Housecall with Dr. Denise
urban NDN - August 2008 - issue 3
My 62 year-old grandpa has been complaining of problems with urination. He says he goes to the washroom to pee so often--even during the night--that his sleep is always disturbed. He further states that, when he has to go pee, he has to go right away; it takes him a long time to finish peeing, but he feels that there’s still something there left. The funny part of the story is when he says that he’s “dripping”! He feels embarrassed when that happens and we would tease him “stinky”! He is strong and has never been sick in his life. What’s wrong with him, is this part of getting old? What should we do about this?
Your grandpa is most probably experiencing what many men in his age group are having. I am referring to a condition called Benign Prostatic Hypertrophy (BPH). Simply put, the prostate gland, which is located around the opening of the male urinary bladder, enlarges, causing it to obstruct the normal flow of urine, thus leading to the kind of symptoms your grandpa’s noticing. How it develops is not yet fully known, but it is thought that impaired hormonal factors are involved. This is commonly seen in men over age 50; it is usually a progressive disease where patients also notice their force/stream of urine is decreased and or interrupted. Hesitancy (experiencing difficulty starting the flow of urine) and urinary tract/bladder infections are not uncommon. I would recommend your grandpa visit his physician to be examined. There are various ways of treating this disorder, either by taking pills to shrink the prostate or improve the symptoms or by undergoing one of the surgical procedures to remove/scrape the prostate gland. For now, I ‘d suggest that your grandpa not drink too much fluid, particularly caffeine-containing beverages and alcohol, before going to bed to avoid getting the urge to urinate at night. There are also some drugs he should avoid, such as decongestants that can stimulate smooth muscle in the bladder neck and prostate, increasing the obstruction and others types that can affect bladder muscle contractility. There are some “alternative” drugs such as Saw Palmetto and African plum tree which are examples of plant extracts used by patients to reduce BPH symptoms, but identification of and how the active ingredients work and long-term efficacy and safety are often unclear in these mixtures.
P.S. Some patients ask me, about their concern of decreasing their “manliness” (eg. Problems achieving/maintaining erections) after prostate surgery, the answer, generally, is NO, although it could be a remote complication they should discuss in more detail with the urologist.
Dear Dr. Denise,
My husband has been having difficulty getting erections for the last several months, and our sex life is suffering. Is there something wrong with him, or is it me?? Help!
Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficiently firm for satisfactory sexual activity. There are many underlying conditions that could present as ED, including reversible (eg., including certain medications, depression, prostatitis) and irreversible (eg., including high blood pressure, smoking, high cholesterol, neurologic disease, diabetes, pelvic surgery or trauma damaging the pelvic nerves related to erections) factors. If sleep-induced and self-stimulated erections are firmer than erections with the sexual partner, this could point to psychological factors such as personal issues he is struggling with (eg., insecurity, perfectionism) or interpersonal issues/difficulties within the relationship. Decreased sexual desire/fewer sexual thoughts and fantasies could be a sign of depression, decreased testosterone levels, increased prolactin hormone levels, medications, and psychodynamic issues (likely complex, such as a learned response not to feel emotions generally). Delayed ejaculation may suggest a medication effect or decreased testosterone. Early and painful ejaculation may be due to prostatitis. The effect of certain drugs, depression, and decreased testosterone levels may lead to decreased orgasm intensity. Whereas generalized and lifelong ED may be due to a congenital or past traumatic blood vessel damage, potentially amenable to microvascular surgery. It is important that you go, preferably as a couple, to see a doctor who would likely review a sexual and medical history and perform a physical examination and laboratory investigations to try to distinguish reversible from irreversible factors as well as look for risks associated with resumption of intercourse and orgasm (eg. Cardiac risk, respiratory or other physical compromise). Depending on the factors contributing to the ED, treatment ranges from psychotherapy/couple’s therapy, to Vacuum Erection Devices, and drugs that can be taken orally such as Viagra/Cialis and those that can be given by injection/urethral instillation. These various forms of treatment all have important contraindications that should be ruled out, so please make sure to have an open, frank discussion with your doctor first.
Remember: your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Take care, and mind your health! Meegwetch!
Saturday, August 23, 2008
Diabetes Mellitus
FJ, Volume 22, Number 11
June 05-20, 2008
FJ, Volume 22, Number 15
August 05-20, 2008
Dear Dra. Denise,
My tatay has diabetes and his kuya also has diabetes. Does that mean I will get diabetes, or can I prevent it somehow?
Diabetes mellitus (DM) is a common long-term metabolic disturbance characterized by high fasting blood sugar. It is a syndrome caused by an absolute or relative lack of insulin, resistance to the action of insulin, or both. When severe, it affects the body’s breakdown of carbohydrates, fats, and proteins. Severe long-term DM may lead to complications involving small blood vessels, large blood vessels, and nerve damage, affecting multiple organs and systems.
The goals of therapy are to control the symptoms; to establish and maintain optimum metabolic control, while avoiding low blood sugars; to prevent or minimize the risk of complications; and to achieve optimal control of other associated illnesses like high blood pressure and high cholesterol
Therapy includes teaching the diabetic about diabetes, the role of diet, exercise and medications, how and when to self-monitor, management of sick days, recognition and treatment of low blood sugar, the major side effects of medications and how to adjust drugs in response to changes in diet and activity, and care of the feet. Individualized diet management counseled by a dietician should be done. Total calorie intake should be reduced to decrease weight and improve metabolic control. Self-monitoring of blood sugar levels is important. Physical activity and exercise improve heart function, enhance sensitivity to insulin, lower blood pressure and cholesterol levels, and improve sugar control. Medications should be adjusted with meals and exercise. Regular doctor check-ups should include blood pressure measurements; foot exams; blood tests of long-term control (usually every 3-6 months); checks of the glucose monitor; diet and diabetes management skills reinforcement; kidney function tests; fasting cholesterol tests (every 1-3 years if initially normal); and eye exams.
To screen for diabetes, a fasting blood glucose level should be measured every 3 years in those over age 40. Earlier and more frequent testing may need to be done in those with higher risk: first degree relative with DM, member of high-risk population (aboriginal, Hispanic, Asian or African descent), history of impaired sugar tolerance or impaired fasting sugar, presence of complications associated with DM, vascular disease, history of DM during pregnancy, high blood pressure, high cholesterol, overweight, abdominal obesity, and certain diseases. Since your tatay is a first-degree relative, you are at a higher risk and should have your blood tested.
Those with high blood sugars but below the diabetes threshold are considered to have prediabetes (includes both impaired fasting glucose and impaired glucose tolerance). Those with metabolic syndrome (obesity, high blood pressure, high cholesterol, insulin resistance, and sugar abnormalities) have a significant risk of DM and of heart and blood vessel disease.
Some studies have shown that progression to DM in high-risk individuals may be preventable: diet modification with restriction of calories and reduced fat intake combined with supervised, moderately intense physical activity of about 150 minutes a week can reduce the risk of DM by 58% at four years. The associated weight loss was about 5% of initial body weight. Some diabetes medications given to high-risk individuals have also shown to help delay/prevent the development of diabetes. There are no known safe and effective measures to prevent type I DM, which tends to affect those at a younger age.
It is great that you are looking after your health—an ounce of prevention is worth a pound of cure! Your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
June 05-20, 2008
FJ, Volume 22, Number 15
August 05-20, 2008
Dear Dra. Denise,
My tatay has diabetes and his kuya also has diabetes. Does that mean I will get diabetes, or can I prevent it somehow?
Diabetes mellitus (DM) is a common long-term metabolic disturbance characterized by high fasting blood sugar. It is a syndrome caused by an absolute or relative lack of insulin, resistance to the action of insulin, or both. When severe, it affects the body’s breakdown of carbohydrates, fats, and proteins. Severe long-term DM may lead to complications involving small blood vessels, large blood vessels, and nerve damage, affecting multiple organs and systems.
The goals of therapy are to control the symptoms; to establish and maintain optimum metabolic control, while avoiding low blood sugars; to prevent or minimize the risk of complications; and to achieve optimal control of other associated illnesses like high blood pressure and high cholesterol
Therapy includes teaching the diabetic about diabetes, the role of diet, exercise and medications, how and when to self-monitor, management of sick days, recognition and treatment of low blood sugar, the major side effects of medications and how to adjust drugs in response to changes in diet and activity, and care of the feet. Individualized diet management counseled by a dietician should be done. Total calorie intake should be reduced to decrease weight and improve metabolic control. Self-monitoring of blood sugar levels is important. Physical activity and exercise improve heart function, enhance sensitivity to insulin, lower blood pressure and cholesterol levels, and improve sugar control. Medications should be adjusted with meals and exercise. Regular doctor check-ups should include blood pressure measurements; foot exams; blood tests of long-term control (usually every 3-6 months); checks of the glucose monitor; diet and diabetes management skills reinforcement; kidney function tests; fasting cholesterol tests (every 1-3 years if initially normal); and eye exams.
To screen for diabetes, a fasting blood glucose level should be measured every 3 years in those over age 40. Earlier and more frequent testing may need to be done in those with higher risk: first degree relative with DM, member of high-risk population (aboriginal, Hispanic, Asian or African descent), history of impaired sugar tolerance or impaired fasting sugar, presence of complications associated with DM, vascular disease, history of DM during pregnancy, high blood pressure, high cholesterol, overweight, abdominal obesity, and certain diseases. Since your tatay is a first-degree relative, you are at a higher risk and should have your blood tested.
Those with high blood sugars but below the diabetes threshold are considered to have prediabetes (includes both impaired fasting glucose and impaired glucose tolerance). Those with metabolic syndrome (obesity, high blood pressure, high cholesterol, insulin resistance, and sugar abnormalities) have a significant risk of DM and of heart and blood vessel disease.
Some studies have shown that progression to DM in high-risk individuals may be preventable: diet modification with restriction of calories and reduced fat intake combined with supervised, moderately intense physical activity of about 150 minutes a week can reduce the risk of DM by 58% at four years. The associated weight loss was about 5% of initial body weight. Some diabetes medications given to high-risk individuals have also shown to help delay/prevent the development of diabetes. There are no known safe and effective measures to prevent type I DM, which tends to affect those at a younger age.
It is great that you are looking after your health—an ounce of prevention is worth a pound of cure! Your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
Wednesday, July 23, 2008
A Kookum Has an Embarrassing Question
Housecall with Dr. Denise
urban NDN -July 2008 - issue 2
This month I'm sharing more health questions I've come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.
My Kookum has been complaining of leaking pee 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 and 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.
I have a new sexual partner who told me 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—however there are medications that can decrease the duration and intensity of recurrences as well as the likelihood of spreading the infection). 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.
urban NDN -July 2008 - issue 2
This month I'm sharing more health questions I've come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.
My Kookum has been complaining of leaking pee 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 and 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.
I have a new sexual partner who told me 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—however there are medications that can decrease the duration and intensity of recurrences as well as the likelihood of spreading the infection). 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.
Monday, June 23, 2008
Loving in a Dangerous Time
Housecall with Dr. Denise
urban NDN - June 2008 - issue 1
Tansi! I’d like to share some health questions I’ve come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.
I just learned that someone I fooled around with a few months ago is HIV-positive. What kinds of activities are risky? What should I do?
You can get HIV if the virus gets into your bloodstream from another person who is infected with HIV. It can enter your body through the infected person’s semen, vaginal fluid, or blood.
The Canadian HIV/AIDS Information Centre ranked activities as:
No risk: To our knowledge, none of the practices in this group has ever lead to HIV infection. There is no potential for transmission since none of the basic conditions for infection are present. This category includes fantasizing, h and holding, phone sex, mutual masturbation, bubblebaths, sensual touch and massage, cybersex, masturbation, hugging, watching erotic videos, dry kissing (no exchange of saliva), unshared use of sex toys, getting the person’s feces or urine on the body.
No real risk: The practices in this category present a potential for HIV transmission because they involved an exchange of body fluids (such as semen, vaginal fluid or blood). However, the possibility of HIV transmission appears to be unlikely. There are no confirmed reports of infection from these activities. This category includes wet kissing (saliva exchanged), receiving fellatio (blow job, getting head), receiving cunnilingus (eating out), giving anilingus (rimming, licking ass), giving or receiving digital/manual intercourse (anal or vaginal fingering or fisting), sharing sex toys with a new condom or disinfected and rinsed, getting the person’s feces or urine into the body.
Low risk: The practices in this category present a potential for HIV transmission. There are also a few reports of infection attributed to these activities: giving fellatio or cunnilingus, receiving anilingus (rim job), vaginal intercourse with a condom, and anal intercourse with a condom.
High risk: Practices in this category present a potential for HIV transmission and there are a significant number of scientific studies that associate these activities with HIV infection: shared sex toys, vaginal intercourse without a condom and anal intercourse without a condom. Any activities that involve drawing blood or break the skin, such as body piercing and tattooing, are high-risk activities that require sterile precautions, i.e., new needles, new ink, proper after care and sterilization every time. These precautions will probably not be available to a do-it-yourselfer or may not be adhered to by less reputable establishments. You should seek out professional technicians who adhere to proper sterilization and safety procedures.
Use of condoms with Nonoxynol 9 (a chemical that kills sperm and prevents pregnancy) is considered risky, because the harsh chemicals in it can damage the lining of the vagina or rectum and provide a transmission route for HIV.
There is a “window period” of three to six months between the time a person is infected with HIV and the time that they will test positive for HIV antibodies. It is during this window period that a person is most infectious and most likely to infect someone else, because they do not know they are infected.
Therefore you should:
Get tested for HIV and all other STIs, and get treated accordingly. Get tested periodically, because earlier detection leads to better outcomes.
Avoid sexual activities until at least 3 to 6 months after your HIV test.
To prevent the exchange of bodily fluids, avoid contact between bodily fluids and you or your partner(s) mouth, vagina, anus, penis, or an open cut or sore.
Practice safer sex.
Use a condom—it substantially reduces the risk of infection if you are giving or receiving. Remember, though, that condom use does not remove the risk of STIs—including HIV, genital warts, syphilis, herpes; condoms just decrease the risk substantially. Abstinence is the only surefire way to remove the risk.
Use a water-based lubricant—it increases your stimulation and decreases the risks.
Reduce the number of sexual partners.
Get the facts—talk to your doctor and keep informed about your health!
urban NDN - June 2008 - issue 1
Tansi! I’d like to share some health questions I’ve come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.
I just learned that someone I fooled around with a few months ago is HIV-positive. What kinds of activities are risky? What should I do?
You can get HIV if the virus gets into your bloodstream from another person who is infected with HIV. It can enter your body through the infected person’s semen, vaginal fluid, or blood.
The Canadian HIV/AIDS Information Centre ranked activities as:
No risk: To our knowledge, none of the practices in this group has ever lead to HIV infection. There is no potential for transmission since none of the basic conditions for infection are present. This category includes fantasizing, h and holding, phone sex, mutual masturbation, bubblebaths, sensual touch and massage, cybersex, masturbation, hugging, watching erotic videos, dry kissing (no exchange of saliva), unshared use of sex toys, getting the person’s feces or urine on the body.
No real risk: The practices in this category present a potential for HIV transmission because they involved an exchange of body fluids (such as semen, vaginal fluid or blood). However, the possibility of HIV transmission appears to be unlikely. There are no confirmed reports of infection from these activities. This category includes wet kissing (saliva exchanged), receiving fellatio (blow job, getting head), receiving cunnilingus (eating out), giving anilingus (rimming, licking ass), giving or receiving digital/manual intercourse (anal or vaginal fingering or fisting), sharing sex toys with a new condom or disinfected and rinsed, getting the person’s feces or urine into the body.
Low risk: The practices in this category present a potential for HIV transmission. There are also a few reports of infection attributed to these activities: giving fellatio or cunnilingus, receiving anilingus (rim job), vaginal intercourse with a condom, and anal intercourse with a condom.
High risk: Practices in this category present a potential for HIV transmission and there are a significant number of scientific studies that associate these activities with HIV infection: shared sex toys, vaginal intercourse without a condom and anal intercourse without a condom. Any activities that involve drawing blood or break the skin, such as body piercing and tattooing, are high-risk activities that require sterile precautions, i.e., new needles, new ink, proper after care and sterilization every time. These precautions will probably not be available to a do-it-yourselfer or may not be adhered to by less reputable establishments. You should seek out professional technicians who adhere to proper sterilization and safety procedures.
Use of condoms with Nonoxynol 9 (a chemical that kills sperm and prevents pregnancy) is considered risky, because the harsh chemicals in it can damage the lining of the vagina or rectum and provide a transmission route for HIV.
There is a “window period” of three to six months between the time a person is infected with HIV and the time that they will test positive for HIV antibodies. It is during this window period that a person is most infectious and most likely to infect someone else, because they do not know they are infected.
Therefore you should:
Get tested for HIV and all other STIs, and get treated accordingly. Get tested periodically, because earlier detection leads to better outcomes.
Avoid sexual activities until at least 3 to 6 months after your HIV test.
To prevent the exchange of bodily fluids, avoid contact between bodily fluids and you or your partner(s) mouth, vagina, anus, penis, or an open cut or sore.
Practice safer sex.
Use a condom—it substantially reduces the risk of infection if you are giving or receiving. Remember, though, that condom use does not remove the risk of STIs—including HIV, genital warts, syphilis, herpes; condoms just decrease the risk substantially. Abstinence is the only surefire way to remove the risk.
Use a water-based lubricant—it increases your stimulation and decreases the risks.
Reduce the number of sexual partners.
Get the facts—talk to your doctor and keep informed about your health!
Wednesday, April 23, 2008
Grief
FJ, Volume 22, Number 6
March 20-April 05, 2008
As anyone who is holding this paper knows, my editor is dead. Not only is my editor gone, but also my tita. And not only my tita, but also my mentor. And to top it all off, I’ve also lost my good friend and the catalyst to my connection to the Winnipeg I now call home, and my connection to the Manitoba Filipino community I now call my people. This really sucks.
I know I’m an adult, but I can’t help feeling downright selfish about the whole situation. Sure, I am terribly sad about what her family and the community have lost—shed tears at the thought--but, when it comes right down to it, I’m most sad about her not being there for me. It’s not that I had contact with her on a daily basis or the honour of being in her inner circle as true family does, but to me, just the knowledge that someone so pure and brilliant, so self-sacrificing and so passionate about our people, so supportive and empowering to me--existed was enough to keep me going. She is probably one of the closest people I’ve known to embodying what I consider a martyr. And now that light is gone.
Of course the light isn’t truly gone, right? I mean, I know the memory and love continues, her vision won’t die, and her legacy will be kept alive, but, really, I have to admit, it’s always better to have that inspiration in the flesh, the gentle persistent reminder phone call from that soft voice about the FJ deadline or the PCCM meeting, the twinkle of recognition in her eyes in a crowd of new faces, the calm knowing smile, the paradoxical sight of her--both fragile and purposeful strength, this beautiful spirit caught in the very real, physical pain of this world.
Being a doctor, I can’t help but focus on this pain. How frustrated I was at her insistence to be strong, when I warned her to take a break, not let the stresses get to her. She always said she was fine, but I knew. It is hard knowing this and caring so much, but not being able to change a thing. It is hard trying to get others to “lay off” and try not to involve her in the petty stresses of everyday life—so she could really heal. It is hard trying to convince someone whose strength of convictions overpower seemingly anything—be it medical knowledge or worried warnings from someone who couldn’t stand the thought of the possibly preventable demise of a loved one. I think we all have contributed to this—it is natural when being around someone so strong to rely on her, to not see that she needs rest, to expect nothing but strength from her, even to push her beyond limits she is not even consciously aware of. This is raw sadness and regret and frustration and love.
I guess if there’s one thing, one message I want to say out of this terrible experience—it is this:
Be selfish. Take a break. Sharpen the saw. Love yourself, and that means all aspects of you—body, heart, mind, soul. If you are feeding your soul with your body, that is not balance, not healthy, and that eventually robs the very people you are serving of the pleasure of being around a healthier you for greater longevity. By all means be passionate and serve the community! But serving the community in a healthful manner means serving yourself too, and giving the gift of contribution to others—let others carry the burden too. Live with integrity. By this I don’t mean simple honesty, but be integrated—balanced. Nurture all the aspects of your being. Take a “mental health” moment. Don’t spread yourself too thin. Listen to what your body is telling you. Strive for feeling, thinking, saying, and acting from an integrated core. Live your truth, not the perception of the truth of others, be they loved ones or a community. Learn to rely on others occasionally. Be okay with sometimes being weak or vulnerable. Love yourself just as much as you love others. Realize that you need this self-love to truly give to others. Openly appreciate the time you have been given, and everything in this world that has been given to you to work with. Above all, let the memory of a fiery leader inspire you to give back to your world from a place of true health.
March 20-April 05, 2008
As anyone who is holding this paper knows, my editor is dead. Not only is my editor gone, but also my tita. And not only my tita, but also my mentor. And to top it all off, I’ve also lost my good friend and the catalyst to my connection to the Winnipeg I now call home, and my connection to the Manitoba Filipino community I now call my people. This really sucks.
I know I’m an adult, but I can’t help feeling downright selfish about the whole situation. Sure, I am terribly sad about what her family and the community have lost—shed tears at the thought--but, when it comes right down to it, I’m most sad about her not being there for me. It’s not that I had contact with her on a daily basis or the honour of being in her inner circle as true family does, but to me, just the knowledge that someone so pure and brilliant, so self-sacrificing and so passionate about our people, so supportive and empowering to me--existed was enough to keep me going. She is probably one of the closest people I’ve known to embodying what I consider a martyr. And now that light is gone.
Of course the light isn’t truly gone, right? I mean, I know the memory and love continues, her vision won’t die, and her legacy will be kept alive, but, really, I have to admit, it’s always better to have that inspiration in the flesh, the gentle persistent reminder phone call from that soft voice about the FJ deadline or the PCCM meeting, the twinkle of recognition in her eyes in a crowd of new faces, the calm knowing smile, the paradoxical sight of her--both fragile and purposeful strength, this beautiful spirit caught in the very real, physical pain of this world.
Being a doctor, I can’t help but focus on this pain. How frustrated I was at her insistence to be strong, when I warned her to take a break, not let the stresses get to her. She always said she was fine, but I knew. It is hard knowing this and caring so much, but not being able to change a thing. It is hard trying to get others to “lay off” and try not to involve her in the petty stresses of everyday life—so she could really heal. It is hard trying to convince someone whose strength of convictions overpower seemingly anything—be it medical knowledge or worried warnings from someone who couldn’t stand the thought of the possibly preventable demise of a loved one. I think we all have contributed to this—it is natural when being around someone so strong to rely on her, to not see that she needs rest, to expect nothing but strength from her, even to push her beyond limits she is not even consciously aware of. This is raw sadness and regret and frustration and love.
I guess if there’s one thing, one message I want to say out of this terrible experience—it is this:
Be selfish. Take a break. Sharpen the saw. Love yourself, and that means all aspects of you—body, heart, mind, soul. If you are feeding your soul with your body, that is not balance, not healthy, and that eventually robs the very people you are serving of the pleasure of being around a healthier you for greater longevity. By all means be passionate and serve the community! But serving the community in a healthful manner means serving yourself too, and giving the gift of contribution to others—let others carry the burden too. Live with integrity. By this I don’t mean simple honesty, but be integrated—balanced. Nurture all the aspects of your being. Take a “mental health” moment. Don’t spread yourself too thin. Listen to what your body is telling you. Strive for feeling, thinking, saying, and acting from an integrated core. Live your truth, not the perception of the truth of others, be they loved ones or a community. Learn to rely on others occasionally. Be okay with sometimes being weak or vulnerable. Love yourself just as much as you love others. Realize that you need this self-love to truly give to others. Openly appreciate the time you have been given, and everything in this world that has been given to you to work with. Above all, let the memory of a fiery leader inspire you to give back to your world from a place of true health.
Saturday, March 01, 2008
Male Genito-Urinary Problems
FJ, Volume 22, Number 4
February 20-March 05, 2008
Magandang araw mga kababayan! I received the following question, and thought it would be a good idea to get the input from one of my local kompadres, Ferdinand Galvan, who received his registered nursing training from UST College of Nursing and medical/general surgery training at DLSU in the Philippines (and practicing as a physician) before coming to Canada. At present, he is working at the Health Sciences Centre as an RN. Salamat po, Ferdie!
Dear Dr. Denise,
My 62 year-old Lolo Totoy has been complaining of problems with urination. He says he goes to the washroom to pee so often--even during the night--that his sleep is always disturbed. He further states that, when he has to go pee, he has to go right away; it takes him a long time to finish peeing, but he feels that there’s still something there left. The funny part of the story is when he says that he’s “dripping”! He feels embarrassed when that happens and we would tease him “stinky”! He is strong and has never been sick in his life. What’s wrong with him, is this part of getting old? What should we do about this?
Jun-Jun
Dear Jun-Jun,
Your Lolo Totoy is most probably experiencing what many men in his age group are having. I am referring to a condition called Benign Prostatic Hypertrophy (BPH). Simply put, the prostate gland, which is located around the opening of the male urinary bladder, enlarges, causing it to obstruct the normal flow of urine, thus leading to the kind of symptoms your lolo’s noticing. How it develops is not yet fully known, but it is thought that impaired hormonal factors are involved. This is commonly seen in men over age 50; it is usually a progressive disease where patients also notice their force/stream of urine is decreased and or interrupted. Hesitancy (experiencing difficulty starting the flow of urine) and urinary tract/bladder infections are not uncommon. I would recommend your lolo visit his physician and have himself examined. There are various ways of treating this disorder, either by taking pills to shrink the prostate or improve the symptoms or by undergoing one of the surgical procedures to remove/scrape the prostate gland. For now, I ‘d suggest that your lolo not drink too much fluid, particularly caffeine-containing beverages and alcohol, before going to bed to avoid getting the urge to urinate at night. There are also some drugs he should avoid, such as decongestants that can stimulate smooth muscle in the bladder neck and prostate, increasing the obstruction and others types that can affect bladder muscle contractility. There are some “alternative” drugs such as Saw Palmetto and African plum tree which are examples of plant extracts used by patients to reduce BPH symptoms, but identification of and how the active ingredients work and long-term efficacy and safety are often unclear in these mixtures.
P.S. Some patients ask me, about their concern of decreasing their “manliness” (eg. Problems achieving/maintaining erections) after prostate surgery, the answer, generally, is NO, although it could be a remote complication they should discuss in more detail with the urologist.
Dear Dr. Denise,
My husband has been having difficulty getting erections for the last several months, and our sex life is suffering. Is there something wrong with him, or is it me?? Help!
Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficiently firm for satisfactory sexual activity. There are many underlying conditions that could present as ED, including reversible (eg., including certain medications, depression, prostatitis) and irreversible (eg., including high blood pressure, smoking, high cholesterol, neurologic disease, diabetes, pelvic surgery or trauma damaging the pelvic nerves related to erections) factors. If sleep-induced and self-stimulated erections are firmer than erections with the sexual partner, this could point to psychological factors such as personal issues he is struggling with (eg., insecurity, perfectionism) or interpersonal issues/difficulties within the relationship. Decreased sexual desire/fewer sexual thoughts and fantasies could be a sign of depression, decreased testosterone levels, increased prolactin hormone levels, medications, and psychodynamic issues (likely complex, such as a learned response not to feel emotions generally). Delayed ejaculation may suggest a medication effect or decreased testosterone. Early and painful ejaculation may be due to prostatitis. The effect of certain drugs, depression, and decreased testosterone levels may lead to decreased orgasm intensity. Whereas generalized and lifelong ED may be due to a congenital or past traumatic blood vessel damage, potentially amenable to microvascular surgery. It is important that you go, preferably as a couple, to see a doctor who would likely review a sexual and medical history and perform a physical examination and laboratory investigations to try to distinguish reversible from irreversible factors as well as look for risks associated with resumption of intercourse and orgasm (eg. Cardiac risk, respiratory or other physical compromise). Depending on the factors contributing to the ED, treatment ranges from psychotherapy/couple’s therapy, to Vacuum Erection Devices, and drugs that can be taken orally such as Viagra/Cialis and those that can be given by injection/urethral instillation. These various forms of treatment all have important contraindications that should be ruled out, so please make sure to have an open, frank discussion with your doctor first.
Remember, Pinoys and Pinays--your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
February 20-March 05, 2008
Magandang araw mga kababayan! I received the following question, and thought it would be a good idea to get the input from one of my local kompadres, Ferdinand Galvan, who received his registered nursing training from UST College of Nursing and medical/general surgery training at DLSU in the Philippines (and practicing as a physician) before coming to Canada. At present, he is working at the Health Sciences Centre as an RN. Salamat po, Ferdie!
Dear Dr. Denise,
My 62 year-old Lolo Totoy has been complaining of problems with urination. He says he goes to the washroom to pee so often--even during the night--that his sleep is always disturbed. He further states that, when he has to go pee, he has to go right away; it takes him a long time to finish peeing, but he feels that there’s still something there left. The funny part of the story is when he says that he’s “dripping”! He feels embarrassed when that happens and we would tease him “stinky”! He is strong and has never been sick in his life. What’s wrong with him, is this part of getting old? What should we do about this?
Jun-Jun
Dear Jun-Jun,
Your Lolo Totoy is most probably experiencing what many men in his age group are having. I am referring to a condition called Benign Prostatic Hypertrophy (BPH). Simply put, the prostate gland, which is located around the opening of the male urinary bladder, enlarges, causing it to obstruct the normal flow of urine, thus leading to the kind of symptoms your lolo’s noticing. How it develops is not yet fully known, but it is thought that impaired hormonal factors are involved. This is commonly seen in men over age 50; it is usually a progressive disease where patients also notice their force/stream of urine is decreased and or interrupted. Hesitancy (experiencing difficulty starting the flow of urine) and urinary tract/bladder infections are not uncommon. I would recommend your lolo visit his physician and have himself examined. There are various ways of treating this disorder, either by taking pills to shrink the prostate or improve the symptoms or by undergoing one of the surgical procedures to remove/scrape the prostate gland. For now, I ‘d suggest that your lolo not drink too much fluid, particularly caffeine-containing beverages and alcohol, before going to bed to avoid getting the urge to urinate at night. There are also some drugs he should avoid, such as decongestants that can stimulate smooth muscle in the bladder neck and prostate, increasing the obstruction and others types that can affect bladder muscle contractility. There are some “alternative” drugs such as Saw Palmetto and African plum tree which are examples of plant extracts used by patients to reduce BPH symptoms, but identification of and how the active ingredients work and long-term efficacy and safety are often unclear in these mixtures.
P.S. Some patients ask me, about their concern of decreasing their “manliness” (eg. Problems achieving/maintaining erections) after prostate surgery, the answer, generally, is NO, although it could be a remote complication they should discuss in more detail with the urologist.
Dear Dr. Denise,
My husband has been having difficulty getting erections for the last several months, and our sex life is suffering. Is there something wrong with him, or is it me?? Help!
Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficiently firm for satisfactory sexual activity. There are many underlying conditions that could present as ED, including reversible (eg., including certain medications, depression, prostatitis) and irreversible (eg., including high blood pressure, smoking, high cholesterol, neurologic disease, diabetes, pelvic surgery or trauma damaging the pelvic nerves related to erections) factors. If sleep-induced and self-stimulated erections are firmer than erections with the sexual partner, this could point to psychological factors such as personal issues he is struggling with (eg., insecurity, perfectionism) or interpersonal issues/difficulties within the relationship. Decreased sexual desire/fewer sexual thoughts and fantasies could be a sign of depression, decreased testosterone levels, increased prolactin hormone levels, medications, and psychodynamic issues (likely complex, such as a learned response not to feel emotions generally). Delayed ejaculation may suggest a medication effect or decreased testosterone. Early and painful ejaculation may be due to prostatitis. The effect of certain drugs, depression, and decreased testosterone levels may lead to decreased orgasm intensity. Whereas generalized and lifelong ED may be due to a congenital or past traumatic blood vessel damage, potentially amenable to microvascular surgery. It is important that you go, preferably as a couple, to see a doctor who would likely review a sexual and medical history and perform a physical examination and laboratory investigations to try to distinguish reversible from irreversible factors as well as look for risks associated with resumption of intercourse and orgasm (eg. Cardiac risk, respiratory or other physical compromise). Depending on the factors contributing to the ED, treatment ranges from psychotherapy/couple’s therapy, to Vacuum Erection Devices, and drugs that can be taken orally such as Viagra/Cialis and those that can be given by injection/urethral instillation. These various forms of treatment all have important contraindications that should be ruled out, so please make sure to have an open, frank discussion with your doctor first.
Remember, Pinoys and Pinays--your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
Saturday, February 23, 2008
Journey to the Philippines Part 4: Meeting with the Presidents—Past and Current
FJ Volume 22, Number 3
Feb 05-20, 2008
I have so many wonderful memories of my trip to the Philippines July to August, 2007 that I’ve written about: attending the Ambassadors’, Consul Generals’, and Tourism Directors’ Tour (ACGTDT), a visit to the Senate and Philippine National Red Cross with Senator Dick Gordon, important interviews and continuing work on my Field Practicum for my Master’s in Public Health exploring the migration of Filipino doctors and health care workers to Canada. This column reviews my meetings with the Presidents—Gloria Macapagal-Arroyo and Fidel V. Ramos.
With the help and coordination of Senator Gordon, I was able to attend the July 28th inauguration of the Pacific Pearl Airways at Subic International Airport where President Macapagal-Arroyo and many other politicians and Pinoy bigwigs were going to be. The evening before, I hitched a ride to Subic with the dynamic Congresswoman Carissa Coscoluella where I got to ask her about her personal experience with Philippine politics while she treated me to a Jollibee Double Yum/Cheesy Cheese Fries combo on the drive up. The following morning I went to the Airport for the inauguration where I joked and shared a sumptuous lunch with the distinguished and charming members of the police force seated at my table. After President GMA entered, several presentations ensued. Following the festivities were some foto ops at the front, and I was lucky to get swept up in the crowd to get a photo with her. Amidst the crowd, I met briefly with GMA where I delivered a very short speech I prepared in Tagalog, thanks to the help of my table-mates and the servers. She was extremely gracious and quite warm, holding my hand and giving me a big hug. I then got a tour of Subic, including a look at the bankers where war supplies and ammo were kept, feeding the fish at Camayan Beach, an exhilarating Slide For Life in the jungle, checking out the macaque monkeys and bats, and topped off with a gorgeous Parasailing experience. I treated my guides to a delicious Pilipino meal at CocoLime’s before the drive home. What an awesome jam-packed day!
After my chance meeting with the gregarious former President Fidel Ramos at the PNRC, I gathered enough bravado to request an interview/meeting with him. I got the call that I would be meeting him August 6, 2007, 4 pm at his office at the 26th Floor, Ramos Peace and Dev’t Foundn (RPDEV). When he met with me, there was a bluster of activity while he spent a lot of his precious time setting me up with photographs, copies of his and others’ writing, and some keepsakes which he very graciously autographed for me, including a couple of books, one of his famous cigars, and a golfball! He reviewed the motto of his Foundation--a nonpartisan, non-profit, non-stock organization dedicated to achieving lasting piece, sustainable development, democratic governance and promoting socio-economic diplomacy in the Philippines and in the larger Asia-Pacific region: “Responsible citizenship is caring for others sharing what the Almighty has given each of us, and daring to make a positive difference in others’ lives. It is this quality of caring, sharing and daring for each other that the defining quality of what is called ‘civic responsibility.’” I learned of many of his initiatives and projects he is working on, including advocating for reforms to address the water crisis in Asia. He gave me a tour of the RPDEV rooms—first off was the Mt. Everest Room where he showed me his proud display of the three young Filipinas he supported who were the first to climb Mt. Everest. He taught me a lot of the history of the Philippines and about the important aspects of leadership, including the basics of leading a country. We discussed the problems of poverty and politics, including a comparison of the current administration with that of 10 years ago. He spoke of the war on terrorism and the importance of respecting religious differences. President Ramos was extremely funny, cracking jokes about golf and turning 100 years old to Department of Environment and Natural Resources Chairman, Cirio Santiago and me over a glass of wine. We discussed medical tourism and setting up health care facilities in areas of need as well as development of land. He showed me many of his photographs and shared anecdotes with me, and ended my meeting with a motivational greeting to the Filipino community in Canada, “The Philippines is a great country and so is Canada. But Filipinos …(-)Canadians or Canadians who used to be Filipinos should be sure to visit the motherland, which is the Philippines, because here we are caring sharing, and daring…We earned our independence just like Canada, the hard way. And they’re still fighting as a people to keep it pure, to keep it according to universal standards, and so, we need the help of everyone, including those out there, especially the Filipino-Canadians….the Philippines and Canada have an enduring partnership to promote a better world for everyone. This is what we call the Ramos Development Foundation. Our caring sharing and daring for each other and for everyone else. Thank you. Mabuhay. Kaiwana ito. We can do it.”
I was so honoured to take in such positive energy from GMA and “Steady Eddie” and to come home with so many gifts and memories from them. Maraming salamat po, Presidents past and present for the tremendous experience! Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
Feb 05-20, 2008
I have so many wonderful memories of my trip to the Philippines July to August, 2007 that I’ve written about: attending the Ambassadors’, Consul Generals’, and Tourism Directors’ Tour (ACGTDT), a visit to the Senate and Philippine National Red Cross with Senator Dick Gordon, important interviews and continuing work on my Field Practicum for my Master’s in Public Health exploring the migration of Filipino doctors and health care workers to Canada. This column reviews my meetings with the Presidents—Gloria Macapagal-Arroyo and Fidel V. Ramos.
With the help and coordination of Senator Gordon, I was able to attend the July 28th inauguration of the Pacific Pearl Airways at Subic International Airport where President Macapagal-Arroyo and many other politicians and Pinoy bigwigs were going to be. The evening before, I hitched a ride to Subic with the dynamic Congresswoman Carissa Coscoluella where I got to ask her about her personal experience with Philippine politics while she treated me to a Jollibee Double Yum/Cheesy Cheese Fries combo on the drive up. The following morning I went to the Airport for the inauguration where I joked and shared a sumptuous lunch with the distinguished and charming members of the police force seated at my table. After President GMA entered, several presentations ensued. Following the festivities were some foto ops at the front, and I was lucky to get swept up in the crowd to get a photo with her. Amidst the crowd, I met briefly with GMA where I delivered a very short speech I prepared in Tagalog, thanks to the help of my table-mates and the servers. She was extremely gracious and quite warm, holding my hand and giving me a big hug. I then got a tour of Subic, including a look at the bankers where war supplies and ammo were kept, feeding the fish at Camayan Beach, an exhilarating Slide For Life in the jungle, checking out the macaque monkeys and bats, and topped off with a gorgeous Parasailing experience. I treated my guides to a delicious Pilipino meal at CocoLime’s before the drive home. What an awesome jam-packed day!
After my chance meeting with the gregarious former President Fidel Ramos at the PNRC, I gathered enough bravado to request an interview/meeting with him. I got the call that I would be meeting him August 6, 2007, 4 pm at his office at the 26th Floor, Ramos Peace and Dev’t Foundn (RPDEV). When he met with me, there was a bluster of activity while he spent a lot of his precious time setting me up with photographs, copies of his and others’ writing, and some keepsakes which he very graciously autographed for me, including a couple of books, one of his famous cigars, and a golfball! He reviewed the motto of his Foundation--a nonpartisan, non-profit, non-stock organization dedicated to achieving lasting piece, sustainable development, democratic governance and promoting socio-economic diplomacy in the Philippines and in the larger Asia-Pacific region: “Responsible citizenship is caring for others sharing what the Almighty has given each of us, and daring to make a positive difference in others’ lives. It is this quality of caring, sharing and daring for each other that the defining quality of what is called ‘civic responsibility.’” I learned of many of his initiatives and projects he is working on, including advocating for reforms to address the water crisis in Asia. He gave me a tour of the RPDEV rooms—first off was the Mt. Everest Room where he showed me his proud display of the three young Filipinas he supported who were the first to climb Mt. Everest. He taught me a lot of the history of the Philippines and about the important aspects of leadership, including the basics of leading a country. We discussed the problems of poverty and politics, including a comparison of the current administration with that of 10 years ago. He spoke of the war on terrorism and the importance of respecting religious differences. President Ramos was extremely funny, cracking jokes about golf and turning 100 years old to Department of Environment and Natural Resources Chairman, Cirio Santiago and me over a glass of wine. We discussed medical tourism and setting up health care facilities in areas of need as well as development of land. He showed me many of his photographs and shared anecdotes with me, and ended my meeting with a motivational greeting to the Filipino community in Canada, “The Philippines is a great country and so is Canada. But Filipinos …(-)Canadians or Canadians who used to be Filipinos should be sure to visit the motherland, which is the Philippines, because here we are caring sharing, and daring…We earned our independence just like Canada, the hard way. And they’re still fighting as a people to keep it pure, to keep it according to universal standards, and so, we need the help of everyone, including those out there, especially the Filipino-Canadians….the Philippines and Canada have an enduring partnership to promote a better world for everyone. This is what we call the Ramos Development Foundation. Our caring sharing and daring for each other and for everyone else. Thank you. Mabuhay. Kaiwana ito. We can do it.”
I was so honoured to take in such positive energy from GMA and “Steady Eddie” and to come home with so many gifts and memories from them. Maraming salamat po, Presidents past and present for the tremendous experience! Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
Sunday, December 23, 2007
Journey to the Philippines Part 3: The Migration, Settlement, and Licensure of Filipino Physicians to Canada
FJ Volume 21, Number 23
December 05-20, 2007
Magandang araw, mga kaibigan naman! Kumusta kayo?? Ay nako, it’s been too long—these last couple of months I’ve been “in hiding” a bit, finishing up my Master’s of Public Health Field Practicum and frantically writing up my project papers and presenting my findings to the Department of Community Health Sciences at the University of Manitoba. Phew! Pagod na pagod po ako dahil trabaho/pararalan! My last two columns sported reflections of my journey to the Philippines July 12th - August 10th. I first reported on the Ambassadors’, Consul Generals’, and Tourism Directors’ Tour (ACGTDT) and urged readers to respond to my Field Practicum questionnaire exploring the migration of Filipino doctors and health care workers to Canada. In Part 2, I then described my experiences at the Philippine Senate and Philippine National Red Cross with Senator Dick Gordon, with a cameo from the very charming former President Fidel Ramos.
My adventures didn’t end there, however. I was able to do/learn/see so much more during my time in the Philippines, particularly getting exposure to the different perspectives related to the Philippine health care system and the migration of Filipino HCWs to Canada. I got to interview many key players in this complex issue, including: Migrante International, a non-profit grassroots organization dedicated to the advocacy and wellbeing of OFWs; previous Secretary of Health, public health physician, and Pinoy HCW migration expert, Dr. Jaime Z. Galvez Tan; UP College of Medicine professors and students including Dean Alberto Roxas and Dr. Leo Cubillan; media station GMA-7’s Sandra Aguinaldo, who did a documentary on “Dr. Nurses”; governmental agencies including the Canadian Immigration Integration Program/Canadian Embassy, Philippine Overseas Employment Authority, Department of Labour and Employment; and numerous other physicians/residents/medical students/health care workers/stakeholders who proved very gracious in giving me their time and input. I also found myself in a position to take part in clinical/missionary work--Dr. Hector Santos and the rest of the plastic surgery staff at the Managed Care Clinic invited me to come to their Operation Smile mission where they perform free surgical care and rehabilitation (eg speech language pathology) to those in need who cannot afford the treatments. Not only did I get to interview the gang for my project, but I also observed cleft lip and palate surgery on young patients and listened to the surgical team serenade each other—what a happy musical bunch! After a very inspiring discussion about global health with Dr. Galvez Tan, he also invited me to experience a medical mission--this one in Tondo with the UP Family Medical residents, but unfortunately, typhoons prevented the mission. Sayang! Other major highlights include a trip to Subic to meet PGMA a second time around and an in-depth interview with President Ramos. I will have to write in more detail about these amazing experiences in an upcoming column/my blog. I did witness some of the unpleasant and downright scary aspects of the Philippines, such as my “undercover” research in the form of “kidney-shopping” with cabdrivers and the demoralizing Filipino “crab mentality” Dr. Roxas enlightened me of. I might even reveal some of my more candid reactions, culture shocks, and rude awakenings learning about the distinctly Pinoy way of life. These all made for a very rich and life-changing experience for me, and I consider myself blessed for being given the opportunity to experience it all.
This project also led me to experiences in Winnipeg with the WRHA/Manitoba Health/Department of Labour and Immigration (Physician Resource Coordination Office); IMG (International Medical Graduate) Program, Faculty of Medicine, University of Manitoba; College of Physicians and Surgeons of Manitoba (CPSM); University of Winnipeg, Global College; Philippine-Canadian Centre of Manitoba; Community clinics/organizations such as Welcome Place and ANAK; CBC; The Filipino Journal; and of course, key informants Pinoy and other IMG docs. I also went to Ottawa and learned much from the Philippine Embassy; Federal Government Departments (Multiculturalism and Canadian Identity; Citizenship and Immigration; & Health); and the Canadian Public Health Association Conference, where I got to hear from such notable speakers as environmentalist David Suzuki, Nobel Peace Prize Winner David Orbinski (Doctors without Borders), Public Health Agency of Canada leader Dr. David Butler-Jones, and Health Minister Tony Clement, among others.
Clearly, my findings from this field practicum are quite extensive and comprehensive. Some of my conclusions:
There is a massive unmanaged migration of Filipino health care workers, including physicians and MD-RNs, worldwide, including to Canada. There are many socio-politico-ecological factors which drive HHR (Health Human Resources) to move abroad, and the effects include a Brain Drain in the health system, an economy held afloat by the remittances, broken families, abuse/health problems of these workers, worsening health status of the Philippines, an increased disparity between the economic classes, and a disturbing culture perpetuated by the American Dream. Pinoy doctors/IMGs face many challenges in their migration, settlement, and licensure to Canada. Their integration success depends on many factors, particularly their ability to gain licensure to practice medicine. Despite a huge need for doctors in Canada, numerous barriers to licensure exist, including a complex web of stakeholders (eg federal, provincial, RHA, licensing bodies, medical educators, etc) with jurisdictional mandates/authorities that leave the IMG falling through the cracks; not well-known, unclear, variable pathways to licensure; competing interests of more aggressive destination countries; a resulting process that is blocked up to the point of paralysis; and the rigours of adjusting to a new lifestyle and culture. Certainly, the Canadian system has many areas of improvement but is definitely moving in the right direction. Canada should strive to address these gaps in the system in a collaborative, globally-sensitive way, including engaging in high-level discussions with the Philippines to come up with some Win-Win solutions, ensuring a consistent, fair licensure process for the various primary care workers congruent with immigration goals and practice, and still taking a proactive, ethically-minded role in the global HHR market. In this way, our country can proudly tap into the tremendous potential value and contribution of the Filipino physician.
I presented some of my experiences and conclusions to my Department at the University, and it was very nice to see mga kababayan attend my presentation. To the Filipino community and all involved with this project, thank you so much for your support, responses to my questionnaire, and much-needed input/advice! Talagang nagpapasalamat ako sa inyo. I plan to present my findings in more detail to the community, particularly for those who expressed regret in missing my presentation, so stay tuned for my next community meeting announcement. I plan to further much work in this area, so please contact me at my blog or email if you are interested in learning more or helping out.
So that wraps up this column for now. Please remember: health starts at home; your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands! Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
December 05-20, 2007
Magandang araw, mga kaibigan naman! Kumusta kayo?? Ay nako, it’s been too long—these last couple of months I’ve been “in hiding” a bit, finishing up my Master’s of Public Health Field Practicum and frantically writing up my project papers and presenting my findings to the Department of Community Health Sciences at the University of Manitoba. Phew! Pagod na pagod po ako dahil trabaho/pararalan! My last two columns sported reflections of my journey to the Philippines July 12th - August 10th. I first reported on the Ambassadors’, Consul Generals’, and Tourism Directors’ Tour (ACGTDT) and urged readers to respond to my Field Practicum questionnaire exploring the migration of Filipino doctors and health care workers to Canada. In Part 2, I then described my experiences at the Philippine Senate and Philippine National Red Cross with Senator Dick Gordon, with a cameo from the very charming former President Fidel Ramos.
My adventures didn’t end there, however. I was able to do/learn/see so much more during my time in the Philippines, particularly getting exposure to the different perspectives related to the Philippine health care system and the migration of Filipino HCWs to Canada. I got to interview many key players in this complex issue, including: Migrante International, a non-profit grassroots organization dedicated to the advocacy and wellbeing of OFWs; previous Secretary of Health, public health physician, and Pinoy HCW migration expert, Dr. Jaime Z. Galvez Tan; UP College of Medicine professors and students including Dean Alberto Roxas and Dr. Leo Cubillan; media station GMA-7’s Sandra Aguinaldo, who did a documentary on “Dr. Nurses”; governmental agencies including the Canadian Immigration Integration Program/Canadian Embassy, Philippine Overseas Employment Authority, Department of Labour and Employment; and numerous other physicians/residents/medical students/health care workers/stakeholders who proved very gracious in giving me their time and input. I also found myself in a position to take part in clinical/missionary work--Dr. Hector Santos and the rest of the plastic surgery staff at the Managed Care Clinic invited me to come to their Operation Smile mission where they perform free surgical care and rehabilitation (eg speech language pathology) to those in need who cannot afford the treatments. Not only did I get to interview the gang for my project, but I also observed cleft lip and palate surgery on young patients and listened to the surgical team serenade each other—what a happy musical bunch! After a very inspiring discussion about global health with Dr. Galvez Tan, he also invited me to experience a medical mission--this one in Tondo with the UP Family Medical residents, but unfortunately, typhoons prevented the mission. Sayang! Other major highlights include a trip to Subic to meet PGMA a second time around and an in-depth interview with President Ramos. I will have to write in more detail about these amazing experiences in an upcoming column/my blog. I did witness some of the unpleasant and downright scary aspects of the Philippines, such as my “undercover” research in the form of “kidney-shopping” with cabdrivers and the demoralizing Filipino “crab mentality” Dr. Roxas enlightened me of. I might even reveal some of my more candid reactions, culture shocks, and rude awakenings learning about the distinctly Pinoy way of life. These all made for a very rich and life-changing experience for me, and I consider myself blessed for being given the opportunity to experience it all.
This project also led me to experiences in Winnipeg with the WRHA/Manitoba Health/Department of Labour and Immigration (Physician Resource Coordination Office); IMG (International Medical Graduate) Program, Faculty of Medicine, University of Manitoba; College of Physicians and Surgeons of Manitoba (CPSM); University of Winnipeg, Global College; Philippine-Canadian Centre of Manitoba; Community clinics/organizations such as Welcome Place and ANAK; CBC; The Filipino Journal; and of course, key informants Pinoy and other IMG docs. I also went to Ottawa and learned much from the Philippine Embassy; Federal Government Departments (Multiculturalism and Canadian Identity; Citizenship and Immigration; & Health); and the Canadian Public Health Association Conference, where I got to hear from such notable speakers as environmentalist David Suzuki, Nobel Peace Prize Winner David Orbinski (Doctors without Borders), Public Health Agency of Canada leader Dr. David Butler-Jones, and Health Minister Tony Clement, among others.
Clearly, my findings from this field practicum are quite extensive and comprehensive. Some of my conclusions:
There is a massive unmanaged migration of Filipino health care workers, including physicians and MD-RNs, worldwide, including to Canada. There are many socio-politico-ecological factors which drive HHR (Health Human Resources) to move abroad, and the effects include a Brain Drain in the health system, an economy held afloat by the remittances, broken families, abuse/health problems of these workers, worsening health status of the Philippines, an increased disparity between the economic classes, and a disturbing culture perpetuated by the American Dream. Pinoy doctors/IMGs face many challenges in their migration, settlement, and licensure to Canada. Their integration success depends on many factors, particularly their ability to gain licensure to practice medicine. Despite a huge need for doctors in Canada, numerous barriers to licensure exist, including a complex web of stakeholders (eg federal, provincial, RHA, licensing bodies, medical educators, etc) with jurisdictional mandates/authorities that leave the IMG falling through the cracks; not well-known, unclear, variable pathways to licensure; competing interests of more aggressive destination countries; a resulting process that is blocked up to the point of paralysis; and the rigours of adjusting to a new lifestyle and culture. Certainly, the Canadian system has many areas of improvement but is definitely moving in the right direction. Canada should strive to address these gaps in the system in a collaborative, globally-sensitive way, including engaging in high-level discussions with the Philippines to come up with some Win-Win solutions, ensuring a consistent, fair licensure process for the various primary care workers congruent with immigration goals and practice, and still taking a proactive, ethically-minded role in the global HHR market. In this way, our country can proudly tap into the tremendous potential value and contribution of the Filipino physician.
I presented some of my experiences and conclusions to my Department at the University, and it was very nice to see mga kababayan attend my presentation. To the Filipino community and all involved with this project, thank you so much for your support, responses to my questionnaire, and much-needed input/advice! Talagang nagpapasalamat ako sa inyo. I plan to present my findings in more detail to the community, particularly for those who expressed regret in missing my presentation, so stay tuned for my next community meeting announcement. I plan to further much work in this area, so please contact me at my blog or email if you are interested in learning more or helping out.
So that wraps up this column for now. Please remember: health starts at home; your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands! Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
Thursday, September 20, 2007
Journey to the Philippines Part 2: The Senate of the Philippines and the Philippine National Red Cross
FJ Volume 21, Number 17
September 05 - 20, 2007
Mabuhay! In Part 1 about my journey to the Philippines July 12th - August 10th, I reported on the Ambassadors’, Consul Generals’, and Tourism Directors’ Tour (ACGTDT) and my Field Practicum questionnaire for my Master’s in Public Health exploring the migration of Filipino doctors and health care workers to Canada. If you haven’t responded to the questionnaire yet, please take the time to do so (askdrdenise@mts.net or http://www.askdrdenise.blogspot.com/) as your much-needed input could form projects and initiatives to address the many difficulties Filipino HCWs face in Canada. Thank you po!
This issue chronicles my amazing experiences at the Senate and the Philippine National Red Cross with presidential candidate, Department of Tourism’s Wow Philippines “spear-header”, and humanitarian “extraordinaire” Senator Richard “Dick” Gordon. I had the great fortune of being seated on the flight to Manila close to Senator Dick who overheard me speaking of my ambitious project and graciously offered any assistance while in the Philippines. My project leads were proving difficult to contact, so I decided to take him up on the offer, just missing the opportunity to watch President GMA’s State of the Nation Address (Sayang naman!!). My disappointment was quickly assuaged by an invitation to check out the Senate the following day! So on July 24-25th, I had the privilege of witnessing the first Session for the Fourteenth Senate of the Philippines where the main issue was the discussion surrounding further action following a resolution by 17 of the 22 senators asking that the Senate support newly elected Senator Trillanes, to be able to sit at the Senate and perform his functions. The problem is this: in July 2003, a group of 321 armed soldiers who called themselves “Bagong Katipuneros” led by Army Capt. Gerardo Gambala and Lt. Antonio Trillanes IV, of the Philippine Navy took over (and apparently rigged with bombs) the Oakwood Premier Ayala Center service apartment tower in Makati City to show the Filipino people the alleged corruption of the GMA administration. This Oakwood mutiny effort was quickly thwarted, and Trillanes is currently incarcerated for an alleged criminal charge. Following this, he ran for senator, and won with more than 11 million votes. Interesting dilemma. Dissecting this issue further reveals many insights into the checkered and complex political and cultural history of the Philippines. I got to hear many compelling arguments from the various senators, ranging from the popular notion that he represents the people by such strong public support, that not allowing him to sit in the senate could be perceived as a human rights violation, the precedent of previous politician Mantolo being allowed to sit his duties, minimization of any harms that Trillanes would pose by letting him do his duties (unlikely flight risk, he’d only be 1 of 22 senators so his influence would be “diluted”, options for security and teleconferencing), etc. Hmmmm. I also heard from the four senators (Gordon, Arroyo, Enrile, and Santiago) who voted against the resolution—mainly the separation of powers of jurisdictions, the gravity of the charge, the importance of accountability in the definition of courage, the slippery slope argument, the moral problem with the senate stepping outside its jurisdiction, the inherent conflict of interest in a senate essentially allowing one of its own to “be above the law”, and much more. I got to discuss the ethical and moral facets of the issue with Senator Gordon, before his final speech—this would not even be happening in Canada!-- and I must say, we were all proud that he “nailed it” by getting his points across so passionately and eloquently. There are 5 clips of his speech (with me in the background trying to tape it!) on http://www.youtube.com/watch?v=eKhUi7vSE98. The ante was upped when it was suggested each senator reveal the reasons for her/his vote, and though the resolution was passed, it was exciting to witness government in action, as well as see the media frenzy that followed the session.
Afterward, I saw his dedicated staff work late into the evening while he met with Filipinos who came to ask for his help and guidance, did an inspiring interview (and mini cultural and history lesson) with an Italian-Filipino initiative called Stila Magazine, foto-op with a Filipino-American hip-hop group, another interview with a group of elementary students, and a general debriefing with his staff. On top of all these great experiences and learning opportunities, Senator Gordon facilitated my project work with the Dept of Labour and Employment/Philippine Oversease Employment Agency as well as some time with the Philippine National Red Cross.
I sat in on a teaching session he held with his PNRC staff on Disaster Response Planning, and I got to put my two cents in on what some of the Canadian programs do. I also got to attend the meeting of the Board, which Senator Dick chairs. What an illustrious and welcoming group! Discussing the ins and outs of humanitarian work and the challenges of administering and managing public care and aid through the PNRC were both educational and inspiring to me as a budding public health specialist. My heart grew with pride when a couple of Filipinas from Canada dropped in to give a donation.
At the end of the meeting, we found that former President Fidel Ramos was at the PNRC getting his blood pressure checked! My blood pressure went through the roof as I joined the crowd to meet “Steady Eddie”, the beloved president I read about in my (and the first) Philippine Studies Institute class only a couple of weeks prior. He cajoled the gang and the foto ops and smiles were endless. I was able to set up an interview with him, so more about him soon.
To crown off the evening, I joined Senator Dick’s staff in catching the tail end of the year-long-awaited nail-biting basketball game between the rival universities - Ateneo vs De La Salle. The standing-only half-green (DLSU), half-blue (ADMU) crowd went wild the whole game, which went (close match in over-time) to Senator Dick’s home team, Ateneo.What a rush!
All in all, I was really impressed with Senator Gordon and what he stands for, especially his continually connecting Filipino history, culture—identity--to the future of the Philippines in a positive light, particularly with the young Filipinos who often need reminding of our colourful past and why things are the way they are in the Philippines. Looking at the difficulties in life Filipinos face, it seems so easy to forget or even divorce from the country’s past, and embrace the “new” whether out of a sense of shame or survival. This man, through his example to everyone he meets, has given me a true appreciation for the different pieces of a puzzle I’d been trying to work out for quite some time now: tourism/economy and social business, history, culture, human rights and humanitarianism, health of individuals and populations, hard individual work with collective spirit and mentality, all mixed with a fierce love of two countries. I learned so much, and I could see how he ignites others to be their best. I feel very blessed to have been able to see so many great facets of the Filipino people, and to experience Filipinos working in earnest to better the country. Thank you, Senator Dick!
Well, that about caps up this article. So, folks, please remember that your health (physical/body, emotional, spiritual, mental) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
September 05 - 20, 2007
Mabuhay! In Part 1 about my journey to the Philippines July 12th - August 10th, I reported on the Ambassadors’, Consul Generals’, and Tourism Directors’ Tour (ACGTDT) and my Field Practicum questionnaire for my Master’s in Public Health exploring the migration of Filipino doctors and health care workers to Canada. If you haven’t responded to the questionnaire yet, please take the time to do so (askdrdenise@mts.net or http://www.askdrdenise.blogspot.com/) as your much-needed input could form projects and initiatives to address the many difficulties Filipino HCWs face in Canada. Thank you po!
This issue chronicles my amazing experiences at the Senate and the Philippine National Red Cross with presidential candidate, Department of Tourism’s Wow Philippines “spear-header”, and humanitarian “extraordinaire” Senator Richard “Dick” Gordon. I had the great fortune of being seated on the flight to Manila close to Senator Dick who overheard me speaking of my ambitious project and graciously offered any assistance while in the Philippines. My project leads were proving difficult to contact, so I decided to take him up on the offer, just missing the opportunity to watch President GMA’s State of the Nation Address (Sayang naman!!). My disappointment was quickly assuaged by an invitation to check out the Senate the following day! So on July 24-25th, I had the privilege of witnessing the first Session for the Fourteenth Senate of the Philippines where the main issue was the discussion surrounding further action following a resolution by 17 of the 22 senators asking that the Senate support newly elected Senator Trillanes, to be able to sit at the Senate and perform his functions. The problem is this: in July 2003, a group of 321 armed soldiers who called themselves “Bagong Katipuneros” led by Army Capt. Gerardo Gambala and Lt. Antonio Trillanes IV, of the Philippine Navy took over (and apparently rigged with bombs) the Oakwood Premier Ayala Center service apartment tower in Makati City to show the Filipino people the alleged corruption of the GMA administration. This Oakwood mutiny effort was quickly thwarted, and Trillanes is currently incarcerated for an alleged criminal charge. Following this, he ran for senator, and won with more than 11 million votes. Interesting dilemma. Dissecting this issue further reveals many insights into the checkered and complex political and cultural history of the Philippines. I got to hear many compelling arguments from the various senators, ranging from the popular notion that he represents the people by such strong public support, that not allowing him to sit in the senate could be perceived as a human rights violation, the precedent of previous politician Mantolo being allowed to sit his duties, minimization of any harms that Trillanes would pose by letting him do his duties (unlikely flight risk, he’d only be 1 of 22 senators so his influence would be “diluted”, options for security and teleconferencing), etc. Hmmmm. I also heard from the four senators (Gordon, Arroyo, Enrile, and Santiago) who voted against the resolution—mainly the separation of powers of jurisdictions, the gravity of the charge, the importance of accountability in the definition of courage, the slippery slope argument, the moral problem with the senate stepping outside its jurisdiction, the inherent conflict of interest in a senate essentially allowing one of its own to “be above the law”, and much more. I got to discuss the ethical and moral facets of the issue with Senator Gordon, before his final speech—this would not even be happening in Canada!-- and I must say, we were all proud that he “nailed it” by getting his points across so passionately and eloquently. There are 5 clips of his speech (with me in the background trying to tape it!) on http://www.youtube.com/watch?v=eKhUi7vSE98. The ante was upped when it was suggested each senator reveal the reasons for her/his vote, and though the resolution was passed, it was exciting to witness government in action, as well as see the media frenzy that followed the session.
Afterward, I saw his dedicated staff work late into the evening while he met with Filipinos who came to ask for his help and guidance, did an inspiring interview (and mini cultural and history lesson) with an Italian-Filipino initiative called Stila Magazine, foto-op with a Filipino-American hip-hop group, another interview with a group of elementary students, and a general debriefing with his staff. On top of all these great experiences and learning opportunities, Senator Gordon facilitated my project work with the Dept of Labour and Employment/Philippine Oversease Employment Agency as well as some time with the Philippine National Red Cross.
I sat in on a teaching session he held with his PNRC staff on Disaster Response Planning, and I got to put my two cents in on what some of the Canadian programs do. I also got to attend the meeting of the Board, which Senator Dick chairs. What an illustrious and welcoming group! Discussing the ins and outs of humanitarian work and the challenges of administering and managing public care and aid through the PNRC were both educational and inspiring to me as a budding public health specialist. My heart grew with pride when a couple of Filipinas from Canada dropped in to give a donation.
At the end of the meeting, we found that former President Fidel Ramos was at the PNRC getting his blood pressure checked! My blood pressure went through the roof as I joined the crowd to meet “Steady Eddie”, the beloved president I read about in my (and the first) Philippine Studies Institute class only a couple of weeks prior. He cajoled the gang and the foto ops and smiles were endless. I was able to set up an interview with him, so more about him soon.
To crown off the evening, I joined Senator Dick’s staff in catching the tail end of the year-long-awaited nail-biting basketball game between the rival universities - Ateneo vs De La Salle. The standing-only half-green (DLSU), half-blue (ADMU) crowd went wild the whole game, which went (close match in over-time) to Senator Dick’s home team, Ateneo.What a rush!
All in all, I was really impressed with Senator Gordon and what he stands for, especially his continually connecting Filipino history, culture—identity--to the future of the Philippines in a positive light, particularly with the young Filipinos who often need reminding of our colourful past and why things are the way they are in the Philippines. Looking at the difficulties in life Filipinos face, it seems so easy to forget or even divorce from the country’s past, and embrace the “new” whether out of a sense of shame or survival. This man, through his example to everyone he meets, has given me a true appreciation for the different pieces of a puzzle I’d been trying to work out for quite some time now: tourism/economy and social business, history, culture, human rights and humanitarianism, health of individuals and populations, hard individual work with collective spirit and mentality, all mixed with a fierce love of two countries. I learned so much, and I could see how he ignites others to be their best. I feel very blessed to have been able to see so many great facets of the Filipino people, and to experience Filipinos working in earnest to better the country. Thank you, Senator Dick!
Well, that about caps up this article. So, folks, please remember that your health (physical/body, emotional, spiritual, mental) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
Tuesday, September 18, 2007
Journey to the Philippines, Part 1: ACGTDT & MPH Field Practicum
FJ Volume 21, Number 16
Aug 20 - Sep 05/07
Magandang araw mga kababayan! It feels good to write after a long-enough hiatus—I just got back August 10th from our homeland, the Philippines, after a month jam-packed with cultural events, adventures, meetings, opportunities, and overall major personal growth. What a lot to report, and where to begin?? I guess at the beginning…this will be Part 1 of a series that will include the ACGTDT, my Field Practicum research, experiences at the Senate and Philippine National Red Cross with Senator Richard Gordon, a trip to Subic to meet PGMA, and interviews with former president, Fidel V. Ramos, Migrante International, previous Secretary of Health Dr. Jaime Z. Galvez Tan, UP College of Medicine Dean Alberto Roxas, Sandra Aguinaldo from GMA-7, agencies including the Canadian Immigration Integration Program/Canadian Embassy, Philippine Overseas Employment Authority, Department of Labour and Employment, several physicians and medical students, “undercover” research in the form of “kidney-shopping” with cab-drivers, a stint at Operation Smile with Drs. Hector Santos and the Managed Care Clinic, and I might even reveal some of my more candid reactions, culture shocks, and rude awakenings learning about the distinctly Pinoy way of life. I will be posting my articles on my blog Ask Dr. Denise and its “angry” off-shoot POP soon, so if you miss any, feel free to check out the blogs at: http://www.askdrdenise.blogspot.com/.
As many of you may know, I am completing my Masters in Public Health degree, which requires a 3-month Field Practicum, as part of my Community Medicine residency. I reasoned—what better way to work on a project I am passionate about that fits precisely into my world vision and life mission, with an opportunity for exposure and immersion at multiple health-related organizations and initiatives/programs, particularly my homeland, working on the many projects I have been toiling away in my spare time that are potentially good for the health of the Filipino and Canadian people, the health of the overall systems of my two beloved countries, and all involved? Plus I’d get to learn so much more about my roots, the language, the culture--a true Win-Win.
So I decided to start my Philippines portion of my practicum piggy-backing onto the 3rd Ambassadors, Consuls General and Tourism Directors Tour of the Philippines (ACGTDT), July 14-17, 2007. The weeks prior to my departure July 12 involved making last-minute preparations and finalizing trip plans, celebrating Philippine Independence and Heritage, plus taking in what I could of the Philippine Studies Institute first course History and Culture of the Philippines with Dr. Michael Culinane, including the very relevant forum to my project on The Brain Drain of Filipinos to North America. What an excellent and timely course and associated events schedule to kick off my trip to the Philippines!
The ACGTDT to the Philippines is a joint collaboration between Philippine government offices (the Departments of Foreign Affairs, of Tourism, and of Trade and Industry), designed to bring the Philippines closer to communities in North America, offering participants countless opportunities in terms of cultural enrichment and people-to-people exchanges, leisure and recreation, retirement programs and business networking. Of the almost 650 tour participants, 21 booked or came from Agana, Guam, 9 from Atlanta, 50 from Chicago, 114 from Honolulu, 146 from Los Angeles, 11 from Miami, 69 from New York, 130 from San Francisco, 29 from Washington DC, 7 from Calgary, 26 from Edmonton, 22 from Ottawa, 3 from Vancouver, and 10 from Winnipeg. The Winnipeg group included: Dr. Salvador and Josephine Andres from Saskatoon (my parents are Dr. Sal’s godparents), Alexandra, Luz, Nemesio, and Victoria Buen, Allen, Esmeralda, and Kelly Joe Harvard, and Antonina Huypungco (I booked through Ottawa as Hon. Jose S. Brillantes was my preceptor for the Philippine portion of my MPH FP).
We arrived groggy at just after 4 am July 14 to the welcoming tunes of a Filipino “mariachi band” and fragrant sampaguita leis. A quick orientation at the Shangri-la Makati Hotel, and we were whisked to the Serendra Club House for breakfast care of Megaworld Inc. and business meetings courtesy of the department of Trade and Industry. Here we learned of small investment opportunities in the provinces, Philippine brand franchising opportunities, the OTOP (One Town One Product) initiative, Meycauayan Jewelry Industry Association, etc. We could then mingle, sample more delicious Filipino foods, check out and purchase Filipino jewelry, and then embark on a City Tour of Manila and Makati which included Intramuros, Fort Santiago, and Bahay Tsinoy while some opted for Pasarap (spa/massage) or Paganda (mani/pedicure or haircut) for a small fee. We became VIPs when we were escorted by motorbike-police through the traffic-jammed streets of Manila to help get us to our “Exotic Mindanao” welcome dinner at the Sofitel Philippine Plaza. Canadian Ambassador Peter Sutherland joined us as we were wowed by an eye-popping Muslim Filipiniana song/dance/fashion-show where the beautiful dancers, singers, and models show-pieced the Mindanao delicacies served from the stage onto our plates, all emceed by a former Miss Philippines. After the dinner, I got to tsis-mis more with delegates from Ontario, Montreal, and Alberta when the Ambassador treated us to a late-nite coffee across the street from the Shangri-la Makati Hotel.
Sunday after another scrumptious breakfast, we got to choose from tours to Corregidor, Villa Escudero, or Tagaytay. I chose the Taal/Tagaytay/Batangas Eco-Cultural Tour, and was impressed by the serene drive through the countryside and the gorgeous landscape featuring the smallest Taal volcano, all to the silly jokes of our tour guide. We stopped for a merienda at the Tagaytay Highlands in a pagoda-style tearoom, then traveled to and lunched at the famous Sonya’s Garden. We stopped by the Tagaytay Medical Centre as one of our delegates had an asthma attack, but once we were assured of our group’s safety and health, we made it back in time to go to either a Show and Dinner in Tiendesitas Stalls, Ortigas, or Star Studio, ABS-CBN Cocktails with “stars”. I got a chance to have my first Krispy Kreme Donut at Star Studio, then hung with stars from Pinoy Big Brother and other famous Filipino teen shows. I also got some photo ops with the 2 Miss Teen American Philippines and camped it up in front of the camera some more with the teen Pinoy and Pinay hotties.
Monday started with a Wreath-Laying Ceremony in the brilliant (and unforgiving!) sun at Rizal Monument to give respect and honour our national hero, Jose Rizal. Then we arrived at Malacanang Palace for a Tour of the Museum—if anyone finds copies of the cheeky fotos of me showing off my shoes “Imelda-style” at the table where Marcos declared martial law, please let me know!!--then another belly-stretching lunch complete with Halo-Halo and other Filipino goodies. We met and got photographed at Rizal Hall with President Gloria Macapagal Arroyo, who at first thought the Canadian group was all from Winnipeg and had many wonderful things to say about our awesome province. She and her staff graciously chatted with and took photos with the throngs of delegates who swarmed her. We returned to our hotels via a Rolling Tour of Manila and Makati (included the Cultural Center of the Philippines Complex, Libingan ng mga Bayani, American Cemetery, Forbes Park, Business District) then finished up with a Wellness theme Appreciation Dinner at the Shangri-La Hotel. Here, we could dance the night away to the live bands or hunt through the stacks of tour photos from the tour photographers.
The following day was check-out for some while others could choose from Optional Out-of-Town-Tours such as Aklan/Boracay; Laoag/Vigan; Bohol/Dumaguete; Cebu/Cagayan de Oro; Puerto Princesa, Palawan; Diving in Club Noah Isabelle, Palawan; Golf in Metro Manila’s top 3 courses; Clark, Pampanga/Subic, Olgangapo; as well as a Gawad Kalinga Housing Project Visit and Wowowie Show. All in all the ACGTDT 2007 was an amazing time filled with wonderful experiences and connections with new friends from all over North America and the Philippines. I opted to focus on my ambitious project of looking at the Migration of Health Care Workers, particularly Filipino Doctors, to Canada. I will have to report on this project in an upcoming issue, but I am calling out to you to send me your stories, comments, or advice, or the contact information of those who might be able to help me in this ongoing project:
As I may have mentioned to many of you, I am quite interested in the experience and health of Filipino immigrants, particularly Live-in Caregivers, “nannies”, and health care professionals—whether recognized in their professions or not (credentials, fair and equitable pay, respect, etc). In my Public Health training, I’ve come across some research about the “Healthy Immigrant Effect”—basically that some immigrants tend to be healthier than Canadian-born but then after several years in Canada, their health deteriorates to the level of their Canadian-born controls. I’ve started researching the health of Filipinos across Canada and spent some time in Ottawa, Montreal, the Philippines, as well as locally talking to people about their experiences coming to Canada. I want to hear from you—please, tell me your stories: email me at askdrdenise@mts.net or go to my blog www.askdrdenise.blogspot.com and add your story as a comment to this article or take the questionnaire (to be set up)—if you wish certain parts of your story to be confidential, please use my email address and outline which parts, if any, you are okay with me sharing on my blog or in this column.
The questions I’m particularly interested in:
1) Name, sex, and contact information
2) Age, Year of Birth, Year of immigration to Canada, Dates of any other Caregiving experiences in other countries (including the Philippines)
3) Languages (including dialect, if necessary) spoken and read
4) Process of Immigration to Canada: Were you in the Live-In Caregiver Program, other categories of immigration
5) What type of work do you do? If you are a Caregiver, what field/area are you in? Ie: what training did you have in the Philippines, Canada, elsewhere? Did that translate into what you are doing now?
6) Health status/concerns in the Philippines compared with in Canada
7) Do you believe that being Filipino makes you healthier or less healthy than non-Filipinos? Why? What are the key factors you believe determine Filipino-Canadian health (eg, language, where born, credentialing, education, discrimination/prejudice, connection to community, family, etc)?
8) What are your concerns regarding the health of the Filipino community in Canada and in the Philippines? Is there a Brain Drain? Why or Why not?
9) What are your suggestions for dealing with these issues?
10) Any other comments are greatly appreciated.
Maraming salamat po!
So please remember that your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
Aug 20 - Sep 05/07
Magandang araw mga kababayan! It feels good to write after a long-enough hiatus—I just got back August 10th from our homeland, the Philippines, after a month jam-packed with cultural events, adventures, meetings, opportunities, and overall major personal growth. What a lot to report, and where to begin?? I guess at the beginning…this will be Part 1 of a series that will include the ACGTDT, my Field Practicum research, experiences at the Senate and Philippine National Red Cross with Senator Richard Gordon, a trip to Subic to meet PGMA, and interviews with former president, Fidel V. Ramos, Migrante International, previous Secretary of Health Dr. Jaime Z. Galvez Tan, UP College of Medicine Dean Alberto Roxas, Sandra Aguinaldo from GMA-7, agencies including the Canadian Immigration Integration Program/Canadian Embassy, Philippine Overseas Employment Authority, Department of Labour and Employment, several physicians and medical students, “undercover” research in the form of “kidney-shopping” with cab-drivers, a stint at Operation Smile with Drs. Hector Santos and the Managed Care Clinic, and I might even reveal some of my more candid reactions, culture shocks, and rude awakenings learning about the distinctly Pinoy way of life. I will be posting my articles on my blog Ask Dr. Denise and its “angry” off-shoot POP soon, so if you miss any, feel free to check out the blogs at: http://www.askdrdenise.blogspot.com/.
As many of you may know, I am completing my Masters in Public Health degree, which requires a 3-month Field Practicum, as part of my Community Medicine residency. I reasoned—what better way to work on a project I am passionate about that fits precisely into my world vision and life mission, with an opportunity for exposure and immersion at multiple health-related organizations and initiatives/programs, particularly my homeland, working on the many projects I have been toiling away in my spare time that are potentially good for the health of the Filipino and Canadian people, the health of the overall systems of my two beloved countries, and all involved? Plus I’d get to learn so much more about my roots, the language, the culture--a true Win-Win.
So I decided to start my Philippines portion of my practicum piggy-backing onto the 3rd Ambassadors, Consuls General and Tourism Directors Tour of the Philippines (ACGTDT), July 14-17, 2007. The weeks prior to my departure July 12 involved making last-minute preparations and finalizing trip plans, celebrating Philippine Independence and Heritage, plus taking in what I could of the Philippine Studies Institute first course History and Culture of the Philippines with Dr. Michael Culinane, including the very relevant forum to my project on The Brain Drain of Filipinos to North America. What an excellent and timely course and associated events schedule to kick off my trip to the Philippines!
The ACGTDT to the Philippines is a joint collaboration between Philippine government offices (the Departments of Foreign Affairs, of Tourism, and of Trade and Industry), designed to bring the Philippines closer to communities in North America, offering participants countless opportunities in terms of cultural enrichment and people-to-people exchanges, leisure and recreation, retirement programs and business networking. Of the almost 650 tour participants, 21 booked or came from Agana, Guam, 9 from Atlanta, 50 from Chicago, 114 from Honolulu, 146 from Los Angeles, 11 from Miami, 69 from New York, 130 from San Francisco, 29 from Washington DC, 7 from Calgary, 26 from Edmonton, 22 from Ottawa, 3 from Vancouver, and 10 from Winnipeg. The Winnipeg group included: Dr. Salvador and Josephine Andres from Saskatoon (my parents are Dr. Sal’s godparents), Alexandra, Luz, Nemesio, and Victoria Buen, Allen, Esmeralda, and Kelly Joe Harvard, and Antonina Huypungco (I booked through Ottawa as Hon. Jose S. Brillantes was my preceptor for the Philippine portion of my MPH FP).
We arrived groggy at just after 4 am July 14 to the welcoming tunes of a Filipino “mariachi band” and fragrant sampaguita leis. A quick orientation at the Shangri-la Makati Hotel, and we were whisked to the Serendra Club House for breakfast care of Megaworld Inc. and business meetings courtesy of the department of Trade and Industry. Here we learned of small investment opportunities in the provinces, Philippine brand franchising opportunities, the OTOP (One Town One Product) initiative, Meycauayan Jewelry Industry Association, etc. We could then mingle, sample more delicious Filipino foods, check out and purchase Filipino jewelry, and then embark on a City Tour of Manila and Makati which included Intramuros, Fort Santiago, and Bahay Tsinoy while some opted for Pasarap (spa/massage) or Paganda (mani/pedicure or haircut) for a small fee. We became VIPs when we were escorted by motorbike-police through the traffic-jammed streets of Manila to help get us to our “Exotic Mindanao” welcome dinner at the Sofitel Philippine Plaza. Canadian Ambassador Peter Sutherland joined us as we were wowed by an eye-popping Muslim Filipiniana song/dance/fashion-show where the beautiful dancers, singers, and models show-pieced the Mindanao delicacies served from the stage onto our plates, all emceed by a former Miss Philippines. After the dinner, I got to tsis-mis more with delegates from Ontario, Montreal, and Alberta when the Ambassador treated us to a late-nite coffee across the street from the Shangri-la Makati Hotel.
Sunday after another scrumptious breakfast, we got to choose from tours to Corregidor, Villa Escudero, or Tagaytay. I chose the Taal/Tagaytay/Batangas Eco-Cultural Tour, and was impressed by the serene drive through the countryside and the gorgeous landscape featuring the smallest Taal volcano, all to the silly jokes of our tour guide. We stopped for a merienda at the Tagaytay Highlands in a pagoda-style tearoom, then traveled to and lunched at the famous Sonya’s Garden. We stopped by the Tagaytay Medical Centre as one of our delegates had an asthma attack, but once we were assured of our group’s safety and health, we made it back in time to go to either a Show and Dinner in Tiendesitas Stalls, Ortigas, or Star Studio, ABS-CBN Cocktails with “stars”. I got a chance to have my first Krispy Kreme Donut at Star Studio, then hung with stars from Pinoy Big Brother and other famous Filipino teen shows. I also got some photo ops with the 2 Miss Teen American Philippines and camped it up in front of the camera some more with the teen Pinoy and Pinay hotties.
Monday started with a Wreath-Laying Ceremony in the brilliant (and unforgiving!) sun at Rizal Monument to give respect and honour our national hero, Jose Rizal. Then we arrived at Malacanang Palace for a Tour of the Museum—if anyone finds copies of the cheeky fotos of me showing off my shoes “Imelda-style” at the table where Marcos declared martial law, please let me know!!--then another belly-stretching lunch complete with Halo-Halo and other Filipino goodies. We met and got photographed at Rizal Hall with President Gloria Macapagal Arroyo, who at first thought the Canadian group was all from Winnipeg and had many wonderful things to say about our awesome province. She and her staff graciously chatted with and took photos with the throngs of delegates who swarmed her. We returned to our hotels via a Rolling Tour of Manila and Makati (included the Cultural Center of the Philippines Complex, Libingan ng mga Bayani, American Cemetery, Forbes Park, Business District) then finished up with a Wellness theme Appreciation Dinner at the Shangri-La Hotel. Here, we could dance the night away to the live bands or hunt through the stacks of tour photos from the tour photographers.
The following day was check-out for some while others could choose from Optional Out-of-Town-Tours such as Aklan/Boracay; Laoag/Vigan; Bohol/Dumaguete; Cebu/Cagayan de Oro; Puerto Princesa, Palawan; Diving in Club Noah Isabelle, Palawan; Golf in Metro Manila’s top 3 courses; Clark, Pampanga/Subic, Olgangapo; as well as a Gawad Kalinga Housing Project Visit and Wowowie Show. All in all the ACGTDT 2007 was an amazing time filled with wonderful experiences and connections with new friends from all over North America and the Philippines. I opted to focus on my ambitious project of looking at the Migration of Health Care Workers, particularly Filipino Doctors, to Canada. I will have to report on this project in an upcoming issue, but I am calling out to you to send me your stories, comments, or advice, or the contact information of those who might be able to help me in this ongoing project:
As I may have mentioned to many of you, I am quite interested in the experience and health of Filipino immigrants, particularly Live-in Caregivers, “nannies”, and health care professionals—whether recognized in their professions or not (credentials, fair and equitable pay, respect, etc). In my Public Health training, I’ve come across some research about the “Healthy Immigrant Effect”—basically that some immigrants tend to be healthier than Canadian-born but then after several years in Canada, their health deteriorates to the level of their Canadian-born controls. I’ve started researching the health of Filipinos across Canada and spent some time in Ottawa, Montreal, the Philippines, as well as locally talking to people about their experiences coming to Canada. I want to hear from you—please, tell me your stories: email me at askdrdenise@mts.net or go to my blog www.askdrdenise.blogspot.com and add your story as a comment to this article or take the questionnaire (to be set up)—if you wish certain parts of your story to be confidential, please use my email address and outline which parts, if any, you are okay with me sharing on my blog or in this column.
The questions I’m particularly interested in:
1) Name, sex, and contact information
2) Age, Year of Birth, Year of immigration to Canada, Dates of any other Caregiving experiences in other countries (including the Philippines)
3) Languages (including dialect, if necessary) spoken and read
4) Process of Immigration to Canada: Were you in the Live-In Caregiver Program, other categories of immigration
5) What type of work do you do? If you are a Caregiver, what field/area are you in? Ie: what training did you have in the Philippines, Canada, elsewhere? Did that translate into what you are doing now?
6) Health status/concerns in the Philippines compared with in Canada
7) Do you believe that being Filipino makes you healthier or less healthy than non-Filipinos? Why? What are the key factors you believe determine Filipino-Canadian health (eg, language, where born, credentialing, education, discrimination/prejudice, connection to community, family, etc)?
8) What are your concerns regarding the health of the Filipino community in Canada and in the Philippines? Is there a Brain Drain? Why or Why not?
9) What are your suggestions for dealing with these issues?
10) Any other comments are greatly appreciated.
Maraming salamat po!
So please remember that your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
Wednesday, July 18, 2007
In Deed
FJ Volume 21, Number 11
June 05 - 20, 2007
'Ako ay Pilipina, indeed.'
That is the stinging concluding remark from a letter to the editor in response to my proud self-statement (a reference to the song Magdaragat introduced me to which eventually helped reconnect me to my heritage) in my FJ article on Folklorama when I first moved to Winnipeg in 2003. Ar-ouch. To this day, 4 years later, I can feel my blood pressure rise and my heart sink when I recall the experience. The writer was not happy with my use of the word “Flip” to refer to Filipinos, apparently considered derogatory by some. I was shocked at the strong negative reaction and attack at not only my character but also my definition of myself as a Filipina—ang bilis bilis, too!--because all my life, that word was a special term, almost of entitlement—like my “peeps”, my “homies.” This was the term my barkadas, a handful of Saskatchewan Filipino-Canadian teens—The Filipinas Youth Group, used to call ourselves—we were cool because we had something no one else did. Like a mini-gang minus the drugs and guns and scare factor. We wore bandannas and break-danced like no other. Heck, we dominated in the dance realm. I don’t know where Bagets (form of dance Magdaragat taught us) originally came from, but it became ours. We serenaded and pen-pal’ed with our Magdaragat friends like it was going out of style. We kicked butt in basketball and sikaran. No one could touch us. Looking back, it was par for the course; identity issues--what all teens go through.
Now 20 years later, that letter triggered another mini identity crisis—I was seeking any reassurance I could get from my parents and the FJ editors. Did I just offend the entire Filipino community with my words?? Was I any less Filipino because that word was power where I came from but here—a cause for immediate ostracism? And why didn’t anyone teach me this in Coconut School??! What about my lack of Tagalog? Or my Chinese blood and Chinese name? What do I do to “fix” this?? Dare I ask the question--who’s “more Filipino” here: someone who tries to build up the Filipino spirit in all its different forms despite glaring “un-Filipino-ness”, or someone with the privilege of breeding & birthright who tries to break it? I think I’d take 10 puti in barongg tagalogs singing our anthem off-key over 1 “purebred” Pinoy holding a gun to another. But that’s just “You’re-not-Filipino…No-you’re-not”–me. I still ask random Pinoys I meet about that word, because I do not want to give up that word; I refuse to give up that pride I’ve associated with it.
With time, I realized that if I wanted to resolve this inner disquiet, I best put my money where my mouth is. I went on a Medical Mission to Catanduanes, and saw and learned so much I hadn’t realized about my heritage. I decided to put my writing skills with my medical knowledge to do something good for the Filipino community—hence my health column, Ask Dr. Denise was born. To better understand our community and culture in addition to trying to serve the community, I ran for the PCCM Board and am now the Communications and Marketing Committee Chair. I started Tagalog/Filipino language classes, and everyone has been really great at encouraging me to use what I’ve learned. I joined the Asian Heritage Society in my quest to help increase the Filipino voice and profile in Manitoba. I am doing what I can to give back to an amazing community that embraced me with barbecues and socials and kain and baon.One of my crowning glories was when I reclaimed my Philippine Dual Citizenship when I visited Ottawa mid-April, while I was there to represent the Canadian Association of Internes and Residents (CAIR) at the Canadian Medical Association Council for Health Policy and Economics meeting. Our Embassy was gracious enough to facilitate the process of documentation requirements with my parents in Regina so that I could pledge allegiance to the Philippines at the Embassy during my trip. I was ecstatic as well as teary-eyed to achieve such an important validation of who I am. I also got my shiny new Pilipinas passport, so it was like winning the lottery!I still get the comments that I am “not Filipino enough” and “too Canadian.” I can only respond by accepting these stinging remarks and actively doing what I can to dispel these beliefs—not for my ego (I know full well who I am and have never hidden this), but because in my vision of what our Filipino community in Canada could become, these attitudes drive people apart rather than pull together as a family, and I must address this. Thus I must sincerely invite and encourage any of my kababayan to please feel free to come directly to me with any concerns they have about my actions/behaviours in the Filipino community. This is not at all a challenge, but an honest plea to the community to help me in this vital aspect of my life. Hopefully through my actions and deeds for the Filipino community, I can gain the acceptance of those I hope to advocate for.
In this way, I feel I can say, truly,
Ako ay Pilipina, in deed.
June 05 - 20, 2007
'Ako ay Pilipina, indeed.'
That is the stinging concluding remark from a letter to the editor in response to my proud self-statement (a reference to the song Magdaragat introduced me to which eventually helped reconnect me to my heritage) in my FJ article on Folklorama when I first moved to Winnipeg in 2003. Ar-ouch. To this day, 4 years later, I can feel my blood pressure rise and my heart sink when I recall the experience. The writer was not happy with my use of the word “Flip” to refer to Filipinos, apparently considered derogatory by some. I was shocked at the strong negative reaction and attack at not only my character but also my definition of myself as a Filipina—ang bilis bilis, too!--because all my life, that word was a special term, almost of entitlement—like my “peeps”, my “homies.” This was the term my barkadas, a handful of Saskatchewan Filipino-Canadian teens—The Filipinas Youth Group, used to call ourselves—we were cool because we had something no one else did. Like a mini-gang minus the drugs and guns and scare factor. We wore bandannas and break-danced like no other. Heck, we dominated in the dance realm. I don’t know where Bagets (form of dance Magdaragat taught us) originally came from, but it became ours. We serenaded and pen-pal’ed with our Magdaragat friends like it was going out of style. We kicked butt in basketball and sikaran. No one could touch us. Looking back, it was par for the course; identity issues--what all teens go through.
Now 20 years later, that letter triggered another mini identity crisis—I was seeking any reassurance I could get from my parents and the FJ editors. Did I just offend the entire Filipino community with my words?? Was I any less Filipino because that word was power where I came from but here—a cause for immediate ostracism? And why didn’t anyone teach me this in Coconut School??! What about my lack of Tagalog? Or my Chinese blood and Chinese name? What do I do to “fix” this?? Dare I ask the question--who’s “more Filipino” here: someone who tries to build up the Filipino spirit in all its different forms despite glaring “un-Filipino-ness”, or someone with the privilege of breeding & birthright who tries to break it? I think I’d take 10 puti in barongg tagalogs singing our anthem off-key over 1 “purebred” Pinoy holding a gun to another. But that’s just “You’re-not-Filipino…No-you’re-not”–me. I still ask random Pinoys I meet about that word, because I do not want to give up that word; I refuse to give up that pride I’ve associated with it.
With time, I realized that if I wanted to resolve this inner disquiet, I best put my money where my mouth is. I went on a Medical Mission to Catanduanes, and saw and learned so much I hadn’t realized about my heritage. I decided to put my writing skills with my medical knowledge to do something good for the Filipino community—hence my health column, Ask Dr. Denise was born. To better understand our community and culture in addition to trying to serve the community, I ran for the PCCM Board and am now the Communications and Marketing Committee Chair. I started Tagalog/Filipino language classes, and everyone has been really great at encouraging me to use what I’ve learned. I joined the Asian Heritage Society in my quest to help increase the Filipino voice and profile in Manitoba. I am doing what I can to give back to an amazing community that embraced me with barbecues and socials and kain and baon.One of my crowning glories was when I reclaimed my Philippine Dual Citizenship when I visited Ottawa mid-April, while I was there to represent the Canadian Association of Internes and Residents (CAIR) at the Canadian Medical Association Council for Health Policy and Economics meeting. Our Embassy was gracious enough to facilitate the process of documentation requirements with my parents in Regina so that I could pledge allegiance to the Philippines at the Embassy during my trip. I was ecstatic as well as teary-eyed to achieve such an important validation of who I am. I also got my shiny new Pilipinas passport, so it was like winning the lottery!I still get the comments that I am “not Filipino enough” and “too Canadian.” I can only respond by accepting these stinging remarks and actively doing what I can to dispel these beliefs—not for my ego (I know full well who I am and have never hidden this), but because in my vision of what our Filipino community in Canada could become, these attitudes drive people apart rather than pull together as a family, and I must address this. Thus I must sincerely invite and encourage any of my kababayan to please feel free to come directly to me with any concerns they have about my actions/behaviours in the Filipino community. This is not at all a challenge, but an honest plea to the community to help me in this vital aspect of my life. Hopefully through my actions and deeds for the Filipino community, I can gain the acceptance of those I hope to advocate for.
In this way, I feel I can say, truly,
Ako ay Pilipina, in deed.
Wednesday, March 07, 2007
Food Safety: Bring on the Baon! & The Health of Caregivers
FJ, Volume 21, Number 5
March 05 - 22, 2007
My boss (I’m a live-in caregiver) is always on my case about food and leftovers. She wants to throw everything away which I think is very wasteful. I was brought up to be thrifty and frugal. Who is right?
You both are. Baon (food taken home from a party or gathering) is a central part of Filipino culture and in my opinion reflects our love of food and thriftiness, as well as resourcefulness and hospitality. We can always tell a Filipino fridge—not just by the jars of jufran, macapuno, bagoong, matamis sa bao (sometimes way past the expiry date!), but also an array of things like: little bowls of patis/soya sauce/kalamansi, Styrofoam plates of pancit, rice, adobo, stew, and cake/pastries covered by tin foil, a pot of sinigang, maybe some of those bright fuschia salted eggs, etcetcetc. Often the rice stays on the counter in the rice cooker which stays on “Warm”, 24 hours a day, 7 days a week. I am always a little scared of my parents’ fridge back home—packed with all sorts of things that I’m not sure are edible anymore and actually emitting loud whirring noises…I think it’s trying to tell my parents that it’s working too hard and should be relieved of its burden! Then there’s the trend for excessive oil use in Filipino cooking, but I think I covered that in my cholesterol article…naman!
Baon is definitely distinctly Filipino, but it can be dangerous.The Canadian Food Inspection Agency (CFIA) is the Government of Canada’s science-based regulator for animal health, plant protection and, in partnership with Health Canada, food safety. Their website (www.inspection.gc.ca) has a lot of useful information on issues related to food, including a list of allergy alerts and food recalls. You can search on it by country—there was a list of products from the Philippines that the CFIA considered unsafe. I remember going into severe withdrawal when they pulled the Nata de Coco jelly cups off the shelves—I’d loved them so much it was hard to hear that kids were choking on them! The CFIA site also provides a useful Food Safety Fact Sheet on Leftovers that I am quoting below. You can also find food safety information on the Health Canada and Canadian Partnership for Consumer Food Safety Education Web sites respectively at www.hc-sc.gc.ca and www.canfightbac.org/en/.
FOOD SAFETY FACTS ON LEFTOVERS
What is foodborne illness?
Food contaminated by bacteria, viruses and parasites can make you sick. Many people have had foodborne illness and not even known it. It’s sometimes called food poisoning, and it can feel like the flu. Symptoms may include the following:
* stomach cramps
* nausea
* vomiting
* diarrhea
* fever
Symptoms can start soon after eating contaminated food, but they can hit up to a month or more later. For some people, especially young children, the elderly, pregnant women and people with weakened immune systems, foodborne illness can be very dangerous.
Public health experts estimate that there are 11 to 13 million cases of foodborne illness in Canada every year. Most cases of foodborne illness can be prevented by using safe food handling practices and using a food thermometer to check that your food is cooked to a safe internal temperature!
Storing leftovers
* Store leftovers within 2 hours of cooking. Discard leftovers if the food has been sitting at room temperature for more than 1 hour. Cold food should be stored at 4ºC (40ºF) or colder.
* Before and after handling and preparing leftovers, wash your hands and sanitize all utensils, dishes and work surfaces with a mild bleach solution (5 ml/1 tsp. bleach per 750 ml/3 cups water).
* Never remove a large pot of food (such as soup, stew, or pasta sauce) from the stove and place it in the refrigerator. Large masses of food can take hours or days to chill properly. A slow cooling process provides an ideal environment for the growth of harmful bacteria.
* Very hot items can be cooled at room temperature, until they stop steaming, prior to being refrigerated. Frequent stirring accelerates the cooling at this stage. Food will cool faster in an uncovered, shallow container.
* An effective way to cool and store hot leftovers is to lay them flat in zipper-type plastic bags. Although the bags must be closed securely, food cools quickly due to the greater surface area exposed to the refrigerated air.
* Refrigerate or freeze leftovers in covered, shallow containers.
* Place containers on wire refrigerator shelves to allow air to flow across the bottom of the container. This practice allows food to cool twice as fast as sitting on a solid shelf.
* Do not overcrowd your refrigerator. Leave airspace around containers to allow circulation of cold air. This will help ensure rapid, even cooling.
* Date leftovers to ensure that they are not stored too long – eat leftovers within 4 days. For frozen leftovers, eat within 4 days of being taken out of the freezer.
* Always put leftovers in clean containers and never mix them with fresh food.
Reheating leftovers
* Reheat solid leftovers to at least 74ºC (165ºF).
* Reheat soups, sauces and gravies to a rolling boil.
* Follow the manufacturer's instructions when reheating commercial foods in a microwave.
* Discard uneaten leftovers after they have been reheated.
NEVER use your nose, eyes or taste buds to judge the safety of food.
You cannot tell if a food may cause foodborne illness by its look, smell or taste.
And remember: "If in doubt, throw it out!"
***
Now, some of you may know that I am quite interested in the experience and health of Filipino immigrants, particularly Live-in Caregivers, “nannies”, and health care professionals—whether recognized in their profession or not (credentials, fair and equitable pay, respect, etc). In my Public Health training, I’ve come across some research (some flaws in research design, etc) that talks about the Healthy Immigrant Effect—basically that some immigrants tend to be healthier than Canadian-born but then after several years in Canada, their health deteriorates to the level of their Canadian-born controls. I’ve started researching the health of Filipinos across Canada and spent some time in Ottawa and Montreal as well as locally talking to people about their experiences coming to Canada. I want to hear from you—please, tell me your stories: email me at askdrdenise@mts.net or add your story as a comment to this article or take the questionnaire (to set up)—if you wish certain parts of your story to be confidential, please use my email address and outline which parts, if any, you are okay with me sharing on my blog or in this column.
The questions I’m particularly interested in:
1) Name, sex, and contact information
2) Age, Year of Birth, Year of immigration to Canada, Dates of any other Caregiving experiences in other countries (including the Philippines)
3) Languages (including dialect, if necessary) spoken and read
4) Process of Immigration to Canada: Were you in the Live-In Caregiver Program, other categories of immigration
5) What type of work do you do? If you are a Caregiver, what field/area are you in? Ie: what training did you have in the Philippines, Canada, elsewhere? Did that translate into what you are doing now?
6) Health status/concerns in the Philippines compared with in Canada
7) Do you believe that being Filipino makes you healthier or less healthy than non-Filipinos? Why? What are the key factors you believe determine Filipino-Canadian health (eg, language, where born, credentialing, education, discrimination/prejudice, connection to community, family, etc)?
8) What are your concerns regarding the health of the Filipino community in Canada and in the Philippines?
9) What are your suggestions for dealing with these issues?
10) Any other comments are greatly appreciated. Salamat po!
So please remember that your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
March 05 - 22, 2007
My boss (I’m a live-in caregiver) is always on my case about food and leftovers. She wants to throw everything away which I think is very wasteful. I was brought up to be thrifty and frugal. Who is right?
You both are. Baon (food taken home from a party or gathering) is a central part of Filipino culture and in my opinion reflects our love of food and thriftiness, as well as resourcefulness and hospitality. We can always tell a Filipino fridge—not just by the jars of jufran, macapuno, bagoong, matamis sa bao (sometimes way past the expiry date!), but also an array of things like: little bowls of patis/soya sauce/kalamansi, Styrofoam plates of pancit, rice, adobo, stew, and cake/pastries covered by tin foil, a pot of sinigang, maybe some of those bright fuschia salted eggs, etcetcetc. Often the rice stays on the counter in the rice cooker which stays on “Warm”, 24 hours a day, 7 days a week. I am always a little scared of my parents’ fridge back home—packed with all sorts of things that I’m not sure are edible anymore and actually emitting loud whirring noises…I think it’s trying to tell my parents that it’s working too hard and should be relieved of its burden! Then there’s the trend for excessive oil use in Filipino cooking, but I think I covered that in my cholesterol article…naman!
Baon is definitely distinctly Filipino, but it can be dangerous.The Canadian Food Inspection Agency (CFIA) is the Government of Canada’s science-based regulator for animal health, plant protection and, in partnership with Health Canada, food safety. Their website (www.inspection.gc.ca) has a lot of useful information on issues related to food, including a list of allergy alerts and food recalls. You can search on it by country—there was a list of products from the Philippines that the CFIA considered unsafe. I remember going into severe withdrawal when they pulled the Nata de Coco jelly cups off the shelves—I’d loved them so much it was hard to hear that kids were choking on them! The CFIA site also provides a useful Food Safety Fact Sheet on Leftovers that I am quoting below. You can also find food safety information on the Health Canada and Canadian Partnership for Consumer Food Safety Education Web sites respectively at www.hc-sc.gc.ca and www.canfightbac.org/en/.
FOOD SAFETY FACTS ON LEFTOVERS
What is foodborne illness?
Food contaminated by bacteria, viruses and parasites can make you sick. Many people have had foodborne illness and not even known it. It’s sometimes called food poisoning, and it can feel like the flu. Symptoms may include the following:
* stomach cramps
* nausea
* vomiting
* diarrhea
* fever
Symptoms can start soon after eating contaminated food, but they can hit up to a month or more later. For some people, especially young children, the elderly, pregnant women and people with weakened immune systems, foodborne illness can be very dangerous.
Public health experts estimate that there are 11 to 13 million cases of foodborne illness in Canada every year. Most cases of foodborne illness can be prevented by using safe food handling practices and using a food thermometer to check that your food is cooked to a safe internal temperature!
Storing leftovers
* Store leftovers within 2 hours of cooking. Discard leftovers if the food has been sitting at room temperature for more than 1 hour. Cold food should be stored at 4ºC (40ºF) or colder.
* Before and after handling and preparing leftovers, wash your hands and sanitize all utensils, dishes and work surfaces with a mild bleach solution (5 ml/1 tsp. bleach per 750 ml/3 cups water).
* Never remove a large pot of food (such as soup, stew, or pasta sauce) from the stove and place it in the refrigerator. Large masses of food can take hours or days to chill properly. A slow cooling process provides an ideal environment for the growth of harmful bacteria.
* Very hot items can be cooled at room temperature, until they stop steaming, prior to being refrigerated. Frequent stirring accelerates the cooling at this stage. Food will cool faster in an uncovered, shallow container.
* An effective way to cool and store hot leftovers is to lay them flat in zipper-type plastic bags. Although the bags must be closed securely, food cools quickly due to the greater surface area exposed to the refrigerated air.
* Refrigerate or freeze leftovers in covered, shallow containers.
* Place containers on wire refrigerator shelves to allow air to flow across the bottom of the container. This practice allows food to cool twice as fast as sitting on a solid shelf.
* Do not overcrowd your refrigerator. Leave airspace around containers to allow circulation of cold air. This will help ensure rapid, even cooling.
* Date leftovers to ensure that they are not stored too long – eat leftovers within 4 days. For frozen leftovers, eat within 4 days of being taken out of the freezer.
* Always put leftovers in clean containers and never mix them with fresh food.
Reheating leftovers
* Reheat solid leftovers to at least 74ºC (165ºF).
* Reheat soups, sauces and gravies to a rolling boil.
* Follow the manufacturer's instructions when reheating commercial foods in a microwave.
* Discard uneaten leftovers after they have been reheated.
NEVER use your nose, eyes or taste buds to judge the safety of food.
You cannot tell if a food may cause foodborne illness by its look, smell or taste.
And remember: "If in doubt, throw it out!"
***
Now, some of you may know that I am quite interested in the experience and health of Filipino immigrants, particularly Live-in Caregivers, “nannies”, and health care professionals—whether recognized in their profession or not (credentials, fair and equitable pay, respect, etc). In my Public Health training, I’ve come across some research (some flaws in research design, etc) that talks about the Healthy Immigrant Effect—basically that some immigrants tend to be healthier than Canadian-born but then after several years in Canada, their health deteriorates to the level of their Canadian-born controls. I’ve started researching the health of Filipinos across Canada and spent some time in Ottawa and Montreal as well as locally talking to people about their experiences coming to Canada. I want to hear from you—please, tell me your stories: email me at askdrdenise@mts.net or add your story as a comment to this article or take the questionnaire (to set up)—if you wish certain parts of your story to be confidential, please use my email address and outline which parts, if any, you are okay with me sharing on my blog or in this column.
The questions I’m particularly interested in:
1) Name, sex, and contact information
2) Age, Year of Birth, Year of immigration to Canada, Dates of any other Caregiving experiences in other countries (including the Philippines)
3) Languages (including dialect, if necessary) spoken and read
4) Process of Immigration to Canada: Were you in the Live-In Caregiver Program, other categories of immigration
5) What type of work do you do? If you are a Caregiver, what field/area are you in? Ie: what training did you have in the Philippines, Canada, elsewhere? Did that translate into what you are doing now?
6) Health status/concerns in the Philippines compared with in Canada
7) Do you believe that being Filipino makes you healthier or less healthy than non-Filipinos? Why? What are the key factors you believe determine Filipino-Canadian health (eg, language, where born, credentialing, education, discrimination/prejudice, connection to community, family, etc)?
8) What are your concerns regarding the health of the Filipino community in Canada and in the Philippines?
9) What are your suggestions for dealing with these issues?
10) Any other comments are greatly appreciated. Salamat po!
So please remember that your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
Wednesday, February 28, 2007
The Myths of Immunization
FJ Vol 21, No 2
Jan 22-Feb 5/07
We have heard a lot of bad/conflicting things about vaccination, and are not sure whether to vaccinate our children and ourselves. What do you think?
Immunization/vaccination is a hot topic in many circles, and many dangerous myths abound. I like to frame the approach from two perspectives—the population and the individual.
From the population perspective, it is an undisputed fact that immunization is one of the greatest success stories of modern medicine. Childhood immunization has saved millions of lives by eliminating many serious childhood diseases. Because of its success, we often no longer hear about many of these diseases, so it’s easy for parents to become complacent about the need to have their kids fully protected and keeping immunizations up to date. However in recent years, several countries have experienced new outbreaks of diseases everyone thought had disappeared—like diphtheria, German measles and polio. They reappeared because governments relaxed their immunization programs or certain groups in the population refused these immunizations.
It is true that as with any medicine, there are very small risks that problems could occur for someone getting a vaccine. From the individual perspective, many people think that since the risk of getting the disease is remote, they are saving themselves any risk of these potential adverse effects from getting the vaccine. However, this logic relies on the rest of the population to get immunized and decrease the risk of potentially fatal diseases occurring in the population. The higher the number of people who do not immunize themselves or their children means the higher the risk for the whole population. For all the vaccines currently offered in Canada/by Manitoba Health, a person’s chance of being harmed by the infection (and the severity of the illness) is far greater than any chance of being harmed by the vaccine. Vaccines are among the safest medical interventions, and they are subjected to rigorous safety and quality control standards. The individual must consider that once a person contracts the illness in question, the consequences could be disastrous. This is even worse, because the illness was vaccine-preventable. It is extremely important to weigh the right factors and not let overblown fear of an unlikely adverse event prevent protection from a potentially fatal and very real disease.
The vaccines currently recommended for adults and children will protect you/your kids against serious diseases that have not disappeared from the world. If people stop using these vaccines, the diseases will almost certainly become common again, causing many illnesses and deaths. These vaccines are extremely safe and highly effective. If you have any questions or concerns about vaccines, check with your doctor or public health office.
Many people go to the Internet looking for up-to-date information about vaccination. You can find current and trustworthy information on the Internet, but some websites have information that can be misleading—although they have been designed to look scientific and accurate, the information may not be scientifically valid. So remember: anyone can create a website. Only proper research methods guarantee the information is trustworthy. Always check the source of the information you read.
A trustworthy website will:
- Purpose
o …have a clearly stated mission and purpose
o …give credible health information based on solid scientific research
o …give info that includes many points of view. Be careful of sites that support a specific cause, group, or source of funding!
- Sponsors:
o …give the sponsor’s contact information; reputable websites don’t hide their identity
o The website address (URL) can help you learn more about them. If the address ends in:
".edu" = it is a school, college or university
".gc.ca" = Canadian government
".ca" = Canadian-based sites
".gov" = U.S.’ government
".org" = non-profit organizations
".int" = international organizations
".com" = commercial sites
- Supporting Organizations:
o …Be endorsed by a health agency/association you can trust.
o …Give info that covers municipal, regional, national or international concerns, not just the views of one person
o …Indicate if it’s part of a network of partners and identify them
o …Give background info about the sponsors
o …Refer to organizations responsible for maintaining standards
- Site Maintenance:
o …Have experts review the information
o …Post new info on a regular basis; often give the date when the info is posted.
- Authors:
o …clearly state the names of authors, their background and experience in vaccination/immunization. Look for details such as university degrees and professional membership in medical, nursing, scientific or public health associations
o …post work by authors who have published articles in established journals. Beware of articles written by “world-famous researchers,” “well-known scientists,” or “noted experts.”
o …give info based on solid research, not on opinion.
o …give references and links to support its statements
Beware:
- websites’ claims that seem too good or too bad to be true
- claims based on the idea of conspiracy; sites that say it discovered “the hidden truth” about vaccines
- information based on emotion rather than scientific fact. Stories about children who became sick or died are hard to read objectively. Even when pain and sickness occur, be aware that there is no substitute for scientific study.
- Information based on facts that aren’t tested. Professional researchers aren’t afraid to say that further research may be required.
- Websites focused on selling books, newsletters or products.
- Sites that give info “for educational purposes” only but don’t recommend a course of action—If a site is not willing to take responsibility for its advice, why should you?
Recommended websites:
- http://www.gov.mb.ca/health/publichealth/cdc/schedule.html: Manitoba Health’s website gives the routine childhood immunization schedule and links to the publicly-funded vaccines.
- www.immuniza.cpha.ca: Canadian Coalition for Immunization Awareness and Promotion
- www.caringforkids.cps.ca: Canadian Paediatric Society
- www.phac-aspc.gc.ca: Public Health Agency of Canada
- www.canadian-health-network.ca: Canadian Health Network
- www.cdc.gov: Centers for Disease Control and Prevention (U.S.)
- www.immunizationinfo.org: National Network for Immunization Information (U.S.)
- www.immunize.org: Immunization Action Coalition (U.S.)
- www.childrensvaccine.org: Children’s Vaccine Programs (U.S. and international partners)
- www.who.int/vaccines: World Health Organization
So please remember that your health is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
Jan 22-Feb 5/07
We have heard a lot of bad/conflicting things about vaccination, and are not sure whether to vaccinate our children and ourselves. What do you think?
Immunization/vaccination is a hot topic in many circles, and many dangerous myths abound. I like to frame the approach from two perspectives—the population and the individual.
From the population perspective, it is an undisputed fact that immunization is one of the greatest success stories of modern medicine. Childhood immunization has saved millions of lives by eliminating many serious childhood diseases. Because of its success, we often no longer hear about many of these diseases, so it’s easy for parents to become complacent about the need to have their kids fully protected and keeping immunizations up to date. However in recent years, several countries have experienced new outbreaks of diseases everyone thought had disappeared—like diphtheria, German measles and polio. They reappeared because governments relaxed their immunization programs or certain groups in the population refused these immunizations.
It is true that as with any medicine, there are very small risks that problems could occur for someone getting a vaccine. From the individual perspective, many people think that since the risk of getting the disease is remote, they are saving themselves any risk of these potential adverse effects from getting the vaccine. However, this logic relies on the rest of the population to get immunized and decrease the risk of potentially fatal diseases occurring in the population. The higher the number of people who do not immunize themselves or their children means the higher the risk for the whole population. For all the vaccines currently offered in Canada/by Manitoba Health, a person’s chance of being harmed by the infection (and the severity of the illness) is far greater than any chance of being harmed by the vaccine. Vaccines are among the safest medical interventions, and they are subjected to rigorous safety and quality control standards. The individual must consider that once a person contracts the illness in question, the consequences could be disastrous. This is even worse, because the illness was vaccine-preventable. It is extremely important to weigh the right factors and not let overblown fear of an unlikely adverse event prevent protection from a potentially fatal and very real disease.
The vaccines currently recommended for adults and children will protect you/your kids against serious diseases that have not disappeared from the world. If people stop using these vaccines, the diseases will almost certainly become common again, causing many illnesses and deaths. These vaccines are extremely safe and highly effective. If you have any questions or concerns about vaccines, check with your doctor or public health office.
Many people go to the Internet looking for up-to-date information about vaccination. You can find current and trustworthy information on the Internet, but some websites have information that can be misleading—although they have been designed to look scientific and accurate, the information may not be scientifically valid. So remember: anyone can create a website. Only proper research methods guarantee the information is trustworthy. Always check the source of the information you read.
A trustworthy website will:
- Purpose
o …have a clearly stated mission and purpose
o …give credible health information based on solid scientific research
o …give info that includes many points of view. Be careful of sites that support a specific cause, group, or source of funding!
- Sponsors:
o …give the sponsor’s contact information; reputable websites don’t hide their identity
o The website address (URL) can help you learn more about them. If the address ends in:
".edu" = it is a school, college or university
".gc.ca" = Canadian government
".ca" = Canadian-based sites
".gov" = U.S.’ government
".org" = non-profit organizations
".int" = international organizations
".com" = commercial sites
- Supporting Organizations:
o …Be endorsed by a health agency/association you can trust.
o …Give info that covers municipal, regional, national or international concerns, not just the views of one person
o …Indicate if it’s part of a network of partners and identify them
o …Give background info about the sponsors
o …Refer to organizations responsible for maintaining standards
- Site Maintenance:
o …Have experts review the information
o …Post new info on a regular basis; often give the date when the info is posted.
- Authors:
o …clearly state the names of authors, their background and experience in vaccination/immunization. Look for details such as university degrees and professional membership in medical, nursing, scientific or public health associations
o …post work by authors who have published articles in established journals. Beware of articles written by “world-famous researchers,” “well-known scientists,” or “noted experts.”
o …give info based on solid research, not on opinion.
o …give references and links to support its statements
Beware:
- websites’ claims that seem too good or too bad to be true
- claims based on the idea of conspiracy; sites that say it discovered “the hidden truth” about vaccines
- information based on emotion rather than scientific fact. Stories about children who became sick or died are hard to read objectively. Even when pain and sickness occur, be aware that there is no substitute for scientific study.
- Information based on facts that aren’t tested. Professional researchers aren’t afraid to say that further research may be required.
- Websites focused on selling books, newsletters or products.
- Sites that give info “for educational purposes” only but don’t recommend a course of action—If a site is not willing to take responsibility for its advice, why should you?
Recommended websites:
- http://www.gov.mb.ca/health/publichealth/cdc/schedule.html: Manitoba Health’s website gives the routine childhood immunization schedule and links to the publicly-funded vaccines.
- www.immuniza.cpha.ca: Canadian Coalition for Immunization Awareness and Promotion
- www.caringforkids.cps.ca: Canadian Paediatric Society
- www.phac-aspc.gc.ca: Public Health Agency of Canada
- www.canadian-health-network.ca: Canadian Health Network
- www.cdc.gov: Centers for Disease Control and Prevention (U.S.)
- www.immunizationinfo.org: National Network for Immunization Information (U.S.)
- www.immunize.org: Immunization Action Coalition (U.S.)
- www.childrensvaccine.org: Children’s Vaccine Programs (U.S. and international partners)
- www.who.int/vaccines: World Health Organization
So please remember that your health is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
Monday, January 15, 2007
Holiday Health
FJ Vol 20, No 24
Dec 15-31/06
One of my friends is new to Canada and is unable to make it home to the Philippines to visit her family. She seems sad all the time, and I think she is depressed. What should I do?
Christmastime is a very difficult time for many people, and problems related to depression and anxiety/stress are more common during this time. Some key features of depression include sad mood, decrease/loss in interest/pleasure, feelings of excessive guilt/worthlessness, decrease in energy/fatigue, indecisiveness or poor concentration, decrease/changes in appetite/weight, sleep disorders, and recurrent thoughts of death or suicide. If your friend has any of these symptoms, you should urge her to see a doctor or health care professional to get help. Her doctor may prescribe medications such as anti-depressants that can help her cope with this difficult time and/or refer her to therapy/counseling. You can remain supportive to her by encouraging her to become active in the community and share her feelings with you as a friend. If she has expressed thoughts of harming herself or others, it is really important that you give her the Mobile Crisis phone number: 946-9109 and consider calling the number if she won’t phone herself. The website www.canmat.org and self-help books such as Mind Over Mood and Feeling Good are useful references you can pass on to her for learning about this type of problems.
Relatively mild anxiety states in reaction to life circumstances are often time-limited, and many people respond to anxiety management strategies without medication. Support, problem-solving and relaxation techniques often help as the environmental crisis resolves. However, specific anxiety or mood disorders may develop from the original reaction. One should control caffeine or other stimulant use, minimize alcohol use (often used to control anxiety), reduce the use of short-acting tranquilizers (eg Valium and Ativan), and take steps to reduce stress including relaxation training and time management. More specific therapy/counselling and referral to a psychiatrist may be necessary if there is little improvement after several months of adequate medication therapy. Clicking on the title "Holiday Health" should link you to the information resource "Coping with Stress" [http://www.cmha.ca/data/1/rec_docs/403_CMHA_coping_with_stress_EN.pdf] by the Canadian Mental Health Association (www.cmha.ca).
I have high cholesterol, and my doctor warned me to stay away from fat. What can I do, especially during the Christmastime?
Having high cholesterol levels in your blood (dyslipidemia) is important, not because you can feel it directly, but because it is associated with a higher risk of cardiovascular disease (CVD; heart attacks and stroke). This is because excess fat deposits in the blood vessels throughout your body (atherosclerosis, AS), which can make it difficult for the heart to pump the blood (with the oxygen it carries) to the tissues that need it. Eventually, the arteries can block up completely, which can cause the tissues that are not getting the blood/oxygen to die (a “heart attack” results from a blockage of the arteries that feed the heart muscle; a stroke from a blockage of the arteries that feed the different areas of the brain). Dyslipidemia, diabetes, overweight, abdominal obesity (overweight in the tummy area), high blood pressure, and low cardio-respiratory fitness are primary risk factors for CVD. You are also at a higher risk if you have a strong family history of heart attacks/stroke or smoke. There are different types of cholesterols and different types of high cholesterol problems; some are genetic (run in the family), and others due to conditions such as hypothyroidism, pregnancy, excess weight, alcohol excess, certain liver and kidney diseases, and medications such as corticosteroids, hormone replacement therapy/oral contraceptives, and some blood pressure and heart medications.
Triglycerides are a type of fat that can be high from certain fats in the diet, but also extra sugars in the blood (excess starches like white breads, alcohol, sugared beverages) that your body turns into triglycerides. Niacin and fibrates help decrease mainly this type of fat.
LDL's (low-density lipoproteins) are the "bad cholesterols--you want them to be low. The “statin” drugs commonly target these fats by helping to lower the amount in your blood, but if you are on one, make sure to check in with your doctor regularly to monitor your liver and muscle enzyme level in your blood, which can go up with this class of drugs. “Resins” are another type of drug that lower LDL and can increase HDLs.
HDL's (high-density lipoproteins) are the good cholesterols that you want high, as they have a protective effect against heart disease + stroke. Regular exercise has been shown to boost this good cholesterol in the blood. Niacin and fibrates can increase this type.
In general, it is important to follow your doctor’s advice about your cholesterol problem, but diet, aimed at reducing blood cholesterol levels and weight (if needed) should always be the first approach. CVD can be reduced by eating less saturated and trans fats, less salt and sufficient amounts of fruit, vegetables and omega-3 and omega-6 polyunsaturated fats. Risk is also reduced with weight control and physical activity. A dietician is usually recommended to reach these goals:
- decrease dietary cholesterol intake to < 300 mg/day (<200 mg/d if AS already a problem): raises blood cholesterol levels but no significant association found yet between CVD and egg consumption (egg yolks—leche flan, dairy products, meat and shellfish)
- restrict fat intake to 30% of calories (20% if AS);
- fat distribution goals as a % of total energy:
o < 10%: Saturated fats tend to raise total & LDL cholesterol levels & are associated with increased risk of CVD: processed foods, coconut oil, lard, hydrogenated hard margarines, butter, full-fat dairy products and fatty meats—so avoid/cut down! Lechon is a big culprit because it is animal fat deep fried in fat—often animal. Yikes!
o < 1%: Trans fats elevate LDL and decrease HDL: partially hydrogenated margarines & shortenings, deep fried foods, processed foods made with partially hydrogenated fats and baked goods—AVOID
o 5-8%: Omega-6 polyunsaturated fats are the most effective replacement for saturated fats to improve heart disease outcomes: soybean, sunflower, safflower, corn and cottonseed oils
o 1-2%: Omega-3 polyunsaturated fats have good effects and decrease fatal CVD: fatty fish (tuna, salmon, mackerel, sea bass, fish oils), plant sources (canola, soybean, flaxseed oils, soft non-hydrogenated margarines, nuts, tofu, ground flaxseed)
o By difference to achieve a total fat intake of 15-30%: Monounsaturated fatty acids lower total & LDL cholesterol levels when substituted for saturated fats but not as well as polyunsaturated fats: canola, olive oils, nuts
- favour high-fibre intake
- limit simple sugars to 8% of total calories
- limit alcohol consumption to 5% of total calories
Plant sterols: the cholesterol-lowering effects have been well documented: vegetable oils, nuts, sesame & sunflower seeds, soy & other legumes.
Other nutrients: fruit and vegetables contribute to heart health through fibre, vitamins, minerals and phytonutrients (esp green leafy & cruciferous veggies, legumes & berries).
Also, if you can increase your fiber intake (10-15 g/d of soluble fiber—eg psyllium, oat bran, kidney beans, artichokes, dried prunes) not only will this help combat constipation which is common with fattening foods and lack of exercise common during Christmastime, but it also may lower cholesterol levels by an additional 10-15%. Pretty good deal! Although some studies suggest a protective role of antioxidants (vitamin E in nuts, seeds, some soft, non-hydrogenated margarines; vitamin C in citrus fruit, berries, tomatoes, potatoes, broccoli, cauliflower, kale, cabbage, sweet peppers; carotenoids/beta-carotene in carrots & tomatoes), controlled studies have not shown much proof. Sodium intake is directly associated with blood pressure, so limit it (salt added to foods, sodium in processed foods & additives like MSG)! Potassium (fruit and vegetables) helps lower blood pressure.
So in summary:
- Avoid hydrogenated oils and fats--Opt for low fat options on the labels of foods you buy.
- Limit the intake of fat from dairy and meat sources; Hidden fats you can cut down on: Whole or 2% milk—go for skim instead.
- Use appropriate vegetable oils in small amounts.
- Ensure a regular intake of fish (1-2 times per week) or plant sources of omega-3 fatty acids.
- Choose foods prepared without frying.
- Eat 400-500 g (6-8 servings) of fruit and vegetables daily.
- Restrict daily salt intake to less than 5 g.
- Choose fibre-rich whole grain cereals, as well as fruits and vegetables.
Increased physical activity may help decrease cholesterol and triglyceride levels while increasing HDL. Try to get regular physical activity/aerobic activity, decrease/stop smoking, watch extra sugars and salts in your foods, and try not to get too stressed during Christmastime! If you overdo it during the holidays, it might be a good idea to discuss this with your doctor to check where your cholesterol levels are at so you can modify your plan to better suit your lifestyle.
Have a healthy and relaxing Christmas! Maligayang Pasko at Masaganang Bagong Taon!
Dec 15-31/06
One of my friends is new to Canada and is unable to make it home to the Philippines to visit her family. She seems sad all the time, and I think she is depressed. What should I do?
Christmastime is a very difficult time for many people, and problems related to depression and anxiety/stress are more common during this time. Some key features of depression include sad mood, decrease/loss in interest/pleasure, feelings of excessive guilt/worthlessness, decrease in energy/fatigue, indecisiveness or poor concentration, decrease/changes in appetite/weight, sleep disorders, and recurrent thoughts of death or suicide. If your friend has any of these symptoms, you should urge her to see a doctor or health care professional to get help. Her doctor may prescribe medications such as anti-depressants that can help her cope with this difficult time and/or refer her to therapy/counseling. You can remain supportive to her by encouraging her to become active in the community and share her feelings with you as a friend. If she has expressed thoughts of harming herself or others, it is really important that you give her the Mobile Crisis phone number: 946-9109 and consider calling the number if she won’t phone herself. The website www.canmat.org and self-help books such as Mind Over Mood and Feeling Good are useful references you can pass on to her for learning about this type of problems.
Relatively mild anxiety states in reaction to life circumstances are often time-limited, and many people respond to anxiety management strategies without medication. Support, problem-solving and relaxation techniques often help as the environmental crisis resolves. However, specific anxiety or mood disorders may develop from the original reaction. One should control caffeine or other stimulant use, minimize alcohol use (often used to control anxiety), reduce the use of short-acting tranquilizers (eg Valium and Ativan), and take steps to reduce stress including relaxation training and time management. More specific therapy/counselling and referral to a psychiatrist may be necessary if there is little improvement after several months of adequate medication therapy. Clicking on the title "Holiday Health" should link you to the information resource "Coping with Stress" [http://www.cmha.ca/data/1/rec_docs/403_CMHA_coping_with_stress_EN.pdf] by the Canadian Mental Health Association (www.cmha.ca).
I have high cholesterol, and my doctor warned me to stay away from fat. What can I do, especially during the Christmastime?
Having high cholesterol levels in your blood (dyslipidemia) is important, not because you can feel it directly, but because it is associated with a higher risk of cardiovascular disease (CVD; heart attacks and stroke). This is because excess fat deposits in the blood vessels throughout your body (atherosclerosis, AS), which can make it difficult for the heart to pump the blood (with the oxygen it carries) to the tissues that need it. Eventually, the arteries can block up completely, which can cause the tissues that are not getting the blood/oxygen to die (a “heart attack” results from a blockage of the arteries that feed the heart muscle; a stroke from a blockage of the arteries that feed the different areas of the brain). Dyslipidemia, diabetes, overweight, abdominal obesity (overweight in the tummy area), high blood pressure, and low cardio-respiratory fitness are primary risk factors for CVD. You are also at a higher risk if you have a strong family history of heart attacks/stroke or smoke. There are different types of cholesterols and different types of high cholesterol problems; some are genetic (run in the family), and others due to conditions such as hypothyroidism, pregnancy, excess weight, alcohol excess, certain liver and kidney diseases, and medications such as corticosteroids, hormone replacement therapy/oral contraceptives, and some blood pressure and heart medications.
Triglycerides are a type of fat that can be high from certain fats in the diet, but also extra sugars in the blood (excess starches like white breads, alcohol, sugared beverages) that your body turns into triglycerides. Niacin and fibrates help decrease mainly this type of fat.
LDL's (low-density lipoproteins) are the "bad cholesterols--you want them to be low. The “statin” drugs commonly target these fats by helping to lower the amount in your blood, but if you are on one, make sure to check in with your doctor regularly to monitor your liver and muscle enzyme level in your blood, which can go up with this class of drugs. “Resins” are another type of drug that lower LDL and can increase HDLs.
HDL's (high-density lipoproteins) are the good cholesterols that you want high, as they have a protective effect against heart disease + stroke. Regular exercise has been shown to boost this good cholesterol in the blood. Niacin and fibrates can increase this type.
In general, it is important to follow your doctor’s advice about your cholesterol problem, but diet, aimed at reducing blood cholesterol levels and weight (if needed) should always be the first approach. CVD can be reduced by eating less saturated and trans fats, less salt and sufficient amounts of fruit, vegetables and omega-3 and omega-6 polyunsaturated fats. Risk is also reduced with weight control and physical activity. A dietician is usually recommended to reach these goals:
- decrease dietary cholesterol intake to < 300 mg/day (<200 mg/d if AS already a problem): raises blood cholesterol levels but no significant association found yet between CVD and egg consumption (egg yolks—leche flan, dairy products, meat and shellfish)
- restrict fat intake to 30% of calories (20% if AS);
- fat distribution goals as a % of total energy:
o < 10%: Saturated fats tend to raise total & LDL cholesterol levels & are associated with increased risk of CVD: processed foods, coconut oil, lard, hydrogenated hard margarines, butter, full-fat dairy products and fatty meats—so avoid/cut down! Lechon is a big culprit because it is animal fat deep fried in fat—often animal. Yikes!
o < 1%: Trans fats elevate LDL and decrease HDL: partially hydrogenated margarines & shortenings, deep fried foods, processed foods made with partially hydrogenated fats and baked goods—AVOID
o 5-8%: Omega-6 polyunsaturated fats are the most effective replacement for saturated fats to improve heart disease outcomes: soybean, sunflower, safflower, corn and cottonseed oils
o 1-2%: Omega-3 polyunsaturated fats have good effects and decrease fatal CVD: fatty fish (tuna, salmon, mackerel, sea bass, fish oils), plant sources (canola, soybean, flaxseed oils, soft non-hydrogenated margarines, nuts, tofu, ground flaxseed)
o By difference to achieve a total fat intake of 15-30%: Monounsaturated fatty acids lower total & LDL cholesterol levels when substituted for saturated fats but not as well as polyunsaturated fats: canola, olive oils, nuts
- favour high-fibre intake
- limit simple sugars to 8% of total calories
- limit alcohol consumption to 5% of total calories
Plant sterols: the cholesterol-lowering effects have been well documented: vegetable oils, nuts, sesame & sunflower seeds, soy & other legumes.
Other nutrients: fruit and vegetables contribute to heart health through fibre, vitamins, minerals and phytonutrients (esp green leafy & cruciferous veggies, legumes & berries).
Also, if you can increase your fiber intake (10-15 g/d of soluble fiber—eg psyllium, oat bran, kidney beans, artichokes, dried prunes) not only will this help combat constipation which is common with fattening foods and lack of exercise common during Christmastime, but it also may lower cholesterol levels by an additional 10-15%. Pretty good deal! Although some studies suggest a protective role of antioxidants (vitamin E in nuts, seeds, some soft, non-hydrogenated margarines; vitamin C in citrus fruit, berries, tomatoes, potatoes, broccoli, cauliflower, kale, cabbage, sweet peppers; carotenoids/beta-carotene in carrots & tomatoes), controlled studies have not shown much proof. Sodium intake is directly associated with blood pressure, so limit it (salt added to foods, sodium in processed foods & additives like MSG)! Potassium (fruit and vegetables) helps lower blood pressure.
So in summary:
- Avoid hydrogenated oils and fats--Opt for low fat options on the labels of foods you buy.
- Limit the intake of fat from dairy and meat sources; Hidden fats you can cut down on: Whole or 2% milk—go for skim instead.
- Use appropriate vegetable oils in small amounts.
- Ensure a regular intake of fish (1-2 times per week) or plant sources of omega-3 fatty acids.
- Choose foods prepared without frying.
- Eat 400-500 g (6-8 servings) of fruit and vegetables daily.
- Restrict daily salt intake to less than 5 g.
- Choose fibre-rich whole grain cereals, as well as fruits and vegetables.
Increased physical activity may help decrease cholesterol and triglyceride levels while increasing HDL. Try to get regular physical activity/aerobic activity, decrease/stop smoking, watch extra sugars and salts in your foods, and try not to get too stressed during Christmastime! If you overdo it during the holidays, it might be a good idea to discuss this with your doctor to check where your cholesterol levels are at so you can modify your plan to better suit your lifestyle.
Have a healthy and relaxing Christmas! Maligayang Pasko at Masaganang Bagong Taon!
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.
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