FJ Vol 20, No 22
Nov 17-30/06
My lola has been complaining of leaking ihi when she coughs, laughs, or sneezes. She is too embarrassed to see the doctor. Why is this happening, and what can she do?
Stress incontinence (the loss of urine due to an increase in pressure in the tummy) is more common in women. Weakness in the pelvis muscles (eg due to childbirth, abdominal obesity--overweight in the tummy) and thinning of the bladder and vaginal muscles and tissues from the decrease in estrogen after menopause are often contributing factors. Urge incontinence is leakage due to inability to delay peeing when an urge is felt. Causes include bladder wall hyperactivity and neurological disorders such as Parkinson’s Disease and stroke. Overflow incontinence involves leakage due to an over-distended bladder usually from blocked urine outlet (eg. enlarged prostate) or neurological causes (eg. multiple sclerosis, diabetes affecting the nerves). Functional incontinence is caused by the inability to get to a toilet such as due to physical constraints (eg restricted mobility), mental factors (eg. dementia, depression), and environmental barriers (eg. distance to toilet, positioning).
Her doctor should rule out problems like a urinary tract infection or a problem with the nerves controlling the bladder muscles. Some things she can do include: decreasing caffeine intake; addressing any bowel problems like constipation; limiting fluid intake—1.5-2 L/d is considered appropriate; losing weight; quitting smoking; watching high-impact physical activities; avoiding some types of medications (check with her doctor) like diuretics, some blood pressure and depression drugs, and alcohol; and improving mobility & accessibility to toilets. When secondary causes have been ruled out or treated, she can try pelvic floor muscle training (aka Kegels): do a minimum of 30-45 pelvic floor muscle contractions (goal of 10 seconds for each contraction); done in 2 or 3 sets; may take 6-8 weeks to see results. To contract the pelvic floor muscle, instruct her to pee, and while she’s peeing, she should squeeze her pelvic muscles to stop the flow of pee. Biofeedback and/or electrical stimulation therapy can teach her to isolate and control these muscles if she is not having any luck. If the problem is severe, her doc might refer her to a gynecologist/urologist who could confirm the diagnosis + possibly book her for surgery. Another option is wearing pads/ “Depends” to catch the leak. Depending on the cause, there are some medications her doctor can prescribe to help manage her symptoms. There are different treatments available for men who have difficulty with stress incontinence after having prostate surgery—check with their urologist.
My family is going to the Philippines for Christmas. What do we need to do ahead of time?
According to the Health Canada (http://www.hc-sc.gc.ca/iyh-vsv/life-vie/travel-voyage_e.html) and WRHA websites (http://www.wrha.mb.ca/community/travel/manual_countries.php), Canadians traveling internationally should contact their doctor or a travel clinic 6-8 weeks before traveling, regardless of where they are going, to have their risk assessed. Based on your current health, travel itinerary and previous immunization history, your doctor can determine what immunizations and/or preventive medication you may need, as well as advise you on how you can avoid disease risks.
By far the most common complaint while traveling is diarrhea. This is usually caused by the differences in water purity. Travelers may have diarrhea if they drink the local water or food prepared with local water in these countries.
You can also be at risk for a number of childhood illnesses (Diphtheria, Tetanus, Polio, Measles, Mumps, Rubella) when you travel, especially if you have not been immunized against them or haven’t kept your immunizations up to date. In countries where sanitary conditions are poor, immunizations may be recommended—there is a higher risk of hepatitis A (immunization recommended for all travelers) and typhoid in the Philippines. Depending on your travel activities and the local disease situation, you may need to be immunized against Meningitis, Japanese encephalitis (depending on degree of exposure), European tick-borne encephalitis, Hepatitis B (higher risk), Rabies (higher risk). Depending on where you are traveling, you may also be at risk of Malaria (caused by infected mosquito bites in many tropical countries; rural areas only, except no risk in Manila and province of Bohol, Catanduanes and Cebu), Yellow fever (caused by infected mosquito bites in Central Africa and South America; if traveling from an endemic zone and > 1 yr of age), Dengue fever (caused by infected mosquito bites in many tropical countries), Schistosomiasis (caused by a parasite in fresh water in the Carribean, South America, Africa, the Middle East and Southeast Asia). You are also at a higher risk of tuberculosis that is resistant to many drugs we use to treat it. As well, some sexually transmitted diseases, such as HIV/AIDS, are more common in some countries than they are in Canada.
You should also be safety conscious when traveling. Economic conditions in developing countries can cause increased crime rates and tourists are often targeted.
Some tips to help you enjoy safe travel:
_. Make sure all your regular vaccinations are up to date.
_. Before you travel, contact a travel clinic or your doctor six to eight weeks before you go, to allow time for any vaccinations you may need. This is especially true if you are going to tropical areas or developing countries.
_. Arrange for private health insurance while you are away, as your provincial/territorial health insurance may not cover you. Your travel agent can advise you on this.
_. If you are going to an area where malaria is present, it is important that you take anti-malarial medication as prescribed by your doctor.
_. Since anti-malarial medication does not guarantee absolute protection against the disease, preventing mosquito bites is very important. Use mosquito repellents when outside, especially between dusk and dawn. Sleep in well-screened or air conditioned accommodation or use a bed net. Wear trousers and long sleeves at dusk.
_. If you become ill in the first two months to a year after you return, see your doctor immediately and tell her/him that you have visited an area where malaria occurs.
_. To prevent diarrhea, the key principles to remember are: boil it, cook it, peel it or leave it! Always drink purified water or commercially bottled beverages, and pasteurized milk. Avoid ice, salads, re-heated foods, uncooked shellfish, fruit that is not peeled and food from street vendors.
_. Wash your hands often with soap or a sanitizing agent when travelling, especially before eating or drinking.
_. Should you experience diarrhea, be sure to drink plenty of liquids to prevent becoming dehydrated, especially in warm climates.
_. In warmer climates, always use a sunblock with a minimum SPF of 15.
_. To help prevent sexually transmitted diseases, always use a condom if you have sex with someone you meet while travelling.
_. Never share needles to inject intravenous drugs with anyone.
_. Swim in fresh water only if you know it is free of biharzia, the parasites that cause schistosomiasis.
_. Do not walk alone in remote areas, back streets or beaches, where you may be at risk of a personal attack or bag snatching. Valuables should be left at home or deposited in hotel safes. Travellers cheques, cash, passports and tickets should not be carried in bags that can be snatched. It is recommended that you use a body belt.
_. Do not ride in over-crowded vehicles or on motorcycles, especially at night outside of urban areas.
_. If you need medication for an existing medical condition, take enough with you to last during your travel. Make sure the containers are clearly marked and carry a copy of the doctor's prescription with you. Essential medication should be carried in two different pieces of luggage, in case one should get lost or stolen.
_. If your medication requires sterile syringes or needles, carry a doctor's explanation or medical certificate with you. In many countries where drug trafficking is a problem, a traveller found with syringes and without adequate explanation, could be in serious trouble with the police.
Sunday, December 10, 2006
Wednesday, December 06, 2006
Ask Dr. Denise: Gout & STD screening
The Filipino Journal: October 20-November 5 2006 issue; Volume 20, Number 20 p 10
By Denise Koh, BSc (mcl), MD, CCFP
* My dad suffers from gout. What is it, and what can he do to treat it?
Gout is a disease in which uric acid (UA, the normal end product of the breakdown of purines) crystals deposit in body tissues. This causes recurrent attacks of severe joint pain and inflammation, deposits in soft tissues, kidney problems, and kidney stones. Many genetic and environmental factors affect the chain of events that regulate UA formation, transport, and disposal. Any problem in these processes can lead to too much UA in the blood and gout. Filipinos have a predisposition to gout. There is a higher blood level seen in Filipinos living in North America compared with Filipinos living in the Philippines. Filipinos have a limited ability to excrete/remove UA leading to a tendency to high blood UA levels manifested when a diet with a relatively high purine content, such as the usual North American diet, is eaten. Your dad can do several things to control his disease: lose weight, avoid foods high in purines, avoid alcohol (increases production and impairs removal of UA), avoid dehydration (drink lots of water!), and avoid diuretics (“water pills” often used for high blood pressure) if possible. High purine foods include visceral (organ) meats (liver, tripe), sardines, shellfish, turkey, salmon, trout, beans, peas, asparagus, and spinach.
* I have a new sexual partner and was told to get checked for STD’s, even though I feel fine. What is involved in an STD screen, and when should someone get checked?
A common misperception is that no symptoms, means no STI (sexually-transmitted infections). This is far from the truth, and is a huge reason for the continued spread of STIs. Get tested when: you have unprotected (no condom) sex, you have a new partner, you are worried about it, you are experiencing any symptoms such as discharge, pelvic pain/burning, lumps, bumps, sores, unusual vaginal bleeding, or fertility concerns. Many people choose to get tested regularly, such as every 6 months, or with their annual physical exam. A typical screen can include blood tests for HIV (anonymous and requires your consent), Hepatitis B, Syphilis, and Herpes Simplex (although some docs don’t check for herpes because it is so common, and can’t be cured). Gonorrhea and Chlamydia can be checked in two ways: 1) a pee test or 2) a swab. For women, this is a swab of the inside of the cervix (opening of the uterus) requiring the insertion of a speculum typically used in Pap tests. For men, this requires a swab of the urethra/inside the penis. If you are uncomfortable with the swab tests, you can get the pee test instead, keeping in mind that these tests are not as sensitive as the swabs. It’s way better to get tested than not—for treatment and relief from easily treatable infections, management with improved outcome of the non-curable ones, prevention of spread, and peace of mind. Tests for Genital Warts are more specialized and seldom performed (extremely common and difficult to treat), but often a doctor can recognize them on examination. Tests for vaginal infections (not necessarily sexually-transmitted) such as yeast, trichomonas, and bacterial vaginosis are usually reserved for women with symptoms.
By Denise Koh, BSc (mcl), MD, CCFP
* My dad suffers from gout. What is it, and what can he do to treat it?
Gout is a disease in which uric acid (UA, the normal end product of the breakdown of purines) crystals deposit in body tissues. This causes recurrent attacks of severe joint pain and inflammation, deposits in soft tissues, kidney problems, and kidney stones. Many genetic and environmental factors affect the chain of events that regulate UA formation, transport, and disposal. Any problem in these processes can lead to too much UA in the blood and gout. Filipinos have a predisposition to gout. There is a higher blood level seen in Filipinos living in North America compared with Filipinos living in the Philippines. Filipinos have a limited ability to excrete/remove UA leading to a tendency to high blood UA levels manifested when a diet with a relatively high purine content, such as the usual North American diet, is eaten. Your dad can do several things to control his disease: lose weight, avoid foods high in purines, avoid alcohol (increases production and impairs removal of UA), avoid dehydration (drink lots of water!), and avoid diuretics (“water pills” often used for high blood pressure) if possible. High purine foods include visceral (organ) meats (liver, tripe), sardines, shellfish, turkey, salmon, trout, beans, peas, asparagus, and spinach.
* I have a new sexual partner and was told to get checked for STD’s, even though I feel fine. What is involved in an STD screen, and when should someone get checked?
A common misperception is that no symptoms, means no STI (sexually-transmitted infections). This is far from the truth, and is a huge reason for the continued spread of STIs. Get tested when: you have unprotected (no condom) sex, you have a new partner, you are worried about it, you are experiencing any symptoms such as discharge, pelvic pain/burning, lumps, bumps, sores, unusual vaginal bleeding, or fertility concerns. Many people choose to get tested regularly, such as every 6 months, or with their annual physical exam. A typical screen can include blood tests for HIV (anonymous and requires your consent), Hepatitis B, Syphilis, and Herpes Simplex (although some docs don’t check for herpes because it is so common, and can’t be cured). Gonorrhea and Chlamydia can be checked in two ways: 1) a pee test or 2) a swab. For women, this is a swab of the inside of the cervix (opening of the uterus) requiring the insertion of a speculum typically used in Pap tests. For men, this requires a swab of the urethra/inside the penis. If you are uncomfortable with the swab tests, you can get the pee test instead, keeping in mind that these tests are not as sensitive as the swabs. It’s way better to get tested than not—for treatment and relief from easily treatable infections, management with improved outcome of the non-curable ones, prevention of spread, and peace of mind. Tests for Genital Warts are more specialized and seldom performed (extremely common and difficult to treat), but often a doctor can recognize them on examination. Tests for vaginal infections (not necessarily sexually-transmitted) such as yeast, trichomonas, and bacterial vaginosis are usually reserved for women with symptoms.
Wednesday, October 18, 2006
Ask Dr. Denise: Workplace Safety and Health (part 2)
The Filipino Journal: September 18-October 5 2006 issue p 6
My boss is asking me to work in what I consider unsafe conditions. What can I do?
What are the safety and health rights and responsibilities in the workplace?
When it comes to safety and health, every worker in Manitoba, regardless of age, has 3 basic rights in the workplace:
- The right to know about what hazards there are in the workplace and what precautions must be taken to prevent injuries from these hazards.
- The right to participate in safety and health activities in the workplace without fear of any form of discriminatory action such as discipline.
- The right to refuse unsafe work.
In Manitoba, health and safety rights are guaranteed by the Workplace Safety and Health Act and the Canada Labour Code. Most workers are under provincial authority and are protected by the Workplace Safety and Health Act. The Workers Compensation Act was created to promote healthy, safe workplaces, to encourage safe, timely return to work and to provide insured benefits to workers who get injured on the job. In addition to the laws, every workplace should have its own safety policy, procedures and safe operating practices.
Your employer is legally responsible for putting safe work practices in place, and you’re responsible for following them. If you have safety and health concerns, it’s your responsibility to report them. If a task feels unsafe, tell your immediate supervisor, and explain why you’re not comfortable. If you don’t get a satisfactory answer or s/he isn’t available, go to her/his supervisor. If you’re still not satisfied, ask your safety representative, a member of the safety committee, or a shop steward. Your last resort is the Workplace Safety and Health Division (WSH) or Human Resources and Skills Development Canada (HRSDC). WSH Officers have the power and duties to inspect any workplace, investigate any potential hazards situation and work refusal; and order compliance with the law (eg the Act or Regulations).
Manitoba’s employment standards laws (as outlined in The Employment Standards Code) promote fairness in the workplace for both employees and employers. The Employment Standards Branch is a neutral party that administers laws on minimum wages, hours of work, holidays and other workplace benefits. It is also responsible for investigating complaints of violations of these laws. Most employees in Manitoba fall under this code. Independent contractors (self-employed) are not covered. Some parts of the Code do not apply to agricultural workers, sitters, professionals, part-time domestic workers, Crown employees, family members employed in a family business, temporary election workers and some others.
If you have questions about WSH, visit the Workplace Safety and Health Division website at www.gov.mb.ca/labour/safety. Call the WSHD Client Services office at 945-3446 or 1-800-282-8069. This is the part of the provincial government that promotes and enforces workplace safety and health (law). They can answer your questions or concerns or provide you with information confidentially. If a serious incident, death or other problem is occurring in your workplace, they will send a workplace safety and health officer to your workplace.
The Human Resources and Skills Development Canada (HRSDC) – Labour Program is responsible for federally regulated workplaces such as national railways, grain elevators, inter-provincial trucking/transportation, communications, banks, etc). Call the HRDC – Labour Program at 983-6375. If you live outside Winnipeg, call 1-800-838-2033 or visit the website at www.hrdc-drhc.gc.ca.
The MFL Occupational Health Centre (phone 949-0811 or 1-888-843-1229, www.mflohc.mb.ca) is a community health centre specializing in work-related injuries and diseases. It is a non-profit, charitable organization funded by the Winnipeg Regional Health Authority and by donations from individuals, and unions. Its doctors are specialists in occupational medicine; referrals are not required. The Centre organizes public presentations and offers hands-on workshops tailored to your needs. One of its special initiatives is an Immigrant Workers Education and Outreach Project. It has a library with over 40 fact sheets on workplace health and safety issues such as ergonomics, shift work, work stress, and workplace chemicals. Some are available in Tagalog.
Some interesting facts:
- 40% of all injuries suffered by workers throughout their careers happen in the 1st 6 months on the job.
- 1/3 of all workplace injuries happen to those 15-24 years of age.
- Top 5 injuries in this group:
o Sprains, strains and tears
o Open wounds
o Surface wounds and bruises
o Other traumatic injuries and disorders
o Fractures and dislocations
- Top 5 Causes of injury to young workers:
o Struck by object
o Over exertion
o Bodily reaction (3eg jerking motion)
o Struck against object
o Caught in objects
- Top 5 body parts injured in young workers: hand/fingers/lower back/ eyes/ lower arm/ lower leg
My boss is asking me to work in what I consider unsafe conditions. What can I do?
What are the safety and health rights and responsibilities in the workplace?
When it comes to safety and health, every worker in Manitoba, regardless of age, has 3 basic rights in the workplace:
- The right to know about what hazards there are in the workplace and what precautions must be taken to prevent injuries from these hazards.
- The right to participate in safety and health activities in the workplace without fear of any form of discriminatory action such as discipline.
- The right to refuse unsafe work.
In Manitoba, health and safety rights are guaranteed by the Workplace Safety and Health Act and the Canada Labour Code. Most workers are under provincial authority and are protected by the Workplace Safety and Health Act. The Workers Compensation Act was created to promote healthy, safe workplaces, to encourage safe, timely return to work and to provide insured benefits to workers who get injured on the job. In addition to the laws, every workplace should have its own safety policy, procedures and safe operating practices.
Your employer is legally responsible for putting safe work practices in place, and you’re responsible for following them. If you have safety and health concerns, it’s your responsibility to report them. If a task feels unsafe, tell your immediate supervisor, and explain why you’re not comfortable. If you don’t get a satisfactory answer or s/he isn’t available, go to her/his supervisor. If you’re still not satisfied, ask your safety representative, a member of the safety committee, or a shop steward. Your last resort is the Workplace Safety and Health Division (WSH) or Human Resources and Skills Development Canada (HRSDC). WSH Officers have the power and duties to inspect any workplace, investigate any potential hazards situation and work refusal; and order compliance with the law (eg the Act or Regulations).
Manitoba’s employment standards laws (as outlined in The Employment Standards Code) promote fairness in the workplace for both employees and employers. The Employment Standards Branch is a neutral party that administers laws on minimum wages, hours of work, holidays and other workplace benefits. It is also responsible for investigating complaints of violations of these laws. Most employees in Manitoba fall under this code. Independent contractors (self-employed) are not covered. Some parts of the Code do not apply to agricultural workers, sitters, professionals, part-time domestic workers, Crown employees, family members employed in a family business, temporary election workers and some others.
If you have questions about WSH, visit the Workplace Safety and Health Division website at www.gov.mb.ca/labour/safety. Call the WSHD Client Services office at 945-3446 or 1-800-282-8069. This is the part of the provincial government that promotes and enforces workplace safety and health (law). They can answer your questions or concerns or provide you with information confidentially. If a serious incident, death or other problem is occurring in your workplace, they will send a workplace safety and health officer to your workplace.
The Human Resources and Skills Development Canada (HRSDC) – Labour Program is responsible for federally regulated workplaces such as national railways, grain elevators, inter-provincial trucking/transportation, communications, banks, etc). Call the HRDC – Labour Program at 983-6375. If you live outside Winnipeg, call 1-800-838-2033 or visit the website at www.hrdc-drhc.gc.ca.
The MFL Occupational Health Centre (phone 949-0811 or 1-888-843-1229, www.mflohc.mb.ca) is a community health centre specializing in work-related injuries and diseases. It is a non-profit, charitable organization funded by the Winnipeg Regional Health Authority and by donations from individuals, and unions. Its doctors are specialists in occupational medicine; referrals are not required. The Centre organizes public presentations and offers hands-on workshops tailored to your needs. One of its special initiatives is an Immigrant Workers Education and Outreach Project. It has a library with over 40 fact sheets on workplace health and safety issues such as ergonomics, shift work, work stress, and workplace chemicals. Some are available in Tagalog.
Some interesting facts:
- 40% of all injuries suffered by workers throughout their careers happen in the 1st 6 months on the job.
- 1/3 of all workplace injuries happen to those 15-24 years of age.
- Top 5 injuries in this group:
o Sprains, strains and tears
o Open wounds
o Surface wounds and bruises
o Other traumatic injuries and disorders
o Fractures and dislocations
- Top 5 Causes of injury to young workers:
o Struck by object
o Over exertion
o Bodily reaction (3eg jerking motion)
o Struck against object
o Caught in objects
- Top 5 body parts injured in young workers: hand/fingers/lower back/ eyes/ lower arm/ lower leg
Monday, September 18, 2006
Ask Dr. Denise: Workplace Safety and Health
The Filipino Journal: August 18-September 5 2006 issue p 6
I hurt my back at work today lifting patients (I'm a nurse). What should I do?
If you get hurt or sick because of your job you need to:
1) Get medical attention as soon as possible. Be sure to let your healthcare provider know you were injured or got ill at work. S/he should fill out a WCB Healthcare Report and fax/mail it to the WCB.
2) Tell your supervisor about any injury or illness as soon as possible after it happens. Ask your employer if they have a modified return-to-work program you could get involved in while you are recovering. Your employer has a responsibility to report workplace injuries to the WCB as soon as possible after learning of the injury (within 5 working days). Your employer must also pay you for the full day of the day you were hurt at work, not just up to the time of your injury.
3) If you miss time from work because of the injury, check with your employer whether you are covered by the Workers Compensation Board of Manitoba (WCB). If so, report the accident or illness to the WCB as soon as possible (954-4100; toll-free 1-800-362-3340 between 8 am – 7 pm Monday to Friday).You will be given a claim number and contact info of an adjudicator who will handle your claim. If you have to pay for any medication or other expenses related to your injury, keep your original receipts and advise your Adjudicator. These expenses may be covered by the WCB. WCB will ensure the injury occurred as a result of your employment and confirm the extent of your injury with your HCP, determine your benefit entitlement, and contact you to let you know what the decision is on your claim and if/when you can expect to receive benefits and services. Check out www.wcb.mb.ca for more information.
4) Follow your doctor/HCP’s treatment plan and attend any follow up appointments. It is important for you to get better and go back to work as soon as you are able. WCB benefits can be reduced or stopped if you are not doing what you can to get better.
5) Stay in touch with your employer on a regular basis to ensure they are aware of your recovery progress and when you may be able to return to modified/alternate work or your regular job duties. Stay in touch with your Adjudicator to ensure s/he is aware of any relevant changes with respect to your injury, recovery, and ability to return to your regular job.
In general, if you’ve strained your back, try a hot bath or shower followed by stretching exercises. Gradually increase your walking distance. While progressing with your stretching exercises and your walking distance, gradually introduce strengthening exercises. If you are overweight, consider changing your eating and exercise habits, as excess body weight places additional strain on the spine. Most back injuries resolve quickly with time and simple treatment. A good posture while standing, sitting and sleeping helps maintain a healthy back. Stay fit, and avoid overeating. Exercise helps to prevent back injury and also speeds recovery. Gentle exercise after a back injury is essential to recovery. Keep a positive attitude. When lifting or carrying even light objects, remember to:
- place your feet shoulder-width apart for good balance
- bend your knees and do not bend over to lift
- keep the load close to the centre of your body
- lightly “tense” your trunk muscles before and during lifting
- lift gradually and smoothly, without jerking, keeping your back straight
- pivot with your feet, don’t twist your back while lifting
- coordinate your lift when working with a partner
I hurt my back at work today lifting patients (I'm a nurse). What should I do?
If you get hurt or sick because of your job you need to:
1) Get medical attention as soon as possible. Be sure to let your healthcare provider know you were injured or got ill at work. S/he should fill out a WCB Healthcare Report and fax/mail it to the WCB.
2) Tell your supervisor about any injury or illness as soon as possible after it happens. Ask your employer if they have a modified return-to-work program you could get involved in while you are recovering. Your employer has a responsibility to report workplace injuries to the WCB as soon as possible after learning of the injury (within 5 working days). Your employer must also pay you for the full day of the day you were hurt at work, not just up to the time of your injury.
3) If you miss time from work because of the injury, check with your employer whether you are covered by the Workers Compensation Board of Manitoba (WCB). If so, report the accident or illness to the WCB as soon as possible (954-4100; toll-free 1-800-362-3340 between 8 am – 7 pm Monday to Friday).You will be given a claim number and contact info of an adjudicator who will handle your claim. If you have to pay for any medication or other expenses related to your injury, keep your original receipts and advise your Adjudicator. These expenses may be covered by the WCB. WCB will ensure the injury occurred as a result of your employment and confirm the extent of your injury with your HCP, determine your benefit entitlement, and contact you to let you know what the decision is on your claim and if/when you can expect to receive benefits and services. Check out www.wcb.mb.ca for more information.
4) Follow your doctor/HCP’s treatment plan and attend any follow up appointments. It is important for you to get better and go back to work as soon as you are able. WCB benefits can be reduced or stopped if you are not doing what you can to get better.
5) Stay in touch with your employer on a regular basis to ensure they are aware of your recovery progress and when you may be able to return to modified/alternate work or your regular job duties. Stay in touch with your Adjudicator to ensure s/he is aware of any relevant changes with respect to your injury, recovery, and ability to return to your regular job.
In general, if you’ve strained your back, try a hot bath or shower followed by stretching exercises. Gradually increase your walking distance. While progressing with your stretching exercises and your walking distance, gradually introduce strengthening exercises. If you are overweight, consider changing your eating and exercise habits, as excess body weight places additional strain on the spine. Most back injuries resolve quickly with time and simple treatment. A good posture while standing, sitting and sleeping helps maintain a healthy back. Stay fit, and avoid overeating. Exercise helps to prevent back injury and also speeds recovery. Gentle exercise after a back injury is essential to recovery. Keep a positive attitude. When lifting or carrying even light objects, remember to:
- place your feet shoulder-width apart for good balance
- bend your knees and do not bend over to lift
- keep the load close to the centre of your body
- lightly “tense” your trunk muscles before and during lifting
- lift gradually and smoothly, without jerking, keeping your back straight
- pivot with your feet, don’t twist your back while lifting
- coordinate your lift when working with a partner
Sunday, August 20, 2006
The Filipino Divide (8/17/06)
Ako ay Pilipina, indeed.
That is the stinging concluding remark from a letter to the editor in response to my proud self-statement (a reference to the song Magdaragat introduced me to which eventually connected me to my heritage) in my FJ article on Folklorama when I first moved to Winnipeg in 2003. Ar-ouch. To this day, during Folklorama 3 years later, I can feel my blood pressure rise and my heart sink when I recall the experience. The writer was not happy with my use of the word “Flip” to refer to Filipinos, apparently considered derogatory by some. I was shocked at the strong negative reaction and attack at not only my character but also my definition of myself as a Filipina—ang bilis bilis, too!--because all my life, that word was a special term, almost of entitlement—like my “peeps”, my “homies.” This was the term my barcadas, a handful of Saskatchewan Filipino-Canadian teens—The Filipinas Youth Group, used to call ourselves—we were cool because we had something no one else did. Like a mini-gang minus the drugs and guns and scare factor. We wore bandannas and break-danced like no other. Heck, we dominated in the dance realm. I don’t know where Bagets (form of dance Magdaragat taught us) originally came from, but it became ours. We serenaded and pen-pal’ed like it was going out of style. We kicked butt in basketball and sikaran. No one could touch us. Looking back, it was par for the course; identity issues--what all teens go through.
Now 20 years later, that letter triggered another mini identity crisis—I was seeking any reassurance I could get from my parents and the FJ editors. Did I just offend the entire Filipino community with my words?? Was I any less Filipino because that word was power where I came from but here—not so much? And why didn’t anyone teach me this in Coconut School??! What about my lack of Tagalog? Or my Chinese blood and Chinese name? What do I do to fix this?? Dare I ask the question--who’s “more Filipino” here: someone who tries to build up the Filipino spirit in all its different forms despite glaring un-Filipino-ness, or someone with the privilege of breeding & birthright who tries to break it? I think I’d take 10 puti in barongg tagalogs singing our anthem off-key over 1 purebred Pinoy holding a gun to another. But that’s just “You’re-not-Filipino…No-you’re-not”–me. I still ask random Pinoys I meet about that word, because I do not want to give up that word; I refuse to give up that pride I’ve associated with it.
I recently went to see Filipino-Canadian comic Ron Josol at Rumour’s Comedy club, and absolutely loved the show. I couldn’t help but laugh along with the largely Filipino crowd at his hilarious jokes about such “Pinoy-isms” as Philippine phonetics (“what’s his pahkking frovlem??”) and the Filipino propensity for choosing nursing as a career. What about the Philippine nanny? Who can deny this stereotype? And is it wrong to laugh at its existence and ourselves as a result? When does laughing at ourselves become harmful and the perpetuation of damaging prejudices? Conversely, when does racial sensitivity and political correctness stunt individual interpretation and expression of culture? Call a spade a spade…but then we’ve gotta look at the definition of excavation implements, the national standards of yard care tools, and if it heard the tree falling in the forest. Naman.
Living here in Winnipeg, I see Filipinos excelling in all sorts of careers, occupations, and work-settings. Certainly, in my medical training and practice, I get to work with a good number of Filipino nurses/health care workers in a variety of settings, both as patients and colleagues. Having just finished my Occupational Medicine rotation for my Community Medicine residency, I’ve gotten the chance to witness Filipinos and their health in the workplace at many different levels—a scope of the Filipino-Canadian experience…from Immigrant to Canadian-born, from caregiver to patient, from teacher to student. We are a vast and varied bunch, a spectrum: brown Filipinos, yellow Filipinos, white Filipinos, Filipino-whites, mestizas/zos, blue, orange, green, and purple Filipinos…you name it. I’ve had in-depth discussions with many Filipinos from all over this rainbow of backgrounds on this collective experience, what I call the Filipino Divide. The “ignorant coconut youth disconnected from their roots” vs the “old guards enmeshed in obsolete thinking” and everything in between. Yes, the words are there on purpose; they’re there to inflame. Why? Because if we don’t acknowledge their existence, we can’t get on top of these problems to work on the root cause. Sometimes the words have to slap us upside the head to get us to see what message lies beneath.
According to the HRSDC website, in 2001:
Filipinos in Canada represented the fourth largest visible minority subgroup (7.7% of total visible minority population; 1% of the total population). Toronto, Vancouver and Winnipeg accounted for 72% of the Filipino population…Filipinos were a very young group. Only 6% of their total population was 65 and over (compared with 13% of the non-visible minority population; 7% of the overall visible minority population). Close to 50% of the total Filipino population were of prime working age (25-54)…Filipinos had a high level of education. Among all visible minority subgroups, they ranked second in terms of the proportion of the population 15 years and over having earned a bachelor’s degree or higher and ranked first in terms of the percentage of the population with more than grade 13…Approximately 31% of Filipinos 15 years and over had a bachelor’s degree or higher compared to only 14% of the non-visible minority population and 24% of the overall visible minority population. In contrast to most of the other visible minority subgroups, a larger percentage of Filipino women than men had earned a university degree (33% vs. 27%)…The most popular fields of study were Commerce Management & Business Administration (27%), Health Professions Sciences & Technologies (22%), Engineering & Applied Sciences Technologies & Trades (13%) and Engineering & Applied Sciences (10%). These four fields made up 72% of the Filipino population that went beyond secondary school education to achieve a degree, certificate or diploma. They represented 1.2% of the total workforce and 9.1% of the overall visible minority workforce…Filipinos were most frequently working in the following Employment Equity Occupational Groups (EEOGs): Intermediate Sales & Service Personnel (19%), Other Sales & Service Personnel (14%), Clerical Personnel (13%) and Semi Skilled Manual Workers (13%)… Filipinos had the highest participation rate and the lowest unemployment rate among all visible minority subgroups. Their participation rate (76%) was considerably higher than that of the non-visible minority population (66.5%). Their unemployment rate was exceptionally low (5.6%) compared to that of the non-visible minority population (7.1%).
This is all good, right? But…
…In spite of their high level of education, the proportion of Filipinos in Professional occupations (12%) was below that observed for both the nonvisible minority population (15%) and the overall visible minority population (17%)…In 2000, Filipinos had the second lowest average income among all visible minority subgroups for full-time, full-year employment. Their income, at $32,748, was equivalent to only 74% of what the non-visible minority population earned ($43,989) and 86% of what total visible minorities earned ($37,957). Filipino women earned 81% of what Filipino men earned.
Okay. I have a huge problem with this. This bothers me to no end. In fact, it sucks big fat greasy lechon. But I am not at all surprised.
I have heard horror stories about the hell Filipino nannies have gone through—not just in Canada but world-wide. They have been abused and raped. The egregious acts done to them in Canada--inconceivable. But true. This is a problem.
I know of a Canadian nurse who worked in the Middle East along-side nurses from all over the world. There was a pay differential among these nurses depending on the country of origin—Filipino nurses being almost at the bottom, North American nurses at the top of the pay scale. So this “top-level” nurse would take the shifts, and if she wanted to take a day off, would get a Filipino nurse or one lower in pay level to take the shift, and she would pocket the difference. Pretty smart Canadian, eh? Of course she was. I wouldn’t blame her. Sure, there was discussion about the lower paid nurses’ countries getting larger grants for their nurses at the government level, and somehow this ‘makes up for the inequity.’ Either way, to me, this is a problem.
I know how dirt-cheap things are in the Philippines—from wares to people and services. $15 for a luxury treatment at a spa vs $80 and up for the same thing here. Don’t think I didn’t take advantage of this—shopping maven that I am. But is this a problem? You bet your shiny new sapatos I just gave you ($3; 2 for $5!) it is.
I have heard accusations and terms such as “corruption” (a touchy buzzword to our kababayyan) in reference to Filipinos who have benefited financially or otherwise in their work—be it facilitation of new immigrants into our community, leading and representing us on a political front, in health care, religious circles, volunteering for the community functions, etc, etc, etc. To the point where some work almost ragged for way less than is fair just to uphold that perception of giving. I come from a family that ascribes to this, so I know. I bet we all do. There is great satisfaction giving something for nothing. But that doesn’t put rice on the table. Again, this is a real big problem.
This divide is in our thinking and in our belief structure. I witness it all the time. What strikes me is this impressive work ethic that transcends all the fields we work in—we take pride in what we do, and we care. Deeply. We are brought up to give and give and give. Give more. Care more. Do and be more. There is nothing to be ashamed about that. Our journals applaud these acts and rightly so. I think we don’t even do this enough. But we are also brought up to be humble and modest, painfully so. If we take in return, this is considered rude and bad--bastos. Somewhere along the line giving all and accepting so little in return became the Philippine way. But this translates into the lowest paid workers, despite definite measurable contribution and awards of excellence in our work. This translates into burnout and loss of the very people trying to make a positive difference. This translates into poorer health in our people and the community as a whole. This translates into Pinoy tearing down Pinoy because of the harmful misguided mentality that one has to lose if another wins rather than a Win/Win or No Deal approach. This divide breaks my heart and my spirit, more than words can ever capture. This must be addressed. We need to build.
When I hear the accent and see the familiar mannerisms I grew up with, I always get a nostalgic twinge of what I call “home”: a deep sense of kinship, belonging, and identity. The pointing with the lips, the wordless eyebrow greetings. The expectation of any stranger for a full plate of food at a Filipino BBQ, and the chastising of any Filipino host who doesn’t represent our hospitality. The respectful greeting of elders with hand to forehead, kneeling. All of it. For some trying to assimilate into North American culture, these things are embarrassing and funny. For me, these things strike an emotional chord—I can relate to these “quirks”, their irrational rationale, their oddness to an on-looker, but there is this intense pride mixed with a sadness in what they represent: the unsurpassable good in our hearts mixed with this dooming self-perception of inferiority and submissiveness. This chord and the divide it represents are rooted deep in my being, and I am only now beginning to understand it. It’s mine.
So I will say it again, and this time with a vengeance: Ako ay Pilipina. Ako ay Flip. I am Pyllifinah. Whatever way I say it, you cannot take that away from me. You can call me a “dirty Flip” any day, and, frankly, I’d love you that much more for it.
That is the stinging concluding remark from a letter to the editor in response to my proud self-statement (a reference to the song Magdaragat introduced me to which eventually connected me to my heritage) in my FJ article on Folklorama when I first moved to Winnipeg in 2003. Ar-ouch. To this day, during Folklorama 3 years later, I can feel my blood pressure rise and my heart sink when I recall the experience. The writer was not happy with my use of the word “Flip” to refer to Filipinos, apparently considered derogatory by some. I was shocked at the strong negative reaction and attack at not only my character but also my definition of myself as a Filipina—ang bilis bilis, too!--because all my life, that word was a special term, almost of entitlement—like my “peeps”, my “homies.” This was the term my barcadas, a handful of Saskatchewan Filipino-Canadian teens—The Filipinas Youth Group, used to call ourselves—we were cool because we had something no one else did. Like a mini-gang minus the drugs and guns and scare factor. We wore bandannas and break-danced like no other. Heck, we dominated in the dance realm. I don’t know where Bagets (form of dance Magdaragat taught us) originally came from, but it became ours. We serenaded and pen-pal’ed like it was going out of style. We kicked butt in basketball and sikaran. No one could touch us. Looking back, it was par for the course; identity issues--what all teens go through.
Now 20 years later, that letter triggered another mini identity crisis—I was seeking any reassurance I could get from my parents and the FJ editors. Did I just offend the entire Filipino community with my words?? Was I any less Filipino because that word was power where I came from but here—not so much? And why didn’t anyone teach me this in Coconut School??! What about my lack of Tagalog? Or my Chinese blood and Chinese name? What do I do to fix this?? Dare I ask the question--who’s “more Filipino” here: someone who tries to build up the Filipino spirit in all its different forms despite glaring un-Filipino-ness, or someone with the privilege of breeding & birthright who tries to break it? I think I’d take 10 puti in barongg tagalogs singing our anthem off-key over 1 purebred Pinoy holding a gun to another. But that’s just “You’re-not-Filipino…No-you’re-not”–me. I still ask random Pinoys I meet about that word, because I do not want to give up that word; I refuse to give up that pride I’ve associated with it.
I recently went to see Filipino-Canadian comic Ron Josol at Rumour’s Comedy club, and absolutely loved the show. I couldn’t help but laugh along with the largely Filipino crowd at his hilarious jokes about such “Pinoy-isms” as Philippine phonetics (“what’s his pahkking frovlem??”) and the Filipino propensity for choosing nursing as a career. What about the Philippine nanny? Who can deny this stereotype? And is it wrong to laugh at its existence and ourselves as a result? When does laughing at ourselves become harmful and the perpetuation of damaging prejudices? Conversely, when does racial sensitivity and political correctness stunt individual interpretation and expression of culture? Call a spade a spade…but then we’ve gotta look at the definition of excavation implements, the national standards of yard care tools, and if it heard the tree falling in the forest. Naman.
Living here in Winnipeg, I see Filipinos excelling in all sorts of careers, occupations, and work-settings. Certainly, in my medical training and practice, I get to work with a good number of Filipino nurses/health care workers in a variety of settings, both as patients and colleagues. Having just finished my Occupational Medicine rotation for my Community Medicine residency, I’ve gotten the chance to witness Filipinos and their health in the workplace at many different levels—a scope of the Filipino-Canadian experience…from Immigrant to Canadian-born, from caregiver to patient, from teacher to student. We are a vast and varied bunch, a spectrum: brown Filipinos, yellow Filipinos, white Filipinos, Filipino-whites, mestizas/zos, blue, orange, green, and purple Filipinos…you name it. I’ve had in-depth discussions with many Filipinos from all over this rainbow of backgrounds on this collective experience, what I call the Filipino Divide. The “ignorant coconut youth disconnected from their roots” vs the “old guards enmeshed in obsolete thinking” and everything in between. Yes, the words are there on purpose; they’re there to inflame. Why? Because if we don’t acknowledge their existence, we can’t get on top of these problems to work on the root cause. Sometimes the words have to slap us upside the head to get us to see what message lies beneath.
According to the HRSDC website, in 2001:
Filipinos in Canada represented the fourth largest visible minority subgroup (7.7% of total visible minority population; 1% of the total population). Toronto, Vancouver and Winnipeg accounted for 72% of the Filipino population…Filipinos were a very young group. Only 6% of their total population was 65 and over (compared with 13% of the non-visible minority population; 7% of the overall visible minority population). Close to 50% of the total Filipino population were of prime working age (25-54)…Filipinos had a high level of education. Among all visible minority subgroups, they ranked second in terms of the proportion of the population 15 years and over having earned a bachelor’s degree or higher and ranked first in terms of the percentage of the population with more than grade 13…Approximately 31% of Filipinos 15 years and over had a bachelor’s degree or higher compared to only 14% of the non-visible minority population and 24% of the overall visible minority population. In contrast to most of the other visible minority subgroups, a larger percentage of Filipino women than men had earned a university degree (33% vs. 27%)…The most popular fields of study were Commerce Management & Business Administration (27%), Health Professions Sciences & Technologies (22%), Engineering & Applied Sciences Technologies & Trades (13%) and Engineering & Applied Sciences (10%). These four fields made up 72% of the Filipino population that went beyond secondary school education to achieve a degree, certificate or diploma. They represented 1.2% of the total workforce and 9.1% of the overall visible minority workforce…Filipinos were most frequently working in the following Employment Equity Occupational Groups (EEOGs): Intermediate Sales & Service Personnel (19%), Other Sales & Service Personnel (14%), Clerical Personnel (13%) and Semi Skilled Manual Workers (13%)… Filipinos had the highest participation rate and the lowest unemployment rate among all visible minority subgroups. Their participation rate (76%) was considerably higher than that of the non-visible minority population (66.5%). Their unemployment rate was exceptionally low (5.6%) compared to that of the non-visible minority population (7.1%).
This is all good, right? But…
…In spite of their high level of education, the proportion of Filipinos in Professional occupations (12%) was below that observed for both the nonvisible minority population (15%) and the overall visible minority population (17%)…In 2000, Filipinos had the second lowest average income among all visible minority subgroups for full-time, full-year employment. Their income, at $32,748, was equivalent to only 74% of what the non-visible minority population earned ($43,989) and 86% of what total visible minorities earned ($37,957). Filipino women earned 81% of what Filipino men earned.
Okay. I have a huge problem with this. This bothers me to no end. In fact, it sucks big fat greasy lechon. But I am not at all surprised.
I have heard horror stories about the hell Filipino nannies have gone through—not just in Canada but world-wide. They have been abused and raped. The egregious acts done to them in Canada--inconceivable. But true. This is a problem.
I know of a Canadian nurse who worked in the Middle East along-side nurses from all over the world. There was a pay differential among these nurses depending on the country of origin—Filipino nurses being almost at the bottom, North American nurses at the top of the pay scale. So this “top-level” nurse would take the shifts, and if she wanted to take a day off, would get a Filipino nurse or one lower in pay level to take the shift, and she would pocket the difference. Pretty smart Canadian, eh? Of course she was. I wouldn’t blame her. Sure, there was discussion about the lower paid nurses’ countries getting larger grants for their nurses at the government level, and somehow this ‘makes up for the inequity.’ Either way, to me, this is a problem.
I know how dirt-cheap things are in the Philippines—from wares to people and services. $15 for a luxury treatment at a spa vs $80 and up for the same thing here. Don’t think I didn’t take advantage of this—shopping maven that I am. But is this a problem? You bet your shiny new sapatos I just gave you ($3; 2 for $5!) it is.
I have heard accusations and terms such as “corruption” (a touchy buzzword to our kababayyan) in reference to Filipinos who have benefited financially or otherwise in their work—be it facilitation of new immigrants into our community, leading and representing us on a political front, in health care, religious circles, volunteering for the community functions, etc, etc, etc. To the point where some work almost ragged for way less than is fair just to uphold that perception of giving. I come from a family that ascribes to this, so I know. I bet we all do. There is great satisfaction giving something for nothing. But that doesn’t put rice on the table. Again, this is a real big problem.
This divide is in our thinking and in our belief structure. I witness it all the time. What strikes me is this impressive work ethic that transcends all the fields we work in—we take pride in what we do, and we care. Deeply. We are brought up to give and give and give. Give more. Care more. Do and be more. There is nothing to be ashamed about that. Our journals applaud these acts and rightly so. I think we don’t even do this enough. But we are also brought up to be humble and modest, painfully so. If we take in return, this is considered rude and bad--bastos. Somewhere along the line giving all and accepting so little in return became the Philippine way. But this translates into the lowest paid workers, despite definite measurable contribution and awards of excellence in our work. This translates into burnout and loss of the very people trying to make a positive difference. This translates into poorer health in our people and the community as a whole. This translates into Pinoy tearing down Pinoy because of the harmful misguided mentality that one has to lose if another wins rather than a Win/Win or No Deal approach. This divide breaks my heart and my spirit, more than words can ever capture. This must be addressed. We need to build.
When I hear the accent and see the familiar mannerisms I grew up with, I always get a nostalgic twinge of what I call “home”: a deep sense of kinship, belonging, and identity. The pointing with the lips, the wordless eyebrow greetings. The expectation of any stranger for a full plate of food at a Filipino BBQ, and the chastising of any Filipino host who doesn’t represent our hospitality. The respectful greeting of elders with hand to forehead, kneeling. All of it. For some trying to assimilate into North American culture, these things are embarrassing and funny. For me, these things strike an emotional chord—I can relate to these “quirks”, their irrational rationale, their oddness to an on-looker, but there is this intense pride mixed with a sadness in what they represent: the unsurpassable good in our hearts mixed with this dooming self-perception of inferiority and submissiveness. This chord and the divide it represents are rooted deep in my being, and I am only now beginning to understand it. It’s mine.
So I will say it again, and this time with a vengeance: Ako ay Pilipina. Ako ay Flip. I am Pyllifinah. Whatever way I say it, you cannot take that away from me. You can call me a “dirty Flip” any day, and, frankly, I’d love you that much more for it.
Tuesday, July 18, 2006
Ask Dr. Denise: Accessing Medical Care
exerpts published in The Filipino Journal: July 5-20 2006 issue p 19
Kumusta ka and thank you for your queries, support, and good wishes! Thank you also for challenging me to do a quick tutorial in Tagalog—there’s no better way to learn than diving right in! I must however, mention that as I am still learning our native tongue, I am unable to fully address your questions if posed in Tagalog, and because I must protect your health information, I can’t simply forward your letters to translators. If at all possible, please send me your questions/comments in English, and if you’d like a tagalog translation, I can attempt to do that. I really value your questions/comments, and will do my best to help out in as timely a fashion as I am able. Please keep in mind that due to the nature of this forum (my limited ability to gather a medical history or perform physical examinations or laboratory tests) and from a medico-legal perspective, I can’t offer explicit individual medical advice nor provide any type of follow-up care. I cannot take the role of a reader's physician or health care provider. All I can do is provide general health education with the intent of having this health information accessible to the Filipino Journal's readers. My plan is to incorporate my responses in this column, along with your medical questions. Please indicate precisely if/how you would like your question published. I do not plan to identify you or anyone you've inquired about in the column unless you specifically request this and I have received written consent from the involved individuals. Depending on the volume of readers' questions I receive, I may need to prioritize my responses in the journal (leave some questions for future issues) and categorize types of questions for summarizing my responses. Salamat po—thank you for your patience and understanding. Here are a couple excellent questions that have come up:
- I just immigrated to Canada. I need a doctor, preferably Filipino/Filipina. How do I get one?
Finding a family physician here is difficult, and finding a Pinoy one is even tougher. I don’t know of any Filipino doctors right now accepting patients, but I’m looking into compiling a list. Your best bet is to contact:
The Family Doctor Connection at (204) 786-7111. The Manitoba College of Family Physicians and Manitoba Health will give you an up-to-date list of Winnipeg family doctors accepting new patients.
- Our daughter has been feeling quite ill, throwing up and headaches. When should we take her to see a doctor?
If you have an urgent medical concern, please contact your doctor or health care provider, if possible. On Page 08 of the Health Services Directory (dark blue pages in the middle of the MTS Winnipeg White Pages, there are Emergency Room Tips and the contact information for the Emergency Departments. The Urgent Care Centre (Misericordia Health Centre) and Pan Am Minor Injury Clinic are good places to consider for non-emergent/less urgent problems. You can also try one of the walk-in clinics in your area. It is always helpful to call ahead of time, if possible, to coordinate your care.
If you are unsure if you need medical care and/or are unable to contact your doctor, you can call Health Links-Info Sante at (204) 788-8200; Toll-free 1-888-315-9257 where registered nurses can answer your health-related questions and direct you in more detail.
If your question is specifically regarding a medication/drug you are taking, you can contact your dispensing pharmacist for details on the medications.
For Mental Health concerns (such as for depression, anxiety, etc): you can call the WRHA Mobile Crisis Service at (204) 946-9109 where hospital emergency rooms and the Urgent Care Centre provide some mental health crisis services. KLINIC has a 24-hour Crisis/Suicide Line at (204) 786-8686; Toll-free 1-888-322-3019; Deaf Access (204) 784-4097; Counselling Appointments at (204) 784-4059; Drop-in Counselling call (204) 784-4067.
The 24-hour Sexual Assault Crisis Line is (204) 786-8631; Toll-free 1-888-292-7565; Deaf Access (204) 784-4097; Counselling Appointments at (204) 784-4059; Drop-in Counselling call (204) 784-4067.
Health Emergency/Ambulance call 911.
For the Poison Helpline call (204) 787-2591.
A couple of useful websites:
The Winnipeg Regional Health Authority www.wrha.mb.ca; (204) 926-7000
Manitoba Health: www.gov.mb.ca/health
- My lola hasn't been to the doctor in years. She is scared to be examined by the doctor. What can she expect?
I encourage patients to be pro-active about their care, especially considering the current difficulties with access to physicians/medical care. If there are any parts of the doctor’s visit that you don’t understand, please feel free to ask your doctor. S/he should run through the procedure with you ahead of time, if you are fearful. Doctors also have the duty to keep personal health information confidential. Often the pap/gynecological/breast exams are the more worrisome to some women. Nothing is done w/o consent of the patient, so if it feels uncomfortable, don’t necessarily do it. A patient also has the right to request a helper. Many physicians automatically bring in a “helper”/witness because of the sensitive nature of the tests.
Kumusta ka and thank you for your queries, support, and good wishes! Thank you also for challenging me to do a quick tutorial in Tagalog—there’s no better way to learn than diving right in! I must however, mention that as I am still learning our native tongue, I am unable to fully address your questions if posed in Tagalog, and because I must protect your health information, I can’t simply forward your letters to translators. If at all possible, please send me your questions/comments in English, and if you’d like a tagalog translation, I can attempt to do that. I really value your questions/comments, and will do my best to help out in as timely a fashion as I am able. Please keep in mind that due to the nature of this forum (my limited ability to gather a medical history or perform physical examinations or laboratory tests) and from a medico-legal perspective, I can’t offer explicit individual medical advice nor provide any type of follow-up care. I cannot take the role of a reader's physician or health care provider. All I can do is provide general health education with the intent of having this health information accessible to the Filipino Journal's readers. My plan is to incorporate my responses in this column, along with your medical questions. Please indicate precisely if/how you would like your question published. I do not plan to identify you or anyone you've inquired about in the column unless you specifically request this and I have received written consent from the involved individuals. Depending on the volume of readers' questions I receive, I may need to prioritize my responses in the journal (leave some questions for future issues) and categorize types of questions for summarizing my responses. Salamat po—thank you for your patience and understanding. Here are a couple excellent questions that have come up:
- I just immigrated to Canada. I need a doctor, preferably Filipino/Filipina. How do I get one?
Finding a family physician here is difficult, and finding a Pinoy one is even tougher. I don’t know of any Filipino doctors right now accepting patients, but I’m looking into compiling a list. Your best bet is to contact:
The Family Doctor Connection at (204) 786-7111. The Manitoba College of Family Physicians and Manitoba Health will give you an up-to-date list of Winnipeg family doctors accepting new patients.
- Our daughter has been feeling quite ill, throwing up and headaches. When should we take her to see a doctor?
If you have an urgent medical concern, please contact your doctor or health care provider, if possible. On Page 08 of the Health Services Directory (dark blue pages in the middle of the MTS Winnipeg White Pages, there are Emergency Room Tips and the contact information for the Emergency Departments. The Urgent Care Centre (Misericordia Health Centre) and Pan Am Minor Injury Clinic are good places to consider for non-emergent/less urgent problems. You can also try one of the walk-in clinics in your area. It is always helpful to call ahead of time, if possible, to coordinate your care.
If you are unsure if you need medical care and/or are unable to contact your doctor, you can call Health Links-Info Sante at (204) 788-8200; Toll-free 1-888-315-9257 where registered nurses can answer your health-related questions and direct you in more detail.
If your question is specifically regarding a medication/drug you are taking, you can contact your dispensing pharmacist for details on the medications.
For Mental Health concerns (such as for depression, anxiety, etc): you can call the WRHA Mobile Crisis Service at (204) 946-9109 where hospital emergency rooms and the Urgent Care Centre provide some mental health crisis services. KLINIC has a 24-hour Crisis/Suicide Line at (204) 786-8686; Toll-free 1-888-322-3019; Deaf Access (204) 784-4097; Counselling Appointments at (204) 784-4059; Drop-in Counselling call (204) 784-4067.
The 24-hour Sexual Assault Crisis Line is (204) 786-8631; Toll-free 1-888-292-7565; Deaf Access (204) 784-4097; Counselling Appointments at (204) 784-4059; Drop-in Counselling call (204) 784-4067.
Health Emergency/Ambulance call 911.
For the Poison Helpline call (204) 787-2591.
A couple of useful websites:
The Winnipeg Regional Health Authority www.wrha.mb.ca; (204) 926-7000
Manitoba Health: www.gov.mb.ca/health
- My lola hasn't been to the doctor in years. She is scared to be examined by the doctor. What can she expect?
I encourage patients to be pro-active about their care, especially considering the current difficulties with access to physicians/medical care. If there are any parts of the doctor’s visit that you don’t understand, please feel free to ask your doctor. S/he should run through the procedure with you ahead of time, if you are fearful. Doctors also have the duty to keep personal health information confidential. Often the pap/gynecological/breast exams are the more worrisome to some women. Nothing is done w/o consent of the patient, so if it feels uncomfortable, don’t necessarily do it. A patient also has the right to request a helper. Many physicians automatically bring in a “helper”/witness because of the sensitive nature of the tests.
Saturday, July 01, 2006
Ask Dr. Denise: Readers' health questions welcome
The Filipino Journal: Vol 20, No 11 p 25
June 4-20 2006 issue
Kumusta kayo, mga kababayan! It feels good to greet you in Tagalog. I’d like to introduce this column and myself. My name is Denise Marie Koh, and I am a physician here in Winnipeg. I was born in Regina, Saskatchewan of Filipino parents after they took up citizenship here in the 70s. Although my family has left the Philippines, the Philippines is still very much in us. Throughout my life, my family has always been actively involved with the Filipino community at many levels—in the social, religious, and creative/artistic spheres, to name a few. From a young age, I have continually been encouraged to be proactive and speak out on issues close to home. In Regina, as a Filipinas Youth Group Ambassador, I was involved with Philippine Folk dancing and the language school. When I moved to Winnipeg in 2003 to continue my medical training, my journey to understanding my roots kicked into high gear. Since my move, I’ve had an opportunity not only to plug into the culturally rich Filipino network and eat a lot more pancit, lumpia, and other goodies, but I have also gotten to work closely with many Filipinos. I got a good look at the health issues affecting our people, having seen and treated Filipino patients at the hospitals and outpatient clinics. I’ve noticed recurring themes in my medical practice, especially among the Filipino patient population. This was reinforced greatly by my medical mission to Catanduanes in January, 2005.
What an eye-opener. When the majority of the hundreds of patients I saw requested vitamins, I learned of a serious problem that makes my stomach turn. In this day and age, no one should suffer malnutrition. Ever. On top of limited essentials such as running water and electricity, I noticed a major lack of health care services and medications, and saw the problems inherent in this health care system, particularly compounded in rural areas. I learned only too well that the people who need the health resources the most in our and many communities, get the least by way of limited access, communication difficulties, and cultural barriers. This socio-cultural isolation is self-perpetuating—the perfect catch 22. I have seen certain illnesses and health issues that are common to our kababayan, and at the suggestions of some patients, I’d like to address those problems as a service to you. It is one of my life missions to educate and help Filipinos understand about their health and make a positive impact on their collective wellbeing. Simply put, I know I can help Filipinos lead a healthy and healthful lifestyle, and I am hoping to use this forum to do so. I plan to discuss such issues as gout, diabetes, sexual health, high blood pressure, high cholesterol, musculoskeletal injuries, drugs and alcohol, depression, nutritional supplements, common medications, and laboratory tests. A Q & A format would be most useful, and would ensure the column is tailored to what you, the readers, want. Despite my busy schedule, I am doing this with no expectation of remuneration (I'm not kidding, Tita Linda!). So please, feel free to ask me any health or medical questions—if I can’t answer you, I will find the right sources who can. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
written ~5/31/06
June 4-20 2006 issue
Kumusta kayo, mga kababayan! It feels good to greet you in Tagalog. I’d like to introduce this column and myself. My name is Denise Marie Koh, and I am a physician here in Winnipeg. I was born in Regina, Saskatchewan of Filipino parents after they took up citizenship here in the 70s. Although my family has left the Philippines, the Philippines is still very much in us. Throughout my life, my family has always been actively involved with the Filipino community at many levels—in the social, religious, and creative/artistic spheres, to name a few. From a young age, I have continually been encouraged to be proactive and speak out on issues close to home. In Regina, as a Filipinas Youth Group Ambassador, I was involved with Philippine Folk dancing and the language school. When I moved to Winnipeg in 2003 to continue my medical training, my journey to understanding my roots kicked into high gear. Since my move, I’ve had an opportunity not only to plug into the culturally rich Filipino network and eat a lot more pancit, lumpia, and other goodies, but I have also gotten to work closely with many Filipinos. I got a good look at the health issues affecting our people, having seen and treated Filipino patients at the hospitals and outpatient clinics. I’ve noticed recurring themes in my medical practice, especially among the Filipino patient population. This was reinforced greatly by my medical mission to Catanduanes in January, 2005.
What an eye-opener. When the majority of the hundreds of patients I saw requested vitamins, I learned of a serious problem that makes my stomach turn. In this day and age, no one should suffer malnutrition. Ever. On top of limited essentials such as running water and electricity, I noticed a major lack of health care services and medications, and saw the problems inherent in this health care system, particularly compounded in rural areas. I learned only too well that the people who need the health resources the most in our and many communities, get the least by way of limited access, communication difficulties, and cultural barriers. This socio-cultural isolation is self-perpetuating—the perfect catch 22. I have seen certain illnesses and health issues that are common to our kababayan, and at the suggestions of some patients, I’d like to address those problems as a service to you. It is one of my life missions to educate and help Filipinos understand about their health and make a positive impact on their collective wellbeing. Simply put, I know I can help Filipinos lead a healthy and healthful lifestyle, and I am hoping to use this forum to do so. I plan to discuss such issues as gout, diabetes, sexual health, high blood pressure, high cholesterol, musculoskeletal injuries, drugs and alcohol, depression, nutritional supplements, common medications, and laboratory tests. A Q & A format would be most useful, and would ensure the column is tailored to what you, the readers, want. Despite my busy schedule, I am doing this with no expectation of remuneration (I'm not kidding, Tita Linda!). So please, feel free to ask me any health or medical questions—if I can’t answer you, I will find the right sources who can. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
written ~5/31/06
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