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!
Monday, January 15, 2007
Sunday, December 10, 2006
Stress Incontinence & Travel Health
FJ Vol 20, No 22
Nov 17-30/06
My lola has been complaining of leaking ihi when she coughs, laughs, or sneezes. She is too embarrassed to see the doctor. Why is this happening, and what can she do?
Stress incontinence (the loss of urine due to an increase in pressure in the tummy) is more common in women. Weakness in the pelvis muscles (eg due to childbirth, abdominal obesity--overweight in the tummy) and thinning of the bladder and vaginal muscles and tissues from the decrease in estrogen after menopause are often contributing factors. Urge incontinence is leakage due to inability to delay peeing when an urge is felt. Causes include bladder wall hyperactivity and neurological disorders such as Parkinson’s Disease and stroke. Overflow incontinence involves leakage due to an over-distended bladder usually from blocked urine outlet (eg. enlarged prostate) or neurological causes (eg. multiple sclerosis, diabetes affecting the nerves). Functional incontinence is caused by the inability to get to a toilet such as due to physical constraints (eg restricted mobility), mental factors (eg. dementia, depression), and environmental barriers (eg. distance to toilet, positioning).
Her doctor should rule out problems like a urinary tract infection or a problem with the nerves controlling the bladder muscles. Some things she can do include: decreasing caffeine intake; addressing any bowel problems like constipation; limiting fluid intake—1.5-2 L/d is considered appropriate; losing weight; quitting smoking; watching high-impact physical activities; avoiding some types of medications (check with her doctor) like diuretics, some blood pressure and depression drugs, and alcohol; and improving mobility & accessibility to toilets. When secondary causes have been ruled out or treated, she can try pelvic floor muscle training (aka Kegels): do a minimum of 30-45 pelvic floor muscle contractions (goal of 10 seconds for each contraction); done in 2 or 3 sets; may take 6-8 weeks to see results. To contract the pelvic floor muscle, instruct her to pee, and while she’s peeing, she should squeeze her pelvic muscles to stop the flow of pee. Biofeedback and/or electrical stimulation therapy can teach her to isolate and control these muscles if she is not having any luck. If the problem is severe, her doc might refer her to a gynecologist/urologist who could confirm the diagnosis + possibly book her for surgery. Another option is wearing pads/ “Depends” to catch the leak. Depending on the cause, there are some medications her doctor can prescribe to help manage her symptoms. There are different treatments available for men who have difficulty with stress incontinence after having prostate surgery—check with their urologist.
My family is going to the Philippines for Christmas. What do we need to do ahead of time?
According to the Health Canada (http://www.hc-sc.gc.ca/iyh-vsv/life-vie/travel-voyage_e.html) and WRHA websites (http://www.wrha.mb.ca/community/travel/manual_countries.php), Canadians traveling internationally should contact their doctor or a travel clinic 6-8 weeks before traveling, regardless of where they are going, to have their risk assessed. Based on your current health, travel itinerary and previous immunization history, your doctor can determine what immunizations and/or preventive medication you may need, as well as advise you on how you can avoid disease risks.
By far the most common complaint while traveling is diarrhea. This is usually caused by the differences in water purity. Travelers may have diarrhea if they drink the local water or food prepared with local water in these countries.
You can also be at risk for a number of childhood illnesses (Diphtheria, Tetanus, Polio, Measles, Mumps, Rubella) when you travel, especially if you have not been immunized against them or haven’t kept your immunizations up to date. In countries where sanitary conditions are poor, immunizations may be recommended—there is a higher risk of hepatitis A (immunization recommended for all travelers) and typhoid in the Philippines. Depending on your travel activities and the local disease situation, you may need to be immunized against Meningitis, Japanese encephalitis (depending on degree of exposure), European tick-borne encephalitis, Hepatitis B (higher risk), Rabies (higher risk). Depending on where you are traveling, you may also be at risk of Malaria (caused by infected mosquito bites in many tropical countries; rural areas only, except no risk in Manila and province of Bohol, Catanduanes and Cebu), Yellow fever (caused by infected mosquito bites in Central Africa and South America; if traveling from an endemic zone and > 1 yr of age), Dengue fever (caused by infected mosquito bites in many tropical countries), Schistosomiasis (caused by a parasite in fresh water in the Carribean, South America, Africa, the Middle East and Southeast Asia). You are also at a higher risk of tuberculosis that is resistant to many drugs we use to treat it. As well, some sexually transmitted diseases, such as HIV/AIDS, are more common in some countries than they are in Canada.
You should also be safety conscious when traveling. Economic conditions in developing countries can cause increased crime rates and tourists are often targeted.
Some tips to help you enjoy safe travel:
_. Make sure all your regular vaccinations are up to date.
_. Before you travel, contact a travel clinic or your doctor six to eight weeks before you go, to allow time for any vaccinations you may need. This is especially true if you are going to tropical areas or developing countries.
_. Arrange for private health insurance while you are away, as your provincial/territorial health insurance may not cover you. Your travel agent can advise you on this.
_. If you are going to an area where malaria is present, it is important that you take anti-malarial medication as prescribed by your doctor.
_. Since anti-malarial medication does not guarantee absolute protection against the disease, preventing mosquito bites is very important. Use mosquito repellents when outside, especially between dusk and dawn. Sleep in well-screened or air conditioned accommodation or use a bed net. Wear trousers and long sleeves at dusk.
_. If you become ill in the first two months to a year after you return, see your doctor immediately and tell her/him that you have visited an area where malaria occurs.
_. To prevent diarrhea, the key principles to remember are: boil it, cook it, peel it or leave it! Always drink purified water or commercially bottled beverages, and pasteurized milk. Avoid ice, salads, re-heated foods, uncooked shellfish, fruit that is not peeled and food from street vendors.
_. Wash your hands often with soap or a sanitizing agent when travelling, especially before eating or drinking.
_. Should you experience diarrhea, be sure to drink plenty of liquids to prevent becoming dehydrated, especially in warm climates.
_. In warmer climates, always use a sunblock with a minimum SPF of 15.
_. To help prevent sexually transmitted diseases, always use a condom if you have sex with someone you meet while travelling.
_. Never share needles to inject intravenous drugs with anyone.
_. Swim in fresh water only if you know it is free of biharzia, the parasites that cause schistosomiasis.
_. Do not walk alone in remote areas, back streets or beaches, where you may be at risk of a personal attack or bag snatching. Valuables should be left at home or deposited in hotel safes. Travellers cheques, cash, passports and tickets should not be carried in bags that can be snatched. It is recommended that you use a body belt.
_. Do not ride in over-crowded vehicles or on motorcycles, especially at night outside of urban areas.
_. If you need medication for an existing medical condition, take enough with you to last during your travel. Make sure the containers are clearly marked and carry a copy of the doctor's prescription with you. Essential medication should be carried in two different pieces of luggage, in case one should get lost or stolen.
_. If your medication requires sterile syringes or needles, carry a doctor's explanation or medical certificate with you. In many countries where drug trafficking is a problem, a traveller found with syringes and without adequate explanation, could be in serious trouble with the police.
Nov 17-30/06
My lola has been complaining of leaking ihi when she coughs, laughs, or sneezes. She is too embarrassed to see the doctor. Why is this happening, and what can she do?
Stress incontinence (the loss of urine due to an increase in pressure in the tummy) is more common in women. Weakness in the pelvis muscles (eg due to childbirth, abdominal obesity--overweight in the tummy) and thinning of the bladder and vaginal muscles and tissues from the decrease in estrogen after menopause are often contributing factors. Urge incontinence is leakage due to inability to delay peeing when an urge is felt. Causes include bladder wall hyperactivity and neurological disorders such as Parkinson’s Disease and stroke. Overflow incontinence involves leakage due to an over-distended bladder usually from blocked urine outlet (eg. enlarged prostate) or neurological causes (eg. multiple sclerosis, diabetes affecting the nerves). Functional incontinence is caused by the inability to get to a toilet such as due to physical constraints (eg restricted mobility), mental factors (eg. dementia, depression), and environmental barriers (eg. distance to toilet, positioning).
Her doctor should rule out problems like a urinary tract infection or a problem with the nerves controlling the bladder muscles. Some things she can do include: decreasing caffeine intake; addressing any bowel problems like constipation; limiting fluid intake—1.5-2 L/d is considered appropriate; losing weight; quitting smoking; watching high-impact physical activities; avoiding some types of medications (check with her doctor) like diuretics, some blood pressure and depression drugs, and alcohol; and improving mobility & accessibility to toilets. When secondary causes have been ruled out or treated, she can try pelvic floor muscle training (aka Kegels): do a minimum of 30-45 pelvic floor muscle contractions (goal of 10 seconds for each contraction); done in 2 or 3 sets; may take 6-8 weeks to see results. To contract the pelvic floor muscle, instruct her to pee, and while she’s peeing, she should squeeze her pelvic muscles to stop the flow of pee. Biofeedback and/or electrical stimulation therapy can teach her to isolate and control these muscles if she is not having any luck. If the problem is severe, her doc might refer her to a gynecologist/urologist who could confirm the diagnosis + possibly book her for surgery. Another option is wearing pads/ “Depends” to catch the leak. Depending on the cause, there are some medications her doctor can prescribe to help manage her symptoms. There are different treatments available for men who have difficulty with stress incontinence after having prostate surgery—check with their urologist.
My family is going to the Philippines for Christmas. What do we need to do ahead of time?
According to the Health Canada (http://www.hc-sc.gc.ca/iyh-vsv/life-vie/travel-voyage_e.html) and WRHA websites (http://www.wrha.mb.ca/community/travel/manual_countries.php), Canadians traveling internationally should contact their doctor or a travel clinic 6-8 weeks before traveling, regardless of where they are going, to have their risk assessed. Based on your current health, travel itinerary and previous immunization history, your doctor can determine what immunizations and/or preventive medication you may need, as well as advise you on how you can avoid disease risks.
By far the most common complaint while traveling is diarrhea. This is usually caused by the differences in water purity. Travelers may have diarrhea if they drink the local water or food prepared with local water in these countries.
You can also be at risk for a number of childhood illnesses (Diphtheria, Tetanus, Polio, Measles, Mumps, Rubella) when you travel, especially if you have not been immunized against them or haven’t kept your immunizations up to date. In countries where sanitary conditions are poor, immunizations may be recommended—there is a higher risk of hepatitis A (immunization recommended for all travelers) and typhoid in the Philippines. Depending on your travel activities and the local disease situation, you may need to be immunized against Meningitis, Japanese encephalitis (depending on degree of exposure), European tick-borne encephalitis, Hepatitis B (higher risk), Rabies (higher risk). Depending on where you are traveling, you may also be at risk of Malaria (caused by infected mosquito bites in many tropical countries; rural areas only, except no risk in Manila and province of Bohol, Catanduanes and Cebu), Yellow fever (caused by infected mosquito bites in Central Africa and South America; if traveling from an endemic zone and > 1 yr of age), Dengue fever (caused by infected mosquito bites in many tropical countries), Schistosomiasis (caused by a parasite in fresh water in the Carribean, South America, Africa, the Middle East and Southeast Asia). You are also at a higher risk of tuberculosis that is resistant to many drugs we use to treat it. As well, some sexually transmitted diseases, such as HIV/AIDS, are more common in some countries than they are in Canada.
You should also be safety conscious when traveling. Economic conditions in developing countries can cause increased crime rates and tourists are often targeted.
Some tips to help you enjoy safe travel:
_. Make sure all your regular vaccinations are up to date.
_. Before you travel, contact a travel clinic or your doctor six to eight weeks before you go, to allow time for any vaccinations you may need. This is especially true if you are going to tropical areas or developing countries.
_. Arrange for private health insurance while you are away, as your provincial/territorial health insurance may not cover you. Your travel agent can advise you on this.
_. If you are going to an area where malaria is present, it is important that you take anti-malarial medication as prescribed by your doctor.
_. Since anti-malarial medication does not guarantee absolute protection against the disease, preventing mosquito bites is very important. Use mosquito repellents when outside, especially between dusk and dawn. Sleep in well-screened or air conditioned accommodation or use a bed net. Wear trousers and long sleeves at dusk.
_. If you become ill in the first two months to a year after you return, see your doctor immediately and tell her/him that you have visited an area where malaria occurs.
_. To prevent diarrhea, the key principles to remember are: boil it, cook it, peel it or leave it! Always drink purified water or commercially bottled beverages, and pasteurized milk. Avoid ice, salads, re-heated foods, uncooked shellfish, fruit that is not peeled and food from street vendors.
_. Wash your hands often with soap or a sanitizing agent when travelling, especially before eating or drinking.
_. Should you experience diarrhea, be sure to drink plenty of liquids to prevent becoming dehydrated, especially in warm climates.
_. In warmer climates, always use a sunblock with a minimum SPF of 15.
_. To help prevent sexually transmitted diseases, always use a condom if you have sex with someone you meet while travelling.
_. Never share needles to inject intravenous drugs with anyone.
_. Swim in fresh water only if you know it is free of biharzia, the parasites that cause schistosomiasis.
_. Do not walk alone in remote areas, back streets or beaches, where you may be at risk of a personal attack or bag snatching. Valuables should be left at home or deposited in hotel safes. Travellers cheques, cash, passports and tickets should not be carried in bags that can be snatched. It is recommended that you use a body belt.
_. Do not ride in over-crowded vehicles or on motorcycles, especially at night outside of urban areas.
_. If you need medication for an existing medical condition, take enough with you to last during your travel. Make sure the containers are clearly marked and carry a copy of the doctor's prescription with you. Essential medication should be carried in two different pieces of luggage, in case one should get lost or stolen.
_. If your medication requires sterile syringes or needles, carry a doctor's explanation or medical certificate with you. In many countries where drug trafficking is a problem, a traveller found with syringes and without adequate explanation, could be in serious trouble with the police.
Wednesday, December 06, 2006
Ask Dr. Denise: Gout & STD screening
The Filipino Journal: October 20-November 5 2006 issue; Volume 20, Number 20 p 10
By Denise Koh, BSc (mcl), MD, CCFP
* My dad suffers from gout. What is it, and what can he do to treat it?
Gout is a disease in which uric acid (UA, the normal end product of the breakdown of purines) crystals deposit in body tissues. This causes recurrent attacks of severe joint pain and inflammation, deposits in soft tissues, kidney problems, and kidney stones. Many genetic and environmental factors affect the chain of events that regulate UA formation, transport, and disposal. Any problem in these processes can lead to too much UA in the blood and gout. Filipinos have a predisposition to gout. There is a higher blood level seen in Filipinos living in North America compared with Filipinos living in the Philippines. Filipinos have a limited ability to excrete/remove UA leading to a tendency to high blood UA levels manifested when a diet with a relatively high purine content, such as the usual North American diet, is eaten. Your dad can do several things to control his disease: lose weight, avoid foods high in purines, avoid alcohol (increases production and impairs removal of UA), avoid dehydration (drink lots of water!), and avoid diuretics (“water pills” often used for high blood pressure) if possible. High purine foods include visceral (organ) meats (liver, tripe), sardines, shellfish, turkey, salmon, trout, beans, peas, asparagus, and spinach.
* I have a new sexual partner and was told to get checked for STD’s, even though I feel fine. What is involved in an STD screen, and when should someone get checked?
A common misperception is that no symptoms, means no STI (sexually-transmitted infections). This is far from the truth, and is a huge reason for the continued spread of STIs. Get tested when: you have unprotected (no condom) sex, you have a new partner, you are worried about it, you are experiencing any symptoms such as discharge, pelvic pain/burning, lumps, bumps, sores, unusual vaginal bleeding, or fertility concerns. Many people choose to get tested regularly, such as every 6 months, or with their annual physical exam. A typical screen can include blood tests for HIV (anonymous and requires your consent), Hepatitis B, Syphilis, and Herpes Simplex (although some docs don’t check for herpes because it is so common, and can’t be cured). Gonorrhea and Chlamydia can be checked in two ways: 1) a pee test or 2) a swab. For women, this is a swab of the inside of the cervix (opening of the uterus) requiring the insertion of a speculum typically used in Pap tests. For men, this requires a swab of the urethra/inside the penis. If you are uncomfortable with the swab tests, you can get the pee test instead, keeping in mind that these tests are not as sensitive as the swabs. It’s way better to get tested than not—for treatment and relief from easily treatable infections, management with improved outcome of the non-curable ones, prevention of spread, and peace of mind. Tests for Genital Warts are more specialized and seldom performed (extremely common and difficult to treat), but often a doctor can recognize them on examination. Tests for vaginal infections (not necessarily sexually-transmitted) such as yeast, trichomonas, and bacterial vaginosis are usually reserved for women with symptoms.
By Denise Koh, BSc (mcl), MD, CCFP
* My dad suffers from gout. What is it, and what can he do to treat it?
Gout is a disease in which uric acid (UA, the normal end product of the breakdown of purines) crystals deposit in body tissues. This causes recurrent attacks of severe joint pain and inflammation, deposits in soft tissues, kidney problems, and kidney stones. Many genetic and environmental factors affect the chain of events that regulate UA formation, transport, and disposal. Any problem in these processes can lead to too much UA in the blood and gout. Filipinos have a predisposition to gout. There is a higher blood level seen in Filipinos living in North America compared with Filipinos living in the Philippines. Filipinos have a limited ability to excrete/remove UA leading to a tendency to high blood UA levels manifested when a diet with a relatively high purine content, such as the usual North American diet, is eaten. Your dad can do several things to control his disease: lose weight, avoid foods high in purines, avoid alcohol (increases production and impairs removal of UA), avoid dehydration (drink lots of water!), and avoid diuretics (“water pills” often used for high blood pressure) if possible. High purine foods include visceral (organ) meats (liver, tripe), sardines, shellfish, turkey, salmon, trout, beans, peas, asparagus, and spinach.
* I have a new sexual partner and was told to get checked for STD’s, even though I feel fine. What is involved in an STD screen, and when should someone get checked?
A common misperception is that no symptoms, means no STI (sexually-transmitted infections). This is far from the truth, and is a huge reason for the continued spread of STIs. Get tested when: you have unprotected (no condom) sex, you have a new partner, you are worried about it, you are experiencing any symptoms such as discharge, pelvic pain/burning, lumps, bumps, sores, unusual vaginal bleeding, or fertility concerns. Many people choose to get tested regularly, such as every 6 months, or with their annual physical exam. A typical screen can include blood tests for HIV (anonymous and requires your consent), Hepatitis B, Syphilis, and Herpes Simplex (although some docs don’t check for herpes because it is so common, and can’t be cured). Gonorrhea and Chlamydia can be checked in two ways: 1) a pee test or 2) a swab. For women, this is a swab of the inside of the cervix (opening of the uterus) requiring the insertion of a speculum typically used in Pap tests. For men, this requires a swab of the urethra/inside the penis. If you are uncomfortable with the swab tests, you can get the pee test instead, keeping in mind that these tests are not as sensitive as the swabs. It’s way better to get tested than not—for treatment and relief from easily treatable infections, management with improved outcome of the non-curable ones, prevention of spread, and peace of mind. Tests for Genital Warts are more specialized and seldom performed (extremely common and difficult to treat), but often a doctor can recognize them on examination. Tests for vaginal infections (not necessarily sexually-transmitted) such as yeast, trichomonas, and bacterial vaginosis are usually reserved for women with symptoms.
Wednesday, October 18, 2006
Ask Dr. Denise: Workplace Safety and Health (part 2)
The Filipino Journal: September 18-October 5 2006 issue p 6
My boss is asking me to work in what I consider unsafe conditions. What can I do?
What are the safety and health rights and responsibilities in the workplace?
When it comes to safety and health, every worker in Manitoba, regardless of age, has 3 basic rights in the workplace:
- The right to know about what hazards there are in the workplace and what precautions must be taken to prevent injuries from these hazards.
- The right to participate in safety and health activities in the workplace without fear of any form of discriminatory action such as discipline.
- The right to refuse unsafe work.
In Manitoba, health and safety rights are guaranteed by the Workplace Safety and Health Act and the Canada Labour Code. Most workers are under provincial authority and are protected by the Workplace Safety and Health Act. The Workers Compensation Act was created to promote healthy, safe workplaces, to encourage safe, timely return to work and to provide insured benefits to workers who get injured on the job. In addition to the laws, every workplace should have its own safety policy, procedures and safe operating practices.
Your employer is legally responsible for putting safe work practices in place, and you’re responsible for following them. If you have safety and health concerns, it’s your responsibility to report them. If a task feels unsafe, tell your immediate supervisor, and explain why you’re not comfortable. If you don’t get a satisfactory answer or s/he isn’t available, go to her/his supervisor. If you’re still not satisfied, ask your safety representative, a member of the safety committee, or a shop steward. Your last resort is the Workplace Safety and Health Division (WSH) or Human Resources and Skills Development Canada (HRSDC). WSH Officers have the power and duties to inspect any workplace, investigate any potential hazards situation and work refusal; and order compliance with the law (eg the Act or Regulations).
Manitoba’s employment standards laws (as outlined in The Employment Standards Code) promote fairness in the workplace for both employees and employers. The Employment Standards Branch is a neutral party that administers laws on minimum wages, hours of work, holidays and other workplace benefits. It is also responsible for investigating complaints of violations of these laws. Most employees in Manitoba fall under this code. Independent contractors (self-employed) are not covered. Some parts of the Code do not apply to agricultural workers, sitters, professionals, part-time domestic workers, Crown employees, family members employed in a family business, temporary election workers and some others.
If you have questions about WSH, visit the Workplace Safety and Health Division website at www.gov.mb.ca/labour/safety. Call the WSHD Client Services office at 945-3446 or 1-800-282-8069. This is the part of the provincial government that promotes and enforces workplace safety and health (law). They can answer your questions or concerns or provide you with information confidentially. If a serious incident, death or other problem is occurring in your workplace, they will send a workplace safety and health officer to your workplace.
The Human Resources and Skills Development Canada (HRSDC) – Labour Program is responsible for federally regulated workplaces such as national railways, grain elevators, inter-provincial trucking/transportation, communications, banks, etc). Call the HRDC – Labour Program at 983-6375. If you live outside Winnipeg, call 1-800-838-2033 or visit the website at www.hrdc-drhc.gc.ca.
The MFL Occupational Health Centre (phone 949-0811 or 1-888-843-1229, www.mflohc.mb.ca) is a community health centre specializing in work-related injuries and diseases. It is a non-profit, charitable organization funded by the Winnipeg Regional Health Authority and by donations from individuals, and unions. Its doctors are specialists in occupational medicine; referrals are not required. The Centre organizes public presentations and offers hands-on workshops tailored to your needs. One of its special initiatives is an Immigrant Workers Education and Outreach Project. It has a library with over 40 fact sheets on workplace health and safety issues such as ergonomics, shift work, work stress, and workplace chemicals. Some are available in Tagalog.
Some interesting facts:
- 40% of all injuries suffered by workers throughout their careers happen in the 1st 6 months on the job.
- 1/3 of all workplace injuries happen to those 15-24 years of age.
- Top 5 injuries in this group:
o Sprains, strains and tears
o Open wounds
o Surface wounds and bruises
o Other traumatic injuries and disorders
o Fractures and dislocations
- Top 5 Causes of injury to young workers:
o Struck by object
o Over exertion
o Bodily reaction (3eg jerking motion)
o Struck against object
o Caught in objects
- Top 5 body parts injured in young workers: hand/fingers/lower back/ eyes/ lower arm/ lower leg
My boss is asking me to work in what I consider unsafe conditions. What can I do?
What are the safety and health rights and responsibilities in the workplace?
When it comes to safety and health, every worker in Manitoba, regardless of age, has 3 basic rights in the workplace:
- The right to know about what hazards there are in the workplace and what precautions must be taken to prevent injuries from these hazards.
- The right to participate in safety and health activities in the workplace without fear of any form of discriminatory action such as discipline.
- The right to refuse unsafe work.
In Manitoba, health and safety rights are guaranteed by the Workplace Safety and Health Act and the Canada Labour Code. Most workers are under provincial authority and are protected by the Workplace Safety and Health Act. The Workers Compensation Act was created to promote healthy, safe workplaces, to encourage safe, timely return to work and to provide insured benefits to workers who get injured on the job. In addition to the laws, every workplace should have its own safety policy, procedures and safe operating practices.
Your employer is legally responsible for putting safe work practices in place, and you’re responsible for following them. If you have safety and health concerns, it’s your responsibility to report them. If a task feels unsafe, tell your immediate supervisor, and explain why you’re not comfortable. If you don’t get a satisfactory answer or s/he isn’t available, go to her/his supervisor. If you’re still not satisfied, ask your safety representative, a member of the safety committee, or a shop steward. Your last resort is the Workplace Safety and Health Division (WSH) or Human Resources and Skills Development Canada (HRSDC). WSH Officers have the power and duties to inspect any workplace, investigate any potential hazards situation and work refusal; and order compliance with the law (eg the Act or Regulations).
Manitoba’s employment standards laws (as outlined in The Employment Standards Code) promote fairness in the workplace for both employees and employers. The Employment Standards Branch is a neutral party that administers laws on minimum wages, hours of work, holidays and other workplace benefits. It is also responsible for investigating complaints of violations of these laws. Most employees in Manitoba fall under this code. Independent contractors (self-employed) are not covered. Some parts of the Code do not apply to agricultural workers, sitters, professionals, part-time domestic workers, Crown employees, family members employed in a family business, temporary election workers and some others.
If you have questions about WSH, visit the Workplace Safety and Health Division website at www.gov.mb.ca/labour/safety. Call the WSHD Client Services office at 945-3446 or 1-800-282-8069. This is the part of the provincial government that promotes and enforces workplace safety and health (law). They can answer your questions or concerns or provide you with information confidentially. If a serious incident, death or other problem is occurring in your workplace, they will send a workplace safety and health officer to your workplace.
The Human Resources and Skills Development Canada (HRSDC) – Labour Program is responsible for federally regulated workplaces such as national railways, grain elevators, inter-provincial trucking/transportation, communications, banks, etc). Call the HRDC – Labour Program at 983-6375. If you live outside Winnipeg, call 1-800-838-2033 or visit the website at www.hrdc-drhc.gc.ca.
The MFL Occupational Health Centre (phone 949-0811 or 1-888-843-1229, www.mflohc.mb.ca) is a community health centre specializing in work-related injuries and diseases. It is a non-profit, charitable organization funded by the Winnipeg Regional Health Authority and by donations from individuals, and unions. Its doctors are specialists in occupational medicine; referrals are not required. The Centre organizes public presentations and offers hands-on workshops tailored to your needs. One of its special initiatives is an Immigrant Workers Education and Outreach Project. It has a library with over 40 fact sheets on workplace health and safety issues such as ergonomics, shift work, work stress, and workplace chemicals. Some are available in Tagalog.
Some interesting facts:
- 40% of all injuries suffered by workers throughout their careers happen in the 1st 6 months on the job.
- 1/3 of all workplace injuries happen to those 15-24 years of age.
- Top 5 injuries in this group:
o Sprains, strains and tears
o Open wounds
o Surface wounds and bruises
o Other traumatic injuries and disorders
o Fractures and dislocations
- Top 5 Causes of injury to young workers:
o Struck by object
o Over exertion
o Bodily reaction (3eg jerking motion)
o Struck against object
o Caught in objects
- Top 5 body parts injured in young workers: hand/fingers/lower back/ eyes/ lower arm/ lower leg
Monday, September 18, 2006
Ask Dr. Denise: Workplace Safety and Health
The Filipino Journal: August 18-September 5 2006 issue p 6
I hurt my back at work today lifting patients (I'm a nurse). What should I do?
If you get hurt or sick because of your job you need to:
1) Get medical attention as soon as possible. Be sure to let your healthcare provider know you were injured or got ill at work. S/he should fill out a WCB Healthcare Report and fax/mail it to the WCB.
2) Tell your supervisor about any injury or illness as soon as possible after it happens. Ask your employer if they have a modified return-to-work program you could get involved in while you are recovering. Your employer has a responsibility to report workplace injuries to the WCB as soon as possible after learning of the injury (within 5 working days). Your employer must also pay you for the full day of the day you were hurt at work, not just up to the time of your injury.
3) If you miss time from work because of the injury, check with your employer whether you are covered by the Workers Compensation Board of Manitoba (WCB). If so, report the accident or illness to the WCB as soon as possible (954-4100; toll-free 1-800-362-3340 between 8 am – 7 pm Monday to Friday).You will be given a claim number and contact info of an adjudicator who will handle your claim. If you have to pay for any medication or other expenses related to your injury, keep your original receipts and advise your Adjudicator. These expenses may be covered by the WCB. WCB will ensure the injury occurred as a result of your employment and confirm the extent of your injury with your HCP, determine your benefit entitlement, and contact you to let you know what the decision is on your claim and if/when you can expect to receive benefits and services. Check out www.wcb.mb.ca for more information.
4) Follow your doctor/HCP’s treatment plan and attend any follow up appointments. It is important for you to get better and go back to work as soon as you are able. WCB benefits can be reduced or stopped if you are not doing what you can to get better.
5) Stay in touch with your employer on a regular basis to ensure they are aware of your recovery progress and when you may be able to return to modified/alternate work or your regular job duties. Stay in touch with your Adjudicator to ensure s/he is aware of any relevant changes with respect to your injury, recovery, and ability to return to your regular job.
In general, if you’ve strained your back, try a hot bath or shower followed by stretching exercises. Gradually increase your walking distance. While progressing with your stretching exercises and your walking distance, gradually introduce strengthening exercises. If you are overweight, consider changing your eating and exercise habits, as excess body weight places additional strain on the spine. Most back injuries resolve quickly with time and simple treatment. A good posture while standing, sitting and sleeping helps maintain a healthy back. Stay fit, and avoid overeating. Exercise helps to prevent back injury and also speeds recovery. Gentle exercise after a back injury is essential to recovery. Keep a positive attitude. When lifting or carrying even light objects, remember to:
- place your feet shoulder-width apart for good balance
- bend your knees and do not bend over to lift
- keep the load close to the centre of your body
- lightly “tense” your trunk muscles before and during lifting
- lift gradually and smoothly, without jerking, keeping your back straight
- pivot with your feet, don’t twist your back while lifting
- coordinate your lift when working with a partner
I hurt my back at work today lifting patients (I'm a nurse). What should I do?
If you get hurt or sick because of your job you need to:
1) Get medical attention as soon as possible. Be sure to let your healthcare provider know you were injured or got ill at work. S/he should fill out a WCB Healthcare Report and fax/mail it to the WCB.
2) Tell your supervisor about any injury or illness as soon as possible after it happens. Ask your employer if they have a modified return-to-work program you could get involved in while you are recovering. Your employer has a responsibility to report workplace injuries to the WCB as soon as possible after learning of the injury (within 5 working days). Your employer must also pay you for the full day of the day you were hurt at work, not just up to the time of your injury.
3) If you miss time from work because of the injury, check with your employer whether you are covered by the Workers Compensation Board of Manitoba (WCB). If so, report the accident or illness to the WCB as soon as possible (954-4100; toll-free 1-800-362-3340 between 8 am – 7 pm Monday to Friday).You will be given a claim number and contact info of an adjudicator who will handle your claim. If you have to pay for any medication or other expenses related to your injury, keep your original receipts and advise your Adjudicator. These expenses may be covered by the WCB. WCB will ensure the injury occurred as a result of your employment and confirm the extent of your injury with your HCP, determine your benefit entitlement, and contact you to let you know what the decision is on your claim and if/when you can expect to receive benefits and services. Check out www.wcb.mb.ca for more information.
4) Follow your doctor/HCP’s treatment plan and attend any follow up appointments. It is important for you to get better and go back to work as soon as you are able. WCB benefits can be reduced or stopped if you are not doing what you can to get better.
5) Stay in touch with your employer on a regular basis to ensure they are aware of your recovery progress and when you may be able to return to modified/alternate work or your regular job duties. Stay in touch with your Adjudicator to ensure s/he is aware of any relevant changes with respect to your injury, recovery, and ability to return to your regular job.
In general, if you’ve strained your back, try a hot bath or shower followed by stretching exercises. Gradually increase your walking distance. While progressing with your stretching exercises and your walking distance, gradually introduce strengthening exercises. If you are overweight, consider changing your eating and exercise habits, as excess body weight places additional strain on the spine. Most back injuries resolve quickly with time and simple treatment. A good posture while standing, sitting and sleeping helps maintain a healthy back. Stay fit, and avoid overeating. Exercise helps to prevent back injury and also speeds recovery. Gentle exercise after a back injury is essential to recovery. Keep a positive attitude. When lifting or carrying even light objects, remember to:
- place your feet shoulder-width apart for good balance
- bend your knees and do not bend over to lift
- keep the load close to the centre of your body
- lightly “tense” your trunk muscles before and during lifting
- lift gradually and smoothly, without jerking, keeping your back straight
- pivot with your feet, don’t twist your back while lifting
- coordinate your lift when working with a partner
Sunday, August 20, 2006
The Filipino Divide (8/17/06)
Ako ay Pilipina, indeed.
That is the stinging concluding remark from a letter to the editor in response to my proud self-statement (a reference to the song Magdaragat introduced me to which eventually connected me to my heritage) in my FJ article on Folklorama when I first moved to Winnipeg in 2003. Ar-ouch. To this day, during Folklorama 3 years later, I can feel my blood pressure rise and my heart sink when I recall the experience. The writer was not happy with my use of the word “Flip” to refer to Filipinos, apparently considered derogatory by some. I was shocked at the strong negative reaction and attack at not only my character but also my definition of myself as a Filipina—ang bilis bilis, too!--because all my life, that word was a special term, almost of entitlement—like my “peeps”, my “homies.” This was the term my barcadas, a handful of Saskatchewan Filipino-Canadian teens—The Filipinas Youth Group, used to call ourselves—we were cool because we had something no one else did. Like a mini-gang minus the drugs and guns and scare factor. We wore bandannas and break-danced like no other. Heck, we dominated in the dance realm. I don’t know where Bagets (form of dance Magdaragat taught us) originally came from, but it became ours. We serenaded and pen-pal’ed like it was going out of style. We kicked butt in basketball and sikaran. No one could touch us. Looking back, it was par for the course; identity issues--what all teens go through.
Now 20 years later, that letter triggered another mini identity crisis—I was seeking any reassurance I could get from my parents and the FJ editors. Did I just offend the entire Filipino community with my words?? Was I any less Filipino because that word was power where I came from but here—not so much? And why didn’t anyone teach me this in Coconut School??! What about my lack of Tagalog? Or my Chinese blood and Chinese name? What do I do to fix this?? Dare I ask the question--who’s “more Filipino” here: someone who tries to build up the Filipino spirit in all its different forms despite glaring un-Filipino-ness, or someone with the privilege of breeding & birthright who tries to break it? I think I’d take 10 puti in barongg tagalogs singing our anthem off-key over 1 purebred Pinoy holding a gun to another. But that’s just “You’re-not-Filipino…No-you’re-not”–me. I still ask random Pinoys I meet about that word, because I do not want to give up that word; I refuse to give up that pride I’ve associated with it.
I recently went to see Filipino-Canadian comic Ron Josol at Rumour’s Comedy club, and absolutely loved the show. I couldn’t help but laugh along with the largely Filipino crowd at his hilarious jokes about such “Pinoy-isms” as Philippine phonetics (“what’s his pahkking frovlem??”) and the Filipino propensity for choosing nursing as a career. What about the Philippine nanny? Who can deny this stereotype? And is it wrong to laugh at its existence and ourselves as a result? When does laughing at ourselves become harmful and the perpetuation of damaging prejudices? Conversely, when does racial sensitivity and political correctness stunt individual interpretation and expression of culture? Call a spade a spade…but then we’ve gotta look at the definition of excavation implements, the national standards of yard care tools, and if it heard the tree falling in the forest. Naman.
Living here in Winnipeg, I see Filipinos excelling in all sorts of careers, occupations, and work-settings. Certainly, in my medical training and practice, I get to work with a good number of Filipino nurses/health care workers in a variety of settings, both as patients and colleagues. Having just finished my Occupational Medicine rotation for my Community Medicine residency, I’ve gotten the chance to witness Filipinos and their health in the workplace at many different levels—a scope of the Filipino-Canadian experience…from Immigrant to Canadian-born, from caregiver to patient, from teacher to student. We are a vast and varied bunch, a spectrum: brown Filipinos, yellow Filipinos, white Filipinos, Filipino-whites, mestizas/zos, blue, orange, green, and purple Filipinos…you name it. I’ve had in-depth discussions with many Filipinos from all over this rainbow of backgrounds on this collective experience, what I call the Filipino Divide. The “ignorant coconut youth disconnected from their roots” vs the “old guards enmeshed in obsolete thinking” and everything in between. Yes, the words are there on purpose; they’re there to inflame. Why? Because if we don’t acknowledge their existence, we can’t get on top of these problems to work on the root cause. Sometimes the words have to slap us upside the head to get us to see what message lies beneath.
According to the HRSDC website, in 2001:
Filipinos in Canada represented the fourth largest visible minority subgroup (7.7% of total visible minority population; 1% of the total population). Toronto, Vancouver and Winnipeg accounted for 72% of the Filipino population…Filipinos were a very young group. Only 6% of their total population was 65 and over (compared with 13% of the non-visible minority population; 7% of the overall visible minority population). Close to 50% of the total Filipino population were of prime working age (25-54)…Filipinos had a high level of education. Among all visible minority subgroups, they ranked second in terms of the proportion of the population 15 years and over having earned a bachelor’s degree or higher and ranked first in terms of the percentage of the population with more than grade 13…Approximately 31% of Filipinos 15 years and over had a bachelor’s degree or higher compared to only 14% of the non-visible minority population and 24% of the overall visible minority population. In contrast to most of the other visible minority subgroups, a larger percentage of Filipino women than men had earned a university degree (33% vs. 27%)…The most popular fields of study were Commerce Management & Business Administration (27%), Health Professions Sciences & Technologies (22%), Engineering & Applied Sciences Technologies & Trades (13%) and Engineering & Applied Sciences (10%). These four fields made up 72% of the Filipino population that went beyond secondary school education to achieve a degree, certificate or diploma. They represented 1.2% of the total workforce and 9.1% of the overall visible minority workforce…Filipinos were most frequently working in the following Employment Equity Occupational Groups (EEOGs): Intermediate Sales & Service Personnel (19%), Other Sales & Service Personnel (14%), Clerical Personnel (13%) and Semi Skilled Manual Workers (13%)… Filipinos had the highest participation rate and the lowest unemployment rate among all visible minority subgroups. Their participation rate (76%) was considerably higher than that of the non-visible minority population (66.5%). Their unemployment rate was exceptionally low (5.6%) compared to that of the non-visible minority population (7.1%).
This is all good, right? But…
…In spite of their high level of education, the proportion of Filipinos in Professional occupations (12%) was below that observed for both the nonvisible minority population (15%) and the overall visible minority population (17%)…In 2000, Filipinos had the second lowest average income among all visible minority subgroups for full-time, full-year employment. Their income, at $32,748, was equivalent to only 74% of what the non-visible minority population earned ($43,989) and 86% of what total visible minorities earned ($37,957). Filipino women earned 81% of what Filipino men earned.
Okay. I have a huge problem with this. This bothers me to no end. In fact, it sucks big fat greasy lechon. But I am not at all surprised.
I have heard horror stories about the hell Filipino nannies have gone through—not just in Canada but world-wide. They have been abused and raped. The egregious acts done to them in Canada--inconceivable. But true. This is a problem.
I know of a Canadian nurse who worked in the Middle East along-side nurses from all over the world. There was a pay differential among these nurses depending on the country of origin—Filipino nurses being almost at the bottom, North American nurses at the top of the pay scale. So this “top-level” nurse would take the shifts, and if she wanted to take a day off, would get a Filipino nurse or one lower in pay level to take the shift, and she would pocket the difference. Pretty smart Canadian, eh? Of course she was. I wouldn’t blame her. Sure, there was discussion about the lower paid nurses’ countries getting larger grants for their nurses at the government level, and somehow this ‘makes up for the inequity.’ Either way, to me, this is a problem.
I know how dirt-cheap things are in the Philippines—from wares to people and services. $15 for a luxury treatment at a spa vs $80 and up for the same thing here. Don’t think I didn’t take advantage of this—shopping maven that I am. But is this a problem? You bet your shiny new sapatos I just gave you ($3; 2 for $5!) it is.
I have heard accusations and terms such as “corruption” (a touchy buzzword to our kababayyan) in reference to Filipinos who have benefited financially or otherwise in their work—be it facilitation of new immigrants into our community, leading and representing us on a political front, in health care, religious circles, volunteering for the community functions, etc, etc, etc. To the point where some work almost ragged for way less than is fair just to uphold that perception of giving. I come from a family that ascribes to this, so I know. I bet we all do. There is great satisfaction giving something for nothing. But that doesn’t put rice on the table. Again, this is a real big problem.
This divide is in our thinking and in our belief structure. I witness it all the time. What strikes me is this impressive work ethic that transcends all the fields we work in—we take pride in what we do, and we care. Deeply. We are brought up to give and give and give. Give more. Care more. Do and be more. There is nothing to be ashamed about that. Our journals applaud these acts and rightly so. I think we don’t even do this enough. But we are also brought up to be humble and modest, painfully so. If we take in return, this is considered rude and bad--bastos. Somewhere along the line giving all and accepting so little in return became the Philippine way. But this translates into the lowest paid workers, despite definite measurable contribution and awards of excellence in our work. This translates into burnout and loss of the very people trying to make a positive difference. This translates into poorer health in our people and the community as a whole. This translates into Pinoy tearing down Pinoy because of the harmful misguided mentality that one has to lose if another wins rather than a Win/Win or No Deal approach. This divide breaks my heart and my spirit, more than words can ever capture. This must be addressed. We need to build.
When I hear the accent and see the familiar mannerisms I grew up with, I always get a nostalgic twinge of what I call “home”: a deep sense of kinship, belonging, and identity. The pointing with the lips, the wordless eyebrow greetings. The expectation of any stranger for a full plate of food at a Filipino BBQ, and the chastising of any Filipino host who doesn’t represent our hospitality. The respectful greeting of elders with hand to forehead, kneeling. All of it. For some trying to assimilate into North American culture, these things are embarrassing and funny. For me, these things strike an emotional chord—I can relate to these “quirks”, their irrational rationale, their oddness to an on-looker, but there is this intense pride mixed with a sadness in what they represent: the unsurpassable good in our hearts mixed with this dooming self-perception of inferiority and submissiveness. This chord and the divide it represents are rooted deep in my being, and I am only now beginning to understand it. It’s mine.
So I will say it again, and this time with a vengeance: Ako ay Pilipina. Ako ay Flip. I am Pyllifinah. Whatever way I say it, you cannot take that away from me. You can call me a “dirty Flip” any day, and, frankly, I’d love you that much more for it.
That is the stinging concluding remark from a letter to the editor in response to my proud self-statement (a reference to the song Magdaragat introduced me to which eventually connected me to my heritage) in my FJ article on Folklorama when I first moved to Winnipeg in 2003. Ar-ouch. To this day, during Folklorama 3 years later, I can feel my blood pressure rise and my heart sink when I recall the experience. The writer was not happy with my use of the word “Flip” to refer to Filipinos, apparently considered derogatory by some. I was shocked at the strong negative reaction and attack at not only my character but also my definition of myself as a Filipina—ang bilis bilis, too!--because all my life, that word was a special term, almost of entitlement—like my “peeps”, my “homies.” This was the term my barcadas, a handful of Saskatchewan Filipino-Canadian teens—The Filipinas Youth Group, used to call ourselves—we were cool because we had something no one else did. Like a mini-gang minus the drugs and guns and scare factor. We wore bandannas and break-danced like no other. Heck, we dominated in the dance realm. I don’t know where Bagets (form of dance Magdaragat taught us) originally came from, but it became ours. We serenaded and pen-pal’ed like it was going out of style. We kicked butt in basketball and sikaran. No one could touch us. Looking back, it was par for the course; identity issues--what all teens go through.
Now 20 years later, that letter triggered another mini identity crisis—I was seeking any reassurance I could get from my parents and the FJ editors. Did I just offend the entire Filipino community with my words?? Was I any less Filipino because that word was power where I came from but here—not so much? And why didn’t anyone teach me this in Coconut School??! What about my lack of Tagalog? Or my Chinese blood and Chinese name? What do I do to fix this?? Dare I ask the question--who’s “more Filipino” here: someone who tries to build up the Filipino spirit in all its different forms despite glaring un-Filipino-ness, or someone with the privilege of breeding & birthright who tries to break it? I think I’d take 10 puti in barongg tagalogs singing our anthem off-key over 1 purebred Pinoy holding a gun to another. But that’s just “You’re-not-Filipino…No-you’re-not”–me. I still ask random Pinoys I meet about that word, because I do not want to give up that word; I refuse to give up that pride I’ve associated with it.
I recently went to see Filipino-Canadian comic Ron Josol at Rumour’s Comedy club, and absolutely loved the show. I couldn’t help but laugh along with the largely Filipino crowd at his hilarious jokes about such “Pinoy-isms” as Philippine phonetics (“what’s his pahkking frovlem??”) and the Filipino propensity for choosing nursing as a career. What about the Philippine nanny? Who can deny this stereotype? And is it wrong to laugh at its existence and ourselves as a result? When does laughing at ourselves become harmful and the perpetuation of damaging prejudices? Conversely, when does racial sensitivity and political correctness stunt individual interpretation and expression of culture? Call a spade a spade…but then we’ve gotta look at the definition of excavation implements, the national standards of yard care tools, and if it heard the tree falling in the forest. Naman.
Living here in Winnipeg, I see Filipinos excelling in all sorts of careers, occupations, and work-settings. Certainly, in my medical training and practice, I get to work with a good number of Filipino nurses/health care workers in a variety of settings, both as patients and colleagues. Having just finished my Occupational Medicine rotation for my Community Medicine residency, I’ve gotten the chance to witness Filipinos and their health in the workplace at many different levels—a scope of the Filipino-Canadian experience…from Immigrant to Canadian-born, from caregiver to patient, from teacher to student. We are a vast and varied bunch, a spectrum: brown Filipinos, yellow Filipinos, white Filipinos, Filipino-whites, mestizas/zos, blue, orange, green, and purple Filipinos…you name it. I’ve had in-depth discussions with many Filipinos from all over this rainbow of backgrounds on this collective experience, what I call the Filipino Divide. The “ignorant coconut youth disconnected from their roots” vs the “old guards enmeshed in obsolete thinking” and everything in between. Yes, the words are there on purpose; they’re there to inflame. Why? Because if we don’t acknowledge their existence, we can’t get on top of these problems to work on the root cause. Sometimes the words have to slap us upside the head to get us to see what message lies beneath.
According to the HRSDC website, in 2001:
Filipinos in Canada represented the fourth largest visible minority subgroup (7.7% of total visible minority population; 1% of the total population). Toronto, Vancouver and Winnipeg accounted for 72% of the Filipino population…Filipinos were a very young group. Only 6% of their total population was 65 and over (compared with 13% of the non-visible minority population; 7% of the overall visible minority population). Close to 50% of the total Filipino population were of prime working age (25-54)…Filipinos had a high level of education. Among all visible minority subgroups, they ranked second in terms of the proportion of the population 15 years and over having earned a bachelor’s degree or higher and ranked first in terms of the percentage of the population with more than grade 13…Approximately 31% of Filipinos 15 years and over had a bachelor’s degree or higher compared to only 14% of the non-visible minority population and 24% of the overall visible minority population. In contrast to most of the other visible minority subgroups, a larger percentage of Filipino women than men had earned a university degree (33% vs. 27%)…The most popular fields of study were Commerce Management & Business Administration (27%), Health Professions Sciences & Technologies (22%), Engineering & Applied Sciences Technologies & Trades (13%) and Engineering & Applied Sciences (10%). These four fields made up 72% of the Filipino population that went beyond secondary school education to achieve a degree, certificate or diploma. They represented 1.2% of the total workforce and 9.1% of the overall visible minority workforce…Filipinos were most frequently working in the following Employment Equity Occupational Groups (EEOGs): Intermediate Sales & Service Personnel (19%), Other Sales & Service Personnel (14%), Clerical Personnel (13%) and Semi Skilled Manual Workers (13%)… Filipinos had the highest participation rate and the lowest unemployment rate among all visible minority subgroups. Their participation rate (76%) was considerably higher than that of the non-visible minority population (66.5%). Their unemployment rate was exceptionally low (5.6%) compared to that of the non-visible minority population (7.1%).
This is all good, right? But…
…In spite of their high level of education, the proportion of Filipinos in Professional occupations (12%) was below that observed for both the nonvisible minority population (15%) and the overall visible minority population (17%)…In 2000, Filipinos had the second lowest average income among all visible minority subgroups for full-time, full-year employment. Their income, at $32,748, was equivalent to only 74% of what the non-visible minority population earned ($43,989) and 86% of what total visible minorities earned ($37,957). Filipino women earned 81% of what Filipino men earned.
Okay. I have a huge problem with this. This bothers me to no end. In fact, it sucks big fat greasy lechon. But I am not at all surprised.
I have heard horror stories about the hell Filipino nannies have gone through—not just in Canada but world-wide. They have been abused and raped. The egregious acts done to them in Canada--inconceivable. But true. This is a problem.
I know of a Canadian nurse who worked in the Middle East along-side nurses from all over the world. There was a pay differential among these nurses depending on the country of origin—Filipino nurses being almost at the bottom, North American nurses at the top of the pay scale. So this “top-level” nurse would take the shifts, and if she wanted to take a day off, would get a Filipino nurse or one lower in pay level to take the shift, and she would pocket the difference. Pretty smart Canadian, eh? Of course she was. I wouldn’t blame her. Sure, there was discussion about the lower paid nurses’ countries getting larger grants for their nurses at the government level, and somehow this ‘makes up for the inequity.’ Either way, to me, this is a problem.
I know how dirt-cheap things are in the Philippines—from wares to people and services. $15 for a luxury treatment at a spa vs $80 and up for the same thing here. Don’t think I didn’t take advantage of this—shopping maven that I am. But is this a problem? You bet your shiny new sapatos I just gave you ($3; 2 for $5!) it is.
I have heard accusations and terms such as “corruption” (a touchy buzzword to our kababayyan) in reference to Filipinos who have benefited financially or otherwise in their work—be it facilitation of new immigrants into our community, leading and representing us on a political front, in health care, religious circles, volunteering for the community functions, etc, etc, etc. To the point where some work almost ragged for way less than is fair just to uphold that perception of giving. I come from a family that ascribes to this, so I know. I bet we all do. There is great satisfaction giving something for nothing. But that doesn’t put rice on the table. Again, this is a real big problem.
This divide is in our thinking and in our belief structure. I witness it all the time. What strikes me is this impressive work ethic that transcends all the fields we work in—we take pride in what we do, and we care. Deeply. We are brought up to give and give and give. Give more. Care more. Do and be more. There is nothing to be ashamed about that. Our journals applaud these acts and rightly so. I think we don’t even do this enough. But we are also brought up to be humble and modest, painfully so. If we take in return, this is considered rude and bad--bastos. Somewhere along the line giving all and accepting so little in return became the Philippine way. But this translates into the lowest paid workers, despite definite measurable contribution and awards of excellence in our work. This translates into burnout and loss of the very people trying to make a positive difference. This translates into poorer health in our people and the community as a whole. This translates into Pinoy tearing down Pinoy because of the harmful misguided mentality that one has to lose if another wins rather than a Win/Win or No Deal approach. This divide breaks my heart and my spirit, more than words can ever capture. This must be addressed. We need to build.
When I hear the accent and see the familiar mannerisms I grew up with, I always get a nostalgic twinge of what I call “home”: a deep sense of kinship, belonging, and identity. The pointing with the lips, the wordless eyebrow greetings. The expectation of any stranger for a full plate of food at a Filipino BBQ, and the chastising of any Filipino host who doesn’t represent our hospitality. The respectful greeting of elders with hand to forehead, kneeling. All of it. For some trying to assimilate into North American culture, these things are embarrassing and funny. For me, these things strike an emotional chord—I can relate to these “quirks”, their irrational rationale, their oddness to an on-looker, but there is this intense pride mixed with a sadness in what they represent: the unsurpassable good in our hearts mixed with this dooming self-perception of inferiority and submissiveness. This chord and the divide it represents are rooted deep in my being, and I am only now beginning to understand it. It’s mine.
So I will say it again, and this time with a vengeance: Ako ay Pilipina. Ako ay Flip. I am Pyllifinah. Whatever way I say it, you cannot take that away from me. You can call me a “dirty Flip” any day, and, frankly, I’d love you that much more for it.
Tuesday, July 18, 2006
Ask Dr. Denise: Accessing Medical Care
exerpts published in The Filipino Journal: July 5-20 2006 issue p 19
Kumusta ka and thank you for your queries, support, and good wishes! Thank you also for challenging me to do a quick tutorial in Tagalog—there’s no better way to learn than diving right in! I must however, mention that as I am still learning our native tongue, I am unable to fully address your questions if posed in Tagalog, and because I must protect your health information, I can’t simply forward your letters to translators. If at all possible, please send me your questions/comments in English, and if you’d like a tagalog translation, I can attempt to do that. I really value your questions/comments, and will do my best to help out in as timely a fashion as I am able. Please keep in mind that due to the nature of this forum (my limited ability to gather a medical history or perform physical examinations or laboratory tests) and from a medico-legal perspective, I can’t offer explicit individual medical advice nor provide any type of follow-up care. I cannot take the role of a reader's physician or health care provider. All I can do is provide general health education with the intent of having this health information accessible to the Filipino Journal's readers. My plan is to incorporate my responses in this column, along with your medical questions. Please indicate precisely if/how you would like your question published. I do not plan to identify you or anyone you've inquired about in the column unless you specifically request this and I have received written consent from the involved individuals. Depending on the volume of readers' questions I receive, I may need to prioritize my responses in the journal (leave some questions for future issues) and categorize types of questions for summarizing my responses. Salamat po—thank you for your patience and understanding. Here are a couple excellent questions that have come up:
- I just immigrated to Canada. I need a doctor, preferably Filipino/Filipina. How do I get one?
Finding a family physician here is difficult, and finding a Pinoy one is even tougher. I don’t know of any Filipino doctors right now accepting patients, but I’m looking into compiling a list. Your best bet is to contact:
The Family Doctor Connection at (204) 786-7111. The Manitoba College of Family Physicians and Manitoba Health will give you an up-to-date list of Winnipeg family doctors accepting new patients.
- Our daughter has been feeling quite ill, throwing up and headaches. When should we take her to see a doctor?
If you have an urgent medical concern, please contact your doctor or health care provider, if possible. On Page 08 of the Health Services Directory (dark blue pages in the middle of the MTS Winnipeg White Pages, there are Emergency Room Tips and the contact information for the Emergency Departments. The Urgent Care Centre (Misericordia Health Centre) and Pan Am Minor Injury Clinic are good places to consider for non-emergent/less urgent problems. You can also try one of the walk-in clinics in your area. It is always helpful to call ahead of time, if possible, to coordinate your care.
If you are unsure if you need medical care and/or are unable to contact your doctor, you can call Health Links-Info Sante at (204) 788-8200; Toll-free 1-888-315-9257 where registered nurses can answer your health-related questions and direct you in more detail.
If your question is specifically regarding a medication/drug you are taking, you can contact your dispensing pharmacist for details on the medications.
For Mental Health concerns (such as for depression, anxiety, etc): you can call the WRHA Mobile Crisis Service at (204) 946-9109 where hospital emergency rooms and the Urgent Care Centre provide some mental health crisis services. KLINIC has a 24-hour Crisis/Suicide Line at (204) 786-8686; Toll-free 1-888-322-3019; Deaf Access (204) 784-4097; Counselling Appointments at (204) 784-4059; Drop-in Counselling call (204) 784-4067.
The 24-hour Sexual Assault Crisis Line is (204) 786-8631; Toll-free 1-888-292-7565; Deaf Access (204) 784-4097; Counselling Appointments at (204) 784-4059; Drop-in Counselling call (204) 784-4067.
Health Emergency/Ambulance call 911.
For the Poison Helpline call (204) 787-2591.
A couple of useful websites:
The Winnipeg Regional Health Authority www.wrha.mb.ca; (204) 926-7000
Manitoba Health: www.gov.mb.ca/health
- My lola hasn't been to the doctor in years. She is scared to be examined by the doctor. What can she expect?
I encourage patients to be pro-active about their care, especially considering the current difficulties with access to physicians/medical care. If there are any parts of the doctor’s visit that you don’t understand, please feel free to ask your doctor. S/he should run through the procedure with you ahead of time, if you are fearful. Doctors also have the duty to keep personal health information confidential. Often the pap/gynecological/breast exams are the more worrisome to some women. Nothing is done w/o consent of the patient, so if it feels uncomfortable, don’t necessarily do it. A patient also has the right to request a helper. Many physicians automatically bring in a “helper”/witness because of the sensitive nature of the tests.
Kumusta ka and thank you for your queries, support, and good wishes! Thank you also for challenging me to do a quick tutorial in Tagalog—there’s no better way to learn than diving right in! I must however, mention that as I am still learning our native tongue, I am unable to fully address your questions if posed in Tagalog, and because I must protect your health information, I can’t simply forward your letters to translators. If at all possible, please send me your questions/comments in English, and if you’d like a tagalog translation, I can attempt to do that. I really value your questions/comments, and will do my best to help out in as timely a fashion as I am able. Please keep in mind that due to the nature of this forum (my limited ability to gather a medical history or perform physical examinations or laboratory tests) and from a medico-legal perspective, I can’t offer explicit individual medical advice nor provide any type of follow-up care. I cannot take the role of a reader's physician or health care provider. All I can do is provide general health education with the intent of having this health information accessible to the Filipino Journal's readers. My plan is to incorporate my responses in this column, along with your medical questions. Please indicate precisely if/how you would like your question published. I do not plan to identify you or anyone you've inquired about in the column unless you specifically request this and I have received written consent from the involved individuals. Depending on the volume of readers' questions I receive, I may need to prioritize my responses in the journal (leave some questions for future issues) and categorize types of questions for summarizing my responses. Salamat po—thank you for your patience and understanding. Here are a couple excellent questions that have come up:
- I just immigrated to Canada. I need a doctor, preferably Filipino/Filipina. How do I get one?
Finding a family physician here is difficult, and finding a Pinoy one is even tougher. I don’t know of any Filipino doctors right now accepting patients, but I’m looking into compiling a list. Your best bet is to contact:
The Family Doctor Connection at (204) 786-7111. The Manitoba College of Family Physicians and Manitoba Health will give you an up-to-date list of Winnipeg family doctors accepting new patients.
- Our daughter has been feeling quite ill, throwing up and headaches. When should we take her to see a doctor?
If you have an urgent medical concern, please contact your doctor or health care provider, if possible. On Page 08 of the Health Services Directory (dark blue pages in the middle of the MTS Winnipeg White Pages, there are Emergency Room Tips and the contact information for the Emergency Departments. The Urgent Care Centre (Misericordia Health Centre) and Pan Am Minor Injury Clinic are good places to consider for non-emergent/less urgent problems. You can also try one of the walk-in clinics in your area. It is always helpful to call ahead of time, if possible, to coordinate your care.
If you are unsure if you need medical care and/or are unable to contact your doctor, you can call Health Links-Info Sante at (204) 788-8200; Toll-free 1-888-315-9257 where registered nurses can answer your health-related questions and direct you in more detail.
If your question is specifically regarding a medication/drug you are taking, you can contact your dispensing pharmacist for details on the medications.
For Mental Health concerns (such as for depression, anxiety, etc): you can call the WRHA Mobile Crisis Service at (204) 946-9109 where hospital emergency rooms and the Urgent Care Centre provide some mental health crisis services. KLINIC has a 24-hour Crisis/Suicide Line at (204) 786-8686; Toll-free 1-888-322-3019; Deaf Access (204) 784-4097; Counselling Appointments at (204) 784-4059; Drop-in Counselling call (204) 784-4067.
The 24-hour Sexual Assault Crisis Line is (204) 786-8631; Toll-free 1-888-292-7565; Deaf Access (204) 784-4097; Counselling Appointments at (204) 784-4059; Drop-in Counselling call (204) 784-4067.
Health Emergency/Ambulance call 911.
For the Poison Helpline call (204) 787-2591.
A couple of useful websites:
The Winnipeg Regional Health Authority www.wrha.mb.ca; (204) 926-7000
Manitoba Health: www.gov.mb.ca/health
- My lola hasn't been to the doctor in years. She is scared to be examined by the doctor. What can she expect?
I encourage patients to be pro-active about their care, especially considering the current difficulties with access to physicians/medical care. If there are any parts of the doctor’s visit that you don’t understand, please feel free to ask your doctor. S/he should run through the procedure with you ahead of time, if you are fearful. Doctors also have the duty to keep personal health information confidential. Often the pap/gynecological/breast exams are the more worrisome to some women. Nothing is done w/o consent of the patient, so if it feels uncomfortable, don’t necessarily do it. A patient also has the right to request a helper. Many physicians automatically bring in a “helper”/witness because of the sensitive nature of the tests.
Saturday, July 01, 2006
Ask Dr. Denise: Readers' health questions welcome
The Filipino Journal: Vol 20, No 11 p 25
June 4-20 2006 issue
Kumusta kayo, mga kababayan! It feels good to greet you in Tagalog. I’d like to introduce this column and myself. My name is Denise Marie Koh, and I am a physician here in Winnipeg. I was born in Regina, Saskatchewan of Filipino parents after they took up citizenship here in the 70s. Although my family has left the Philippines, the Philippines is still very much in us. Throughout my life, my family has always been actively involved with the Filipino community at many levels—in the social, religious, and creative/artistic spheres, to name a few. From a young age, I have continually been encouraged to be proactive and speak out on issues close to home. In Regina, as a Filipinas Youth Group Ambassador, I was involved with Philippine Folk dancing and the language school. When I moved to Winnipeg in 2003 to continue my medical training, my journey to understanding my roots kicked into high gear. Since my move, I’ve had an opportunity not only to plug into the culturally rich Filipino network and eat a lot more pancit, lumpia, and other goodies, but I have also gotten to work closely with many Filipinos. I got a good look at the health issues affecting our people, having seen and treated Filipino patients at the hospitals and outpatient clinics. I’ve noticed recurring themes in my medical practice, especially among the Filipino patient population. This was reinforced greatly by my medical mission to Catanduanes in January, 2005.
What an eye-opener. When the majority of the hundreds of patients I saw requested vitamins, I learned of a serious problem that makes my stomach turn. In this day and age, no one should suffer malnutrition. Ever. On top of limited essentials such as running water and electricity, I noticed a major lack of health care services and medications, and saw the problems inherent in this health care system, particularly compounded in rural areas. I learned only too well that the people who need the health resources the most in our and many communities, get the least by way of limited access, communication difficulties, and cultural barriers. This socio-cultural isolation is self-perpetuating—the perfect catch 22. I have seen certain illnesses and health issues that are common to our kababayan, and at the suggestions of some patients, I’d like to address those problems as a service to you. It is one of my life missions to educate and help Filipinos understand about their health and make a positive impact on their collective wellbeing. Simply put, I know I can help Filipinos lead a healthy and healthful lifestyle, and I am hoping to use this forum to do so. I plan to discuss such issues as gout, diabetes, sexual health, high blood pressure, high cholesterol, musculoskeletal injuries, drugs and alcohol, depression, nutritional supplements, common medications, and laboratory tests. A Q & A format would be most useful, and would ensure the column is tailored to what you, the readers, want. Despite my busy schedule, I am doing this with no expectation of remuneration (I'm not kidding, Tita Linda!). So please, feel free to ask me any health or medical questions—if I can’t answer you, I will find the right sources who can. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
written ~5/31/06
June 4-20 2006 issue
Kumusta kayo, mga kababayan! It feels good to greet you in Tagalog. I’d like to introduce this column and myself. My name is Denise Marie Koh, and I am a physician here in Winnipeg. I was born in Regina, Saskatchewan of Filipino parents after they took up citizenship here in the 70s. Although my family has left the Philippines, the Philippines is still very much in us. Throughout my life, my family has always been actively involved with the Filipino community at many levels—in the social, religious, and creative/artistic spheres, to name a few. From a young age, I have continually been encouraged to be proactive and speak out on issues close to home. In Regina, as a Filipinas Youth Group Ambassador, I was involved with Philippine Folk dancing and the language school. When I moved to Winnipeg in 2003 to continue my medical training, my journey to understanding my roots kicked into high gear. Since my move, I’ve had an opportunity not only to plug into the culturally rich Filipino network and eat a lot more pancit, lumpia, and other goodies, but I have also gotten to work closely with many Filipinos. I got a good look at the health issues affecting our people, having seen and treated Filipino patients at the hospitals and outpatient clinics. I’ve noticed recurring themes in my medical practice, especially among the Filipino patient population. This was reinforced greatly by my medical mission to Catanduanes in January, 2005.
What an eye-opener. When the majority of the hundreds of patients I saw requested vitamins, I learned of a serious problem that makes my stomach turn. In this day and age, no one should suffer malnutrition. Ever. On top of limited essentials such as running water and electricity, I noticed a major lack of health care services and medications, and saw the problems inherent in this health care system, particularly compounded in rural areas. I learned only too well that the people who need the health resources the most in our and many communities, get the least by way of limited access, communication difficulties, and cultural barriers. This socio-cultural isolation is self-perpetuating—the perfect catch 22. I have seen certain illnesses and health issues that are common to our kababayan, and at the suggestions of some patients, I’d like to address those problems as a service to you. It is one of my life missions to educate and help Filipinos understand about their health and make a positive impact on their collective wellbeing. Simply put, I know I can help Filipinos lead a healthy and healthful lifestyle, and I am hoping to use this forum to do so. I plan to discuss such issues as gout, diabetes, sexual health, high blood pressure, high cholesterol, musculoskeletal injuries, drugs and alcohol, depression, nutritional supplements, common medications, and laboratory tests. A Q & A format would be most useful, and would ensure the column is tailored to what you, the readers, want. Despite my busy schedule, I am doing this with no expectation of remuneration (I'm not kidding, Tita Linda!). So please, feel free to ask me any health or medical questions—if I can’t answer you, I will find the right sources who can. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
written ~5/31/06
Monday, February 28, 2005
Paglalakbay sa Atin
February 14, 2005
I was a child when I last visited the Philippines twenty years ago. I have vague memories of the mass of people from the airport in Manila to Tita’s house. This time the crowd was not as dense but my cousin Joel Carlos who met us at the airport showed his skill in maneuvering through the noisy and nerve-racking traffic. The streets were alive with cars, jeepneys, tricycles, jaywalkers and peddlers.
A week before and after the mission, we stayed with Tita Lor (Lorinda Carlos) in Paranaque. She threw a party so I had a chance to meet my relatives. A few times we had sumptuous dinners at Tito Rody (Carlos) who lives two minutes away. We had king crabs, large prawns, mussels, bangus, pancit, lechon, etc. Considering the variety of tasty Philippine cuisine, I'm amazed at how the folks maintain their slender figures.
I am grateful to Tita Mimi (Salazar) who took us to Divisoria to buy Capiz goods and to Silahis International in Intramuros, to Ate Ninni (Castro) and Ate Maridee (Carlos) who took us to the megamalls. And what I didn’t get to buy, I got as presents: a crocheted bandana and sungka from Ate Bingle (Dr. Victoria Ascue), the naked man holding a barrel from Cousin Nikka (Carlos), pj and other fancy clothes from Tita Ofie (Carlos) and Tita Cora (Castro) who traveled with Tito Andy from Malolos, a mahjong set with numbered tiles from Tita Lor and various other gifts, too many to mention.
After the mission, I had a great time hanging out with the volunteers at the 5-star Westin Hotel. Later, Mom’s friends, Drs. Romeo and .Ernesta Quintana, brought us to their home in UP Los Banos for a couple of days during which we visited the International Rice Research Institute with Dr. Ben Vergara, one of nine living National Scientists of the Philippines and author of the Farmer’s Primer on Growing Rice. Forty eight editions have been published in 40 languages in more than 20 countries in Asia, Africa, and Latin America which substantially increased global rice production. The Vergaras treated us at the Kamayan sa Palaisdaan where we had a seafood dinner before dessert of kutsinta, puto bumbong, etc. at their magnificent home. Mrs. Lina Vergara showed us the sprawling electrified miniature Christmas village she built.
I gained so many great memories, new-found friendships, and special gifts I don’t know where to begin to thank all relatives and friends. Even on our return trip, my cousin Kuya Parrish Carlos got our seats upgraded to business class which included the use of the lounge, free drinks and more food: arroz caldo, finger food, fresh mangoes and other fruits and pastries.
This trip was a tremendous experience for me both professionally and culturally. The chance to meet and build bonds with my relatives was a big bonus. I’ll do it again if the golden opportunity presents itself.
I was a child when I last visited the Philippines twenty years ago. I have vague memories of the mass of people from the airport in Manila to Tita’s house. This time the crowd was not as dense but my cousin Joel Carlos who met us at the airport showed his skill in maneuvering through the noisy and nerve-racking traffic. The streets were alive with cars, jeepneys, tricycles, jaywalkers and peddlers.
A week before and after the mission, we stayed with Tita Lor (Lorinda Carlos) in Paranaque. She threw a party so I had a chance to meet my relatives. A few times we had sumptuous dinners at Tito Rody (Carlos) who lives two minutes away. We had king crabs, large prawns, mussels, bangus, pancit, lechon, etc. Considering the variety of tasty Philippine cuisine, I'm amazed at how the folks maintain their slender figures.
I am grateful to Tita Mimi (Salazar) who took us to Divisoria to buy Capiz goods and to Silahis International in Intramuros, to Ate Ninni (Castro) and Ate Maridee (Carlos) who took us to the megamalls. And what I didn’t get to buy, I got as presents: a crocheted bandana and sungka from Ate Bingle (Dr. Victoria Ascue), the naked man holding a barrel from Cousin Nikka (Carlos), pj and other fancy clothes from Tita Ofie (Carlos) and Tita Cora (Castro) who traveled with Tito Andy from Malolos, a mahjong set with numbered tiles from Tita Lor and various other gifts, too many to mention.
After the mission, I had a great time hanging out with the volunteers at the 5-star Westin Hotel. Later, Mom’s friends, Drs. Romeo and .Ernesta Quintana, brought us to their home in UP Los Banos for a couple of days during which we visited the International Rice Research Institute with Dr. Ben Vergara, one of nine living National Scientists of the Philippines and author of the Farmer’s Primer on Growing Rice. Forty eight editions have been published in 40 languages in more than 20 countries in Asia, Africa, and Latin America which substantially increased global rice production. The Vergaras treated us at the Kamayan sa Palaisdaan where we had a seafood dinner before dessert of kutsinta, puto bumbong, etc. at their magnificent home. Mrs. Lina Vergara showed us the sprawling electrified miniature Christmas village she built.
I gained so many great memories, new-found friendships, and special gifts I don’t know where to begin to thank all relatives and friends. Even on our return trip, my cousin Kuya Parrish Carlos got our seats upgraded to business class which included the use of the lounge, free drinks and more food: arroz caldo, finger food, fresh mangoes and other fruits and pastries.
This trip was a tremendous experience for me both professionally and culturally. The chance to meet and build bonds with my relatives was a big bonus. I’ll do it again if the golden opportunity presents itself.
The 5th Medical Mission to Catanduanes
February 14, 2005; published in The Filipino Journal
I looked up nervously at the thin, dark 89-year-old woman as she sat down across the table from me. I was still a medical resident; I approached this mission with eagerness and trepidation. This room was a bustle of frenzied activity—crowds of Filipinos outside in the island heat, pressed up against the door to our makeshift waiting room/examining room. About 25 of the docs, nurses, and other volunteers on this mission moved around the group of patients lucky enough to be admitted in, taking brief histories, blood pressures, examining them in their chairs, then directing them to the lab, pharmacy, or consultants elsewhere in this hospital. There were 2 makeshift exam booths in the corners—where a small hospital gurney was separated from the room with a small divider. It was hot, only a couple fans helping to dissipate the heat of all the people milling about in this room that only hours earlier served as church for our daily morning mass. Periodically a volunteer would come by with refreshments—empanadas, bottled water, pan de sal, hopia, juice, assorted Filipino pastries.
Anong sakit po? I attempted in Tagalog, as I scanned her sheet of vital signs. The interpreter translated for me. “Her back hurts.” How long? 3-4 years. I continued to take a history of her complaints which were similar to many of the others’ I’d see—dizziness, weakness, cough, various pains, persistent rashes, bowel complaints sprinkled with the odd tuberculosis, ulcer. Compared to back home in Winnipeg, I saw more unusual infectious diseases and less depression and anxiety. As I examined her, I noticed how spry and hardy the elderly were here compared to the overweight frail in North America. I realized that these people’s health issues were a reflection of the difficult circumstances: chronic malnutrition, inconsistent care, piecemeal investigations and treatments. Here, I knew that if someone was sitting in front of me, it was probably a lot worse than he/she was saying—these people didn’t seek medical attention unless absolutely necessary, shared and used costly medications sparingly over years, and were generally dictated by the price/access of treatments rather than their necessity. Once I realized that these people would likely not see a physician/health care professional for a long time and the treatments/medications I could give them now were essentially all they’d have access to for who knows how long, I let my own insecurities fall to the wayside and dived into the huge work ahead of me. In the interest of seeing as many patients as possible during my short time on this mission, I had less time to spend with each patient.
This mission, the 5th Medical, Surgical, and Dental Mission of the Catanduanes International Association, lasted from January 10-14th, 2005 in the town of Virac. We saw a total of 4892 patients from all 11 towns of the province of Catanduanes. 1146 more patients were registered but not seen for lack of time and resources. Mission volunteers from Canada, the United States and the Philippines registered 1283 patients on general consultations and another 1184 pediatric cases. The balance of the 4892 indigent patients who went to the Eastern Bicol Medical Center during the five-day mission are as follows: 187 Internal Medicine cases, 19 Obstetrics-Gynecology case, 93 Gastroenterology cases, 153 Ophthalmology cases, 310 Refraction cases, 58 Physical Therapy cases, 120 Minor Surgery cases, 76 Major Surgery cases, 500 Dental cases, and 909 Laboratory/X-ray cases. The medical mission, which also brought drugs and medicines, filled a total of 3084 prescriptions and gave vitamins to 168 patients and families. Of the 76 major surgeries, including cataracts, nearly half (33) cases were of excision procedures. The 109 Canadian and American volunteers were reinforced by 68 local Filipino volunteers, including 9 doctors and other medical professionals. The Canadian Volunteers included: Aida Buendia RN, Roger Buendia, Amy Chantengco, RN, Abito Collantes, Maxima Collantes, Pablo Garcia, Jr., Eric Hill, Sharon Hill, RN, Sharon Homer, Dr. Denise Koh, Dr. Jose Cresente Madrilejos, Dr. Mary Madrilejos, Amado Mendoza, Consuelo Mendoza, Marcelino Mendoza, Dr. Raymond Padua, Dr. Rudy Padua, Evelyn Padua, Lulu Regimbal RN, Kim Reimer, Delia Saavedra, Luis Saavedra, Amy Sangalang, Felix Sangalang, Necita Tejerero, Carmelita Tolledo, Leo Tolledo, Victorina Tualla, Conrado Tualla, Marcelo Tualla, Conrado Tualla, Jr. The Winnipeg group of volunteers was,organized by Consuelo and Amado Mendoza Sr. The community showed gratitude by hosting festive parties with wonderful local delicacies in our honour. We got to taste such goodies as buko juice, tikbol, gabe gabe, lechon, tilapia, fresh mangoes, guava, pineapple, jackfruit, dinuguan, pili nuts.
I learned and felt so many things during this mission: the sadness that there were so many who couldn’t be seen, the frustration that a lot of what I prescribed/advised would only last a short while with little to no follow-up, the fear that I couldn’t and would never be able to do enough, the appreciation and guilt for what we have in North America. I was angry at the difficult circumstances Filipinos had to face. But I was also proud of my vibrant culture, the steadfastness and strength of my forebears, the kindness and generosity of Filipinos. The mission solidified my love for a country I had never really known, but whose influences were enmeshed in my daily life in Canada growing up. Not only was this mission an excellent experience for my medical education it was an important step in my journey to understanding my roots.
I looked up nervously at the thin, dark 89-year-old woman as she sat down across the table from me. I was still a medical resident; I approached this mission with eagerness and trepidation. This room was a bustle of frenzied activity—crowds of Filipinos outside in the island heat, pressed up against the door to our makeshift waiting room/examining room. About 25 of the docs, nurses, and other volunteers on this mission moved around the group of patients lucky enough to be admitted in, taking brief histories, blood pressures, examining them in their chairs, then directing them to the lab, pharmacy, or consultants elsewhere in this hospital. There were 2 makeshift exam booths in the corners—where a small hospital gurney was separated from the room with a small divider. It was hot, only a couple fans helping to dissipate the heat of all the people milling about in this room that only hours earlier served as church for our daily morning mass. Periodically a volunteer would come by with refreshments—empanadas, bottled water, pan de sal, hopia, juice, assorted Filipino pastries.
Anong sakit po? I attempted in Tagalog, as I scanned her sheet of vital signs. The interpreter translated for me. “Her back hurts.” How long? 3-4 years. I continued to take a history of her complaints which were similar to many of the others’ I’d see—dizziness, weakness, cough, various pains, persistent rashes, bowel complaints sprinkled with the odd tuberculosis, ulcer. Compared to back home in Winnipeg, I saw more unusual infectious diseases and less depression and anxiety. As I examined her, I noticed how spry and hardy the elderly were here compared to the overweight frail in North America. I realized that these people’s health issues were a reflection of the difficult circumstances: chronic malnutrition, inconsistent care, piecemeal investigations and treatments. Here, I knew that if someone was sitting in front of me, it was probably a lot worse than he/she was saying—these people didn’t seek medical attention unless absolutely necessary, shared and used costly medications sparingly over years, and were generally dictated by the price/access of treatments rather than their necessity. Once I realized that these people would likely not see a physician/health care professional for a long time and the treatments/medications I could give them now were essentially all they’d have access to for who knows how long, I let my own insecurities fall to the wayside and dived into the huge work ahead of me. In the interest of seeing as many patients as possible during my short time on this mission, I had less time to spend with each patient.
This mission, the 5th Medical, Surgical, and Dental Mission of the Catanduanes International Association, lasted from January 10-14th, 2005 in the town of Virac. We saw a total of 4892 patients from all 11 towns of the province of Catanduanes. 1146 more patients were registered but not seen for lack of time and resources. Mission volunteers from Canada, the United States and the Philippines registered 1283 patients on general consultations and another 1184 pediatric cases. The balance of the 4892 indigent patients who went to the Eastern Bicol Medical Center during the five-day mission are as follows: 187 Internal Medicine cases, 19 Obstetrics-Gynecology case, 93 Gastroenterology cases, 153 Ophthalmology cases, 310 Refraction cases, 58 Physical Therapy cases, 120 Minor Surgery cases, 76 Major Surgery cases, 500 Dental cases, and 909 Laboratory/X-ray cases. The medical mission, which also brought drugs and medicines, filled a total of 3084 prescriptions and gave vitamins to 168 patients and families. Of the 76 major surgeries, including cataracts, nearly half (33) cases were of excision procedures. The 109 Canadian and American volunteers were reinforced by 68 local Filipino volunteers, including 9 doctors and other medical professionals. The Canadian Volunteers included: Aida Buendia RN, Roger Buendia, Amy Chantengco, RN, Abito Collantes, Maxima Collantes, Pablo Garcia, Jr., Eric Hill, Sharon Hill, RN, Sharon Homer, Dr. Denise Koh, Dr. Jose Cresente Madrilejos, Dr. Mary Madrilejos, Amado Mendoza, Consuelo Mendoza, Marcelino Mendoza, Dr. Raymond Padua, Dr. Rudy Padua, Evelyn Padua, Lulu Regimbal RN, Kim Reimer, Delia Saavedra, Luis Saavedra, Amy Sangalang, Felix Sangalang, Necita Tejerero, Carmelita Tolledo, Leo Tolledo, Victorina Tualla, Conrado Tualla, Marcelo Tualla, Conrado Tualla, Jr. The Winnipeg group of volunteers was,organized by Consuelo and Amado Mendoza Sr. The community showed gratitude by hosting festive parties with wonderful local delicacies in our honour. We got to taste such goodies as buko juice, tikbol, gabe gabe, lechon, tilapia, fresh mangoes, guava, pineapple, jackfruit, dinuguan, pili nuts.
I learned and felt so many things during this mission: the sadness that there were so many who couldn’t be seen, the frustration that a lot of what I prescribed/advised would only last a short while with little to no follow-up, the fear that I couldn’t and would never be able to do enough, the appreciation and guilt for what we have in North America. I was angry at the difficult circumstances Filipinos had to face. But I was also proud of my vibrant culture, the steadfastness and strength of my forebears, the kindness and generosity of Filipinos. The mission solidified my love for a country I had never really known, but whose influences were enmeshed in my daily life in Canada growing up. Not only was this mission an excellent experience for my medical education it was an important step in my journey to understanding my roots.
Monday, August 18, 2003
Folklorama Revisited
The Filipino Journal: August 1-15 2003 issue pp17-18
I was pleasantly surprised by the goosebumps I felt when the first bars of The Tapis started playing and the beautiful Magdaragat dancers in their vibrant costumes took the stage. It has been almost 20 years since I myself was onstage—complete with stage make-up, slicked back bun, an assortment of colourful attire, and, of course, that big friendly Filipina smile. It seems I’d almost forgotten my “brown-ness,” born in Saskatchewan, raised a coconut (ya know, brown outside, white inside) and having basically immersed myself in pseudo-white culture for all these years. I figured my recent move to Winnipeg would help me get back to my roots, and I was absolutely right: thanks to Tita Linda, Tito Rod, and the warm Filipino community who’ve embraced me whole-heartedly, despite my non-existent Tagalog. What a treat to kick off my new Winnipeg/reborn Filipina life with an awesome Folklorama experience starting with my home pavilion. The event struck a sentimental chord in me for another reason: back during my days in the Regina Filipinas Youth Group, Magdaragat came to perform for Mosaic, the Regina equivalent of Folklorama. During that time, we billeted and became fast friends and pen pals with all these lively members, took artistic workshops with the group, and were thoroughly inspired by founder Dante Buenaventura’s artistic talents, work ethic, and above all his fierce love of the Philippines and its fabulous culture.
There were many highlights of my evening at the Pearl of the Orient Pavilion: clapping along to the cute children in their hip hop segment; the nail-biting ankle-snapping frenzy of the dexterous Tinikling dancers; the heart-breakingly enchanting Singkil with the wonderfully haughty queen (the rhythm still brings a tear to my eyes); the coy and playful Tapis (I got a chance to shake my booty too, thanks to the audience participation part!); tsismis-sing with the ladies about you name it—shoes and purses—at the cultural display; the amazing voice of Melanie Centeno, our very own Star Search Superstar; the engaging and hilarious emcee, Patrick; and topping it off with a lengthy bout of photo-op action with Karen Alvarez, the extremely talented and gracious lead actress for Miss Saigon.
Next stop was the Argentina Tango Pavilion where I got VIP treatment from the helpful volunteers and settled in for a wonderful show which interspersed a screen map tour of Argentina with an entertaining emcee, some excellent children’s folk dances, the sizzling tango, moving songs from a live Argentinean band, and the energetic malambo where the dancers use wooden balls on cords swung in eye-popping patterns and their boot heels to tap the floor creating a catchy rhythm. I got to sample the Cervico, a tasty wine and fruit drink and mingle with the gregarious crowd.
I also got a warm Mabuhay at the Philippine Pavilion Nayong Pilipino where I again got to delight in the impressive talents of my fellow Filipinos. This time the Kayumanggi Philippine Performing Arts members strutted their stuff; my Filipina pride was growing to boastful proportions as I watched the primal movements of the Igorot, the Filipino thrift and resourcefulness captured in the rural dances, the Spanish-influenced romantic wedding dance, another spine-tingling Singkil (this time with a sword-flashing prince), and the powerful voices of local songbirds.
I then pigged out on a heaping plate of mouth-watering barbecue, pancit, caldaretta, lumpia, and rice—washing it down with a refreshing mango juice.
With a full tummy and a contented sigh, I headed home with the resolve to visit as many pavilions as I could. My final thoughts on my Folklorama Revisited kick-off: Manitoba really is Friendly with a cultural landscape second to none; and wow, we Flips really are a beautiful, multi-talented, fun, diverse, warm group. We really rock. Ako ay Pilipina.
I was pleasantly surprised by the goosebumps I felt when the first bars of The Tapis started playing and the beautiful Magdaragat dancers in their vibrant costumes took the stage. It has been almost 20 years since I myself was onstage—complete with stage make-up, slicked back bun, an assortment of colourful attire, and, of course, that big friendly Filipina smile. It seems I’d almost forgotten my “brown-ness,” born in Saskatchewan, raised a coconut (ya know, brown outside, white inside) and having basically immersed myself in pseudo-white culture for all these years. I figured my recent move to Winnipeg would help me get back to my roots, and I was absolutely right: thanks to Tita Linda, Tito Rod, and the warm Filipino community who’ve embraced me whole-heartedly, despite my non-existent Tagalog. What a treat to kick off my new Winnipeg/reborn Filipina life with an awesome Folklorama experience starting with my home pavilion. The event struck a sentimental chord in me for another reason: back during my days in the Regina Filipinas Youth Group, Magdaragat came to perform for Mosaic, the Regina equivalent of Folklorama. During that time, we billeted and became fast friends and pen pals with all these lively members, took artistic workshops with the group, and were thoroughly inspired by founder Dante Buenaventura’s artistic talents, work ethic, and above all his fierce love of the Philippines and its fabulous culture.
There were many highlights of my evening at the Pearl of the Orient Pavilion: clapping along to the cute children in their hip hop segment; the nail-biting ankle-snapping frenzy of the dexterous Tinikling dancers; the heart-breakingly enchanting Singkil with the wonderfully haughty queen (the rhythm still brings a tear to my eyes); the coy and playful Tapis (I got a chance to shake my booty too, thanks to the audience participation part!); tsismis-sing with the ladies about you name it—shoes and purses—at the cultural display; the amazing voice of Melanie Centeno, our very own Star Search Superstar; the engaging and hilarious emcee, Patrick; and topping it off with a lengthy bout of photo-op action with Karen Alvarez, the extremely talented and gracious lead actress for Miss Saigon.
Next stop was the Argentina Tango Pavilion where I got VIP treatment from the helpful volunteers and settled in for a wonderful show which interspersed a screen map tour of Argentina with an entertaining emcee, some excellent children’s folk dances, the sizzling tango, moving songs from a live Argentinean band, and the energetic malambo where the dancers use wooden balls on cords swung in eye-popping patterns and their boot heels to tap the floor creating a catchy rhythm. I got to sample the Cervico, a tasty wine and fruit drink and mingle with the gregarious crowd.
I also got a warm Mabuhay at the Philippine Pavilion Nayong Pilipino where I again got to delight in the impressive talents of my fellow Filipinos. This time the Kayumanggi Philippine Performing Arts members strutted their stuff; my Filipina pride was growing to boastful proportions as I watched the primal movements of the Igorot, the Filipino thrift and resourcefulness captured in the rural dances, the Spanish-influenced romantic wedding dance, another spine-tingling Singkil (this time with a sword-flashing prince), and the powerful voices of local songbirds.
I then pigged out on a heaping plate of mouth-watering barbecue, pancit, caldaretta, lumpia, and rice—washing it down with a refreshing mango juice.
With a full tummy and a contented sigh, I headed home with the resolve to visit as many pavilions as I could. My final thoughts on my Folklorama Revisited kick-off: Manitoba really is Friendly with a cultural landscape second to none; and wow, we Flips really are a beautiful, multi-talented, fun, diverse, warm group. We really rock. Ako ay Pilipina.
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