evaluations. A child with special needs may require several different types of therapy.

At Therapy Works, children can be evaluated simultaneously by an OT and speech therapist. Having both therapists present at this initial stage means that from the very beginning their therapeutic plan is designed to co-support the different therapeutic elements that individual needs.

When you consider how closely these therapists’ roles overlap and impact one another, it almost seems strange that this is not the status quo.

Springing from this idea, Robyn and Sara also began providing another innovative service: back-to-back therapy sessions, where children are scheduled in to see their required therapists in one visit.

This benefits not only the child, but the team, as they can communicate and collaborate before, during, and after the sessions; and it is also fantastic for the parents, who frequently have to take time of work several days a week in order to get their child to an array of appointments.

T H E RA P Y WO R KS

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TREATMENT

Just observing some of the practical aspects of the clinic and the nature of what they are providing is pretty inspiring. When you actually move past this to the detail of the therapies and the groups they run you really see the motivation and dedication they have to their work. Here are some of the options they offer: ZONES OF REGULATION:

SOCIAL DETECTIVE (7 YRS +):

An intensive therapy program which teaches children self-regulation and emotional regulation to help increase focus and attention in school. Children are taught strategies and tools to use to help them stay in the “Green Zone.” The child’s classroom teacher is invited to a one-hour teacher training following completion of the program to ensure carry over into the classroom.

This group provides a structured program where children are able to explore the unwritten rules and skills needed to be successful social beings. Social Skills are often thought of as just making eye contact and being friendly, but it really isn’t that easy. Social Skills, or “Social Smarts” as the team refers to them, are used whenever we are around other people. We use our Social Smarts whenever others have thoughts about us and we have thoughts about them. In this program children use the concept of a detective to uncover clues and use tips to help explore our Social World.

Social Thinking Groups: THE INCREDIBLE FLEXIBLE YOU (AGES 4–6 YRS): A two-week intensive group that helps children explore the complex world of Social Thinking. Through bright colourful story books and fun, engaging songs, children learn the building blocks of non-verbal communication and social skills.

These lessons include exploring thoughts and feelings, following group plans, and whole body listening.The engaging activities and topics are easy to implement at home and school and teacher training is again offered to ensure carryover of the lessons learned in group into the classroom.

YOUNG ADULT LIMES: This is a fun group that meets monthly, sometimes at Therapy Works office, sometimes at a restaurant, and sometimes at someone's house. This group gives adults with developmental disabilities a chance to lime on their own, with friends, without their parents or siblings present, something that most neuro-typical individuals take for granted!

SIBSHOPS: A monthly support group for siblings (ages 6 –12) of

children with special needs. Two hours of fun, sharing and growth; active and exciting activities work to explore the good and not so good things about having a sibling with special needs. It is an opportunity for siblings to meet other children who have similar experiences, helping them to realize there are other children out there whose siblings also have challenges.

FRONT PORCH FOUNDATION: A non-profit NGO created to help provide therapeutic assistance to those families that may not be able to afford the level of care their child needs.

Therapy Works and their passionate team are providing a much needed and infinitely valuable therapeutic service. They are empowering and providing hope to the families of those with special needs in Trinidad and Tobago, and they do it with unbounded enthusiasm and love.

If you would like more information about Therapy Works or the Front Porch Foundation, information is available on their FB page.

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THE NEXT U July to September

STERILIZATION IN HEALTH CARE FACILITIES THE IMPORTANCE OF INFECTION PREVENTION.

Anti Oxidants What You Need To Know.

Aromatherapy The art and science of using aromatic plant oils.

Chennette A Delicious Nutritious Snack that Nourishes and Gives Us Energy.

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