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Joining hands for health: caring and sharing at Easter time
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Permanent Link: http://ufdc.ufl.edu/AA00013240/00001
 Material Information
Title: Joining hands for health: caring and sharing at Easter time
Abbreviated Title: Joining hands for health
Physical Description: 32 p. ; 28 cm.
Language: English
Creator: Public Hospital Authority
Publisher: Public Hospital Authority
Place of Publication: Nassau, Bahamas
Publication Date: 1983
 Subjects
Subjects / Keywords: Health care--Bahamas.   ( lcsh )
Spatial Coverage: Caribbean Area
 Notes
Abstract: The main thrusts in primary health care is the improvement of our maternal and child health services within the Bahamas.
General Note: Booklet contains information regarding caring and sharing for the young child.
 Record Information
Source Institution: College of The Bahamas
Holding Location: College of The Bahamas
Rights Management: All rights reserved by the source institution.
System ID: AA00013240:00001

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.-Volume1No.21983-84 / ).rrj}. JOININGHANDSFOR HEALTH

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CONTENTSMessageH.Munnings MessageH.MahlerThankyou, ,. Editorial .Don'tPushMe.I'mnota MachineM.Lowe Report Maternal&Child Health WorkshopB.Simms Caring fortheInfantinUteroG.Sherman De las DaysE.Rolle Protect Your ChildF.Sands Up-Date F. Aymer CareoftheYoung Child P.McNeil Healthy Infants -Excerpt0000000Caring for Children Away fromhome.00S.Farquharson Wednesday's ChildrenC.ThompsonThoughtsonWeaningE.Rolle Teething in an Isolated Setting000E.JohnsonCoping with a New Baby, Older Children, aJob...0V.Braithwaite HopingtoTouchYou.....00F.AymerEvaluation...00000AbouttheContributors.000000Acknowledgements .... 0000000 Ip.1p.2p.2p.3p.3p.6p.10p.llp.12p.15p.18po20 p.22 p.24 p.25p.28p.29p.3lp.33po32po32

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)-\ i PRESIDING AT HEADOFTABLEp(.\{.)(0 --' .....J, :btJ
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WONG'SPRINTINGCOMPANYTHE PHASES OF OFFSETPRINTINGPhaseIITYPESETTING Phase IV CAMERA ROOM L=.I Phase VII BINDERY&PACKAGING Phase I FRONTOFFICE(Management) Phase VIOFFSETPRESS (Printing) Phase V STRIPPING/PLATE BURNING

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JOININGHANDSFORHEALTH"CARINGAND SHARINGFORTHEYOUNGCHILD"Message fromthePermanentSecretary"Theeducational sector also has animportantparttoplayinthedevelopment andoperationofprimary health care.Communityeducationhelps peopletounderstandtheirhealth problems, possible solutionstothemandthecostofdifferent alternatives. Instructive literature canbedeveloped anddistributedthroughtheeducationalsystem."TheabovequotationisfromtheAlma-Ata1978PrimaryHealth Caredocument.Itscontextismostapplicabletoourpresentsituationfor HealthEducationhas been identified as animportantpartofthethrustfor"HealthForAllbytheYear2000."Itismygreat pleasureto theHealthEducationDivision for having initiatedthenewsletter"Joining Hands forHealth"which servesthepurposeofkeeping its readers informed and educatedonhealth matters.Thethemeofthis second editionis"Caring and Sharing fortheYoung Child." Oneofourmainthrustsin primary health careistheimprovementofourmaternal and child health services. This year, World Health Day, April 7, has for itstheme,"Children's Health,Tomorrow'sWealth," which coin cides withthethemeforthesecond editionof"JoiningHands forHealth"anditismostappropriatethatit should.Inidentifying athrusttowardsimprovingthehealthoftheyoungchild,wemust begin with a healthyexpectantmotherwhoisafforded good health care sothatshe hasthebestopportunitytoproducea healthy child.Thehealth servicesoffercare forthechild through its services and so givethechildthebestopportunityofbeing healthy.Wemustnot,however, lose sightoftheresponsibilityofeach person inthecommunitywhoisexpectedtobea responsible citizen anddoallthatispossibletocontributetowardsbetterhealth for himself/herselforfor thoseunderhis/her care.Thehealth servicescontinuetobe heavilyburdenedin giving caretothosewho could have assisted in preventing diseases, illnesses and accidents.Ofparticularnotearetheincrease in cancer duetosmoking,thenumberofaccidental poisonings inyoungchildren,thenumberofroad accidents still seenonourstreets.Ifthese preventable accidents were reducedbyfifty (50) percent, wewouldhavemoreofourhealth servicesbudgettospend forthoseillnessesthatare unavoidable and be abletooffer a greaternumberofdisease prevention andpromotionalhealth services. I would wishtoexpressthanksand appreciationtotheNational Health Education Council (Bahamas)fortheprovisionoffunds, once again, for this second edition. I would also wishtocon gratulatetheHealthEducationDivisionofthePublic HealthDepartmentand all thosewhohavecontributedtowardsthis publication. I look forwardtoreadingthisedition. I anticipatethatthisquarterlyhealth education newsletter willcontinueformanyyearstocome and moveonfrom strengthtostrength. BEST WISHES AND A HAPPY EASTER TOALL.Harold A. Munnings

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Message fromtheDirector General World Health Organisation (WHO) CHILDREN'S HEALTH TOMORROW'S WEALTH This theme will afford an occasiontoconveytoa worldwide audiencethemessagethatchildren are a priceless resource, andthatanynation which neglects them would do so at its peril. World Health Day 1984,7thApril, will thus spotlightthebasictruththatwe must all safeguard the healthy minds and bodiesofthe world's children,notonlyasa key factor in attaining health forallbythe year 2000,butalsoasa guarantee for each nation's healthinthenext millennium. Care for-the healthofthe child startsinthefamily, even before conception, through wise family spacing.Itcontinues from conception on, and particularlyinthe developing countries, the child must be protectedbyallmeans available fromthemortal diseases whetherbysuitable care during pregnancy and delivery, safe drinking-water and basic sanitation or proper nutrition. Diarrhoeal diseases represent an ever-present and recurrent menace; the widespread useoforal rehydration therapybymothersintheir homes cansavemillionsofyoung lives throughout the wofld. A numberofinfectious diseasesthatkillormaim children can be preventedbyeffective immunization. Acute respiratory infections also take a heavy toll and havetobe adequately treated.Allthis implies making the best useofprimary health careincommunities. These and all factors having a bearing ontheyoung child will be embraced withinthe1984 World Health theme.Asfortheolder child, we proposetodefer our attention until the following year: World Health Day 1985 will therefore be devotedto"Youth,"inkeeping with the United Nations' International Youth Year. Halfdan Mahler THANK YOU Once again,theHealth Education DivisionoftheMinistryofHealth's Public Health Departmentisdeeply gratefultotheNational Health Education Council (Bahamas) for facilitating the publicationofthesecond editionofits quarterly "Newsletter," Joining Hands for Health. FormedinNovember, 1980,theCouncilisanotfor profit umbrella organisationofvoluntary agencies concerned about health promotion and health maintenance through the mediumofeduca tion. Its fundingisderived mainly through donations from the private sector. A nominal membership feeoftendollars ($10.00)ispayable annually.Todate; the Council has successfully co-ordinated two (2) Health Fairs/Exhibitions with the active involvementofbothgovernment and non government health and health related agencies.Ithas produced a numberofleaflets on Nutrition, participated intheCommonwealth Fair -anannual activityofthe MinistryofAgriculture, Fisheries and Local Government, conducted a schools' poster competition, attempted a needs assessmentofhealth education resourcesingovernment schools throughout the Bahamas and conducted a four (4) day workshop for its members.Itishopedthatthereportofthis workshop will form the basisofresource materials which can be used throughouttheeducation system. The Council interested and caring groupsand/orindividualstojoin theminworking to ward improving health }\ractices amongallresidentsinthe Bahamas. Meetings are held rhonthly onthethirdOrd)Thursday at 6 p.m. attheRassin Hospital, Collins Avenue, Nassau. Further information abouttheCouncil may be obtainedfrom:-2The President,MsLouise Simms c/o Box N-972 The Treasurer, Bishop Harcourt Pinder c/o Box N-972 Tel. (809) 323 2710ORTheHealth Education Division Public Health Department P.O. Box N-3729 Tel. (809) 322 4908

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EDITORIAL"Children's Health -Tomorrow'sWealth:"ThethemeofWorld Health Day -7thApril -ismostrelevanttothatofthe Division's second issueofJoining Hands for Health Caring and Sharing fortheYoung Child. In essence caring begins withtheconscious decisionofa coupletoshare their lifetogetherandtoassume full responsibility forthelife oJ another/others. Inthepasttheimplicationsofthese decisions, awesome thoughtheywere, defferred very few.Todayhowever, increasing numbersofcouples are optingto-forgo them. Biologicalparenthoodistheone role for whichnopreparationisrequired. Hereinthe Caribbean,' itisalso variously assumed for economic reasons,proofofsexuality,proofofidentitythus beginning the spiralofa vicious and apparently unbreakable cycle with adverse effectsontheindividual, the family and ultimatelythesociety. Can anything be donetopreventand/orbreak this spiral? Perhaps at noothertimeinany young child's life are caring and sharing moreimportantthanat its conception.Isthis childtheproductofa truly caring relationship? Do its parents acceptthepregnancyasa f'recious gift, somethingtobe cherished? Can father live uptowhathe may have promised or whatisexpectedofhim? How much emotionaland/oreconomicsupportcan the womanexpectinpregnancy and afterwards? In shorthowwill this new life affecttheirlife? These are someofthevariables which determinethequalityofcaringandsharingtheyoung child receives.Inourmodemand dynamic societyinwhichbothparents increasingly feel compelledtocompeteinthejobmarket,youngchildren haveofnecessitytobecared for communally nurseries, pre school or left at home withthe"maid,"atwhatcost? How much caring and sharing can working parents, often the working parent, provideaftera long hard day attheworkplace? Whoishelping the young child develop healthy habits? Whoissharingthewonderofplay and life in general withthechild? Whoisansweringtheyoung child's myriad questions? Whoissimply talkingto/withtheyoungchild? Whois comfoI1ing the young child when he/she has a cold, feels unwell?Istheyoung child learning from exampleorbyrote?Weadults feel very acutelytheneedtobe cared for and sharewith someone.Wewill gotogreat lengthstofindthatsomeone. How much more acutemustbetheyoungchild's feelingsandsearch? Whilethereisnoprecise prescription for child rearing, warmth, love, emotional security are indisputable ingredients fortheyoungchild's healthy growth andadjustmenttoadult life.Theyare developed from conception. Society initially, throughtheMinistryofHealth, provides servicestohelp parents care for their children intherealisationthatthechild's health determines its (society's)futurewell-being. Easterisa timeofrejoicing. Deathisnottheend. Let us rejoice also forourchildren. Let us rejoicewithourchildren. Let us care and share for them,theyaretrulyourwealth. Happy Easter."DON'TPUSHME.I'MNOTAMACHINE!"MARYLOWE"Oh,I justplayed."Howmanyparents have hadthatanswer fromtheirpre-schoolers whentheyasked, "What didyoudoinschool today"?" And howmanyparents have felt indignanttothinkthattheyare paying goodmoneyjusttohavetheirchildren"play"inschool? Buthowmanyparents stoptothinkthatthatisexactlywhattheir2,3,or 4yearaIdsoughttobe doing? How many parents begintoapply pressureontheschooltoteach their 2', 3,or4yearaidstoread,towrite,todosums? How many parents begintoapply pressureontheirchildrentolearntoread, write and do sums?3

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4How many parents believethattheearlier a child begins the academic learning process the more successfulthatchild will beinhis future career andinlife in general? How many parents are awareoftheeffectsofthis pressure on their children? Teachersinpre-schools are awareoftheeffectsofthis pressure. During the past sixoreight yearstheyhave seen more and more tears and tantrums, silence and apathy, aggression and dis obedience, anxiety and confusion, amongthechildrenintheir care. They have seen children unabletorelatetothem ortootherchildren, they have seen children unabletotalk because nobody talkstothem, they have seen children unabletodress themselves because nobody has the timetoletthem try,theyhave seen children unabletoname common objects because nobody takes the timetotell them what they are, they have seen children scaredtotry, to make mistakes, to make a mess because somebody will punish them, they have seen children unabletolearn because they have had few opportunitiestoplay. BUT, these children are being pressuredtolearntoread,towrite,todosums.Ifthechildren under pressure could only formulatetheidea andputitinto words they would say,"Don'tpush me. I am learning. I am learning what I needtolearn, not what youthinkI should be learning. I am a human being,nota machine." Teachers too, feel this pressuretoteach theacademics,buttheyknowthatthey cannot fulfil this function until the children are attheright stageofdevelopment. l'eachers rejoicetosee happy, well adjusted children developing naturally undertheguidance, supervision and disciplineoftheir parents. They knowthatthese arethechildren who are goingtolearn and be successfulinlife and their future careers. How then do we helpourpre-schoolagechildrentoreach this stage? By allowingourchildrentodevelop naturally,topass through each stageofdevelopment attheright time for the child,byobserving and communicating withourchildren so that we are awareofwhat the child needs at each stage,byproviding supervision, guidance and loving disciplineaswellassuitable materials\and by providing enough time for play. WHATISPLAY? Playisa natural and important partofgrowing up.Itissomethingthatwe do all our lives,asbabies andasadults. Playishaving fun, trying new things, sharing our experience with friends, making believe and learningtodonew things while enjoying yourself. Playisanimportant partofa child's life, at homeorin school, because; CHILDREN LEARN WHILE THEY ARE PLAYING. Play is: a basic skillthathelps children's knowledge grow, a natural partofeveryone's life. PlayisNOT a wasteoftime, a babyish activity, something only done with toys, somethingtodo when thereisnothing importanttodo.HOWDOES PLAY DEVELOP? Play changes from babyhoodtolater childhood, and it helps children at every age with their development. Little babies are 'Rlaying when they grab their own toes,orputthingsintheir mouths,orfeel thingsorshake them. 01der babies liketoplay simple games like peek-a-boo. They laughastheyplay and those around them laugh too. Babies watch others playing andtrytoimitate them. Very young children havetolearn howtoplay withotherchildren.Atfirst they play alongside others rather than with them. They liketobe near each otherbuttheyarenotreadytoplay together. Very young children are happy with familiar objects and activities. When playing they repeat the same action over and over. During pre-school years children's play involves much make-believe. They pretendtobe mother or father, a favourite T.V. character, a dog or a cat. This actingoutofexperiences or stories helps childrentounderstand what other people are thinking and feeling and how events happen. At theageoffourtofive, children can usually play cooperatively together for quite long periods

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oftime.Theycan solve problemsthatoccurwhiletheyplay.Theyalso liketotrynewtoysoractivities. Playisa basic skillthatseemstocome naturallytochildren. Most childrendonotneedtobetaught howtoplay,butplay can improve with practice and with help fromotherpeople. Children who learntoplaybetterwill getmoreoutoftheirplay. WHYISPLAY IMPORTANT? Playisoneofthemostimportantthingsthatchildren do.Itisa basicskilJthatmay affecthowwell children will learn in school andhowwelltheywill get along in later life. Playisbasic because itisanimportantway for childrentolearnaboutandunderstandtheworld. Playisa way foryoungchildrentoexpress theirthoughtsandideas. Play helps childrentryoutmanywaysofbehaving. Both children and adults needtoknowmanydifferent waysofbehavinginordertodeal withthedifferentthingsthathappentothem. Play helps childrentotryoutmanydifferent emotions. Play helps childrentogain mastery and feel incontroloftheirlives. Thisisimportantbecause successful adults usually feelthattheyareincontroloftheirownlives. When playing alone,orwithotherchildrenorwith adults, childrendomanythingsthatare useful for learning. Play lets children use alltheirsenses; seeing, hearing, smelling, tasting, touching. In this waytheytake in and organize newinformation.Theycan discover problems and find solu tions.Theycan create and explore.Theycan gain anunderstandingoftheirworld. CHILDREN WHOAREGOOD PLAYERSAREUSUALLY GOODLEARNERSOFOTHERSKILLS. PLAY WITH YOUR CHILDREN! Having fun and playing withyourchildrenisjustasimportantasproviding materials for them. Showthemthatyouenjoy having a good timewiththem.Every daytrytoset aside some playing time foryourchildren,but,rememberthatthisistheiractivity. Letthechildren choosethegames, settherules and tellyouwhatparttoplay.Talktoyourchildrenastheyplay.Thinkofplayassomething valuable: letyourchildrenknowthatyouthinktheirplayisusefulandimportant.Make suretheyhavetimefor play intheirday. Maketimetoobserve their play sothatyoucan become awareofthestagesofdevelopmenttheyare passing through.Youwill never regretthetimespentin this way andyouwill be pleasedtoseehowyourchildren learn and develop inmanyways. REMEMBER THESE POINTS: '"'"'"'"'"'" Playisa basic skillthathelps children's knowledgetogrow. Play shouldbeanimportantpartofevery pre-school programme.Thechangesinplayaschildrenmatureshow the waythatchildren's minds, bodies and feelings are developing. Playisimportantbecauseitaffectshowwell children learn in school andhowtheywill get alonginlater life. Children's freely chosen play activities helpthemtodevelopotherskills, suchasskills in language, maths, science, reading, writing andproblemsolving. Parents can helptheirchildrenplaybyproviding materials,byplaying withtheirchildren,bybelievingthatplayisimportant,byproviding supervision, guidance and loving discipline,byrememberingthatifplayismissedoutoftheearly stagesthechildren will only havetomakeitupagain later, perhaps whentheyshould bestudyingforimportantexams. PARENTS HELPTHEIRCHILDREN LEARN BY HELPING THEM TO PLAY.Bibliogra phyTheModern Nursery Marion DowlingTheLearning Match BettyRowen,JoanByrne, Lois WinterGoodSchools forYoungChildren Leeper, Dales, Skipper, WitherspoonGettingInvolved -staffofContractResearchCorporation(CRe)andHumanDevelopment. 5

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REPORTONMATERNALAND CHILD HEALTH WORKSHOPBrenda A.SimmsTheTechnicalGroupMeetingon Matemal and Child HealthintheCaribbean was held in Barbados, West Indies, from 24-27October,1983andorganisedbythePAHO. Twenty-six(26)technical specialists representing eleven (11) Caribbean territories and representativesfromseveral regional agenciesandinternationalbodiesparticipatedinthemeeting. Participants included: HealthEducators,theNursing Profession -Tutors,Nursing Officers fromCommunityandHospitals,theMedical ProfessionObstetricians, Paediatricians, PhysiciansinAdministrationandtheCommunity.Specialist organisations e.g., CaribbeanFoodandNutritionInstitute(CFNI),UnitedNationsFundforPopulationActivities (UNFPA),theDepartmentofMedicine, UniversityoftheWest Indies, Family Planners, Child CareOfficers, Paediatric Researcher,aswell asstaffofthePanAmericanHealth Organisation (PAHO).Theoverall goal,torevisetheexisting Maternal and Child HealthStrategyfortheregionfonnulatedin 1975 was achieved.Theobjectivesofthemeetingwere:-1.Toreview,modifyandupdatetheMaternalandChild HealthStrategyfortheCaribbean Community.2.Todefine activitiesandtargetsmoreprecisely.3.TopromoteandstrengthentheRisk Approach. 4.Toexamine(andpromoteasindicated)otherinnovative approachestoMCH programmes. BecausetheCommonwealthCaribbean has long recognisedtheneedtoimprovethehealthstatusofmothersand children,andpresentpopulationtrendsindicatea rapid increase intherelative sizeofthezerotofive(0-5)yearage groupintheCaribbean,thereisanurgentneedtoplanforandmeettheneedsofthis group,particularlyinfantsbelowoneyear. PROBLEMSIDENTIFIEDThemajorcausesofdeathin childrenunderfive yearsofage inmostoftheCaribbean territories are conditions originatingintheperinatal period.Thehealthoftheinfantduringtheneonatalperiod, particularly duringthefirstweekoflife,dependslargelyonobstetrical conditions; its weightandapgar score atbirth"thetypeandqualityofcare providedfortheinfantat riskorforthesickinfantandtheadequacyoffacilities forthelevelofcare required,amongotherfactors.1.Thefacilities, servicesandtrainingopportunitiesintheregion are grosslyinadequatetodealwiththis situation.2.Thereisneed forimprovementinfacilities, service andqualityofcare,throughstrengtheningofthe"risk" c0';lcept in perinatal health care programmesandinlaterstagesofearly childhood.\3.IntheCaribbean as a whole,theincidenceofcertain diseases, preventablethroughimmunization,suchasdiptheria,whoopingcough, tetanus, and measles,isstill significant. Epidemicsofpoliomyelitis and measles have occuredinrecent years.Thisall servestounderscorethefactthattheimmunizationstatusofthepopulationgenerally,andthatofyoungchildreninparticu lar,isunsatisfactory. 4.Thereisadearthofspecialist experience andequipmentintheregion forthemanagementofthedisease conditions leadingtochronicdisability andmortalityin children. 65.Thementalhealthofchildren has largelybeenneglectedandthereisneedfor training and utilizationofspecialized personnelinthis area.

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6.Thetraditionaldichotomybetweenpreventiveandcurative services in child health care has ledtoduplicationofeffortsand unnecessary delaysinthemanagementofproblems. RECOMMENDATIONSA.CareoftheNewbornandInfantsoflowbirthweighti)Eachcountryshould ensurethatthereareadequateresourcesandfacilities forthecare and followup-ofnewborninfants,bothnormalandthoseofhigh risk, utilizingtheperinatalteamapproach(Obstetrician, Paediatrician,andNurse). By meansofa)b)readyavailabilityofbasic suppliesandequipment.provisionofcontinuingeducationprogrammes for all levelsofstaffin volved inthecareofchildren. ii) High riskpregnantpatientsshouldbedelivered in specializedperinatalunits.Ifthisisnotpossible withinthelimitsofavailable resourees, provisionshouldbemadeforthesickinfanttobetransportedtoan intensive careunit.iii) Provisionofcontinuingcare forandclosemonitoringofallhigh risk infants during early childhood.Thehigh riskinfantwasdefinedasfollows:-infantsoflowbirthweight infantsofmotherswithpre-eclamptictoxaemiainfantsofdiabeticandgestational diabeticmothersinfantswhoare largeforgestational age infants with jaundice withintwenty-fourhoursofbirthinfantswithrespiratory distressofanycause infantswithasphyxiaorhypoxiainfants withbirthtraumainfantsofteenage(under18)mothersinfantsofmotherswhohavehadprevious still-bornorneonataldeathinfantsofanyhigh risk pregnancy infantswithamajorcongenital anomaly. iv) Eachcountryshould ensurethatmothersare allowed accesstotheirwell and sicknewborn,asearlyaspossible,withtheencouragementandsupervisionoftheperinatal team.v)Breast feeding should beginimmediatelyafterbirth sickneonateswhoare unabletosuckshould be given expressedbreastmilk. (These aretheRegionalrecommendationstobeusedasinputforNational Policy decisions andsubsequentimplementation).B.Early Child Health Care:TheChild'stotalhealthcare needs shouldbemetinchildhealthclinics in which preventative and curative services are provided simultaneously. Viz.:monitoringofgrowththroughweight charts assessmentofdevelopment,utilizingstandardizedlandmarks7

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8 estimationofhaemaglobin and provisionofiron supplements identification, referral and followupofhighrisk children immunizationpromotionofdental healthtreatmentofcommonhealthproblems emergencytreatmentas required. Oralrehydrationshould be a priority, healtheducationin a continuous, dynamic dialogue between the child'smotherorcaretaker andthehealthcare providers. home visiting formonitoringofselected cases and for follow-upofdefaulters. developmentofa standardized clinic and home based health recordtobeintroducedby eachcountryby(1985). This record should include: basic vitaldatagrowth chart frombirthtofive years. developmental landmarksnutritionand breast feedinginformationrecordofillness reason for special care immunization Depending ontheresourcesoftheindividual territories, a schedule for visiting a health clinic should be instituted viz.;monthlyvisits for the first six (6)monthsoflife,quarterlyvisits from sixmonthstotwoyearsofage,thereafterannual visitsuntiltheageof5 years. All high risk children should be identified and a system established for follow up.C.Immunizationi)Introductionoflegislationtoensurethatall children are comprehensively immunized before admissiontoany school forthefirst time. ii) Eachterritoryshould aim towards having 85% comprehensive immunizationofchildrenunderone yearofage.D.Nutrition and Breast Feeding i) Everycountryshould institute a system forthecontinuoussurveillanceofthenutritional statusofchildren, based on weight-for-age measurements. ii) Breast feeding should be exclusively and actively encouraged forthefirst four (4)monthsoflife.50%ofwomen should be doing soby1986and 70% by 1990. iii) All pregnant \,omen should havetheeducation neededtopreparethemfor breast feeding at the pre natal clinics.iv)The international code on breast milk substitutes should be supportedbymembergovern ments.v)Breast milk substitutes shouldnotbe allowed on maternity, neonatalorpaediatricunitsexceptbya physician's written orders.vi)Theperinatal team should assess the situation quarterlytoensurethatthisismaintained. Formula rooms/milk kitchens should be phasedoutbytheendof1984.

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vii)Government,healthpersonnel,andthepublicshould beeducatedInsupportofbreast feeding. vii)Themass media andschool'scurriculumshouldbe utilized forthepromotionofbreastfeeding.ix)Continuationofbreast feedingbyworkingmothersshouldbe facilitatedbyactivitiesofestablishedwomen'sgroupsandtheinstitutionofvoluruarywomen'sbreastfeeding groups.Thelattershould receive financial assistancewherepossible from localorinternationalagenCles.E.InstitutionalandDayCarei)Eachterritoryshouldimplementinstitutionalanddaycare facilities foryoungchildren. ii) Residentialcentresshouldbephasedoutandreplacedbyfacilities fordaycare, foster care and smallergrouporfamilyhomeswherefeasible. iii) Largeinstitutions,e.g., hospitals,andfactorieswhichemploya highpercentageofmothers,should havedaycare centresontheirpremises. iv) Family -typedaycare centres, e.g.,'backyardnurseries,'shouldbeencouragedandappropriatelyregisteredandcontrolled.v)Parentsshouldbeencouragedtomakeuseofdaycare centres andbedissuaded from leavingyoungchildrenaloneinprivate homes. vi) All childrenadmittedtodaycarecentresshouldbeadequatelyimmunizedtothe age level. F. ChildrenwithSerious ProblemsandtheHandicappedChild i) A regional ReferralCentreshouldbeestablishedforeachcountryorgroupofcountriesin whichthechildpopulationexceeds300,000,wherespecialistpaediatricserviceswouldbeoffered. Servicesshouldinclude:-cardiac assessmentandsurgeryneurologyandneurosurgerypaediatricorthopaedicsurgeryandrehabilitationear, nose andthroatsurgerymanagementofspeechandhearingdisorders. ii) Eachcountryshouldestablish asystemwherebyacommitteeofconsultantswoulddecidethepriorityinwhichchildrenshouldbetransferredtotheRegional Referral Centre. iii) Specialists fromtheReferralCentreshouldvisittheparticipatingcountriesperiodically fortheexchangeofinformation,expertiseandfollow-up.iv)TheUniversityoftheWest Indies shouldexpanditsDepartmentofChildPsychology/Psychiatryinordertobetterservethementalhealthneedsofchildren intheregion.Treatmentofcommonchildhooddiseasesandcontrolofdiarrhoealdiseasesweredealtwith.Therewerenosignificant changes inmanagement.9

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III I' 10Themeeting provided a forum fortheexchangeoftechnical information andcontinuingeducationthroughthepresentationofpapers on selected Maternal and Child Healththemesandbymeansofseminars. Participantsworkedextremely hard, many times wellintothenight.Theatmosphere was warm and friendly. I was grateful fortheopportunitytoattendthis Technical Meeting, and should liketore-iteratemysincerethankstoallwhomade it possible.CARINGFORTHEINFANTINUTEROGeorge Sherman Caring fortheinfantinuteroisa very simpletaskin approximatelyninetypercent (90%)ofpregnancies, because in reality,theinfant basically cares for itselfifall its needs and requirements are met. Thereforethecornerstoneofcaring for this individualisgood antenatalorprenatal obstetric care, and nowhereistheadage"anounceofpreventionisworthapoundofcure"more appropriatethanin this instance. Perhaps,in these inflationary times, it may even beworthatonofcure. Antenatal Care begins whenthepatientattendsthephysicianorclinic for her first visit whichisusually aboutthethirdmonthortwelfth weekofpregnancy.Inactuality however,the,antenatal period starts at conception anditisthis period, fromconceptiontoapproximatelythetwelfth week,thattheunbornchildissubjectedtomanyofthevicissitudesbroughtaboutbytheingestionofinappropriate drugs,thedamaging effectsofcertainVIRALINFECTIONS,aswellasthecrippling effectsofcertain Carcinogens. Thereforethecornerstoneofgood Antenatal Careistaking athoroughhistory.Thehistory should beasdetailedaspossible and will establishthedurationofthepregnancy bydetermmmgthedateofthelast normal menstrual period (menstrual age),thedateofthelast ovulation (ovulatory age),aswellasthedateofdeliveryorexpecteddateofconfinement.Itisbecauseofthisthattheexpecteddateofdelivery has a marginoferroroftwoweeks dependinguponwhetherthedateofovulationorofmenstruationisused.Thehistoryisfollowedbya complete andproperphysical exam.ination at which timethebase line weight andbloodpressure are established. This examination must include a thorough pelvic examinationaswellasa pap smear.Attheconclusionofthephysical examinationthenecessarybloodworkisdone andbylaw itisrequiredtoknowthemother'sbloodtypeand Rhesus factor and do a test for syphilis (VDRLorother),butequallyasimportant,thoughnotrequiredbylaw, isthehemaglobincontentoftheblood, sickle cell preparation and complete urinalysis. These baseline studies areimportantbecause severalofthem,theweight, urine andbloodpressure are checked on each return visittothedoctororclinic, whilethehemaglobin andtestfor syphilis are repeated at thirty-six weeks. Oncethehistory and physical are complete,thepatientisgiventhenecessary prenatal instruc tionsasto diet, worketc., whentomakereturn visits and an adequate supplyofprenatal vitamin and iron table,s.Itiscustomary forthepregnant patienttovisitthedoctormonthlyuntil twenty-eight weeks gestation(7months)thenfortnightly until thirty-six weeks (9 months)thenweeklythereafteruntil delivery which should usually occur at40weeks or'10 lunar months. (The old wives' talethat7monthbabies liveordobetterthan8monthbabiesisnottrue). During each pren atal visit thebaseline factors above are measured and compared with past ones, the sizeoftheuterus .is noted(theuterusisnotfeltintheabdomenbytheexamineruntilthethirteenth to fourteenth week) andany abnormality experiencedbythepatientordiscoveredbythedoctorare investigated and corrected where possible.

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Asalludedtoabove there are approximately ten percent00%)ofpregnanciesinwhich com plications arise, andtheunborn then must .actively be cared for or its well being may be jeopardized. Someofthese conditions are diabetes mellitus, heart diseaseinthemother, Rhesus incompatibility, toxemia (High blood pressure withorwithoutfits) anemias and certain infectionsjusttoname a few.Tomanage these complicated pregnancies one must useallthe parameters at one's disposal to determine the statusofthe fetus. Someofthese parameters include the useofthe Ultrasound Machine, a computerthatallowsthebaby to be visualized on a screen and its well being assessed, Amniocentesis, whichistakingoffsomeoftheliquid in whichthebaby floats,todetermine abnormalities, Spectophotometry which determinestheamountofbilirubinintheamniotic fluid and givesanindicationofhow much troublethebabyisin.There are manyotherinvestigative para metersbutI willnotboreyouwiththemin this short article.Theuterus continues to grow and atabout4 months (16 weeks) the patient experiences "quickening"orthe first movementofthe baby. At this time the baby weighs about one hundred grams whichisslightly less than a quarterofa pound andisfloatinginabout two hundred milliliters (200cc)ofwaterorabouttheamountcontained in ahalfglassofwater.Thebaby and uterus then continuetogrow so that atfivemonths ortwentyweeks the leveloftheumbilicusornavelisreached, and at termorforty weeks it reachesthetipofthe breast bone, from where it recedesbya process knownas"lightening" whichiswhen the baby drops. This dropping makesthepelvis and ambulation (Walkingormoving) extremely painful and uncomfortable. Duringthesecond trimester and uptothirtysix weeks, fetal well beingisassessedbyuterine growth, mother's weight gain, statusofher urine and blood pressure as wellasfetal activity.Ifallthese fall within a normal range then we have an uncomplicated low riskorno risk pregnancy.Ifhowever anyorallofthese parameters go wrong thenthepregnancy changestooneofhigh risk. Since weightisrelatively more easily controlled thantheotherfactors we should limit weight gaintothirtypoundsorless.Theotherfactors are somewhat beyondourcontrol.Asmentioned before,throughoutthe normal pregnancy,theunborn forallintents and purposes looksoutfor itselfaslongasits necessary requirements are met. Thisisdone simply and efficientlybytheplacentaorafterbirth which sitsina poolofblood intheuterine wall from which nutrients are extracted and into which waste materials are emptied. Occasionally the feta-placental unitasitis-called, fails to function properly andweget con ditions knownasToxemia, referredtoabove, abruption and depositionofcalciumjusttoname a few. These conditions leadtoproblem pregnancies. In conclusion therefore, it can be categorically statedthattheprenatalorantenatal periodisoneofthemost amazing periodsoflife and at noothertimeinthehistoryofmanisthegrowth rate so rapidasduring this time, because a simple one cell Zygote,thatisbarely visibletathe naked eye growstaform billionsofcells and attain a weight any where from seventoten pounds. Thisistruly a wonderful phenomenonofnature!Aftera periodofapproximatelytwohundred and eighty days, forty weeksorten lunar months, labor ensues and birth follows. In spiteofits simplicity, we havenotyetbeen abletofigureoutwhatinitiates labor or exactly when it will begin. Nature once again points upourhuman frailties and inefficiencies.Bethatasit may, birth takes placebya varietyofavenues and means andtheantenatal period comestoan abrupt end. P.S.TheIdeal aimofObstetricsisa healthymotherand a healthy baby. Happy Easter!Delas DaysNUTRITION IN PREGNANCY -A BABY'S VIEWElizabeth RoUe Been born and bred in Mayguanain1902 was no picnic comparedtoda easy life today. A kanfagetdaday I was borntwoo'clock indamorninon31.5.1902.Itwassowarm and comfortableinmi mom's belly gettin errryting a neededtagrow widnohassle what-so-ever. Dem deliciousokrasoup, spinach and rice and specially the sea food like fish, conch and lobsterII

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,,-12aldam fresh meat from we goats, cows, pigs and chickens keptmimom lookin like a peach; a guess it was cause she always eat different kindsoffood. Erry day mi dad usetaget milk fromdacoworgoat andmibrothers and sisters usually gadder da limes and udder fruits and vegetables from da field. So erry day da meals eaten were fresh and dere was a variety cause we grow we ownfood since dere was no shop like taday. Gramma usetamake switcher fromdalimes and juice fromdaoranges and grapefruit clem and dere was always udder fruitstasnack on like watermelon, pineapples, sugar apples, etc. Iwon'ttalkboutjuju and hog plum dem specially sea grapes, she useta"kill" dem sometimes,but gramma usetasaytoomuch a dese was gua makehersick causetoomuch a anytingisgood fa nuttin.Mymom never did eat plenty food specially during the first couple months cause she always had bad feelins particularlyinda mornin time,buttank goodness she always wanted different kindsoffood insteadofeatinthesame ting erry day. In dos days, dere wasn't dem fancy foods like tadayoriron and vitamin pills;butI sure my mom got enuff fa me andherfromthefoods she ate and drank cause she was rosey and I was rosey and we'en hadnoproblems wid low blood (anaemia)orhigh blood (hypertension)ordemothertings de sayisnutritional deficiencies. Afterboutthirtysix weeksinmy mom's belly I mus be was gettintoobig cause before, I was able to spin around and do my own ting in any position I want,butallofa sudden I couldn't do this no more.Mihead gon get stuckinmi mom's pelvissonowI could only movemilimbs andbodya little,butdespite this, it wasn't uncomfortable and it suredidn'tinterfere widmifood supply. Dat daydey callmibirth day was the most! First, it felt like somethin keep squeezin me and lettingoand pushin me; andalldemIiImanoeuvresImadeIcouldn't donuttinboutit, andallofa sudden, it feel like sumthinbrokeloose, and quickasa wink,Iwas pushed into a cold open space.Icould feel sumthin holdinbothsidesofmihead; thenIlanded on this hard surface. WhenIopened mi eyes and sawtwomasked monstrous lookin tings standing over me,Iscreamed, especially when dey cut mi nahel string cause disishowIdid get all mi food and ting. Just dataurtofhavintause upmienergytosuckmifood now, made mi angry, thereforeIkept screamin. DeytaurtIwas cold so dey quickly wrappedmeup.Iwas weighed and examined. Allofa sudden some one stuck me wid a needle, and a mas"teardown"da place wid de hollerin! Dis made mi feel very hungry; musbecause a use uptoomuch energy. Next tingIknow dey lay me side mi mom cause deytinkI was hungry.Aroot tilldatbubbywas set good in mi mout. Now das da best tingdatever happentame; a suckedtamiheart's content, den a hear one nurse say "dis baby sure get a good pullin ondatbubby he done know he gatta eattosurvive." Dese gatta be da las days.PROTECfYOUR CHILD! BREAST-FEED AND IMMUNISE!FredericaE.Sands,ToPROTECTistoGUARDorDEFEND.\Imagine a mother 'breast-feeding her infant. Whether sheislying or sitting,herbabyisheld closeasherarm,lovingly and. tenderly encircles him/her.Isshenotguarding her infant with this very act? In what other waysisthismotherwhoisbreast-feeding PROTECTING her baby?1.Sheisgivingherbaby milkthatbaby can easily digest; for God made it especially for him. She wouldnotthinkofgiving her baby cow's milk! No, that milk was made for the calf's easy digestion! Wouldthecowgiveher calf baby's milk?!Ofcourse not! Even the cowismore intelligent than that! Animals would never thinkoffeeding their young with the milkofanother species. But we, intelligent beings do itallthe time!2.Sheisgiving her baby milk whichisalways clean and contains practically everythingher

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child could need(atthecorrectproportion)duringthefirst fourtosixmonthsoflife. A breast-fedbabyisa well nourished baby!3.SheisprovidingherbabywithanumberofImmunological Factorsthatenablebabytoresist certain infectionsordiseases. Onlymother'scolostrum andmother'smilk can provide this kind ofprotection,bottlemilk could neverdothat!4. Sheisdeveloping an intimacy, interacting withherchild, which occurs so naturally during breast-feeding so settingthestage for her child's future social andemotionaldevelopment; sheisformingthebasisofherchild'smaturepersonality and healthy adjustmentto/society.In short,themere actofnursing enchancesthepossibilityofher rearing a well adjusted child.Ithas been saidthata childwhoisentirelv breast-fed, attains abettermental developmentthanonewhoisentirely bottle-fed. Speaking .about socialadjustment-Iremembera little eighteenmonthold (a breast-fedbaby)who came sauntering intoherGod-mather'sroomwhere I was breast-feedingmybaby, boldly asking me, a stranger,"CanI havesome?"Now ifthat'snotsocially adjusted,whatis?! Evenaftertheyhave grownoutofthetoddlerstage, children still rememberthewarmth,comfortand securityofbeingbreastfed. My little boy,whois four years old,oftencuddles uptome, lovingly strokesmybreasts and says,"Mummy,I LD-V-Eyourmuscles!" AND WHATAREMUSCLES FOR? TO PROTECT,OFCOURSE!NOWTHAT YOUAREWELL ONTHEROAD TO HAPPY BREAST FEEDING, LETUSTHINKOFANOTHER WAYTOPROTECTourprecious littlegifts-"IMMUNISATION"Wise parents immunisetheirinfants becausetheyknowthatthroughImmunisationtheirbabydevelopstheabilitytofight infection. WhenbabyisImmunised against a certain disease,babyisgiven a smallamountofspecially prepared, weakenedordead germsthatcausethatparticular disease.Thebodythenbuildsupa resistancetothatdisease and soprotectsbaby. Becausethenewborn'simmunity(PROTECTION) with which heisbornlasts only for ashorttime, itisvery necessarytostartimmunisation early inordertomaintain baby'sprotection.TheMinistryofHealth's National schedule recommends therefore,thatall children begintheirimmunisations atthreemonthsofage. Children can be immunised (PROTECTED) againstthedeadly diseasesofDiptheria, Whooping Cough, Tetanus, Poliomyelitis and Measles.Toattain maximum protectIOn, baby will need an injectionofD.P.T. and Oral Polio drops at agesthreemonths,fivemonthsand sevenmonths;and a Measles injection onthefirstbirthday.Booster Doses (which"Top-up"thelevelofProtection) will alsobeneeded at ages eighteenmonthsandfourtofive years. Some parents may feelthatitisbetterforthebabytogetthedisease and develop itsimmunitynaturally.Donotbe fooled. These diseases can KILL!Ifthechildisfortunateenoughtosurvivethedisease, he maybeleftpennanentlydisabled.Itisbyfarmoreprudenttospend one sleep less nightifnecessary, comforting an irritable child followingthefirst injectionthantospend count less nights,countingthecost. Parentsdon'tdelay,startbaby'sIMMUNISATIONS today! IMMUNISATIONS are available freeofcharge from any MinistryofHealth (Government) clinic in New Providence andtheFamily Islands. AdviceonCaring and Sharing fortheyoungchild (uptotheageof5 years) especiallywithregard to breast feeding and immunisation is readily and easily availablethroughouttheCommonwealthoftheBahamas. This advice/helpisavailable freeofcostatCommunityClinics, and for a fee privately. REMEMBER PPREPARED Breast-milk is well prepared.13

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R-READYo-ORDINARYT-TRUSTEDEEDIBLEC-CLEANT-TRUEI IMMUNISATIONo-OPPORTUNE NNECESSARY Breast-milkisalways ready. Breast-milkisordinary,butvery good. Breast-milk can be trusted. Breast-milkisspecially designed for human babies. .Breast-milkisalways clean and free from harmful germs. Breast-milkisalways truetoyourbaby. -Toimmuniseiswise. -OurImmunisation scheduleisWell-timed. Sticktoit! Baby's Immunisations are very necessary. \ 1 I..], Putthemalltogether andtheyspell,PROTECTION!!A listoftheClinicsinNew Providenceissetoutbelow:-Adelaide Clinic Adelaide Village Ann'sTownClinic Williams LaneoffKemp Road Blue Hill Road Clinic Blue Hill Road, North Carmichael Clinic Immediately behindtheold Carmichael School Coconut Grove Clinic Acklins Street Fox Hill Clinic Bernard Road Gambier Clinic Gambier Village In all (major) settlements intheFamily Islands (Every week-day from 9 a.m.)14Telephone No.(809) 32-50300 (809) 32-35553 (809) 32-54013 (809) 32-43255 (809) 32-78354

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u-pD-A-T-E Felicity AYlllcrHEALTHEDUCATION DIVISIONThcDivision was relocatedtomorespaciousaccommodationonthe4th floor oftheMosko(Immigration)Building, Hawkins Hilljust before Christmas.Onemajordisadvantageisthenon availabilityofthetelephonealthoughwe can be reached,courtesyoftheDepartmentofEnvironmentalHealth Services.ThankyouMr.Directorforyourinvaluable assistanceinourdaytodayoperations.Ontheotherhand,theviewissimply magnificent. "Living"upthereremindsus most" poignantly,thattherearetwoSidestoevery coinIGOODBYE It waswithmutualmixedfeelingsthatwesaidgood-byetoMissAudreyDeveaux,SeniorHealthEducationOfficer,attheendofJanuary.Miss Deveauxisthe"mother"oftheDivisionandlike all"good"mothersrealisedthatatsometimefamilymembersareseparated.Whileweweresaddenedhyherdeparture,we realisethatchangeisan integralpartofgrowthanddevelopment.Weare pleasedthatwe shallmaintainourlinkswithAudreyasshe has agreedto se(Ve as amemberofourEditorialCommittee.Ourlossisverymuchsomeoneelse's gain.WewishAudreyevery successandhappinessinhernewjob.Weknowthatsheiscapableofrisingtoitsnumerousandvaried challenges,andwehopemostardentlythatvery little,indeedthatNO"BitingoftheBullet"will beencounteredinthesechallenges.GoodluckAudrey,wemissyourhumourandcharm.CONTINUINGEDUCATIONAworkshopinEpidemiologyiscurrentlyunderwayattheDepartmentof Nlirsing Education.Participatingare Physiciansand Nurses fromtheCommunity,Princess Margaret Hospital,SandilandsRehabilitationCentreaswellasHealthInspectors.Theworkshop,consistingoftwelve(12)sessions,February-May,is organisedandconductedbystaffmembersofthePublicHealthDepartment.BeginningTuesday21stFebruaryDistrictNurses arebeing bro'-.lght uptodateinRehabilitationtheoryandmethods.Sessions areconducted by PhysiotherapistsatthePrincess Margaret Hospital.CommunityNurse MarcelJohnsonstationedatCoopersTownAbaca,willbeattendinga seven (7)monthcourseinNutritionbeginningearly March in Barbados.Wewishyousuccess Marcel.Wehopeyouenjoythecourseandwillbe"enriched"bytheexperience.HealthInspector,AndrewThompson,oftheDepartmentofEnvironmentalHealth Servicesisattendingatwo(2)monthcourseincomprehensiveVectorControlattheUniversityofSouthCarolina.Three(3)Nurses intheCommunityNursing ServicesofthePublicHealthDepartmentrecentlyattendedafour(4)weekcourse(8thJanuary-4thFebruary),inthediagnosisofandcontacttracingforSexuallyTransmittedDiseases (STD) intheUSA.Theywere:-Mrs.ThirzaDean,SandraColebyandBrendaArmbrister.IncludedinthecoursewereInterviewingTechniquesandProblemSolvingmethodsrelativetocontacts.AhalfdayworkshoponChildAbusewashostedattheSandilandsRehabilitationCentreonThursday9th,February.please see p.24forabriefreport.TheMedicalAssociationoftheBahamashelditsannualConferenceonFridayandSaturday20thand21stJanuary,1984,attheBritanniaBeachTowers(Hotel)Paradise Island.ThethemeoftheFriday'smeetingwasSubstanceAbuse, atopicwhichiscurrentlyextremelypopularandconsequentlydrewlargepublicresponse.Theevening sessionwhichwas again very wellattendedwas also highlyemotiveandincredibilyrevealing.Isthisformatthepreludeofanewrelationshipbetweenthemedicalprofessionandthepublicindealingwithhealthproblems?InfuturehowmuchemphasiswilltheprofessionbegivingtothePREVENTIVEaspectsofSubstanceUse/Abuse?

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WELCOME Dr. Francis Mwaisela(pronouncedMi-sell-a)tothePublic HealthDepartment.Dr. Mwaisela received his medical training at the UniversitiesofDares-Salam, Tanzania, and West Indies and has servedasMedical OfficerofHealth intheparishesofSt. James, Hanover and Westmoreland, western Jamaica. His areasofmedical interest are Hanson's and SexuallyTransmittedDiseases.Wehopeyouwillbeveryhappyand enjoyyourstaybothintheDepartmentand inthecountryDr. Mwaisela.** *** *Dr. Colin MatthewstotheGeneral Practice ClinicofthePrincess Margaret Hospital.Wehopeyouwill managetostayafloat intheseaofhumansuffering whichyouencounterdaily attheP.M.H.! Health AssistantEuthelGreentoDriggs Hill, Andros. AlthoughMr.Green will be working on a part-time basis only, we are surethattherewill be significant improvementsto/intheenvironmentat Driggs Hill,southAndros.Weare suretheresidents will helpyoutohelpthem.Good luck Mr. Green. Mrs. Marie McDonald, receptionist withtheDepartmentofEnvironmental Health Services.Weappreciateyourcourtesy and cheerfulness. WelcomebackMr. Edwin Strachan -Ag.DeputyDirector,DepartmentofEnvironmental Health Services from a periodofstudyattheUniversityofTennessee. A characteristicofstaffofthatdepartmentistheirseeming inabilitytoget ruffled, Mr. Strachanisnoexception andhowwe need calm in these hectic times! Mrs. Lucinda Forbes and Veronica Poitier,CommunityNurses in New Providence and Grand Bahama respectivelyoncompletionofa one year diploma course inCommunityHealth attheUniversityoftheWest Indies.Weknowtherewill be improvements; intheservicesasa resultofyourindefatigable hardworkattheUWI.A special welcometoMr. Mark Crowley, Statistician withthePan American Health Organisation (PAHOIWHO). Mr. Crowley presently worksoutoftheHealth Information Unit, Princess Margaret Hospital.Wehopeyouwon'tbetoooverwhelmedbyourexpectationsofyourservices Mr. Crowley.Wewishyouevery success inyourworkhere andhopethatyouandyourwife havenothingbuthappy experiences intheBahamas! 111,11'1 16CHANGE AND???Dr.C.J agadeesh transferredtotheRagged Island districtwitheffect 16th January. Dr. J agadeesh formerly as.a Nedical Officer atth.ePrincess Hospital (Out-patient Department).WehopeyoursOjourn10 rrte Faml1y Islands w111 be most enjoyable forbothyouandthereSIdents. Miss Eugienie Smith, Executive Officer recently joinedthestaffoftheDepartmentofEnviron mental Health Servicesontransfer fromtheDepartmentofPublic Personnel.WehopeyouwillbeveryhappyintheDepartmentMiss Smith.TheDepartmentofEnvironmental Health Services moved officestothe4thFlooroftheMosko (Immigration) Building(oppositethe Health Education Division) in early January.Theynotonly have more adequate accommodation,butareina muchbetterpositionthanwe are, havingtheir"almost"full rangeoffacilities. Eye services have beenextendedtotheFamily Islands.Theinaugural clinic was held in Kemp's Bay Andros in December, 1983 followed by oneinGovernor'sHarbour, Eleuthera.

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Nextmonth,April,the2ndyearpreregistration House officers will beginrotatingthroughtheCommunityClinics inNewProvidenceandtheFamily Islands. Why aretheylooking forward so eagerlytothese experiences? Will anyoptfor a"pieceofthataction?"AlaboratoryforidentificationofspeciesoftheAnopholesmosquitoesisbeing establishedinNew Providence. Viz: AlbimanusandCrucians.Theprogrammefortreatingbreeding sites hasbeenintensified. MonitoringoftheAedes Aegypti continues. GOOD-BYE Dr. MaudeStevensonsole femaleConsultantandHeadoftheDepartmentofPaediatricsat the Princess Margaret Hospital has retiredafterservingmorethan20 years.WeunderstandDr. Stevenson willbereturningtohernative Irelandshortly.Wewish Dr. StevensonGod'sspeed, goodhealth,happiness,anda longretirement.Wehopetheweatherwon'tbetooinsufferable!CONGRATULATIONS** **Dr. Percy onyourelectionasPresidentofthtMedical AssociationoftheBahamas. Dr. PatrickRobertsonyourappointmentas Acting HeadofthePaediatricDepartment,Princess Margaret Hospital.Thirteen(13) Nurseswhosuccessfullycompletedthefirstpostbasic psychiatric nursing course heldattheSandilandsRehabilitationCentre.Thosenurses attheSandilandsRehabilitationCentrewhosuccessfullycompleteda basic pro fessional nursingprogrammeas well asthosewhocompletedthetrainedclinical nursing (T.C.N)programmerecently. NEWS ABOUTTHEHEALTHEDUCATIONCOUNCILThe"Council"held itsannualgeneral meetingonThursday26thJanuary,1984.BoththePresidentandTreasurerpresentedreports. Electionswereheld and Mrs. Louise Simms,muchtohersurpriseandpleasure wasunanimouslyre-elected as President.Otherofficers electedwere:-Barry Rassin, (RassinHospital)-Vice President AzelIa Major, (Bahamas CouncilonAlcoholism)-SecretaryErnestineDouglas (Nurses Association) AssistantSecretaryHarcourtPinder(Bahamas Christian Council) -Treasurer.Bertram Rolle (BahamasRedCross Society) PublicRelationsOfficerSomeactivities fortheyearwillbe:-HealthFair/ExhibitionshortweeklycolumnintheGuardian.17

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18CAREOFTHEYOUNG CHILD UPTOAGE 5 YEARS Percival McNeil As with child carethroughouttheworld,therearemanytraditionswhich persistandinfluence health-careattitudes.Breastfeedingisnolongerthetraditionalmanneroffeeding newbornsintheBahamas. Mostinfantsare fedevaporatedmilk which hasbeenadjustedtothebabies needs,orformula. Likewise,theappearanceoftheumbilical cordwiththecord clamp on it,isfairly new, andmothersarereluctanttotouchthis sincetheyare afraidof"hurtingthebaby."Thefailuretobreastfeedandtocare for the umbilical cord arecommonlocal practices which willnotbe easilyeradicatedandinthis instance are negative health-care practices.Thepositive sideofthingsisthatonceweknowthatthereisa defined problem, we canconcentrateoureffortsin these areas.Thereisalsothetendencytocomparebabies.Twoinfants,bothattwomonthsofage one sleepingthroughthenight,theotherstillupscreaming.Thetruthisthatlike adults,infantsare all different.Thesizeofthebabyatbirthdependsonthesizeofthemother'swombandtheenvironmentinsidethewomb.Ifthereisdecreased availabilityofoxygen inthebloodtotheinfantbecauseofcigarette smoking,thebabywill be smallerthanitspotentialsizejsimilar thingshappenifthemotherhas highbloodpressureorkidneydisease.Oncethebabyisborn,thenhe/shecan growtotheirpotential,dependingonthesizeofbothparents.Someinfantsthenwill grow very rapidly whileothersremain smaller.Forthehealth-careworker,themostuseful guideisthegrowthchartor, as hasbeeninstitutedinothercountries -theChild Health Passport Thisdocument,similartotheyellow card used forimmunization,has agrowthchartonit,therebyfacilitating earlydetectionofabnormalgrowth. While it has been saidthattheabsolute weightisnotasimportantasthepatternofweight gaip. over a periodoftime, onecannotunder-emphasizetheimportanceofgrowthevaluationinchildren sincegrowthistheultimatemeasureofwell-beinginthechildhoodyears. Inordertokeepourchildrenhealthywe needtoimmunizethem.These agentsprotectouryoungones from diptheria,tetanus,whoopingcough, polio and measles.Thecommonestproblemlackofimmunizations-continuestothreatenus. Childrennormallyhave 6to9 coldsperyear,ifwepostponeimmunizationsbecauseofcolds,theirchancesofbeing immunizedadequatelyinthefirstyearwouldbequiteremote.Insummary, colds arenotacontraindicationtoimmunization.Theyshouldnotbegivenwithfever, (since thiscancause a diagnostic dilemma -whatcausedthefever -theoriginalconditionorthevaccine,andiftherewas a reaction -wouldtheoriginal conditionorthevaccine betoblame). (Feveris1000F rectallyorhigher). Oral polio drops shouldnotbe given in the presenceofdiarrhoeasincethevaccinemaynot'take'.Oneofthemajor problems associated with preventative health-careisthatforsomepeoplewithmore pressing problems,theimmediate valueoftaking a childtotheclinic for animmunizationisnotrealized, sothatsomeattemptmustbemadetoidentify non-compliers and health-care should be takentothem(ifat all possible).Theillnessesthatimmunizationsprevent are all very serious andwithoutthemandthesubsequentprolonged hospitalization,thereismoretimefornormal development. Having growing childreninthehomeisa fascinating experience since itisreally a reflection onhowwewerewhen much younger. Likegrowth,children developattheirownpace aidedofcourse,byastimulatingenvironment.Atwell-child clinics, one doesnotusually godowna long listofdevelopmental milestonespertinenttotheage,butattentionispaidtothemostappropriatemotor,adaptive, social and language achievements.Ifamotherwith,otherchildren or agrandmothercomplainsthata child'sdevelopmentisslowthenevaluationmust be in detail.Ifonquestioningtheparent,thechild is supposedly slow in anumberofareas,thenagain evaluationmustbe in detail.Atbirth, infants are abletodomanythings -theycan seewitha preference forthehumanface.Throughcrying,theyexpress hunger, painordiscomfort,theneedfor companionship, etc.Theycan hear, they can discriminate taste,theycanturntheirheads from sidetoside while lying facedownthey have a startleormororeflex, arootingreflex which enablesthemtofindthemother'snipple;theycan suck,theyhavea grasp reflex sothatthehandautomaticallygrasps objects placed inthepalms.Anotherimportantconsiderationisthatnewborns areobduratenosebreathers-theyonly. breathe through theirmouthswhentheycry. In keepingwiththis,theyare abletobreatheand

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swallow at the same time.Theyare often attentive forbriefmomentsand after the first few weeks, smile socially. Most infants will sit up atabout7 months,startsaying a few words (dada) between seven and ninemonths;and walk between 12 and15months.Atthis time,theyhave single wordsthattheyuse with specific meaning -theyunderstand alotmorethanthey can say. At 3 years they speak in sentences and play well withotherchildren. Most health-care workersknowthatbetweentheagesof6monthsto 2Y2 years children seemtobecomequiteanxiousaboutcontactwith strangers e.g., atthehealth-care visitstheytendtocry a lot duringtheexamination. Thisisa normal developmental milestone andofcourse shouldnotbe taken personally.Thesame childisa lot moreconfidentwhen heldbya parent. Toilet training readinessispresent at 18monthsand usuallyiscompletedbyage 3 years. 2 year oldisimpressivebyhis/her endless energy, fast hands and explorativeattitudewith no fearofdanger. So muchsothatweoftenhear people talkingaboutthe'terrible twos.''No'isthefavourite wordofthe1 year old,beyondage 2theyare into questions. Questionsabouteverything things so basicthatwe oftentakethem for granted. With an understandingofchildhood development, things are easier e.g.,thereisless spankingofthe2 year old,theirexplorative attitudesisa wayoflearningandtheyhavetobeprotectedfrom danger;thequestions arebettertolerated since thariswhatshould be goingonaround this time. Toilet trainingisinappropriate at one yearofage. Some parentsoftenaskaboutchild-rearing patterns.Wefrequently hear the saying 'Spare the rod and spoilthechild' whereasothersdonotbelieveinstrict discipline enforced by corporal punish ment. Child-rearing habits dependuponpersonal preferences. No onemethodhas proven superiortotheother. What wedoknowisthatfrom infancy, children show personality patterns e.g., calm, easily comforted, cries onlyifinpainvs.fussy, prolonged screamingatnight, etc.Ithelpstobe awareofa particular infant's personality sothatthereisan appropriate responsetotheinfant's needs and perhaps distinguishing betweenthefussyinfant and onewhoisillmight be a bit easier. Fever, cough, colds, ear infections, chest infections and gastroenteritisconstitutethecommonestchildhood illnesses.Thereare some simple guidelines for ustofollow:-1.Feverinexcessof1000F (axilla)or1010F orallyisNOT causedbyteething. 2. Although we can treat fever usuallywitha preparation containing acetaminophen/ paracetamol, e.g., calpol, tempra,tylenol -itisimportanttoknowwhatcausedthefever.3.When medicationisgiven for fever, it takesaboutonehourtobringthetemperaturedownsignificantly. This process can be aidedbyspongingthechild down with luke warm water. 4.Theyoungest infantstolerateinfections least well. Infants lessthan3monthswithfevers should be evaluatedasearlyaspossible. Gastroenteritis (vomiting and frequent loose stoqls)isacommonchildhood illness.Itisuncommoninthebreast-fed infant.Therearetwomain complications infection and excessive lossofbodyfluid (dehydration) thislatterbeingthemostcommoncomplication. Health-care workers presently have available 'oral rehydration salts' whichifmixed correctlywithwaterandgiven appropriately will preventdehydrationand keepthechild welluntilthediarrhoea has subsided. Parents shouldknowofthis formoftreatment.Fornon-breast-feeding infants,itshould be available inthehomewith instructions for its use sothatintheeventofthistypeofillness,treatmentcan be started early. In discussingthecareofyoung children, we have emphasizedtheirgrowthanddevelopment andtheWorld Health Organization's (WHO's) recommendationsthatpertaintoimproving health care in young children. Theseare:-19

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1.Breastfeeding 2.Theeasy availabilityofOralRehydrationSalts forthetreatmentofdiarrhoea. 3. Adequate immunizations. 4. The Child Health Passport fortheearlydetectionofabnormal growthpatternsand in particular malnu trition. With appropriate emphasisonthese aspectsofcare,theworkofparents and health-care workers shouldbeconsiderably easier.Excerptfrom: HEALTHY PEOPLETheSurgeon General'sReportOn Health PromotionandDisease Prevention DHEW (PHS) Publication No. 79-55071 HEALTHY INFANTS Much has happened inrecentyearstomake life safer for babies. (IntheUS),theinfantmortalityrate nowisonlyaboutone-eighthofwhat it was duringthefirst decadesofthecenturythankstobetternutrition and housing,andimproved prenatal, obstetrical, and pediatric care. Yet, despitetheprogress,thefirst yearoflife remainsthemosthazardous perioduntilage 65, and black infants are nearly twiceaslikelytodie beforetheirfirst birthdaysaswhiteinfants.Thetwoprincipalthreatstoinfant survival and good health are low birth weight and congenital disorders includingbirth Accordingly, thetwoachievements which wouldmostsignificantly unprove the health recordofmfantswould be a reductioninthenumberoflowbirthweight infants and a reductioninthenumberbornwith birth defects. Butnotall health problems are reflected in mortality and morbidity figures.Itisalsoimportanttofoster earlydetectionofdevelopmental disorders duringthefirstyearoflifetomaximizethebenefitsofcare. And the firstyearisa significant period for layingthefoundation for sound mental health through thepromotionofloving relationships between parents and child. Low birth weightisthegreatest single hazard for infants, increasing vulnerabilitytodevelop mental problems -andtodeath.Ofallinfant deaths, two-thirds occur in those weighing lessthan5.5pounds(2500grams)atbirth. Infants below this weight are morethan20 times likelytodie withinthefirst year. Lowbirth weighJ issometimes associatedwithincreased occurenceofmental retardation, birth defects, growthand problems, blindness, autism, cerebral palsy and epilepsy. Many maternal factors are associated with low infantbirthweight: lackofprenatal care,poor20

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nutrition, smoking, alcohol and drug abuse, age (especiallyyouthofthe mother), social and economic background, and marital status. Given no prenatal care, an expectantmotheristhree timesaslikely to have a low birth weight child.--Andmany women least likelytoreceive adequate prenatal care are those most likelytohaveotherrisk factors working against them.About70 percentofexpectant mothers under age15receive no care duringthefirst monthsofpregnancy,theperiodmostimportanttofetal development,25percentoftheir babies are premature, a rate three timesthatfor older mothers. Maternal nutritionisa critical factor for infant health. Pregnant women lacking proper nutrition have a greater chanceofbearing either a low birth weight infantora still born. Diet supple; mentation programmes especially those providing suitable proteins and calories materially increase the likelihoodofa normal delivery and a healthy child, and attention to sound nutrition forthemotherisa very important aspectofearly, continuing prenatal care. Also hazardous forthechild are maternal cigarette smoking and alcohol consumption. Smoking slows fetal growth, doublesthechanceoflow birth weight, and increases the riskofstillbirth. Recent studies suggestthatsmoking may be a significant contributing factorin20to40percentoflow weight infants borninthe United States and Canada. Studies also indicatethatinfantsofmothers regularly consuming large amountsofalcohol may suffer from lowbirthweight, birth defects, and/or mental retardation. Maternalageisanotherdeterminantofinfant health. Infantsofmothers aged35and older have greater riskofbirth defects. Thoseofteenage mothers are twiceaslikelyasotherstobeoflow birth weight. And subsequent pregnancies during adolescence areateven higher risk for complications. Family planning services, therefore, areimportantand, for pregnant adolescents, good prenatal care, which can improve the outcome. Birth defects include congenital physical anomalies, mental retardation, and genetic diseases. Many present immediate serious hazardstoinfants. Many others,ifnotdiagnosed and treated immediately after birthorduring the first yearoflife, can affect health and well-beinginlater years. Birth defects are responsible for one-sixthofallinfant deaths. They are the second leading causeofdeath for children onetofour years old, andthethird leading cause for thosefiveto 14 years old. Approximately twotothree percentofinfants have a serious birth defect identified withinthefirst weeksoflife and 5to10 percentofthese are fatal. Thosemostlikelytobe lethal include malformationsofbrain and spine, congenital heart defects, and combinationsofseveral malforma tions. OtherImportantProblems Several other problems with major impact on infant health: INJURIES AT BIRTH Birth injuries, difficult labor, andotherconditions causing lackofadequate oxygen fortheinfant are amongtheleading reasons for newborn deaths. Although most pregnant women experience normal childbirth, complications may be detectedinadvance, during prenatal care. Others unidentifiable beforehand promptmanagement. They include hemorrhaging from the siteofattachmentofthe placenta (afterbirth); abnormal placental location; abnormal fetal position; premature membrane rupture; multiple births; sudden appearanceorexacerbationoftoxemia; and sudden intensificationofa known medical problem suchasheart disease or diabetes. SUDDEN INFANT DEATH Certain babies,withoutapparent cause or warning, suddenlystop breathing and die, even after21

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I,I ( apparently uncomplicated pregnancy and birth. This unexplained event, called the sudden infant death syndrome,isbelievedbysome authoritiestobe the leading causeofdeath for babies older than one month. Recently evidence has been accumulatingthatabnormal sleep patterns with increased riskofbreathing interruptions (apnea) may be associated withtheunexpected deaths. A varietyoffactors, suchasprematurity and maternal smoking, are emergingaspossible contributorstoincreased risk for sudden infant death,butthereisa needtolearn more. ACCIDENTS Moreth-an1,100 infants died in accidentsin1977.Theprincipal causes were suffocation from inhalation and ingestionoffood or other objects,motorvehicle accidents, and fires. Many deaths reflect failuretoanticipate andprotectagainst situations hazardous for developing infants. Child abusemayalso account for some deaths. INADEQUATE DIETS AND PARENTAL INADEQUACY Although they arenotmajor causesofdeath, problems relatedtoinfant care have significant impact on infant health, Many infants arenotreceiving appropriate diets and suffer from deficienciesofnutrients needed for development. Frequently, itisovernutrition rather than undernutrition whichistheproblem setting the stage for obesity laterinlife. Recognitionoftheextentto which parental attitudes are important to a child's development and, the needtobring parents and babies together psychologically -isreceiving increasing attention. Breastfeedingistobe encouragednotonly for its nutritional benefitsbutalso forthecontributionit can maketopsychological development. The factisthatgrowthofa "senseoftrust"has been identifiedasa significantaspectofhealthy infancy. Intimate, enjoyable care for babies fostersthatgrowth and the buildingofsound emotional and mental health. Recently, there has been growing recognitionthatcertain disorders occur when thereisneglectorinappropriate care foraninfant. Oneis"failuretothrive" or developmental attrition withthechild losing abilitytoprogress normally to more complex activities suchasstanding, walking, talking, and learning. Other disorders linked to neglectorinappropriate care include abnormalitiesineating and digestive functions, sleep disorders, and disturbancesinother activites. Allofthese problems underscore the need for regular medical care duringtheprenatal period and early monthsofinfancy. Such care should be sensitively designedtoenhancetherelationship between parents and childaswellastoensure sound nutrition, appropriate immunizations, and early detection andtreatmentofany developmental problems.Toa greaterextentthan ever before, we have a clearer understandingofthe factors important to ensuring healthy infants.\,CARINGFOR CHILDRENAWAYFROMHOMESharon FarquharsonAninstitutionorhome for children referstoa twenty-four hour residential facilityinwhich a groupofunrelated children live togetherinthe careofa groupofunrelated adults. These institutions are established to care for children while they are away from their natural homes duetoa numberofreasons. Hence, various institutions have been established to deal with their needs. There are institutions established for normal dependent and neglected children, i.e., Pearce Ward, Geriatric Hospital; for physically handicapped children, and for -therehabilitationofjuvenilesLe.,Boysand'Girls Industrial Schools.22

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Thereisacommonfactorexperiencedbyallchildrenadmittedtoanyoftheabove institutions,thatis,theygothrougha periodofadjustmentduringwhichtheydevelop new relationships andbecomeacquaintedwiththerulesandregulationsoftheinstitutions.Thosechildrenwhoareadmittedtoaninstitutionfor normaldependentand neglected childrenarethosewhohave experiencedpoorsocio-economicconditionsas wellaspoorinterpersonal relation shipswiththeirimmediatefamily. Inotherwordstheirparentsfailedtoprovideadequatefood, shelter,clothingand supervision.Someoftheseparentsmayhave been alcoholics; child abusers, or displayed a poo, attitudetoparenting. Hencethechildorchildren is/areatrisk in theenvironmentandconsequently h<).s hadtobe placedina safeenvironment.Managementofchildren whileinan instinItionisdonebya groupofunrelatedstaff member?,. Theyhave anenormoustaskoftryingtoprovide a'homeenvironment'forthechildren. In tryingtoprovide a'goodhome'theysometimesforget a veryimportantingredientthata child needs for growth-stimulation. Normally, childrenintheirnaturalhomeshaveadequateparenting, receivewarmth,loveandaffection. In aninstitutionwhichaccommodatesa largenumberofchildren, these vital ingredients are at aminimumoralmostnon-existent.Staffmembersare basically ensuringthatthechildren are providedwithfood, shelterandclothingbutlittleattentionisgiventotheiremotionalneeds.Thereisa need forstaffinsuchinstitutionstherefore,tobe sensitivetotheneedsofchildrenandprovidetherequiredstimulationfor -theirhealthygrowthand development. Initiallythechildren themselves are stressful whentheyare placedinthehomeand this will becompoundediftheyare managedbystaffmemberswhoare insensitivetotheirneeds.Thedegreeofstress ex periencedbythechild seemstobe minimizedwhenplaced along withothersiblings.Theytendtocomfortandsupporteachotherduringthistransitionalperiod.Theageoftheindividual being placedisalsoanotherfactorwhichdeterminestheextentoftheiradjustmentinthehome.A threemontholdbabyappearstosettlequicklyintotheroutineofthehome,while aoneyearold may be fretful,sufferlossofappetiteandhave amelancholyappearance. This indicatesdiscomfortwiththenewsurroundings.Italso indicatesthattheoneyearold has formed social relationshipsandthusexperiences some distressduetotheseparation, whentheydonotsee familiar facesaround.Hence childrenaboutoneyearandoldertendtobe irritable duringtheearly stagesofplacement.Sometimeschildrenunderoneyearare irritable as well, particularlyiftheyhave been usedtobeinginsomeone'sarms allthetime.Duetothepressuresofphysically caring forthechildren,staffmembersrarely ha\ timetodevotetoorcuddle a child astheyshould.Thelengthoftimeforthechild/childrentoadjusttothehome/institutioncanvary from aweektotendays. However, this willdependonhowoftenanadultfigureinteractswiththechild, sothattheycan begintoestablishnewrelationships.Oncetheyhave overcome thisperiodtheybegintoplayeitheralone(dependingontheageofthechild)ortointeractwithotherchildren. All childrenneedamotherandfatherfigure becausetheydependonthemfor guidance.Forthevery you'ng child residing away fromhome,theneed seemstobe greater.Anymaleorfemale seenatthehomeisquicklyregardedasaparentalfigure. These personsmayonlybe visitingthehome,buttothechildrentheyrepresent'mommy'or'daddy.'Notonlydochildren being cared for awayfromhomegothroughanadjustmentperiodbutadditionally,theysometimesexperiencepoorhealthduring this critical period.Thusfurtheraggravatingtheirsituationwhiletryingtoadjusttoa new Thenormal,dependentneglected childquiteoftenhastobede-wormed, requires vitaminsandquitefrequentlyrequires treatmentfor scalp infections.Thevery yo\1ng childmayalso requireimmunization,whichthehomewill havetoarrange. All childrenwhopassthroughthevariousinstitutionswill be citizensoftomorrowandso itisimportantthattheybeeducatedsothattheycanmaximizetheirfull potential. Schoolattendanceisthereforeparamountandshouldtakeplaceeitheronthepremises or,thechildren can betakentoschools intheneighbourhood.Goingtoneighbourhoodschools helpstogivethechildren a senseofselfworth,thatis, it helpsthemtobegintosee themselves as apartofthecommunityandnotjustasaninmateofaninstitutionset asidefromtherestofthecommunity.Thedemandforinstitutioncare for children awayfromhomeseemstobeontheincrease. Thismaybeduetothestageofsocio-economicdevelopmentinoursociety. Suchinstitutionswill there fore be indemandandeveryeffortshouldbemadetoprovide theseinstitutionswithadequateandtrained personnel.Thisisallimportantbecausethetrainingoftheyoungpeopleresident in23

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institutions falls heavily onthestaff.Ifwe aretoassist theseyoungpersonstodevelopintouseful citizens, personnelwhowill trainthemand also act as positive models forthemmustbe provided."WEDNESDAY'S CHILDREN"Reportona Workshopon"CHILD ABUSE IN THE BAHAMAS TODAY"CherylThompson As a resultoftheincreasing incidenceofchild abuse intheBahamas, a workshop, designedto"identifyand develop new strategies and approaches for dealing withtheproblemofchildabuse"was held attheSandilands Rehabilitation Centre (SRC) on Thursday,9thFebruary, 1984.Theworkshop was officially openedbytheMinisterofHealththeHon. Livingston Coakley and chairedbyDr. Sandra Dean-Patterson, Co-ordinatorofthePsychiatric Social ServicesdepartmentoftheSRC. In his opening addresstheMinister expressed his pleasure at seeing somanypersonswhowere concerned withtheproblemofchild abuse. Henotedthatfartoomanypersons seemed immersed intheirindividual roles and that ifany lasting good weretocomeoutofoureffortswewould havetoworktogether.For"Child Abuseiseverybody's business, and we are working foronepeople."Participants attheworkshop included Teachers, Social Workers, Physicians (SRC&PMH), Police Officers, MembersoftheJuvenile Panel, Nurses (Community, SRC&PMH), Guidance Counsellors, MinistersofReligion. Presenting paperswere:-Dr. Percy McNeil, Consultant Paediatrician atthePrincess Margaret Hospital (P.M.H.),whonotedthatthemajorityofreportedcasesofChild Abuse attheAccident and EmergencyDepartment(P.M.H.) wereboysaroundthe ageoftwoyears;Ms.Carol Watkins, Paediatric Social Worker, P.M.H.whosaidthat"Child Abuseandneglect were ontheincrease," with a higher incidenceofboys; Dr. Ayube Nezamudeen, Psychiatric RegistrarattheSRC Adolescent Clinic,whocited studies suggestingthat"childrenwho are abusedtodaywillmorethanlikely be abusersoftheirownchildrentomorrow;"and Gladys Manuel, lawyer, whosetalkcenteredaroundtheneedtoupdatethelawtoaccommodate present situations. She also invited participantstoexaminethephenomenonofChild Abuseasit relatedtoChild labor. Group discussions followed.Theobjectivesofthesmall group discussions were:1.Tolistthevarious formsofchild abuse group members saw/dealt withasapartoftheirjobs.2.Todetermine additional resources/policies, etc., needed to deal withtheproblemofchild abuse. 3.Tomake action recommendations.toassistinimproving co-ordinationofservices fortheabused childonwhich ministries could ml\ve todevelop and implement policies, forthe abw\ed child.ISomeofthesuggestions for dealing withtheproblemofchild abusewere:-1.A clear definition/descriptionoftheproblem Child Abuse thevarious formsofabuse mention ed were physical, emotional neglect and sexual abuse.2.Additional Resources/Policies Needed1.Full-time Social Worker, Psychologistinall schools.24

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2.Hotline for abused children3.Day Care Centre SystemofSliding Scales for determiningpayment3.Recommendations1.formationofa National Child Abuse Committee2.update the law relatingtochild abuse3.half-way house for children andinsome cases for families 4.education-tofacilitate people's understandingofchild abuse i.e., where discipline ends and abuse begins.THOUGHTSON WEANINGElizabeth Rolle Whether mothers choose to breast feed orgivetheir infants formula, they need factsaswellasreassuranceinsodoing. When it comestofeeding babies everybody suddenly becomes an"expert."Relatives, friends and especiallyothermothers are usually onlytoohappytotell young motherswhattodoand howtodoit, each claimingthather wayis"right."Afterallifit worked for her baby, it will probably work for yours. Infant feeding and nutrition are such complex subjectsthatoften thereisno "right" waytofeed a baby. What works for onemotherand baby might beallwrong for another. Even the"experts"don'tyetknowalltheanswers, andasourknowledge about foods and their nutritive values changes,sodoourfeeding practices. Perhaps most perplexingtothe newmotheristhewide rangeofprofessional opinions on the subject. Withinthemedical and nursing fields for example, there are differing views on what, how and whentofeed infants. In addition, the many food products and feeding devices available today seem designedtomake infant feeding unduly complicated. In thismodemsociety unwanted pregnancies shouldnotexist, bu t they still do and seemtobe increasing annually despite improved knowledge and teaching regarding family planning and con traception. The need for family life educationtoreach the entire communityistherefore imperative and should involve the churches,theschools, andthemedia. This view, frequently expressed by a numberofhealth andotherprofessionals would seemtobe justified in lightofthefactthatthemajorityofnutritional deficiencies seeninourclinics are among young infants fromthehomesofyoung single parents in the lower socia-economic group and who have threeormore childreninquick succession. Conversely, nutritional deficiencies are also seen in infants from "middle class" homes where the priorityiseither clothesorhome improvement. Infant feeding really startsinutero.Itiswise therefore for a womantoplan her pregnancies,asshe can then adequately prepare herself nutritionally forthatpregnancy. Motherswhoare nutritionally adequate before pregnancy arebetterabletocope withtheminor disordersofpregnancy when andiftheyoccur and their babies arebetternourished and healthier. All mothers should realizethatthemostcritical periodofherchild's lifeisthetime spent in utero and the first year after birth. During this time those three questions, whattofeed, how to feed, and whentofeed are very importantastheydeterminetheinfant's health status and survival.Theycan also be answered very simply breast milk,asdemandedbythebaby. Breast milk providesallbaby's needs for calories and nutrients forthefirst four monthsoflife.Thesmall amountof"solids" offered from this time -4/12-isinitially a supplemental sourceofcalories and provides additional nutrients which the rapidly growing infant requires for healthy growth. After six months weaning foods are considered essential with breast milk increasingly becomingthesupplemental food. What thenisweaning? 25

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There still exists some doubt in individual's minds regarding weaning among clients seenattheclinics andinthe communityaswellasamong health and other professional people. Here are some repliestothequestionofweaninga) "I didn't havetoworry about weaning because I never breast feed my baby." (Infant8/12).b)"Istart weaning him since he wasboutthree weeks cause I havetagobacktowork." (Infant 2/12 being breast and formula fed).c)"He done wean." (6/12 infant feeding on formula and commercial baby foods). Weaningisa gradual change from breast milk or formulatomore solid foods.Itshould be accomplished gradually sothatbothmother and baby findthetransition smooth. Abrupt weaning can be painful for the mother since milk production doesnotstop simply because she has decidedtostop nursingherbaby. Milk production takes timetoestablish and will also take timetoterminate. Weaning should commence between 4-6 months depending ontheinfant's develop ment and appetite andnotnecessarily theage,asinfants the sameagevary in size and maturity from birth. Too early weaning predisposestoallergyasthe infant's digestive tract duringtheearly monthsoflifeisimmature and thereforenotasyetequipped to handle certain foods. It also encourages habitual over eatingthatmight contributetoobesity. The suggestedagefor completionofinfant weaningis24-26 months. Unfortunately,inthe Bahamas today, very few mothers totally breast feed their infants simply because the majority strong ly believe, erroneously. that breast milk aloneisnot sufficient for their babies. Whether infants are breast and/or formula fed weaning should begin at 4-6 months and be completed bytheageofabout 2 years. The following are suggestionsforweaning:-1.Offer one new food at a time(1per week). Should allergic reaction occur, the causative food can be easily detected; it also allows the infanttobecome familiar withthatfood before trying another. 2.Givevery small amountsofany new food e.g., one teaspoonfultostart.3.Offer solid food BEFORE the breast feed. Baby's hunger may make him/her more interest edinthe solid food and therefore willingtoaccept it. However, this maynotapplyineverycaseandtheinfant may require a little breast milk before the solids. Always finish with breast milk during the early weaning months. 4. Baby's first solid foodisnormally cereal,butit shouldnotbe the instant cereal designed for children and adults because these contain certain seasonings which arenotrecommended for babies.Givecreamofwheat/oatmeal mixed with milk and very little sugar.5.Usea very thin consistency when starting solid foods. This can gradually be made more solidastheinfaJlt learns howtouse his tongueinswallowing solids. Placing the foodinthe middleof th.e tongue helps the infanttoswallow more readily. The fact that a baby spits outhisfood may indicatethathe hasnotyetlearnedthetongue movements for swallowing solids ratherthanthathe doesnotlike the food. Try again later.6.Never force an infanttoeat moreofa food than he takes willingly. 7.Ifitisobviousthata baby has a definite dislike for a food (after tryingtofeeditseveral times) omit it for a week or two then try again. If the dislike persists, discontinue until the childisa few months older.26

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8. Varythefoods offered. Babies, like adults, get tiredofthesame foodallthe time, especially cereals and vegetables.9.Foodsshould be only slightly seasoned with salt.Otherseasonmgs should be avoided. 10.Themotherorperson feedingtheinfantmustbe carefultoavoidshowing any dislike forthefood being given. 11. Infants may objecttotaking some foods by themselvesbutwilltakethemif mixed withanotherfood.Forexample, cheese may be mixed with cerealorvegetables,or vegetable.s can be made into a soup with a little milk. 12. Whenthebabyisabletochew, gradually substitUte finelychoppedfruits and vegetables for strainedormashed foods. Usually at eighttotenmonths.13. Home prepared meals are consideredmostappropriate. Offer Home prepared mealsa)Thefoodisfresher b) Noextramoneyisspentonbaby'sfoods,thereforeitischeaper. c)Foodispreparedtoa consistency suitable forthegrowing infant. d)Foodcan be prepared inbulkand individual sized servings can bekeptfrozen for a long periodorintherefrigerator for2-3days. e) Baby becomes familiar withthefamily's meals from an early age. Recipes Meats and Vegetables Y2 cup cubed cookedmeatorvegetable 4-5tabltspoonsmilk, formulaorwaterPut ingredientsinablenderand process at liquefyORsievethru'strainer. (Add fullamountofliquidforyounginfants decrease as child grows older). CannedorFresh Fruits i) cupcookedfruitii) % cupcannedfruit 2teaspoonsyrupfromfruit/water/milkPutingredients in blenderandprocessatliquefyuntilsmoothORsievethru'strainer. Combination dish Y2 cupmeat2tablespoonvegetables Y2 cup milk l,4 cup cooked rice Use strainerorblenderas above. Refrigerateincovered container. Heatonlyamounttobeused for serving. 2-4 servings. 27

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Toddler. Ingredientsasabove. Food can be processed at grind, mashedorchopped depending ontypeoffood used. Fruits neednotbe cooked. TEETHINGINANISOLATED SETTING Does Teething Really Cause AUThe Prob-lems Which Are Usually Attributed To It?ByEllamae Johnson "Good afternoonMrs.Jones, how can I helpyou?""Well Nice, I bring my chile hear dese sores jus brokeoutallover him allover his back, his belly and his hands andlegs.Heeven have some in his head. I fiel like he curtin teeth again. Da las time he was cuttin teeth, he was so sick.Hehad the belly for a whole week!Heeven had the cold and a bad cough. I tellyadese children could really causesomuch trouble when dey reach disage.Fa dese sores, I bade him in the sage,butdat jus cause more soretabrokeouton him. So, I stat now to bade himinthegumma bush,butdey takinsolongtoget better,soI say letmetake himtadaNice. I say maybe da Nice couldgieme some sab what could cause dese sorestoheal up. Nice,yatink hecuninteeth again?" Does teething REALLY causeallthose problems mentionedinthe above 'truetolife' experience? Inhisbook 'The Normal Child,' RonaldS.Illingworth saysthatwhile teething may cause irritability, excessive salivation, and refusaltoeat, mostofthe crying and sleeplessness which some mothers attributetoitissimply duetobad habit formation. Inhisresearch, he has found no evidencetosupport the notionthatteething causes bronchitis, diarrhoea, skin rash, convulsions or fever.Hefeels that this misunderstanding arises fromthefactthatteething usually takes place between theagesof6 monthsto6 years, the period during which children are susceptibletovarious childhood illnesses,thatparents usually attributed any untoward eventtoteething.Asa resultofthis fallacy serious mistakes have been made. With referencetoa survey done byArviLasonenofFinland, on 126 children over a periodoftime during whichtheywere teething, no casesofinfection, diarrhoea, fever, convulsion, skin rash, ear rubbing or bronchitis were observed. Therefore he concluded, teething should be regardedasa natural though sometimes painful condition requiring no medical treatment. The diet may havetobe modified, a teething ring may be given for the childtobite.Ifcryingisexcessive the child can be picked up and comforted being mindfulofthe riskofhabit formation. In his book 'Baby and Child Care,' Dr. Benjamin Spock saidthatchildren differ. One child may fret, drool, and become irritable while for another child, teethingisuneventful. The average child gets the firsttootharound seven monthsbutmay have been drooling, chewing things and having periodsoffretfulness fromtheageofthreetofour months. Since a baby gets 20 teeth in the first 2'72 itiseasytoseewhy the child seemstobe teething for mostofthatentire period. This also explain's why itisso easytoblame every ailment on teething, including those which are defmitely duetogerms. I agree with Dr. Percival McNeil and Dentist Rdoidofthe Princess Margaret Hospital, whose observations arethatteething seemstolowerthechild's resistance makingiteasier foraninfectiontostart.Ifthe child however, becomes sick, or has a fever -ashighas1010Fthe child needstoseea doctor for examination and treatment. In his book 'ModemWaysto Health,' Dr. CliffordR.Anderson says that teethingisa normal process and should not cause any illnessinthe child. However, the gums may become sensitive, causing the childtochew everything he can find and he may become irritable. I randomly interviewed six mothers,fivefromtheFamily Islands and one from Fox Hill; their28

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numberofchildren ranging between 3 and 10.Theyall saidthatfor their children, teething was uneventful.Theyjust"poppedout,"onemothersaid.Anothersaidthatshe only knewthather child had atoothwhen he"startedbiting her breast nipple," onemotherfrom FoxHillsaidthatshe believedthatheroldest child whoisnow nine years old, had diarrhoeaGoneoccasion while teething. My personal experience 'withmy4 children wasthesameasthose mothers interviewed. So,inconclusion we can say,thatfor most children, teethingisa relatively healthy period apart from mild gum sensitivity causing drooling, chewingofthings, fretfulness and some irritability!Fora few, there maybemild casesofcold, cough, diarrhoea and feverunder1010F.TREATMENTThetreatmentforthevarious minor ailments usuallyattributedtoteething vary from IslandtoIsland. Someofthefollowing arecommontomost Islands. DIARRHOEA young gauvaleafteaflour pap with little sugar andno crear.n. COLD COUGH FEVER tappingofthe'mole'withthe'chimbili'ormetusulum. anointingthebackand chest withhotlard or grease along with amixtureofsavor (lemon) and sugar for older children. anointingthechest and back withhotlardorgrease, dressinginwarm clothing and covering with warm bedding taking caretochange clothing immediately when dampenedbysweat and avoid exposingthechildtodraught. (PleaseNote:-Alloftheabovetreatmentshave proven successfulwithoutthechild beingintroducedtoany drugs). COPING WITH A NEW BABY,OLDERCHILDREN AND A JOB Vivian Braithwaite I was asked if I had timetowrite this article.Totellyouthetruth,Idon'teven have timetoreadthenewspaper these days. Firstofall, when IfoundoutthatI was pregnant, after 8 years, I went throughthestagesofbereavement Grief, Denial, Anger, Bargaining, Depression and Acceptance.Ofcoursemyhusband was ecstatic. He would be.Hewouldn'tbe aroundtodeal with wakingupat nights and changing diapers, he works abroad! I guess he was alsoonan ego trip, which men all seemtobeonwhentheyare having children.Thenext step washowtotellmychildren, ages 8 and 10? I had told them, after repeated requests from themtohave a baby,thatI would be crazytohaveanotherone like them. I finally musteredupthenerve when I wasabout3monthspregnant. My10year old daughter's response was, "Mummy, how comeyouarejusttelling us?" Silence, from my 8yearold son.Itwasn't until a few weekslaterwhenmyson's teacher congratulated me andnotedmypuzzlementonhow she knewthatI discoveredmyson'struefeelings. She told methatmyson had created a disturbance intheclass onedaybygoing aroundtoeachstudentand whispering intheirear. She calmly sat down and waiteduntilit was herturntobeincluded inthesecret, which wasnotmuchofa secret becausebythattimethewhole class knewthatI was goingtohave a baby, and he was very proud.Ofcourse hewantedabrotherandmydaughterwanteda sister. Well, anyway,thefirst difficult step was over.Thenext, believeitornot, was picking a name.29

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30Wehad a family conferenceonthis.Wewent through our ancestors and discoveredthattheyall had someone named after them. Then my mother discoveredthatno one had her first name, so we decidedtousethatforthebaby's second name. Then my grandfather died a few weeks after the baby was born, and it was suggestedthatI use his name, which was George. Sowedecidedtouse Georgette.as a middle name, and to findherown first name. However, my mother was not atallpleased, sotoplease everyone, we decidedtousebothnames plus her own first name, and praytoGod sheisa good speller. Finally we ended up with Chandre Ethelyn Georgette, this after spendingabout$10.00 on books with names also.Itwas not until I had spent 3 days away from home-whileinthehospital -thatI discovered my daughtercould comb her hair and my son couldfixhis breakfast, andthatthey could gettoschoolontime without my being there shouting atthem every morning.Ofcoursethatstopped after I was back on my feet.Mysonistickled pink when people saythebaby looks like him. I think this was one reason he paidsomuch attentiontothebaby. The problems really began when I went backtowork, whichiswhat this topic is really about. However, I didn'tgobacktowork until the babywas4 months oldsothatI could fully breast feed.Bythis time Chandre wassousedtome she just refusedtogotoanyone else. The first problem wasthemaids. I went through four in the spaceof2 months. You could imagine havingtobeatwork at 9 a.m. andthemaidnotturning up! I usedtoputthe baby in the car, take hertothe girlsthatwork atthedance school before goingtotheoffice. Sometimes I would leave her with friends inthelab or just drive around with herinthecar.'! think the factthatI told them their main job wastocare forthebaby for them meant they didn't havetodo anything else. Oneofthem usedtojust sit there and look atthebaby while she slept, andnotbother withthehouse work. Another problem wasthefactthatthe baby was a very light sleeper.Welive in a house wherethefloor creaks,soevery one hadtotip toe aroundthebaby. What got on my nerves wasthattheolder children didn't seemtounderstand what it meanttotalk in a whisper whenthebaby was sleep ing, ornotslam the doors. I hadtoset up a rulethatwho ever wokeupthebaby hadthejobofputting her backtosleep. I think this really did the trick. I must saythattheydid help with the careofthebaby, and we often play ping pong with her. Thisisplayed when I wanttoget some rest andputher inthechildren's roomtobe looked after, andthechildren are busy anddon'thave much time for her.Mtera whiletheywill sneak her back in my room, and when she startstobotherme, I will take her backtothechildren's room, andsoon. When I first went backtowork I wasinthe habitofgoing homeatlunch timetobreast feed. Intheend I hadtostop because ittookme almost anhourjusttodrive home and backtothehospital. You can imaginehowhecticitisinthemornings.Mytwo older children will waste time playing withthebaby and fighting over who should hold her and endupbeing late for school. Nowthatthebabyisolder wedoeverything together,thatway things run smoother and quicker. I runthewaterinthetuband bathe everyone, then I fix some breakfast, pullthehigh chair atthetable andwealleat together.Ofcourse mostofthebaby's food ends up on the floor, and someonmy uniform. When it's timetoleave I just hand her overtothe maid while she bawls because she wants to stay with me.Ifthe maid isn't inyetI takethechildrentoschool thengoback home with the baby, and alwaysbythis time she would be at home. Yes, I finally found a responsible maid. Allinall,nowthatI am more mature (well...) and know more aboutthegrowth, develop ment and managementofthechild, I am enjoying her more andcan appreciate her stagesofdevelopment.\I

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HOPINGTOTOUCHYOUPERSPECTIVE-WHATISHEALTHEDUCATION?Felicity Aymer There areasmany perceptionsofHealth Educationasthereareofhealth.Notonlyishealth difficulttodefineinconcrete terms, it carries with it a subjectiveaswell as an objective dimension.Tofurther complicate the issue, health has no intrinsic value, itisa meanstoanend and therein lies a very real dilemma for health workers. For a long time, and this view, surprisingly, still holdswith many today, health was/is seen as synonymous with medicine. Medicine conjures up magical connotations. The Physician was/is"thefix-it person."ThePhysician whose prescription failedtoget immediate results was"nogood," the next step wastotryanother -the"other"notinfrequently beingthe"Obeah person." The task for Health Educationisclearly then,notan easy one inviting and persuadingthoughtand positive actioninan areaaboutwhich, traditionally littlethoughtand very little positive action have been forthcomingbythemassofthepeople. While health informationisthebasis for health education, itisobvioustomost health workersthatitisnotenough. Health workers often bemoanthefactthatdespite "people being told whattodo"theyfailtoact accordingly. In essence, health educationis"anycombinationofmethods designedtofacilitate VOLUNTARY adaptationsinbehaviour which are conducivetohealth."Ourmessages mustbeclear, precise, attractive. Inviting and meaningful.Theaudiencemustbe receptive. They must be willing and abletoact. Abletoknowand understandthechoices available, andtheconsequencesoftheir choices.Aseducators for health, acomponentofthe taskmustbetocreate an environment in which learning and action can occur.Wearethefacilitators,thepeopletheactors and actresses. Without their active involvementinthescenarioallourefforts will be in vain.Aswe approachtheendofthetwentieth century, increasingattentionisbeing paidtohealth and wellness.Theimportance and roleofthe individualinattaining and maintaining this state intheefforttoreach the goalofHealthForAllByThe Year2000(HFAI2000)iscrucial.Thechallenge for Health Educationistremendous and complex orchestrationofthemanyand divergent factions whichtogethercreate the health construct,thegreatest challenge. Through the quarterly publicationofthis Newsletter which we hope will benotonly informa tional and educationalbutalso entertaining, we are attemptingtoprovideourcolleagues and readers with greater insights intothe"worldofhealth and healtheducation."31

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* ** ** ABOUT THE CONTRIBUTORS Felicity AYMERisa Health Education Officer, Health Education Division, MinistryorHealth. Vivian BRAITHWAITE,istheCommunity Liaison Nurse betweenthePaediatric DepartmentofPrincess Margaret Hospital andthePublic Health Department. Sandra FARQUHARSON,istheAdministrator attheChildren's Emergency Hostel and a Senior Welfare Officer intheDepartmentofSocial Services, MinistryofHousing and National Insurance. Ella Mae JOHNSONisa Community Nurse workingintheSchool Health Services, Public Health Department. MaryLOWEistheHeadoftheEarly ChildhoodDepartmentatQueen's College, a private com prehensive school. Percival McNEILisa Consultant PaediatricianatthePrincess Margaret Hospital. HeisalsotheCo-ordinatoroftheOral Rehydration programme and recently elected PresidentoftheMedical AssociationoftheBaharrlds. Elizabeth ROLLEisa Community Nurse based attheAnn'sTownCommunity Clinic. Frederica SANDSisa Nursing OfficerintheCommunityNursing Services and Co-ordinatorofthenational Immunisation programme. George SHERMANisa ConsultantObstetrician/Gynaecologist and HeadoftheDepartmentofObstetrics and Gynaecology, Princess Margaret Hospit:U. BrendaSIMMSis a Nursing Officer withintheCommunity Nursing ServicesofthePublic Health Department. Cheryl THOMPSONisa Trainee Health Education Officer withtheHealth Education Division. ACKNOWLEDGEMENTS The Health Education Division takes thisopportunitytoacknowledgethenumerous good wishes, gesturesof and tokensofappreciation received from its readers for whichweare deeply grateful. These have contributed in a large waytomakingthetaskofpreparingthecurrentissue much more rewarding.WeinviteourreaderstocontinuetoJoinHands with us. Please send us your comments, suggestions, letters, articles for future issues. 32

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Help ustomaketheNewsletterasinteresting and informative as possible. Please complete,detachandreturnthisshort evaluation formtotheHealthEducationDivision, Public HealthDepartment.Tickthemostappropriateresponse. 1.Howdidyoufindthenewsletter?a.very interesting b. interestingc.somewhatinteresting d. uninteresting e. didnotread2.Wasthereany articleofparticularinteresttoyou?Yes0No0Ifyes, please givetitle_ 3. What changes,ifany,wouldyouliketosee? 4. What topicswouldyoulike infutureissues?5.Wouldyouliketocontributetothis newsletter?Ifyes, please give name and address. Yes 0No0 Name: Address: _Thankyouforyourco-operation!HappyEaster33

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34 .\ IHealth Education Division Public HealthDepartmentP.O.Box N-3729 Nassau, Bahamas

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"'.PARENTS,,GUARDIANSHEALTHCAREPROVIDERS .LET'SMAKE 1984 THEYEARWEIMMUNISEAND,PROTECT..OURCHILDREN, CoverDesign by:THEOPIDLUSTHOMPSONLESLIEJOHNSONASHWARDFERGUSON\t ,,'" z ;:1Il .. ...::Et;; .'" ...III III:::> '" ",:!lz'"L--.-


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