FJ Volume 21, Number 23
December 05-20, 2007
Magandang araw, mga kaibigan naman! Kumusta kayo?? Ay nako, it’s been too long—these last couple of months I’ve been “in hiding” a bit, finishing up my Master’s of Public Health Field Practicum and frantically writing up my project papers and presenting my findings to the Department of Community Health Sciences at the University of Manitoba. Phew! Pagod na pagod po ako dahil trabaho/pararalan! My last two columns sported reflections of my journey to the Philippines July 12th - August 10th. I first reported on the Ambassadors’, Consul Generals’, and Tourism Directors’ Tour (ACGTDT) and urged readers to respond to my Field Practicum questionnaire exploring the migration of Filipino doctors and health care workers to Canada. In Part 2, I then described my experiences at the Philippine Senate and Philippine National Red Cross with Senator Dick Gordon, with a cameo from the very charming former President Fidel Ramos.
My adventures didn’t end there, however. I was able to do/learn/see so much more during my time in the Philippines, particularly getting exposure to the different perspectives related to the Philippine health care system and the migration of Filipino HCWs to Canada. I got to interview many key players in this complex issue, including: Migrante International, a non-profit grassroots organization dedicated to the advocacy and wellbeing of OFWs; previous Secretary of Health, public health physician, and Pinoy HCW migration expert, Dr. Jaime Z. Galvez Tan; UP College of Medicine professors and students including Dean Alberto Roxas and Dr. Leo Cubillan; media station GMA-7’s Sandra Aguinaldo, who did a documentary on “Dr. Nurses”; governmental agencies including the Canadian Immigration Integration Program/Canadian Embassy, Philippine Overseas Employment Authority, Department of Labour and Employment; and numerous other physicians/residents/medical students/health care workers/stakeholders who proved very gracious in giving me their time and input. I also found myself in a position to take part in clinical/missionary work--Dr. Hector Santos and the rest of the plastic surgery staff at the Managed Care Clinic invited me to come to their Operation Smile mission where they perform free surgical care and rehabilitation (eg speech language pathology) to those in need who cannot afford the treatments. Not only did I get to interview the gang for my project, but I also observed cleft lip and palate surgery on young patients and listened to the surgical team serenade each other—what a happy musical bunch! After a very inspiring discussion about global health with Dr. Galvez Tan, he also invited me to experience a medical mission--this one in Tondo with the UP Family Medical residents, but unfortunately, typhoons prevented the mission. Sayang! Other major highlights include a trip to Subic to meet PGMA a second time around and an in-depth interview with President Ramos. I will have to write in more detail about these amazing experiences in an upcoming column/my blog. I did witness some of the unpleasant and downright scary aspects of the Philippines, such as my “undercover” research in the form of “kidney-shopping” with cabdrivers and the demoralizing Filipino “crab mentality” Dr. Roxas enlightened me of. I might even reveal some of my more candid reactions, culture shocks, and rude awakenings learning about the distinctly Pinoy way of life. These all made for a very rich and life-changing experience for me, and I consider myself blessed for being given the opportunity to experience it all.
This project also led me to experiences in Winnipeg with the WRHA/Manitoba Health/Department of Labour and Immigration (Physician Resource Coordination Office); IMG (International Medical Graduate) Program, Faculty of Medicine, University of Manitoba; College of Physicians and Surgeons of Manitoba (CPSM); University of Winnipeg, Global College; Philippine-Canadian Centre of Manitoba; Community clinics/organizations such as Welcome Place and ANAK; CBC; The Filipino Journal; and of course, key informants Pinoy and other IMG docs. I also went to Ottawa and learned much from the Philippine Embassy; Federal Government Departments (Multiculturalism and Canadian Identity; Citizenship and Immigration; & Health); and the Canadian Public Health Association Conference, where I got to hear from such notable speakers as environmentalist David Suzuki, Nobel Peace Prize Winner David Orbinski (Doctors without Borders), Public Health Agency of Canada leader Dr. David Butler-Jones, and Health Minister Tony Clement, among others.
Clearly, my findings from this field practicum are quite extensive and comprehensive. Some of my conclusions:
There is a massive unmanaged migration of Filipino health care workers, including physicians and MD-RNs, worldwide, including to Canada. There are many socio-politico-ecological factors which drive HHR (Health Human Resources) to move abroad, and the effects include a Brain Drain in the health system, an economy held afloat by the remittances, broken families, abuse/health problems of these workers, worsening health status of the Philippines, an increased disparity between the economic classes, and a disturbing culture perpetuated by the American Dream. Pinoy doctors/IMGs face many challenges in their migration, settlement, and licensure to Canada. Their integration success depends on many factors, particularly their ability to gain licensure to practice medicine. Despite a huge need for doctors in Canada, numerous barriers to licensure exist, including a complex web of stakeholders (eg federal, provincial, RHA, licensing bodies, medical educators, etc) with jurisdictional mandates/authorities that leave the IMG falling through the cracks; not well-known, unclear, variable pathways to licensure; competing interests of more aggressive destination countries; a resulting process that is blocked up to the point of paralysis; and the rigours of adjusting to a new lifestyle and culture. Certainly, the Canadian system has many areas of improvement but is definitely moving in the right direction. Canada should strive to address these gaps in the system in a collaborative, globally-sensitive way, including engaging in high-level discussions with the Philippines to come up with some Win-Win solutions, ensuring a consistent, fair licensure process for the various primary care workers congruent with immigration goals and practice, and still taking a proactive, ethically-minded role in the global HHR market. In this way, our country can proudly tap into the tremendous potential value and contribution of the Filipino physician.
I presented some of my experiences and conclusions to my Department at the University, and it was very nice to see mga kababayan attend my presentation. To the Filipino community and all involved with this project, thank you so much for your support, responses to my questionnaire, and much-needed input/advice! Talagang nagpapasalamat ako sa inyo. I plan to present my findings in more detail to the community, particularly for those who expressed regret in missing my presentation, so stay tuned for my next community meeting announcement. I plan to further much work in this area, so please contact me at my blog or email if you are interested in learning more or helping out.
So that wraps up this column for now. Please remember: health starts at home; your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands! Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
Sunday, December 23, 2007
Thursday, September 20, 2007
Journey to the Philippines Part 2: The Senate of the Philippines and the Philippine National Red Cross
FJ Volume 21, Number 17
September 05 - 20, 2007
Mabuhay! In Part 1 about my journey to the Philippines July 12th - August 10th, I reported on the Ambassadors’, Consul Generals’, and Tourism Directors’ Tour (ACGTDT) and my Field Practicum questionnaire for my Master’s in Public Health exploring the migration of Filipino doctors and health care workers to Canada. If you haven’t responded to the questionnaire yet, please take the time to do so (askdrdenise@mts.net or http://www.askdrdenise.blogspot.com/) as your much-needed input could form projects and initiatives to address the many difficulties Filipino HCWs face in Canada. Thank you po!
This issue chronicles my amazing experiences at the Senate and the Philippine National Red Cross with presidential candidate, Department of Tourism’s Wow Philippines “spear-header”, and humanitarian “extraordinaire” Senator Richard “Dick” Gordon. I had the great fortune of being seated on the flight to Manila close to Senator Dick who overheard me speaking of my ambitious project and graciously offered any assistance while in the Philippines. My project leads were proving difficult to contact, so I decided to take him up on the offer, just missing the opportunity to watch President GMA’s State of the Nation Address (Sayang naman!!). My disappointment was quickly assuaged by an invitation to check out the Senate the following day! So on July 24-25th, I had the privilege of witnessing the first Session for the Fourteenth Senate of the Philippines where the main issue was the discussion surrounding further action following a resolution by 17 of the 22 senators asking that the Senate support newly elected Senator Trillanes, to be able to sit at the Senate and perform his functions. The problem is this: in July 2003, a group of 321 armed soldiers who called themselves “Bagong Katipuneros” led by Army Capt. Gerardo Gambala and Lt. Antonio Trillanes IV, of the Philippine Navy took over (and apparently rigged with bombs) the Oakwood Premier Ayala Center service apartment tower in Makati City to show the Filipino people the alleged corruption of the GMA administration. This Oakwood mutiny effort was quickly thwarted, and Trillanes is currently incarcerated for an alleged criminal charge. Following this, he ran for senator, and won with more than 11 million votes. Interesting dilemma. Dissecting this issue further reveals many insights into the checkered and complex political and cultural history of the Philippines. I got to hear many compelling arguments from the various senators, ranging from the popular notion that he represents the people by such strong public support, that not allowing him to sit in the senate could be perceived as a human rights violation, the precedent of previous politician Mantolo being allowed to sit his duties, minimization of any harms that Trillanes would pose by letting him do his duties (unlikely flight risk, he’d only be 1 of 22 senators so his influence would be “diluted”, options for security and teleconferencing), etc. Hmmmm. I also heard from the four senators (Gordon, Arroyo, Enrile, and Santiago) who voted against the resolution—mainly the separation of powers of jurisdictions, the gravity of the charge, the importance of accountability in the definition of courage, the slippery slope argument, the moral problem with the senate stepping outside its jurisdiction, the inherent conflict of interest in a senate essentially allowing one of its own to “be above the law”, and much more. I got to discuss the ethical and moral facets of the issue with Senator Gordon, before his final speech—this would not even be happening in Canada!-- and I must say, we were all proud that he “nailed it” by getting his points across so passionately and eloquently. There are 5 clips of his speech (with me in the background trying to tape it!) on http://www.youtube.com/watch?v=eKhUi7vSE98. The ante was upped when it was suggested each senator reveal the reasons for her/his vote, and though the resolution was passed, it was exciting to witness government in action, as well as see the media frenzy that followed the session.
Afterward, I saw his dedicated staff work late into the evening while he met with Filipinos who came to ask for his help and guidance, did an inspiring interview (and mini cultural and history lesson) with an Italian-Filipino initiative called Stila Magazine, foto-op with a Filipino-American hip-hop group, another interview with a group of elementary students, and a general debriefing with his staff. On top of all these great experiences and learning opportunities, Senator Gordon facilitated my project work with the Dept of Labour and Employment/Philippine Oversease Employment Agency as well as some time with the Philippine National Red Cross.
I sat in on a teaching session he held with his PNRC staff on Disaster Response Planning, and I got to put my two cents in on what some of the Canadian programs do. I also got to attend the meeting of the Board, which Senator Dick chairs. What an illustrious and welcoming group! Discussing the ins and outs of humanitarian work and the challenges of administering and managing public care and aid through the PNRC were both educational and inspiring to me as a budding public health specialist. My heart grew with pride when a couple of Filipinas from Canada dropped in to give a donation.
At the end of the meeting, we found that former President Fidel Ramos was at the PNRC getting his blood pressure checked! My blood pressure went through the roof as I joined the crowd to meet “Steady Eddie”, the beloved president I read about in my (and the first) Philippine Studies Institute class only a couple of weeks prior. He cajoled the gang and the foto ops and smiles were endless. I was able to set up an interview with him, so more about him soon.
To crown off the evening, I joined Senator Dick’s staff in catching the tail end of the year-long-awaited nail-biting basketball game between the rival universities - Ateneo vs De La Salle. The standing-only half-green (DLSU), half-blue (ADMU) crowd went wild the whole game, which went (close match in over-time) to Senator Dick’s home team, Ateneo.What a rush!
All in all, I was really impressed with Senator Gordon and what he stands for, especially his continually connecting Filipino history, culture—identity--to the future of the Philippines in a positive light, particularly with the young Filipinos who often need reminding of our colourful past and why things are the way they are in the Philippines. Looking at the difficulties in life Filipinos face, it seems so easy to forget or even divorce from the country’s past, and embrace the “new” whether out of a sense of shame or survival. This man, through his example to everyone he meets, has given me a true appreciation for the different pieces of a puzzle I’d been trying to work out for quite some time now: tourism/economy and social business, history, culture, human rights and humanitarianism, health of individuals and populations, hard individual work with collective spirit and mentality, all mixed with a fierce love of two countries. I learned so much, and I could see how he ignites others to be their best. I feel very blessed to have been able to see so many great facets of the Filipino people, and to experience Filipinos working in earnest to better the country. Thank you, Senator Dick!
Well, that about caps up this article. So, folks, please remember that your health (physical/body, emotional, spiritual, mental) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
September 05 - 20, 2007
Mabuhay! In Part 1 about my journey to the Philippines July 12th - August 10th, I reported on the Ambassadors’, Consul Generals’, and Tourism Directors’ Tour (ACGTDT) and my Field Practicum questionnaire for my Master’s in Public Health exploring the migration of Filipino doctors and health care workers to Canada. If you haven’t responded to the questionnaire yet, please take the time to do so (askdrdenise@mts.net or http://www.askdrdenise.blogspot.com/) as your much-needed input could form projects and initiatives to address the many difficulties Filipino HCWs face in Canada. Thank you po!
This issue chronicles my amazing experiences at the Senate and the Philippine National Red Cross with presidential candidate, Department of Tourism’s Wow Philippines “spear-header”, and humanitarian “extraordinaire” Senator Richard “Dick” Gordon. I had the great fortune of being seated on the flight to Manila close to Senator Dick who overheard me speaking of my ambitious project and graciously offered any assistance while in the Philippines. My project leads were proving difficult to contact, so I decided to take him up on the offer, just missing the opportunity to watch President GMA’s State of the Nation Address (Sayang naman!!). My disappointment was quickly assuaged by an invitation to check out the Senate the following day! So on July 24-25th, I had the privilege of witnessing the first Session for the Fourteenth Senate of the Philippines where the main issue was the discussion surrounding further action following a resolution by 17 of the 22 senators asking that the Senate support newly elected Senator Trillanes, to be able to sit at the Senate and perform his functions. The problem is this: in July 2003, a group of 321 armed soldiers who called themselves “Bagong Katipuneros” led by Army Capt. Gerardo Gambala and Lt. Antonio Trillanes IV, of the Philippine Navy took over (and apparently rigged with bombs) the Oakwood Premier Ayala Center service apartment tower in Makati City to show the Filipino people the alleged corruption of the GMA administration. This Oakwood mutiny effort was quickly thwarted, and Trillanes is currently incarcerated for an alleged criminal charge. Following this, he ran for senator, and won with more than 11 million votes. Interesting dilemma. Dissecting this issue further reveals many insights into the checkered and complex political and cultural history of the Philippines. I got to hear many compelling arguments from the various senators, ranging from the popular notion that he represents the people by such strong public support, that not allowing him to sit in the senate could be perceived as a human rights violation, the precedent of previous politician Mantolo being allowed to sit his duties, minimization of any harms that Trillanes would pose by letting him do his duties (unlikely flight risk, he’d only be 1 of 22 senators so his influence would be “diluted”, options for security and teleconferencing), etc. Hmmmm. I also heard from the four senators (Gordon, Arroyo, Enrile, and Santiago) who voted against the resolution—mainly the separation of powers of jurisdictions, the gravity of the charge, the importance of accountability in the definition of courage, the slippery slope argument, the moral problem with the senate stepping outside its jurisdiction, the inherent conflict of interest in a senate essentially allowing one of its own to “be above the law”, and much more. I got to discuss the ethical and moral facets of the issue with Senator Gordon, before his final speech—this would not even be happening in Canada!-- and I must say, we were all proud that he “nailed it” by getting his points across so passionately and eloquently. There are 5 clips of his speech (with me in the background trying to tape it!) on http://www.youtube.com/watch?v=eKhUi7vSE98. The ante was upped when it was suggested each senator reveal the reasons for her/his vote, and though the resolution was passed, it was exciting to witness government in action, as well as see the media frenzy that followed the session.
Afterward, I saw his dedicated staff work late into the evening while he met with Filipinos who came to ask for his help and guidance, did an inspiring interview (and mini cultural and history lesson) with an Italian-Filipino initiative called Stila Magazine, foto-op with a Filipino-American hip-hop group, another interview with a group of elementary students, and a general debriefing with his staff. On top of all these great experiences and learning opportunities, Senator Gordon facilitated my project work with the Dept of Labour and Employment/Philippine Oversease Employment Agency as well as some time with the Philippine National Red Cross.
I sat in on a teaching session he held with his PNRC staff on Disaster Response Planning, and I got to put my two cents in on what some of the Canadian programs do. I also got to attend the meeting of the Board, which Senator Dick chairs. What an illustrious and welcoming group! Discussing the ins and outs of humanitarian work and the challenges of administering and managing public care and aid through the PNRC were both educational and inspiring to me as a budding public health specialist. My heart grew with pride when a couple of Filipinas from Canada dropped in to give a donation.
At the end of the meeting, we found that former President Fidel Ramos was at the PNRC getting his blood pressure checked! My blood pressure went through the roof as I joined the crowd to meet “Steady Eddie”, the beloved president I read about in my (and the first) Philippine Studies Institute class only a couple of weeks prior. He cajoled the gang and the foto ops and smiles were endless. I was able to set up an interview with him, so more about him soon.
To crown off the evening, I joined Senator Dick’s staff in catching the tail end of the year-long-awaited nail-biting basketball game between the rival universities - Ateneo vs De La Salle. The standing-only half-green (DLSU), half-blue (ADMU) crowd went wild the whole game, which went (close match in over-time) to Senator Dick’s home team, Ateneo.What a rush!
All in all, I was really impressed with Senator Gordon and what he stands for, especially his continually connecting Filipino history, culture—identity--to the future of the Philippines in a positive light, particularly with the young Filipinos who often need reminding of our colourful past and why things are the way they are in the Philippines. Looking at the difficulties in life Filipinos face, it seems so easy to forget or even divorce from the country’s past, and embrace the “new” whether out of a sense of shame or survival. This man, through his example to everyone he meets, has given me a true appreciation for the different pieces of a puzzle I’d been trying to work out for quite some time now: tourism/economy and social business, history, culture, human rights and humanitarianism, health of individuals and populations, hard individual work with collective spirit and mentality, all mixed with a fierce love of two countries. I learned so much, and I could see how he ignites others to be their best. I feel very blessed to have been able to see so many great facets of the Filipino people, and to experience Filipinos working in earnest to better the country. Thank you, Senator Dick!
Well, that about caps up this article. So, folks, please remember that your health (physical/body, emotional, spiritual, mental) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
Tuesday, September 18, 2007
Journey to the Philippines, Part 1: ACGTDT & MPH Field Practicum
FJ Volume 21, Number 16
Aug 20 - Sep 05/07
Magandang araw mga kababayan! It feels good to write after a long-enough hiatus—I just got back August 10th from our homeland, the Philippines, after a month jam-packed with cultural events, adventures, meetings, opportunities, and overall major personal growth. What a lot to report, and where to begin?? I guess at the beginning…this will be Part 1 of a series that will include the ACGTDT, my Field Practicum research, experiences at the Senate and Philippine National Red Cross with Senator Richard Gordon, a trip to Subic to meet PGMA, and interviews with former president, Fidel V. Ramos, Migrante International, previous Secretary of Health Dr. Jaime Z. Galvez Tan, UP College of Medicine Dean Alberto Roxas, Sandra Aguinaldo from GMA-7, agencies including the Canadian Immigration Integration Program/Canadian Embassy, Philippine Overseas Employment Authority, Department of Labour and Employment, several physicians and medical students, “undercover” research in the form of “kidney-shopping” with cab-drivers, a stint at Operation Smile with Drs. Hector Santos and the Managed Care Clinic, and I might even reveal some of my more candid reactions, culture shocks, and rude awakenings learning about the distinctly Pinoy way of life. I will be posting my articles on my blog Ask Dr. Denise and its “angry” off-shoot POP soon, so if you miss any, feel free to check out the blogs at: http://www.askdrdenise.blogspot.com/.
As many of you may know, I am completing my Masters in Public Health degree, which requires a 3-month Field Practicum, as part of my Community Medicine residency. I reasoned—what better way to work on a project I am passionate about that fits precisely into my world vision and life mission, with an opportunity for exposure and immersion at multiple health-related organizations and initiatives/programs, particularly my homeland, working on the many projects I have been toiling away in my spare time that are potentially good for the health of the Filipino and Canadian people, the health of the overall systems of my two beloved countries, and all involved? Plus I’d get to learn so much more about my roots, the language, the culture--a true Win-Win.
So I decided to start my Philippines portion of my practicum piggy-backing onto the 3rd Ambassadors, Consuls General and Tourism Directors Tour of the Philippines (ACGTDT), July 14-17, 2007. The weeks prior to my departure July 12 involved making last-minute preparations and finalizing trip plans, celebrating Philippine Independence and Heritage, plus taking in what I could of the Philippine Studies Institute first course History and Culture of the Philippines with Dr. Michael Culinane, including the very relevant forum to my project on The Brain Drain of Filipinos to North America. What an excellent and timely course and associated events schedule to kick off my trip to the Philippines!
The ACGTDT to the Philippines is a joint collaboration between Philippine government offices (the Departments of Foreign Affairs, of Tourism, and of Trade and Industry), designed to bring the Philippines closer to communities in North America, offering participants countless opportunities in terms of cultural enrichment and people-to-people exchanges, leisure and recreation, retirement programs and business networking. Of the almost 650 tour participants, 21 booked or came from Agana, Guam, 9 from Atlanta, 50 from Chicago, 114 from Honolulu, 146 from Los Angeles, 11 from Miami, 69 from New York, 130 from San Francisco, 29 from Washington DC, 7 from Calgary, 26 from Edmonton, 22 from Ottawa, 3 from Vancouver, and 10 from Winnipeg. The Winnipeg group included: Dr. Salvador and Josephine Andres from Saskatoon (my parents are Dr. Sal’s godparents), Alexandra, Luz, Nemesio, and Victoria Buen, Allen, Esmeralda, and Kelly Joe Harvard, and Antonina Huypungco (I booked through Ottawa as Hon. Jose S. Brillantes was my preceptor for the Philippine portion of my MPH FP).
We arrived groggy at just after 4 am July 14 to the welcoming tunes of a Filipino “mariachi band” and fragrant sampaguita leis. A quick orientation at the Shangri-la Makati Hotel, and we were whisked to the Serendra Club House for breakfast care of Megaworld Inc. and business meetings courtesy of the department of Trade and Industry. Here we learned of small investment opportunities in the provinces, Philippine brand franchising opportunities, the OTOP (One Town One Product) initiative, Meycauayan Jewelry Industry Association, etc. We could then mingle, sample more delicious Filipino foods, check out and purchase Filipino jewelry, and then embark on a City Tour of Manila and Makati which included Intramuros, Fort Santiago, and Bahay Tsinoy while some opted for Pasarap (spa/massage) or Paganda (mani/pedicure or haircut) for a small fee. We became VIPs when we were escorted by motorbike-police through the traffic-jammed streets of Manila to help get us to our “Exotic Mindanao” welcome dinner at the Sofitel Philippine Plaza. Canadian Ambassador Peter Sutherland joined us as we were wowed by an eye-popping Muslim Filipiniana song/dance/fashion-show where the beautiful dancers, singers, and models show-pieced the Mindanao delicacies served from the stage onto our plates, all emceed by a former Miss Philippines. After the dinner, I got to tsis-mis more with delegates from Ontario, Montreal, and Alberta when the Ambassador treated us to a late-nite coffee across the street from the Shangri-la Makati Hotel.
Sunday after another scrumptious breakfast, we got to choose from tours to Corregidor, Villa Escudero, or Tagaytay. I chose the Taal/Tagaytay/Batangas Eco-Cultural Tour, and was impressed by the serene drive through the countryside and the gorgeous landscape featuring the smallest Taal volcano, all to the silly jokes of our tour guide. We stopped for a merienda at the Tagaytay Highlands in a pagoda-style tearoom, then traveled to and lunched at the famous Sonya’s Garden. We stopped by the Tagaytay Medical Centre as one of our delegates had an asthma attack, but once we were assured of our group’s safety and health, we made it back in time to go to either a Show and Dinner in Tiendesitas Stalls, Ortigas, or Star Studio, ABS-CBN Cocktails with “stars”. I got a chance to have my first Krispy Kreme Donut at Star Studio, then hung with stars from Pinoy Big Brother and other famous Filipino teen shows. I also got some photo ops with the 2 Miss Teen American Philippines and camped it up in front of the camera some more with the teen Pinoy and Pinay hotties.
Monday started with a Wreath-Laying Ceremony in the brilliant (and unforgiving!) sun at Rizal Monument to give respect and honour our national hero, Jose Rizal. Then we arrived at Malacanang Palace for a Tour of the Museum—if anyone finds copies of the cheeky fotos of me showing off my shoes “Imelda-style” at the table where Marcos declared martial law, please let me know!!--then another belly-stretching lunch complete with Halo-Halo and other Filipino goodies. We met and got photographed at Rizal Hall with President Gloria Macapagal Arroyo, who at first thought the Canadian group was all from Winnipeg and had many wonderful things to say about our awesome province. She and her staff graciously chatted with and took photos with the throngs of delegates who swarmed her. We returned to our hotels via a Rolling Tour of Manila and Makati (included the Cultural Center of the Philippines Complex, Libingan ng mga Bayani, American Cemetery, Forbes Park, Business District) then finished up with a Wellness theme Appreciation Dinner at the Shangri-La Hotel. Here, we could dance the night away to the live bands or hunt through the stacks of tour photos from the tour photographers.
The following day was check-out for some while others could choose from Optional Out-of-Town-Tours such as Aklan/Boracay; Laoag/Vigan; Bohol/Dumaguete; Cebu/Cagayan de Oro; Puerto Princesa, Palawan; Diving in Club Noah Isabelle, Palawan; Golf in Metro Manila’s top 3 courses; Clark, Pampanga/Subic, Olgangapo; as well as a Gawad Kalinga Housing Project Visit and Wowowie Show. All in all the ACGTDT 2007 was an amazing time filled with wonderful experiences and connections with new friends from all over North America and the Philippines. I opted to focus on my ambitious project of looking at the Migration of Health Care Workers, particularly Filipino Doctors, to Canada. I will have to report on this project in an upcoming issue, but I am calling out to you to send me your stories, comments, or advice, or the contact information of those who might be able to help me in this ongoing project:
As I may have mentioned to many of you, I am quite interested in the experience and health of Filipino immigrants, particularly Live-in Caregivers, “nannies”, and health care professionals—whether recognized in their professions or not (credentials, fair and equitable pay, respect, etc). In my Public Health training, I’ve come across some research about the “Healthy Immigrant Effect”—basically that some immigrants tend to be healthier than Canadian-born but then after several years in Canada, their health deteriorates to the level of their Canadian-born controls. I’ve started researching the health of Filipinos across Canada and spent some time in Ottawa, Montreal, the Philippines, as well as locally talking to people about their experiences coming to Canada. I want to hear from you—please, tell me your stories: email me at askdrdenise@mts.net or go to my blog www.askdrdenise.blogspot.com and add your story as a comment to this article or take the questionnaire (to be set up)—if you wish certain parts of your story to be confidential, please use my email address and outline which parts, if any, you are okay with me sharing on my blog or in this column.
The questions I’m particularly interested in:
1) Name, sex, and contact information
2) Age, Year of Birth, Year of immigration to Canada, Dates of any other Caregiving experiences in other countries (including the Philippines)
3) Languages (including dialect, if necessary) spoken and read
4) Process of Immigration to Canada: Were you in the Live-In Caregiver Program, other categories of immigration
5) What type of work do you do? If you are a Caregiver, what field/area are you in? Ie: what training did you have in the Philippines, Canada, elsewhere? Did that translate into what you are doing now?
6) Health status/concerns in the Philippines compared with in Canada
7) Do you believe that being Filipino makes you healthier or less healthy than non-Filipinos? Why? What are the key factors you believe determine Filipino-Canadian health (eg, language, where born, credentialing, education, discrimination/prejudice, connection to community, family, etc)?
8) What are your concerns regarding the health of the Filipino community in Canada and in the Philippines? Is there a Brain Drain? Why or Why not?
9) What are your suggestions for dealing with these issues?
10) Any other comments are greatly appreciated.
Maraming salamat po!
So please remember that your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
Aug 20 - Sep 05/07
Magandang araw mga kababayan! It feels good to write after a long-enough hiatus—I just got back August 10th from our homeland, the Philippines, after a month jam-packed with cultural events, adventures, meetings, opportunities, and overall major personal growth. What a lot to report, and where to begin?? I guess at the beginning…this will be Part 1 of a series that will include the ACGTDT, my Field Practicum research, experiences at the Senate and Philippine National Red Cross with Senator Richard Gordon, a trip to Subic to meet PGMA, and interviews with former president, Fidel V. Ramos, Migrante International, previous Secretary of Health Dr. Jaime Z. Galvez Tan, UP College of Medicine Dean Alberto Roxas, Sandra Aguinaldo from GMA-7, agencies including the Canadian Immigration Integration Program/Canadian Embassy, Philippine Overseas Employment Authority, Department of Labour and Employment, several physicians and medical students, “undercover” research in the form of “kidney-shopping” with cab-drivers, a stint at Operation Smile with Drs. Hector Santos and the Managed Care Clinic, and I might even reveal some of my more candid reactions, culture shocks, and rude awakenings learning about the distinctly Pinoy way of life. I will be posting my articles on my blog Ask Dr. Denise and its “angry” off-shoot POP soon, so if you miss any, feel free to check out the blogs at: http://www.askdrdenise.blogspot.com/.
As many of you may know, I am completing my Masters in Public Health degree, which requires a 3-month Field Practicum, as part of my Community Medicine residency. I reasoned—what better way to work on a project I am passionate about that fits precisely into my world vision and life mission, with an opportunity for exposure and immersion at multiple health-related organizations and initiatives/programs, particularly my homeland, working on the many projects I have been toiling away in my spare time that are potentially good for the health of the Filipino and Canadian people, the health of the overall systems of my two beloved countries, and all involved? Plus I’d get to learn so much more about my roots, the language, the culture--a true Win-Win.
So I decided to start my Philippines portion of my practicum piggy-backing onto the 3rd Ambassadors, Consuls General and Tourism Directors Tour of the Philippines (ACGTDT), July 14-17, 2007. The weeks prior to my departure July 12 involved making last-minute preparations and finalizing trip plans, celebrating Philippine Independence and Heritage, plus taking in what I could of the Philippine Studies Institute first course History and Culture of the Philippines with Dr. Michael Culinane, including the very relevant forum to my project on The Brain Drain of Filipinos to North America. What an excellent and timely course and associated events schedule to kick off my trip to the Philippines!
The ACGTDT to the Philippines is a joint collaboration between Philippine government offices (the Departments of Foreign Affairs, of Tourism, and of Trade and Industry), designed to bring the Philippines closer to communities in North America, offering participants countless opportunities in terms of cultural enrichment and people-to-people exchanges, leisure and recreation, retirement programs and business networking. Of the almost 650 tour participants, 21 booked or came from Agana, Guam, 9 from Atlanta, 50 from Chicago, 114 from Honolulu, 146 from Los Angeles, 11 from Miami, 69 from New York, 130 from San Francisco, 29 from Washington DC, 7 from Calgary, 26 from Edmonton, 22 from Ottawa, 3 from Vancouver, and 10 from Winnipeg. The Winnipeg group included: Dr. Salvador and Josephine Andres from Saskatoon (my parents are Dr. Sal’s godparents), Alexandra, Luz, Nemesio, and Victoria Buen, Allen, Esmeralda, and Kelly Joe Harvard, and Antonina Huypungco (I booked through Ottawa as Hon. Jose S. Brillantes was my preceptor for the Philippine portion of my MPH FP).
We arrived groggy at just after 4 am July 14 to the welcoming tunes of a Filipino “mariachi band” and fragrant sampaguita leis. A quick orientation at the Shangri-la Makati Hotel, and we were whisked to the Serendra Club House for breakfast care of Megaworld Inc. and business meetings courtesy of the department of Trade and Industry. Here we learned of small investment opportunities in the provinces, Philippine brand franchising opportunities, the OTOP (One Town One Product) initiative, Meycauayan Jewelry Industry Association, etc. We could then mingle, sample more delicious Filipino foods, check out and purchase Filipino jewelry, and then embark on a City Tour of Manila and Makati which included Intramuros, Fort Santiago, and Bahay Tsinoy while some opted for Pasarap (spa/massage) or Paganda (mani/pedicure or haircut) for a small fee. We became VIPs when we were escorted by motorbike-police through the traffic-jammed streets of Manila to help get us to our “Exotic Mindanao” welcome dinner at the Sofitel Philippine Plaza. Canadian Ambassador Peter Sutherland joined us as we were wowed by an eye-popping Muslim Filipiniana song/dance/fashion-show where the beautiful dancers, singers, and models show-pieced the Mindanao delicacies served from the stage onto our plates, all emceed by a former Miss Philippines. After the dinner, I got to tsis-mis more with delegates from Ontario, Montreal, and Alberta when the Ambassador treated us to a late-nite coffee across the street from the Shangri-la Makati Hotel.
Sunday after another scrumptious breakfast, we got to choose from tours to Corregidor, Villa Escudero, or Tagaytay. I chose the Taal/Tagaytay/Batangas Eco-Cultural Tour, and was impressed by the serene drive through the countryside and the gorgeous landscape featuring the smallest Taal volcano, all to the silly jokes of our tour guide. We stopped for a merienda at the Tagaytay Highlands in a pagoda-style tearoom, then traveled to and lunched at the famous Sonya’s Garden. We stopped by the Tagaytay Medical Centre as one of our delegates had an asthma attack, but once we were assured of our group’s safety and health, we made it back in time to go to either a Show and Dinner in Tiendesitas Stalls, Ortigas, or Star Studio, ABS-CBN Cocktails with “stars”. I got a chance to have my first Krispy Kreme Donut at Star Studio, then hung with stars from Pinoy Big Brother and other famous Filipino teen shows. I also got some photo ops with the 2 Miss Teen American Philippines and camped it up in front of the camera some more with the teen Pinoy and Pinay hotties.
Monday started with a Wreath-Laying Ceremony in the brilliant (and unforgiving!) sun at Rizal Monument to give respect and honour our national hero, Jose Rizal. Then we arrived at Malacanang Palace for a Tour of the Museum—if anyone finds copies of the cheeky fotos of me showing off my shoes “Imelda-style” at the table where Marcos declared martial law, please let me know!!--then another belly-stretching lunch complete with Halo-Halo and other Filipino goodies. We met and got photographed at Rizal Hall with President Gloria Macapagal Arroyo, who at first thought the Canadian group was all from Winnipeg and had many wonderful things to say about our awesome province. She and her staff graciously chatted with and took photos with the throngs of delegates who swarmed her. We returned to our hotels via a Rolling Tour of Manila and Makati (included the Cultural Center of the Philippines Complex, Libingan ng mga Bayani, American Cemetery, Forbes Park, Business District) then finished up with a Wellness theme Appreciation Dinner at the Shangri-La Hotel. Here, we could dance the night away to the live bands or hunt through the stacks of tour photos from the tour photographers.
The following day was check-out for some while others could choose from Optional Out-of-Town-Tours such as Aklan/Boracay; Laoag/Vigan; Bohol/Dumaguete; Cebu/Cagayan de Oro; Puerto Princesa, Palawan; Diving in Club Noah Isabelle, Palawan; Golf in Metro Manila’s top 3 courses; Clark, Pampanga/Subic, Olgangapo; as well as a Gawad Kalinga Housing Project Visit and Wowowie Show. All in all the ACGTDT 2007 was an amazing time filled with wonderful experiences and connections with new friends from all over North America and the Philippines. I opted to focus on my ambitious project of looking at the Migration of Health Care Workers, particularly Filipino Doctors, to Canada. I will have to report on this project in an upcoming issue, but I am calling out to you to send me your stories, comments, or advice, or the contact information of those who might be able to help me in this ongoing project:
As I may have mentioned to many of you, I am quite interested in the experience and health of Filipino immigrants, particularly Live-in Caregivers, “nannies”, and health care professionals—whether recognized in their professions or not (credentials, fair and equitable pay, respect, etc). In my Public Health training, I’ve come across some research about the “Healthy Immigrant Effect”—basically that some immigrants tend to be healthier than Canadian-born but then after several years in Canada, their health deteriorates to the level of their Canadian-born controls. I’ve started researching the health of Filipinos across Canada and spent some time in Ottawa, Montreal, the Philippines, as well as locally talking to people about their experiences coming to Canada. I want to hear from you—please, tell me your stories: email me at askdrdenise@mts.net or go to my blog www.askdrdenise.blogspot.com and add your story as a comment to this article or take the questionnaire (to be set up)—if you wish certain parts of your story to be confidential, please use my email address and outline which parts, if any, you are okay with me sharing on my blog or in this column.
The questions I’m particularly interested in:
1) Name, sex, and contact information
2) Age, Year of Birth, Year of immigration to Canada, Dates of any other Caregiving experiences in other countries (including the Philippines)
3) Languages (including dialect, if necessary) spoken and read
4) Process of Immigration to Canada: Were you in the Live-In Caregiver Program, other categories of immigration
5) What type of work do you do? If you are a Caregiver, what field/area are you in? Ie: what training did you have in the Philippines, Canada, elsewhere? Did that translate into what you are doing now?
6) Health status/concerns in the Philippines compared with in Canada
7) Do you believe that being Filipino makes you healthier or less healthy than non-Filipinos? Why? What are the key factors you believe determine Filipino-Canadian health (eg, language, where born, credentialing, education, discrimination/prejudice, connection to community, family, etc)?
8) What are your concerns regarding the health of the Filipino community in Canada and in the Philippines? Is there a Brain Drain? Why or Why not?
9) What are your suggestions for dealing with these issues?
10) Any other comments are greatly appreciated.
Maraming salamat po!
So please remember that your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
Wednesday, July 18, 2007
In Deed
FJ Volume 21, Number 11
June 05 - 20, 2007
'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 helped reconnect me to my heritage) in my FJ article on Folklorama when I first moved to Winnipeg in 2003. Ar-ouch. To this day, 4 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 barkadas, 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 with our Magdaragat friends 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—a cause for immediate ostracism? 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.
With time, I realized that if I wanted to resolve this inner disquiet, I best put my money where my mouth is. I went on a Medical Mission to Catanduanes, and saw and learned so much I hadn’t realized about my heritage. I decided to put my writing skills with my medical knowledge to do something good for the Filipino community—hence my health column, Ask Dr. Denise was born. To better understand our community and culture in addition to trying to serve the community, I ran for the PCCM Board and am now the Communications and Marketing Committee Chair. I started Tagalog/Filipino language classes, and everyone has been really great at encouraging me to use what I’ve learned. I joined the Asian Heritage Society in my quest to help increase the Filipino voice and profile in Manitoba. I am doing what I can to give back to an amazing community that embraced me with barbecues and socials and kain and baon.One of my crowning glories was when I reclaimed my Philippine Dual Citizenship when I visited Ottawa mid-April, while I was there to represent the Canadian Association of Internes and Residents (CAIR) at the Canadian Medical Association Council for Health Policy and Economics meeting. Our Embassy was gracious enough to facilitate the process of documentation requirements with my parents in Regina so that I could pledge allegiance to the Philippines at the Embassy during my trip. I was ecstatic as well as teary-eyed to achieve such an important validation of who I am. I also got my shiny new Pilipinas passport, so it was like winning the lottery!I still get the comments that I am “not Filipino enough” and “too Canadian.” I can only respond by accepting these stinging remarks and actively doing what I can to dispel these beliefs—not for my ego (I know full well who I am and have never hidden this), but because in my vision of what our Filipino community in Canada could become, these attitudes drive people apart rather than pull together as a family, and I must address this. Thus I must sincerely invite and encourage any of my kababayan to please feel free to come directly to me with any concerns they have about my actions/behaviours in the Filipino community. This is not at all a challenge, but an honest plea to the community to help me in this vital aspect of my life. Hopefully through my actions and deeds for the Filipino community, I can gain the acceptance of those I hope to advocate for.
In this way, I feel I can say, truly,
Ako ay Pilipina, in deed.
June 05 - 20, 2007
'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 helped reconnect me to my heritage) in my FJ article on Folklorama when I first moved to Winnipeg in 2003. Ar-ouch. To this day, 4 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 barkadas, 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 with our Magdaragat friends 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—a cause for immediate ostracism? 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.
With time, I realized that if I wanted to resolve this inner disquiet, I best put my money where my mouth is. I went on a Medical Mission to Catanduanes, and saw and learned so much I hadn’t realized about my heritage. I decided to put my writing skills with my medical knowledge to do something good for the Filipino community—hence my health column, Ask Dr. Denise was born. To better understand our community and culture in addition to trying to serve the community, I ran for the PCCM Board and am now the Communications and Marketing Committee Chair. I started Tagalog/Filipino language classes, and everyone has been really great at encouraging me to use what I’ve learned. I joined the Asian Heritage Society in my quest to help increase the Filipino voice and profile in Manitoba. I am doing what I can to give back to an amazing community that embraced me with barbecues and socials and kain and baon.One of my crowning glories was when I reclaimed my Philippine Dual Citizenship when I visited Ottawa mid-April, while I was there to represent the Canadian Association of Internes and Residents (CAIR) at the Canadian Medical Association Council for Health Policy and Economics meeting. Our Embassy was gracious enough to facilitate the process of documentation requirements with my parents in Regina so that I could pledge allegiance to the Philippines at the Embassy during my trip. I was ecstatic as well as teary-eyed to achieve such an important validation of who I am. I also got my shiny new Pilipinas passport, so it was like winning the lottery!I still get the comments that I am “not Filipino enough” and “too Canadian.” I can only respond by accepting these stinging remarks and actively doing what I can to dispel these beliefs—not for my ego (I know full well who I am and have never hidden this), but because in my vision of what our Filipino community in Canada could become, these attitudes drive people apart rather than pull together as a family, and I must address this. Thus I must sincerely invite and encourage any of my kababayan to please feel free to come directly to me with any concerns they have about my actions/behaviours in the Filipino community. This is not at all a challenge, but an honest plea to the community to help me in this vital aspect of my life. Hopefully through my actions and deeds for the Filipino community, I can gain the acceptance of those I hope to advocate for.
In this way, I feel I can say, truly,
Ako ay Pilipina, in deed.
Wednesday, March 07, 2007
Food Safety: Bring on the Baon! & The Health of Caregivers
FJ, Volume 21, Number 5
March 05 - 22, 2007
My boss (I’m a live-in caregiver) is always on my case about food and leftovers. She wants to throw everything away which I think is very wasteful. I was brought up to be thrifty and frugal. Who is right?
You both are. Baon (food taken home from a party or gathering) is a central part of Filipino culture and in my opinion reflects our love of food and thriftiness, as well as resourcefulness and hospitality. We can always tell a Filipino fridge—not just by the jars of jufran, macapuno, bagoong, matamis sa bao (sometimes way past the expiry date!), but also an array of things like: little bowls of patis/soya sauce/kalamansi, Styrofoam plates of pancit, rice, adobo, stew, and cake/pastries covered by tin foil, a pot of sinigang, maybe some of those bright fuschia salted eggs, etcetcetc. Often the rice stays on the counter in the rice cooker which stays on “Warm”, 24 hours a day, 7 days a week. I am always a little scared of my parents’ fridge back home—packed with all sorts of things that I’m not sure are edible anymore and actually emitting loud whirring noises…I think it’s trying to tell my parents that it’s working too hard and should be relieved of its burden! Then there’s the trend for excessive oil use in Filipino cooking, but I think I covered that in my cholesterol article…naman!
Baon is definitely distinctly Filipino, but it can be dangerous.The Canadian Food Inspection Agency (CFIA) is the Government of Canada’s science-based regulator for animal health, plant protection and, in partnership with Health Canada, food safety. Their website (www.inspection.gc.ca) has a lot of useful information on issues related to food, including a list of allergy alerts and food recalls. You can search on it by country—there was a list of products from the Philippines that the CFIA considered unsafe. I remember going into severe withdrawal when they pulled the Nata de Coco jelly cups off the shelves—I’d loved them so much it was hard to hear that kids were choking on them! The CFIA site also provides a useful Food Safety Fact Sheet on Leftovers that I am quoting below. You can also find food safety information on the Health Canada and Canadian Partnership for Consumer Food Safety Education Web sites respectively at www.hc-sc.gc.ca and www.canfightbac.org/en/.
FOOD SAFETY FACTS ON LEFTOVERS
What is foodborne illness?
Food contaminated by bacteria, viruses and parasites can make you sick. Many people have had foodborne illness and not even known it. It’s sometimes called food poisoning, and it can feel like the flu. Symptoms may include the following:
* stomach cramps
* nausea
* vomiting
* diarrhea
* fever
Symptoms can start soon after eating contaminated food, but they can hit up to a month or more later. For some people, especially young children, the elderly, pregnant women and people with weakened immune systems, foodborne illness can be very dangerous.
Public health experts estimate that there are 11 to 13 million cases of foodborne illness in Canada every year. Most cases of foodborne illness can be prevented by using safe food handling practices and using a food thermometer to check that your food is cooked to a safe internal temperature!
Storing leftovers
* Store leftovers within 2 hours of cooking. Discard leftovers if the food has been sitting at room temperature for more than 1 hour. Cold food should be stored at 4ºC (40ºF) or colder.
* Before and after handling and preparing leftovers, wash your hands and sanitize all utensils, dishes and work surfaces with a mild bleach solution (5 ml/1 tsp. bleach per 750 ml/3 cups water).
* Never remove a large pot of food (such as soup, stew, or pasta sauce) from the stove and place it in the refrigerator. Large masses of food can take hours or days to chill properly. A slow cooling process provides an ideal environment for the growth of harmful bacteria.
* Very hot items can be cooled at room temperature, until they stop steaming, prior to being refrigerated. Frequent stirring accelerates the cooling at this stage. Food will cool faster in an uncovered, shallow container.
* An effective way to cool and store hot leftovers is to lay them flat in zipper-type plastic bags. Although the bags must be closed securely, food cools quickly due to the greater surface area exposed to the refrigerated air.
* Refrigerate or freeze leftovers in covered, shallow containers.
* Place containers on wire refrigerator shelves to allow air to flow across the bottom of the container. This practice allows food to cool twice as fast as sitting on a solid shelf.
* Do not overcrowd your refrigerator. Leave airspace around containers to allow circulation of cold air. This will help ensure rapid, even cooling.
* Date leftovers to ensure that they are not stored too long – eat leftovers within 4 days. For frozen leftovers, eat within 4 days of being taken out of the freezer.
* Always put leftovers in clean containers and never mix them with fresh food.
Reheating leftovers
* Reheat solid leftovers to at least 74ºC (165ºF).
* Reheat soups, sauces and gravies to a rolling boil.
* Follow the manufacturer's instructions when reheating commercial foods in a microwave.
* Discard uneaten leftovers after they have been reheated.
NEVER use your nose, eyes or taste buds to judge the safety of food.
You cannot tell if a food may cause foodborne illness by its look, smell or taste.
And remember: "If in doubt, throw it out!"
***
Now, some of you may know that I am quite interested in the experience and health of Filipino immigrants, particularly Live-in Caregivers, “nannies”, and health care professionals—whether recognized in their profession or not (credentials, fair and equitable pay, respect, etc). In my Public Health training, I’ve come across some research (some flaws in research design, etc) that talks about the Healthy Immigrant Effect—basically that some immigrants tend to be healthier than Canadian-born but then after several years in Canada, their health deteriorates to the level of their Canadian-born controls. I’ve started researching the health of Filipinos across Canada and spent some time in Ottawa and Montreal as well as locally talking to people about their experiences coming to Canada. I want to hear from you—please, tell me your stories: email me at askdrdenise@mts.net or add your story as a comment to this article or take the questionnaire (to set up)—if you wish certain parts of your story to be confidential, please use my email address and outline which parts, if any, you are okay with me sharing on my blog or in this column.
The questions I’m particularly interested in:
1) Name, sex, and contact information
2) Age, Year of Birth, Year of immigration to Canada, Dates of any other Caregiving experiences in other countries (including the Philippines)
3) Languages (including dialect, if necessary) spoken and read
4) Process of Immigration to Canada: Were you in the Live-In Caregiver Program, other categories of immigration
5) What type of work do you do? If you are a Caregiver, what field/area are you in? Ie: what training did you have in the Philippines, Canada, elsewhere? Did that translate into what you are doing now?
6) Health status/concerns in the Philippines compared with in Canada
7) Do you believe that being Filipino makes you healthier or less healthy than non-Filipinos? Why? What are the key factors you believe determine Filipino-Canadian health (eg, language, where born, credentialing, education, discrimination/prejudice, connection to community, family, etc)?
8) What are your concerns regarding the health of the Filipino community in Canada and in the Philippines?
9) What are your suggestions for dealing with these issues?
10) Any other comments are greatly appreciated. Salamat po!
So please remember that your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
March 05 - 22, 2007
My boss (I’m a live-in caregiver) is always on my case about food and leftovers. She wants to throw everything away which I think is very wasteful. I was brought up to be thrifty and frugal. Who is right?
You both are. Baon (food taken home from a party or gathering) is a central part of Filipino culture and in my opinion reflects our love of food and thriftiness, as well as resourcefulness and hospitality. We can always tell a Filipino fridge—not just by the jars of jufran, macapuno, bagoong, matamis sa bao (sometimes way past the expiry date!), but also an array of things like: little bowls of patis/soya sauce/kalamansi, Styrofoam plates of pancit, rice, adobo, stew, and cake/pastries covered by tin foil, a pot of sinigang, maybe some of those bright fuschia salted eggs, etcetcetc. Often the rice stays on the counter in the rice cooker which stays on “Warm”, 24 hours a day, 7 days a week. I am always a little scared of my parents’ fridge back home—packed with all sorts of things that I’m not sure are edible anymore and actually emitting loud whirring noises…I think it’s trying to tell my parents that it’s working too hard and should be relieved of its burden! Then there’s the trend for excessive oil use in Filipino cooking, but I think I covered that in my cholesterol article…naman!
Baon is definitely distinctly Filipino, but it can be dangerous.The Canadian Food Inspection Agency (CFIA) is the Government of Canada’s science-based regulator for animal health, plant protection and, in partnership with Health Canada, food safety. Their website (www.inspection.gc.ca) has a lot of useful information on issues related to food, including a list of allergy alerts and food recalls. You can search on it by country—there was a list of products from the Philippines that the CFIA considered unsafe. I remember going into severe withdrawal when they pulled the Nata de Coco jelly cups off the shelves—I’d loved them so much it was hard to hear that kids were choking on them! The CFIA site also provides a useful Food Safety Fact Sheet on Leftovers that I am quoting below. You can also find food safety information on the Health Canada and Canadian Partnership for Consumer Food Safety Education Web sites respectively at www.hc-sc.gc.ca and www.canfightbac.org/en/.
FOOD SAFETY FACTS ON LEFTOVERS
What is foodborne illness?
Food contaminated by bacteria, viruses and parasites can make you sick. Many people have had foodborne illness and not even known it. It’s sometimes called food poisoning, and it can feel like the flu. Symptoms may include the following:
* stomach cramps
* nausea
* vomiting
* diarrhea
* fever
Symptoms can start soon after eating contaminated food, but they can hit up to a month or more later. For some people, especially young children, the elderly, pregnant women and people with weakened immune systems, foodborne illness can be very dangerous.
Public health experts estimate that there are 11 to 13 million cases of foodborne illness in Canada every year. Most cases of foodborne illness can be prevented by using safe food handling practices and using a food thermometer to check that your food is cooked to a safe internal temperature!
Storing leftovers
* Store leftovers within 2 hours of cooking. Discard leftovers if the food has been sitting at room temperature for more than 1 hour. Cold food should be stored at 4ºC (40ºF) or colder.
* Before and after handling and preparing leftovers, wash your hands and sanitize all utensils, dishes and work surfaces with a mild bleach solution (5 ml/1 tsp. bleach per 750 ml/3 cups water).
* Never remove a large pot of food (such as soup, stew, or pasta sauce) from the stove and place it in the refrigerator. Large masses of food can take hours or days to chill properly. A slow cooling process provides an ideal environment for the growth of harmful bacteria.
* Very hot items can be cooled at room temperature, until they stop steaming, prior to being refrigerated. Frequent stirring accelerates the cooling at this stage. Food will cool faster in an uncovered, shallow container.
* An effective way to cool and store hot leftovers is to lay them flat in zipper-type plastic bags. Although the bags must be closed securely, food cools quickly due to the greater surface area exposed to the refrigerated air.
* Refrigerate or freeze leftovers in covered, shallow containers.
* Place containers on wire refrigerator shelves to allow air to flow across the bottom of the container. This practice allows food to cool twice as fast as sitting on a solid shelf.
* Do not overcrowd your refrigerator. Leave airspace around containers to allow circulation of cold air. This will help ensure rapid, even cooling.
* Date leftovers to ensure that they are not stored too long – eat leftovers within 4 days. For frozen leftovers, eat within 4 days of being taken out of the freezer.
* Always put leftovers in clean containers and never mix them with fresh food.
Reheating leftovers
* Reheat solid leftovers to at least 74ºC (165ºF).
* Reheat soups, sauces and gravies to a rolling boil.
* Follow the manufacturer's instructions when reheating commercial foods in a microwave.
* Discard uneaten leftovers after they have been reheated.
NEVER use your nose, eyes or taste buds to judge the safety of food.
You cannot tell if a food may cause foodborne illness by its look, smell or taste.
And remember: "If in doubt, throw it out!"
***
Now, some of you may know that I am quite interested in the experience and health of Filipino immigrants, particularly Live-in Caregivers, “nannies”, and health care professionals—whether recognized in their profession or not (credentials, fair and equitable pay, respect, etc). In my Public Health training, I’ve come across some research (some flaws in research design, etc) that talks about the Healthy Immigrant Effect—basically that some immigrants tend to be healthier than Canadian-born but then after several years in Canada, their health deteriorates to the level of their Canadian-born controls. I’ve started researching the health of Filipinos across Canada and spent some time in Ottawa and Montreal as well as locally talking to people about their experiences coming to Canada. I want to hear from you—please, tell me your stories: email me at askdrdenise@mts.net or add your story as a comment to this article or take the questionnaire (to set up)—if you wish certain parts of your story to be confidential, please use my email address and outline which parts, if any, you are okay with me sharing on my blog or in this column.
The questions I’m particularly interested in:
1) Name, sex, and contact information
2) Age, Year of Birth, Year of immigration to Canada, Dates of any other Caregiving experiences in other countries (including the Philippines)
3) Languages (including dialect, if necessary) spoken and read
4) Process of Immigration to Canada: Were you in the Live-In Caregiver Program, other categories of immigration
5) What type of work do you do? If you are a Caregiver, what field/area are you in? Ie: what training did you have in the Philippines, Canada, elsewhere? Did that translate into what you are doing now?
6) Health status/concerns in the Philippines compared with in Canada
7) Do you believe that being Filipino makes you healthier or less healthy than non-Filipinos? Why? What are the key factors you believe determine Filipino-Canadian health (eg, language, where born, credentialing, education, discrimination/prejudice, connection to community, family, etc)?
8) What are your concerns regarding the health of the Filipino community in Canada and in the Philippines?
9) What are your suggestions for dealing with these issues?
10) Any other comments are greatly appreciated. Salamat po!
So please remember that your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
Wednesday, February 28, 2007
The Myths of Immunization
FJ Vol 21, No 2
Jan 22-Feb 5/07
We have heard a lot of bad/conflicting things about vaccination, and are not sure whether to vaccinate our children and ourselves. What do you think?
Immunization/vaccination is a hot topic in many circles, and many dangerous myths abound. I like to frame the approach from two perspectives—the population and the individual.
From the population perspective, it is an undisputed fact that immunization is one of the greatest success stories of modern medicine. Childhood immunization has saved millions of lives by eliminating many serious childhood diseases. Because of its success, we often no longer hear about many of these diseases, so it’s easy for parents to become complacent about the need to have their kids fully protected and keeping immunizations up to date. However in recent years, several countries have experienced new outbreaks of diseases everyone thought had disappeared—like diphtheria, German measles and polio. They reappeared because governments relaxed their immunization programs or certain groups in the population refused these immunizations.
It is true that as with any medicine, there are very small risks that problems could occur for someone getting a vaccine. From the individual perspective, many people think that since the risk of getting the disease is remote, they are saving themselves any risk of these potential adverse effects from getting the vaccine. However, this logic relies on the rest of the population to get immunized and decrease the risk of potentially fatal diseases occurring in the population. The higher the number of people who do not immunize themselves or their children means the higher the risk for the whole population. For all the vaccines currently offered in Canada/by Manitoba Health, a person’s chance of being harmed by the infection (and the severity of the illness) is far greater than any chance of being harmed by the vaccine. Vaccines are among the safest medical interventions, and they are subjected to rigorous safety and quality control standards. The individual must consider that once a person contracts the illness in question, the consequences could be disastrous. This is even worse, because the illness was vaccine-preventable. It is extremely important to weigh the right factors and not let overblown fear of an unlikely adverse event prevent protection from a potentially fatal and very real disease.
The vaccines currently recommended for adults and children will protect you/your kids against serious diseases that have not disappeared from the world. If people stop using these vaccines, the diseases will almost certainly become common again, causing many illnesses and deaths. These vaccines are extremely safe and highly effective. If you have any questions or concerns about vaccines, check with your doctor or public health office.
Many people go to the Internet looking for up-to-date information about vaccination. You can find current and trustworthy information on the Internet, but some websites have information that can be misleading—although they have been designed to look scientific and accurate, the information may not be scientifically valid. So remember: anyone can create a website. Only proper research methods guarantee the information is trustworthy. Always check the source of the information you read.
A trustworthy website will:
- Purpose
o …have a clearly stated mission and purpose
o …give credible health information based on solid scientific research
o …give info that includes many points of view. Be careful of sites that support a specific cause, group, or source of funding!
- Sponsors:
o …give the sponsor’s contact information; reputable websites don’t hide their identity
o The website address (URL) can help you learn more about them. If the address ends in:
".edu" = it is a school, college or university
".gc.ca" = Canadian government
".ca" = Canadian-based sites
".gov" = U.S.’ government
".org" = non-profit organizations
".int" = international organizations
".com" = commercial sites
- Supporting Organizations:
o …Be endorsed by a health agency/association you can trust.
o …Give info that covers municipal, regional, national or international concerns, not just the views of one person
o …Indicate if it’s part of a network of partners and identify them
o …Give background info about the sponsors
o …Refer to organizations responsible for maintaining standards
- Site Maintenance:
o …Have experts review the information
o …Post new info on a regular basis; often give the date when the info is posted.
- Authors:
o …clearly state the names of authors, their background and experience in vaccination/immunization. Look for details such as university degrees and professional membership in medical, nursing, scientific or public health associations
o …post work by authors who have published articles in established journals. Beware of articles written by “world-famous researchers,” “well-known scientists,” or “noted experts.”
o …give info based on solid research, not on opinion.
o …give references and links to support its statements
Beware:
- websites’ claims that seem too good or too bad to be true
- claims based on the idea of conspiracy; sites that say it discovered “the hidden truth” about vaccines
- information based on emotion rather than scientific fact. Stories about children who became sick or died are hard to read objectively. Even when pain and sickness occur, be aware that there is no substitute for scientific study.
- Information based on facts that aren’t tested. Professional researchers aren’t afraid to say that further research may be required.
- Websites focused on selling books, newsletters or products.
- Sites that give info “for educational purposes” only but don’t recommend a course of action—If a site is not willing to take responsibility for its advice, why should you?
Recommended websites:
- http://www.gov.mb.ca/health/publichealth/cdc/schedule.html: Manitoba Health’s website gives the routine childhood immunization schedule and links to the publicly-funded vaccines.
- www.immuniza.cpha.ca: Canadian Coalition for Immunization Awareness and Promotion
- www.caringforkids.cps.ca: Canadian Paediatric Society
- www.phac-aspc.gc.ca: Public Health Agency of Canada
- www.canadian-health-network.ca: Canadian Health Network
- www.cdc.gov: Centers for Disease Control and Prevention (U.S.)
- www.immunizationinfo.org: National Network for Immunization Information (U.S.)
- www.immunize.org: Immunization Action Coalition (U.S.)
- www.childrensvaccine.org: Children’s Vaccine Programs (U.S. and international partners)
- www.who.int/vaccines: World Health Organization
So please remember that your health is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
Jan 22-Feb 5/07
We have heard a lot of bad/conflicting things about vaccination, and are not sure whether to vaccinate our children and ourselves. What do you think?
Immunization/vaccination is a hot topic in many circles, and many dangerous myths abound. I like to frame the approach from two perspectives—the population and the individual.
From the population perspective, it is an undisputed fact that immunization is one of the greatest success stories of modern medicine. Childhood immunization has saved millions of lives by eliminating many serious childhood diseases. Because of its success, we often no longer hear about many of these diseases, so it’s easy for parents to become complacent about the need to have their kids fully protected and keeping immunizations up to date. However in recent years, several countries have experienced new outbreaks of diseases everyone thought had disappeared—like diphtheria, German measles and polio. They reappeared because governments relaxed their immunization programs or certain groups in the population refused these immunizations.
It is true that as with any medicine, there are very small risks that problems could occur for someone getting a vaccine. From the individual perspective, many people think that since the risk of getting the disease is remote, they are saving themselves any risk of these potential adverse effects from getting the vaccine. However, this logic relies on the rest of the population to get immunized and decrease the risk of potentially fatal diseases occurring in the population. The higher the number of people who do not immunize themselves or their children means the higher the risk for the whole population. For all the vaccines currently offered in Canada/by Manitoba Health, a person’s chance of being harmed by the infection (and the severity of the illness) is far greater than any chance of being harmed by the vaccine. Vaccines are among the safest medical interventions, and they are subjected to rigorous safety and quality control standards. The individual must consider that once a person contracts the illness in question, the consequences could be disastrous. This is even worse, because the illness was vaccine-preventable. It is extremely important to weigh the right factors and not let overblown fear of an unlikely adverse event prevent protection from a potentially fatal and very real disease.
The vaccines currently recommended for adults and children will protect you/your kids against serious diseases that have not disappeared from the world. If people stop using these vaccines, the diseases will almost certainly become common again, causing many illnesses and deaths. These vaccines are extremely safe and highly effective. If you have any questions or concerns about vaccines, check with your doctor or public health office.
Many people go to the Internet looking for up-to-date information about vaccination. You can find current and trustworthy information on the Internet, but some websites have information that can be misleading—although they have been designed to look scientific and accurate, the information may not be scientifically valid. So remember: anyone can create a website. Only proper research methods guarantee the information is trustworthy. Always check the source of the information you read.
A trustworthy website will:
- Purpose
o …have a clearly stated mission and purpose
o …give credible health information based on solid scientific research
o …give info that includes many points of view. Be careful of sites that support a specific cause, group, or source of funding!
- Sponsors:
o …give the sponsor’s contact information; reputable websites don’t hide their identity
o The website address (URL) can help you learn more about them. If the address ends in:
".edu" = it is a school, college or university
".gc.ca" = Canadian government
".ca" = Canadian-based sites
".gov" = U.S.’ government
".org" = non-profit organizations
".int" = international organizations
".com" = commercial sites
- Supporting Organizations:
o …Be endorsed by a health agency/association you can trust.
o …Give info that covers municipal, regional, national or international concerns, not just the views of one person
o …Indicate if it’s part of a network of partners and identify them
o …Give background info about the sponsors
o …Refer to organizations responsible for maintaining standards
- Site Maintenance:
o …Have experts review the information
o …Post new info on a regular basis; often give the date when the info is posted.
- Authors:
o …clearly state the names of authors, their background and experience in vaccination/immunization. Look for details such as university degrees and professional membership in medical, nursing, scientific or public health associations
o …post work by authors who have published articles in established journals. Beware of articles written by “world-famous researchers,” “well-known scientists,” or “noted experts.”
o …give info based on solid research, not on opinion.
o …give references and links to support its statements
Beware:
- websites’ claims that seem too good or too bad to be true
- claims based on the idea of conspiracy; sites that say it discovered “the hidden truth” about vaccines
- information based on emotion rather than scientific fact. Stories about children who became sick or died are hard to read objectively. Even when pain and sickness occur, be aware that there is no substitute for scientific study.
- Information based on facts that aren’t tested. Professional researchers aren’t afraid to say that further research may be required.
- Websites focused on selling books, newsletters or products.
- Sites that give info “for educational purposes” only but don’t recommend a course of action—If a site is not willing to take responsibility for its advice, why should you?
Recommended websites:
- http://www.gov.mb.ca/health/publichealth/cdc/schedule.html: Manitoba Health’s website gives the routine childhood immunization schedule and links to the publicly-funded vaccines.
- www.immuniza.cpha.ca: Canadian Coalition for Immunization Awareness and Promotion
- www.caringforkids.cps.ca: Canadian Paediatric Society
- www.phac-aspc.gc.ca: Public Health Agency of Canada
- www.canadian-health-network.ca: Canadian Health Network
- www.cdc.gov: Centers for Disease Control and Prevention (U.S.)
- www.immunizationinfo.org: National Network for Immunization Information (U.S.)
- www.immunize.org: Immunization Action Coalition (U.S.)
- www.childrensvaccine.org: Children’s Vaccine Programs (U.S. and international partners)
- www.who.int/vaccines: World Health Organization
So please remember that your health is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
Monday, January 15, 2007
Holiday Health
FJ Vol 20, No 24
Dec 15-31/06
One of my friends is new to Canada and is unable to make it home to the Philippines to visit her family. She seems sad all the time, and I think she is depressed. What should I do?
Christmastime is a very difficult time for many people, and problems related to depression and anxiety/stress are more common during this time. Some key features of depression include sad mood, decrease/loss in interest/pleasure, feelings of excessive guilt/worthlessness, decrease in energy/fatigue, indecisiveness or poor concentration, decrease/changes in appetite/weight, sleep disorders, and recurrent thoughts of death or suicide. If your friend has any of these symptoms, you should urge her to see a doctor or health care professional to get help. Her doctor may prescribe medications such as anti-depressants that can help her cope with this difficult time and/or refer her to therapy/counseling. You can remain supportive to her by encouraging her to become active in the community and share her feelings with you as a friend. If she has expressed thoughts of harming herself or others, it is really important that you give her the Mobile Crisis phone number: 946-9109 and consider calling the number if she won’t phone herself. The website www.canmat.org and self-help books such as Mind Over Mood and Feeling Good are useful references you can pass on to her for learning about this type of problems.
Relatively mild anxiety states in reaction to life circumstances are often time-limited, and many people respond to anxiety management strategies without medication. Support, problem-solving and relaxation techniques often help as the environmental crisis resolves. However, specific anxiety or mood disorders may develop from the original reaction. One should control caffeine or other stimulant use, minimize alcohol use (often used to control anxiety), reduce the use of short-acting tranquilizers (eg Valium and Ativan), and take steps to reduce stress including relaxation training and time management. More specific therapy/counselling and referral to a psychiatrist may be necessary if there is little improvement after several months of adequate medication therapy. Clicking on the title "Holiday Health" should link you to the information resource "Coping with Stress" [http://www.cmha.ca/data/1/rec_docs/403_CMHA_coping_with_stress_EN.pdf] by the Canadian Mental Health Association (www.cmha.ca).
I have high cholesterol, and my doctor warned me to stay away from fat. What can I do, especially during the Christmastime?
Having high cholesterol levels in your blood (dyslipidemia) is important, not because you can feel it directly, but because it is associated with a higher risk of cardiovascular disease (CVD; heart attacks and stroke). This is because excess fat deposits in the blood vessels throughout your body (atherosclerosis, AS), which can make it difficult for the heart to pump the blood (with the oxygen it carries) to the tissues that need it. Eventually, the arteries can block up completely, which can cause the tissues that are not getting the blood/oxygen to die (a “heart attack” results from a blockage of the arteries that feed the heart muscle; a stroke from a blockage of the arteries that feed the different areas of the brain). Dyslipidemia, diabetes, overweight, abdominal obesity (overweight in the tummy area), high blood pressure, and low cardio-respiratory fitness are primary risk factors for CVD. You are also at a higher risk if you have a strong family history of heart attacks/stroke or smoke. There are different types of cholesterols and different types of high cholesterol problems; some are genetic (run in the family), and others due to conditions such as hypothyroidism, pregnancy, excess weight, alcohol excess, certain liver and kidney diseases, and medications such as corticosteroids, hormone replacement therapy/oral contraceptives, and some blood pressure and heart medications.
Triglycerides are a type of fat that can be high from certain fats in the diet, but also extra sugars in the blood (excess starches like white breads, alcohol, sugared beverages) that your body turns into triglycerides. Niacin and fibrates help decrease mainly this type of fat.
LDL's (low-density lipoproteins) are the "bad cholesterols--you want them to be low. The “statin” drugs commonly target these fats by helping to lower the amount in your blood, but if you are on one, make sure to check in with your doctor regularly to monitor your liver and muscle enzyme level in your blood, which can go up with this class of drugs. “Resins” are another type of drug that lower LDL and can increase HDLs.
HDL's (high-density lipoproteins) are the good cholesterols that you want high, as they have a protective effect against heart disease + stroke. Regular exercise has been shown to boost this good cholesterol in the blood. Niacin and fibrates can increase this type.
In general, it is important to follow your doctor’s advice about your cholesterol problem, but diet, aimed at reducing blood cholesterol levels and weight (if needed) should always be the first approach. CVD can be reduced by eating less saturated and trans fats, less salt and sufficient amounts of fruit, vegetables and omega-3 and omega-6 polyunsaturated fats. Risk is also reduced with weight control and physical activity. A dietician is usually recommended to reach these goals:
- decrease dietary cholesterol intake to < 300 mg/day (<200 mg/d if AS already a problem): raises blood cholesterol levels but no significant association found yet between CVD and egg consumption (egg yolks—leche flan, dairy products, meat and shellfish)
- restrict fat intake to 30% of calories (20% if AS);
- fat distribution goals as a % of total energy:
o < 10%: Saturated fats tend to raise total & LDL cholesterol levels & are associated with increased risk of CVD: processed foods, coconut oil, lard, hydrogenated hard margarines, butter, full-fat dairy products and fatty meats—so avoid/cut down! Lechon is a big culprit because it is animal fat deep fried in fat—often animal. Yikes!
o < 1%: Trans fats elevate LDL and decrease HDL: partially hydrogenated margarines & shortenings, deep fried foods, processed foods made with partially hydrogenated fats and baked goods—AVOID
o 5-8%: Omega-6 polyunsaturated fats are the most effective replacement for saturated fats to improve heart disease outcomes: soybean, sunflower, safflower, corn and cottonseed oils
o 1-2%: Omega-3 polyunsaturated fats have good effects and decrease fatal CVD: fatty fish (tuna, salmon, mackerel, sea bass, fish oils), plant sources (canola, soybean, flaxseed oils, soft non-hydrogenated margarines, nuts, tofu, ground flaxseed)
o By difference to achieve a total fat intake of 15-30%: Monounsaturated fatty acids lower total & LDL cholesterol levels when substituted for saturated fats but not as well as polyunsaturated fats: canola, olive oils, nuts
- favour high-fibre intake
- limit simple sugars to 8% of total calories
- limit alcohol consumption to 5% of total calories
Plant sterols: the cholesterol-lowering effects have been well documented: vegetable oils, nuts, sesame & sunflower seeds, soy & other legumes.
Other nutrients: fruit and vegetables contribute to heart health through fibre, vitamins, minerals and phytonutrients (esp green leafy & cruciferous veggies, legumes & berries).
Also, if you can increase your fiber intake (10-15 g/d of soluble fiber—eg psyllium, oat bran, kidney beans, artichokes, dried prunes) not only will this help combat constipation which is common with fattening foods and lack of exercise common during Christmastime, but it also may lower cholesterol levels by an additional 10-15%. Pretty good deal! Although some studies suggest a protective role of antioxidants (vitamin E in nuts, seeds, some soft, non-hydrogenated margarines; vitamin C in citrus fruit, berries, tomatoes, potatoes, broccoli, cauliflower, kale, cabbage, sweet peppers; carotenoids/beta-carotene in carrots & tomatoes), controlled studies have not shown much proof. Sodium intake is directly associated with blood pressure, so limit it (salt added to foods, sodium in processed foods & additives like MSG)! Potassium (fruit and vegetables) helps lower blood pressure.
So in summary:
- Avoid hydrogenated oils and fats--Opt for low fat options on the labels of foods you buy.
- Limit the intake of fat from dairy and meat sources; Hidden fats you can cut down on: Whole or 2% milk—go for skim instead.
- Use appropriate vegetable oils in small amounts.
- Ensure a regular intake of fish (1-2 times per week) or plant sources of omega-3 fatty acids.
- Choose foods prepared without frying.
- Eat 400-500 g (6-8 servings) of fruit and vegetables daily.
- Restrict daily salt intake to less than 5 g.
- Choose fibre-rich whole grain cereals, as well as fruits and vegetables.
Increased physical activity may help decrease cholesterol and triglyceride levels while increasing HDL. Try to get regular physical activity/aerobic activity, decrease/stop smoking, watch extra sugars and salts in your foods, and try not to get too stressed during Christmastime! If you overdo it during the holidays, it might be a good idea to discuss this with your doctor to check where your cholesterol levels are at so you can modify your plan to better suit your lifestyle.
Have a healthy and relaxing Christmas! Maligayang Pasko at Masaganang Bagong Taon!
Dec 15-31/06
One of my friends is new to Canada and is unable to make it home to the Philippines to visit her family. She seems sad all the time, and I think she is depressed. What should I do?
Christmastime is a very difficult time for many people, and problems related to depression and anxiety/stress are more common during this time. Some key features of depression include sad mood, decrease/loss in interest/pleasure, feelings of excessive guilt/worthlessness, decrease in energy/fatigue, indecisiveness or poor concentration, decrease/changes in appetite/weight, sleep disorders, and recurrent thoughts of death or suicide. If your friend has any of these symptoms, you should urge her to see a doctor or health care professional to get help. Her doctor may prescribe medications such as anti-depressants that can help her cope with this difficult time and/or refer her to therapy/counseling. You can remain supportive to her by encouraging her to become active in the community and share her feelings with you as a friend. If she has expressed thoughts of harming herself or others, it is really important that you give her the Mobile Crisis phone number: 946-9109 and consider calling the number if she won’t phone herself. The website www.canmat.org and self-help books such as Mind Over Mood and Feeling Good are useful references you can pass on to her for learning about this type of problems.
Relatively mild anxiety states in reaction to life circumstances are often time-limited, and many people respond to anxiety management strategies without medication. Support, problem-solving and relaxation techniques often help as the environmental crisis resolves. However, specific anxiety or mood disorders may develop from the original reaction. One should control caffeine or other stimulant use, minimize alcohol use (often used to control anxiety), reduce the use of short-acting tranquilizers (eg Valium and Ativan), and take steps to reduce stress including relaxation training and time management. More specific therapy/counselling and referral to a psychiatrist may be necessary if there is little improvement after several months of adequate medication therapy. Clicking on the title "Holiday Health" should link you to the information resource "Coping with Stress" [http://www.cmha.ca/data/1/rec_docs/403_CMHA_coping_with_stress_EN.pdf] by the Canadian Mental Health Association (www.cmha.ca).
I have high cholesterol, and my doctor warned me to stay away from fat. What can I do, especially during the Christmastime?
Having high cholesterol levels in your blood (dyslipidemia) is important, not because you can feel it directly, but because it is associated with a higher risk of cardiovascular disease (CVD; heart attacks and stroke). This is because excess fat deposits in the blood vessels throughout your body (atherosclerosis, AS), which can make it difficult for the heart to pump the blood (with the oxygen it carries) to the tissues that need it. Eventually, the arteries can block up completely, which can cause the tissues that are not getting the blood/oxygen to die (a “heart attack” results from a blockage of the arteries that feed the heart muscle; a stroke from a blockage of the arteries that feed the different areas of the brain). Dyslipidemia, diabetes, overweight, abdominal obesity (overweight in the tummy area), high blood pressure, and low cardio-respiratory fitness are primary risk factors for CVD. You are also at a higher risk if you have a strong family history of heart attacks/stroke or smoke. There are different types of cholesterols and different types of high cholesterol problems; some are genetic (run in the family), and others due to conditions such as hypothyroidism, pregnancy, excess weight, alcohol excess, certain liver and kidney diseases, and medications such as corticosteroids, hormone replacement therapy/oral contraceptives, and some blood pressure and heart medications.
Triglycerides are a type of fat that can be high from certain fats in the diet, but also extra sugars in the blood (excess starches like white breads, alcohol, sugared beverages) that your body turns into triglycerides. Niacin and fibrates help decrease mainly this type of fat.
LDL's (low-density lipoproteins) are the "bad cholesterols--you want them to be low. The “statin” drugs commonly target these fats by helping to lower the amount in your blood, but if you are on one, make sure to check in with your doctor regularly to monitor your liver and muscle enzyme level in your blood, which can go up with this class of drugs. “Resins” are another type of drug that lower LDL and can increase HDLs.
HDL's (high-density lipoproteins) are the good cholesterols that you want high, as they have a protective effect against heart disease + stroke. Regular exercise has been shown to boost this good cholesterol in the blood. Niacin and fibrates can increase this type.
In general, it is important to follow your doctor’s advice about your cholesterol problem, but diet, aimed at reducing blood cholesterol levels and weight (if needed) should always be the first approach. CVD can be reduced by eating less saturated and trans fats, less salt and sufficient amounts of fruit, vegetables and omega-3 and omega-6 polyunsaturated fats. Risk is also reduced with weight control and physical activity. A dietician is usually recommended to reach these goals:
- decrease dietary cholesterol intake to < 300 mg/day (<200 mg/d if AS already a problem): raises blood cholesterol levels but no significant association found yet between CVD and egg consumption (egg yolks—leche flan, dairy products, meat and shellfish)
- restrict fat intake to 30% of calories (20% if AS);
- fat distribution goals as a % of total energy:
o < 10%: Saturated fats tend to raise total & LDL cholesterol levels & are associated with increased risk of CVD: processed foods, coconut oil, lard, hydrogenated hard margarines, butter, full-fat dairy products and fatty meats—so avoid/cut down! Lechon is a big culprit because it is animal fat deep fried in fat—often animal. Yikes!
o < 1%: Trans fats elevate LDL and decrease HDL: partially hydrogenated margarines & shortenings, deep fried foods, processed foods made with partially hydrogenated fats and baked goods—AVOID
o 5-8%: Omega-6 polyunsaturated fats are the most effective replacement for saturated fats to improve heart disease outcomes: soybean, sunflower, safflower, corn and cottonseed oils
o 1-2%: Omega-3 polyunsaturated fats have good effects and decrease fatal CVD: fatty fish (tuna, salmon, mackerel, sea bass, fish oils), plant sources (canola, soybean, flaxseed oils, soft non-hydrogenated margarines, nuts, tofu, ground flaxseed)
o By difference to achieve a total fat intake of 15-30%: Monounsaturated fatty acids lower total & LDL cholesterol levels when substituted for saturated fats but not as well as polyunsaturated fats: canola, olive oils, nuts
- favour high-fibre intake
- limit simple sugars to 8% of total calories
- limit alcohol consumption to 5% of total calories
Plant sterols: the cholesterol-lowering effects have been well documented: vegetable oils, nuts, sesame & sunflower seeds, soy & other legumes.
Other nutrients: fruit and vegetables contribute to heart health through fibre, vitamins, minerals and phytonutrients (esp green leafy & cruciferous veggies, legumes & berries).
Also, if you can increase your fiber intake (10-15 g/d of soluble fiber—eg psyllium, oat bran, kidney beans, artichokes, dried prunes) not only will this help combat constipation which is common with fattening foods and lack of exercise common during Christmastime, but it also may lower cholesterol levels by an additional 10-15%. Pretty good deal! Although some studies suggest a protective role of antioxidants (vitamin E in nuts, seeds, some soft, non-hydrogenated margarines; vitamin C in citrus fruit, berries, tomatoes, potatoes, broccoli, cauliflower, kale, cabbage, sweet peppers; carotenoids/beta-carotene in carrots & tomatoes), controlled studies have not shown much proof. Sodium intake is directly associated with blood pressure, so limit it (salt added to foods, sodium in processed foods & additives like MSG)! Potassium (fruit and vegetables) helps lower blood pressure.
So in summary:
- Avoid hydrogenated oils and fats--Opt for low fat options on the labels of foods you buy.
- Limit the intake of fat from dairy and meat sources; Hidden fats you can cut down on: Whole or 2% milk—go for skim instead.
- Use appropriate vegetable oils in small amounts.
- Ensure a regular intake of fish (1-2 times per week) or plant sources of omega-3 fatty acids.
- Choose foods prepared without frying.
- Eat 400-500 g (6-8 servings) of fruit and vegetables daily.
- Restrict daily salt intake to less than 5 g.
- Choose fibre-rich whole grain cereals, as well as fruits and vegetables.
Increased physical activity may help decrease cholesterol and triglyceride levels while increasing HDL. Try to get regular physical activity/aerobic activity, decrease/stop smoking, watch extra sugars and salts in your foods, and try not to get too stressed during Christmastime! If you overdo it during the holidays, it might be a good idea to discuss this with your doctor to check where your cholesterol levels are at so you can modify your plan to better suit your lifestyle.
Have a healthy and relaxing Christmas! Maligayang Pasko at Masaganang Bagong Taon!
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