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Joining hands for health

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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:
Ministry of Health ( Publisher )
Publisher:
Ministry of Health, Health Education Division
Place of Publication:
Nassau, Bahamas
Publication Date:
Frequency:
semiannual
completely irregular

Subjects

Subjects / Keywords:
Health care. -- Bahamas   ( lcsh )
Public health -- Bahamas
Genre:
serial   ( sobekcm )
government publication   ( marcgt )
periodical   ( marcgt )
Temporal Coverage:
1983 - 1988
Spatial Coverage:
Caribbean Area

Notes

Statement of Responsibility:
Ministry of Health

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:
AA00013240:00006


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,, 1, \ I I I I I I Volume 4 No. 2, 1986/87 5 \ \ \' \ ( \ \

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TABLE OF CONTENTS Page Editorial ...................................................................................................................................................................... Where Do Babies Come From ...................................................... .Leila Fountain & Catherine Wilson 2 Breast is Best .............................................................................................................................. Marcel Johnson 2 Paediatrician and Mother ............................................................................................... Evet Benjamin-Peet 5 Growth Development and Early Childhood Stimulation ........................................................................................................ Paul Roberts 6 Baby's Teeth Are lmportant ................................................................................................... : .. Munir Rashad 10 Immunisation .................................................................................................................................. Felicity Aymer 11 Understanding Diarrhoea .......... .......................................................................................... Percival McNeil 13 Christmas in Grand Bahama ............................................................................................................................. .. 14 Up-Date ........................................................................................................................................... Felicity Aymer 16 The Goose Got Fat ....................................................................................................................... Dwight Allen 25 The Overweight Problem ...................................................................................................... Patrick Whitfield 26 Nutrition and Cancer ............................................................................................................... Cancer Society 29 Bahamas Diabetic Association in Pictures ..................................................................................................... 30 AIDS A Progress Report ................................................................. Felicity Aymer & Rosa Mae Bain 31 Evaluation .................................................................................................................................................................. 31 About the Contributors ........................................................................................................................................ .. Inside Back Editorial Committee ................................................................................................................................................ Inside Back

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1987 EDITORIAL ... The Easter edition of Joining Hands For Health deals in the main, with the care of the young child under the age of one year, a critical period in the life of every individ ual. At this age the child has developed very few defences against the many infectious agents which live in and co-exist in our environment. The baby is therefore especially at risk of developing diseases which can lead to serious illness, disabling conditions and death. Protecting the health and life of the nation's babies is one of the priority areas within the Ministry of Health and should be the chief concern of every parent. This can best be done through promotion of exclusive breastfeeding by every mother of every child for at least the first four months of life. In a society in which more than half of all mothers are single and in which parents work outside the home, this may well not be practical. A review of the situation though, may reveal that more women, given the active support of health providers, could in fact give babies breast milk exclusively for at least the first four months of their child's life. Perhaps mothers may wish to consider negotiating with employers to facilitate breastfeeding. A commitment to sustained use of an effective method of child spacing would go a long way to reduce employers' reluctance to provide practical and much needed facilities such as longer paid maternity leave, nurseries attached to business houses, flexible working hours for mothers of very young children under the age of six months. Basic immunization coverage by the age of twelve months, safe transportation to gether with loving, caring parents are only some of the other essential needs of every young child. The baby who is held in one arm while the parent tries to control the ve hicle with the other is most vulnerable. Bumper stickers warning "Baby aboard" is no insurance against rear-end collision. The baby who travels in the arms of the front seat passenger is equally at risk. Babies are much safer in special seats/carriers on the back seat where they are less likely to be thrown through the windscreen. For those readers with other interests, we have begun to focus on health promo tion, of adults However, health promotion really begins in infancy and this will be dealt with in a systematic and detailed way in the next and subsequent issues.

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WHERE DO BABffiS COME FROM? LEILA FOUNTAIN AND CATHERINE WILSON A question frequentty asked by us among ourselves when we were growing up and at times when we felt the mood was right we would dare to ask our parents was "Where do babies come from?" Living in small neighbourhoods, it was very easy to know all the women who became pregnant. It was also easy to observe them as their bellies grew. The common description was "she is carrying a baby" or "she big", or "heavy''. We would watch those bellies grow and grow and grow until it seemed as though they would burst. How did the babies get in their mother's bellies? How will they get out? We would wonder. At this stage we would ask our mothers, "How will the babies come?" The babies they would say, come by plane, by boat or stork. "How did they get in their mother's bellies?" and Mama would always say, ''When you are grown you will know''. 'Well mama; how the man get to be the daddy?" My mother would respond quickly, ''That's man and woman business". The questions continued in our minds, "if babies came by planes and boats, why was it necessary for the mother to be put to bed for nine days -in closed rooms, curtains drawn, lights dimmed, frequent visits from the midwife, the bush bath for mother and baby on the ninth day, the midwife, or granny as she was called taking the baby for a stroll around the house nine times, first exposure to the sunlight and the outside world?" You would think that if babies came by planes or boats that they were already exposed. "But, if mama say so, it's so". If new babies were brought by the stork, plane or the boat, why was it necessary to transport the pregnant mother to Nassau by boat to have her baby? Our best source of information came from the animals. Living in a farming environment and having hogs, goats, chickens and other animals who were not aware of our curious minds and unanswered questions had its advantages. Another question emerged when at times it was nec essary to assist mother with difficult deliveries of these ani mals. Were their deliveries similar or different to the human mother? There are no limits to the questions in the minds of children. We can also appreciate the dilemma of parents who found themselves faced with questions they were/are not capable of answering, for whatever reason. Our generation was capable of asking questions. We were given few answers, and for the most part those few answers were untrue. This new generation is more curious and more fortunate, isn't it? MARCEL JOHNSON lntrodudion Today, only a small percentage of Bahamian moth ers breastfeed their babies, thus bottte-feeding seems to be the order of the day. Many mothers feel that it is more convenient to bottte-feed, however, concomittant 2 with bottte-feeding are the high cost of artificial feeds and the danger of infection. Between 1978 and 1983, of all the reported cases of diarrhoea in young children, twenty two to twenty nine per cent were admitted to the Princess Margaret

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Breast milk is so good! Hospital. Infant feeding practices are significant factors which contribute to this problem. This article will focus on preparation for breastfeeding, advantages, constraints and myths about breastfeeding, weaning and feeding from the family pot. Preparation for breast feeding Every mother should be encouraged and well pre pared to breastfeed her baby. Ideally this preparation should begin in early pregnancy. The breasts enlarge during pregnancy, therefore it is advisable for the preg nant woman to wear a well-fitting bra. Special maternity bras are available and should be worn for support and comfort. Hygiene of the breasts is very important. The mother should wash her breasts daily, dry them carefully and rub the nipples gently with vaseline, lotion, lanolin cream or baby oil to keep them soft and supple. During this process, the nipples should be pulled out between the fingers to make them stand out and to prevent soreness when breastfeeding. Towards the end of her pregnancy the woman may observe a thin, yellowish fluid coming from her nipples. This fluid is called colostrum. This should be squeezed from the breast from the thirty fourth week of pregnancy. The expressing of the colostrum enables the milk to flow more easily. Advantages of breastfeeding The best milk for a new born baby is breast milk. Recent information agrees that breastfeeding is most de sirable for both mother and infant from a nutritional and emotional/psychological stance. Studies show that even mothers who are poorly nourished provide enough milk of good quality and only the vitamin content may be low if the mother's are vitamin deficient. Breast milk is convenient and needs no preparation. Breast milk is cheaper than artificial milk. It costs much less to provide a nutritious meal for the preg nant mother than to feed the baby on artificial milk. Breast feeding promotes bonding. This is the close relationship between the mother and baby. Breast milk is practically sterile and it also prevents the baby from getting many of the infections to which young babies are so prone. Breastfeeding aids involution of the uterus. The more vigorously the baby sucks, the greater the supply of breast milk. Ninety five per cent of mothers can successfully breastfeed their babies. Women who breastfeed their babies may have no periods (amenorhoea) during the time. A reliable birth spacing method is highly recom mended. If a mother has flat or inverted nipples, breastfeed ing may seem virtually impossible. It is possible, however, for even this mother to breastfeed if she prepares herself during pregnancy using some of the steps mentioned above. Wearing a breast shield should also help. A mother with twins can also breastfeed her babies. The babies' sucking stimulates the breasts to produce the milk so there will be sufficient milk for one or both babies. CONSTRAINTS/MYTHS ABOUT BREASTFEEDING There are a few constraints to breastfeeding. These are psychiatric disorders, severe epilepsy and infections. It is an old myth that breastfeeding causes the breasts to sag. This is not true. A good supportive bra helps the breasts to remain fuller and rounder for a longer period of time. The quality of breast milk is not determined by its appearance. 3

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Weaning and feeding from the family pot Weaning is the gradual introduction of foods other than milk to the infant's diet. This milk could be either human or cow's. Breast milk is obviously more desirable. The infant should be completely breastfed for the first four months of life. At four months of age the mother may begin intro ducing weaning foods. She may begin with thick cereal mixed with milk and some brown sugar added to sweet en. The cereal should be fed to baby from a cup and spoon. It is important to remember that weaning is a grad ual process so the mother should begin using a little of each food at a time. She could use the homemade ce reals, for example, cornmeal, cream of wheat, oats. Use two to three teaspoonsful initially then grad ually increase the amount. By the time the baby is six months he/she should be having four ounces of cereal twice daily. At this time (four months), fruit should be introduced. It could either be mashed or juiced. The mother can give the baby mashed fruit or fruit pureed in a blender. She can alternate the fruit with juice. Fruit can be given twice daily. When introducing weaning foods, mothers should re member that it is important to introduce each new food slowly over the period of a week to allow the baby to become accustomed to new tastes and to be able to detect any allergies easily. 4 Feeding from the family pot By the time the child is six months old he/she is ready to be introduced to food from the family pot. The mother should mix a variety of food from the six food groups to ensure good nutrition. This embodies the use of the multi-mix concept. The meal should always begin with a staple. It is important to give well cooked mixtures of staple foods (eg. rice, macaro!'li, potato, grits) peas and beans with the skins removed, food from animals (eg. eggs, meat, milk, fish, cheese) dark, green leafy or yellow vegetables (eg. broccoli, carrots, pumpkin, spinach) The food should be moistened with margarine or gravy. Fruits and fruit juices will complete the meal. About six tablespoonsful should be given at six months of age. The food should be taken from the family pot, mashed with a fork and rubbed through a strainer. If the mother has a blender she can puree the food in her blender. For a six month old baby the mother should use two tablespoonsful of weaning mixture. A seven-month-old can have four tablespoons of weaning mixture. The amount should gradually be in creased as the child gets older. By the time the child is nine months of age the 'multimixes' can be chopped coarsely to encourage the infant to chew. Larger amounts should be given and fruits contin ued. Breastfeeding should be continued. By the time the child is twelve months of age she/he should be eating most of the foods cooked for the rest of the family. During weaning, the mother should not give the child food with high seasonings. She should allow the child to develop his/her own taste. Peppers and spices are not recommended. It is important that the mother observes high stan dards of personal hygiene and domestic cleanliness, thorough hand washing before preparing food and feeding baby is critical to his/her health. It is hoped that this information will encourage more mothers to breast feed their babies and at the same time help to reduce the incidence of diarrhoea in the community. Knowledge of breast feeding and positive ap proaches to breast feeding and weaning will enable The Bahamas as a community to make greater and more ef strides towards attaining our goal of "Health For All By The Year 2000".

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PAEDIATRICIAN AND MOTHER ) EVEY BENJAMIN-PEET First of all, let me say that whatever profession any woman has, we all have one basic thing in common we are females/women/mothers. The excitement of being pre gnant with a wanted child is universal and I was no exception. After the first three months of morning sickness and craving for long forgotten foods, my equilibrium was re-es tablished and I functioned as a normal working Paediatric Resident with my 24 hour or more on-call rotations. My greatest fears were whether my child would be healthy and normal the gender was unimportant most of us are aware that the risk of having offspring who are ill or mal formed appears to be greater for women in the medical world. Needless to say, my anxiety was allayed when our beautiful daughter arrived in this world on Friday, the sixth of December, 1985. Her father arrived on the scene one hour before delivery after having taken two aeroplanes with a most unwanted delay between flights. He was and still is the proudest father in town. Having gone through labour, I now realize that the pain only disappears when the baby is born Pethidine makes one drowsy enough to sleep between the contractions, whilst your coach and the breathing exercises allow your mind to concentrate on something more pleasant. It was worth it all when I was able to hold my beautiful Princess in my arms here she was in the land of strange giants with only one familiar heart MINE! MOTHER! Enter the next phase, feeding breastfeeding! Whoever said it was going to be easy? Initially, it was absolute ly painful and I even got cracked nipples; but knowing the proven advantages of breastfeeding, I persevered. When I could not bear the pain of suckling, I resorted to expressing the milk into a bottle. My persistence paid off because after a few weeks, the pain and soreness disappeared and I be gan to really enloy the nurturing process. Vinette was 3.15 kg at birth but doubled her weight by the time she was four months and she developed rapidly, attaining some of her milestones before the standard ages. She was breastfed for six months and would have continued for longer but the pressures of Residency and studying for final examinations were not conducive to the prolongation of this rewarding experience. She went through her colicky phase and responded well to being walked to and fro; daddy was proficient at that! She received her primary immunizations without squealing and has continued to feed and develop in a very healthy manner. She was introduced to fruits at age four months, then as she grew older, other foods were added. She is given natural foods as opposed to preserved foodstuff and these are pureed in a blender before eating. Her food is cooked without seasoning and she gets no sugar in her orange juice. She is now one year and seven weeks old and weighs 11.8 kg. She is walking, running (calling), climbing and speaking in long sentences, with inflections, but I haven't mastered the meanings of her language as yet. Having been through the process of pregnancy and childbirth and now going through her stages of devel opment, I certainly have a better insight in my chosen pro fession and I know I will be a better Paediatrician and mother because of my unique combination. 5

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GROWTH, DEVELOPMENT AND EARLY CHILDHOOD STIMULATION PAUL ROBERTS Growth and development are continuous processes in each individual and occur in an orderly sequence for ev eryone. There are, however, great variations in these proc esses from one individual to another. These variations are due to hereditary and environmental factors. Both growth and development begin at conception and continue to ma turity. The term growth is used to indicate an increase in baby size which results from an increase in the number and, or, size of individual cells which make up the body. Development, on the other hand, signifies maturation of organ systems, the acquisition of skills and the ability to adapt to changing situations. Growth and development of children may easily be followed by medical and paramedical per-Sonnel. Growth is followed by simply measuring weight, height or length, and head circumference The measurements are plotted on to a growth chart (as seen on a childhealth Passport), from which an impression of how a child is growing, in relation to what is expected for a given population of children of the same age, can be made. See fig I. Those charts which are available, provide useful guidelines for growth. Growth curves vary from one populat i on to another as a result of a number of interacting factors, for example race (Orientals and Indians are gener ally smaller than Caucasians and Africans. There are also race differences as seen by comparing the large sizes of members of the Bantu tribe with the smallness of members of the Pygmy tribe); sex (boys are generally bigger than girls and each show periods of accelerated growth); geographical factors (populations at sea level generally grow larger and at a faster rate than do populations at high alti tudes); socio-economic factors (a sanitary environment, ad equate nutrition and health core enhance growth and de velopment); psycho-social factors (a child deprived of love, affection and interpersonal interactions will show growth and developmental delay). It is also important to note that variations occur in each population (small parents will gen erally have small children). From the growth charts one may find that a child's head growth is lagging behind the other parameters; this may be an i ndication of microcephaly (small head) which is associated with mental retardation An increase in head growth of more than one centimeter in circumference per week may indicate hydrocephalus (water-head), which re quires a shunt operation to reduce flui d accumulation and intracranial pressure in order to prevent mental retardation and destruct i on of brain tissue. 6 Failure to gain weight or to increase height or length may be the first indications of failure to thrive or malnu trition. It is also important to realise that when plots of mea surements on successive occasions cross percentile lines (that is lines on the growth chart), though they remain in the normal range, that this may be an early indication that 'something is going wrong' and that more experienced ad vice should be sought. In the event that the age of a child is n9t known, some information of the child's growth and well-being may be derived from plotting his weight against hisheight. Where growth charts are not available the following formulae are useful for estimating the predicted weight or height of a child at a given age. 1. Predicted weight (wt.) lbs for age (3-12 months). wt. = [ .age (months) + 11 J lbs. 2. Predicted ht. (ins.) from age (2-14 years). ht. = [(2V2 x age) + 30J ins. 3. Predicted wt. (lbs) as a function of ht. wt. (lbs)= [48 + l'i-23) x lbs. 4. Predicted adult ht. Formula of Tanner et al (Relates Ht. at 3 yrs to expected adult height) I Adult ht. (cm) = 1.27 x ht3 + 54.9 cm (male). Adult ht. (cm) = 1.29 x ht3 + 42. 3 cm (female). The assessment of development necessitates a keen observation and a basic knowledge of the normal age ranges at which children achieve given milestones Table I. Table I: Age ranges at which milestones are reached Milestone Smiles Holds up head Reaches for objects Turns to sound Sits alone Creeps Walks with support Drinks from cup Attempts to feed self Pincer grasp Says 2 3 words Walks alone 2 Word Sentences Age (months) 0-2 0-3 2 -3 3 5 5 9 8 -12 9 12 9 -1 1 9 11 9 12 12 14 9 -15 14 -21

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It should be realised that there is a wide range of 'normal' in developmental terms, for example, some chil dren walk as early as seven to eight mon .ths while others walk at fifteen months. Development may be divided into four major catego-ries: a) Motor i) Gross (head control, rolling over, walking). ii) Fine (more controlled and skilled movements, e.g. hand to mouth, pincer grasp, writing) b) Social-adaptive (interpersonal interactions and adjustment to the environment, e.g. smiling with care-givers, be coming withdrawn with stangers, dressing, feeding self). c) Language functioning (acquisition of words and using them meaningfully to commu nicate). d) Cognitive functioning ('conception of the environment and how one relates to it, e.g. turns to sound, foHows objects visually, explores objects, uses key to wind toy). Any child who is lagging behind in all (global delay) or in one or more of the four areas should be evaluated in great detail both physically and developmentally to obviate any treatable cause for the delay. A number of developmental screening tests of varying complexities have been developed. Perhaps the most com monly used of these is the Denver Development Screening Test, which tests all four development categories. At the end of each test one is able to conclude the level at which a child is functioning for each category. The results of the screening tests will enable one to devise early stimulation programmes to suit the need of each individual child, emphasizing the category or categories in which the child is found to be deficient. Development is greatly influenced by environmental factors which may significantly modify hereditary factors. Down's Syndrome, for example, is a disease due to chro mosomal anomalies and is associated with global delay. Many such children, if stimulated early, i.e. are shown a great deal of love, patience and assistance in learning and acquiring skills, may become self sufficient and manage simple jobs to support themselves (some children with Down's Syndrome have been reported to have acquired skills in advanced mathematics). Environment may also greatly influence the devel opment of a 'normal' child. Children raised in an inade qua te environment, e.g. an hostel where there is a shortage of personnel and lack of individual attention, or a deprived home setting, may show evidence of psychomotor retarda tion after months or years of neglect. Sub-standard nutrition also plays a role in delayed development: severe malnu trition over a prolonged period may cause permanent handicap. Most of these 'normal' children will, however, 'catch-up' developmentally once the environment improves and adequate stimulation is initiated. Children raised in 'optimal' environments realise their developmental potentials earlier, are usually ambitious and lead successful lives. The importance of monitoring growth and devel opment and instituting early childhood stimulation cannot be over-emphasized. These may help to reduce family fears and anxiety, improve the well-being of affected children and reduce the expenditure of individual families as well as at the national level. Baseline data on which to monitor the infant's progress is colleded by the Nurse and Dodor at all baby clinics. Baseline data being colleded by Nurse at infant's first visit. 7

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co I CARIBBEAN GROWTH CHART (WEIGHT FOR AGE) I 22 oz --. ..... ---...... .... 2-21 .... Nam. . ........ -...,,,,, .... Date of birth. ... ....... ..... ... c; -------------:/ ?('\ --,, -----Co---..... 19 ----.------18 18 ,/. ,,, ------------------..... ---l/ --------........ 17 I 17 ,, .. Oz --.... -----------.... -..... 2-16 16 -..... .... --,__ ----..... ----c;..; --------.. p.C -----------15 ,, ffiGz 15 ,.,, ,,.,,,,. ,.,,, ------------------------14 14 L..--' _. -..-"' "' -.. -->-;...;""" -----..... ;; .. .... ..... ----,7 --_ .. 13 .... 13 v ....... ... ,,.,,,.. ------->-------->----..... >---------v ----12 .... .... 12 ....-:: t------..... ----,,,, >-----..-..: >------------------, .. .... -II ,,.,,,.. II V-i--...-------7 ---;--i----..... --_,_ ----_..;;; ......... .. -------.. -:-. .._. _. 10 ... 10 I' ,,,. ....-------7 7 --------:::: ---------..... -:: -, 1 ...... i-9 9 .... ----..... -/ --, ----:..-........----_,_ -----------'="" to&:: -----------lo .. -Cl) 8 Ill" "=-,,,_. ... ... 8 2 -----/ --v _.,A ----------;::. -..... ::::.. ------------4( 7 .. .. ... /. ""'" ... .... 38 40 4244'6 9 60 .... II. (!) ----; / --,_ --.. -----------ot::: 3s J .. .... /_ ,, "" ... ... Wei: ..... v..... ---------------------. ... 0 5 / ,/ 1d5 26 27 28 29 30 32 33 34 35 36 4th YEAR 5th lyfi ,... pi -... ;:; ""'.:.: ------...... --z I 4 J ii I I I I I I I I c. ..... rs:'.' --------------/ .. 3 / 13 t4 15 16 17 18 19 20 21 22 23 24 3rd YEAR .. .. :c 2 WATCH THE DIRECTION OF THE .... LINE SHOWINQ THE CHILD'S 8ROW11t a:o I 2 3 5 6 7 0 9 10 II 12 I I I I I I I I I 2nd YEAR .--.... 1000 DANIU VlRY w AGE IN MONTHS lllN DANKROUI l.t YEj CARl88Alle FOOD a NUTRITION INSTITUTE (MHO /WHO) t9M

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CLINIC VISITS Dates when appointments given Ages to bring child by the clinics to c 1 in ic Schedule I x Reschedule 1 month 2 months 3 months 4 .____ months Date 5 months 6 months 9 months 12 months 15 months 18 months 21 months 24 months 30 months 42 months 54 months I = Kept appointment; X = Did not keep appointment HOME, HOSPITAL OR DOCTOR VISITS Remarks/Diagnosis In it i a 1 Date Remarks/Diagnosis I x In it i a 1 SUGGESTED FEEDING SCHEDULE FOR THE FIRST YEAR OF LIFE TAKE HOME GROWTH CHART Health Centre Regd. No. Ch i 1 d s Name Date of birth Mother's name: Guardian's name (if other than mother): Where the child 1 ives (Address) BROTHERS AND SISTERS Year Boy/ Year Boy/ of Remarks of Remarks Birth Girl Birth Girl IMMUNIZATIONS WHOOPING COUGH, TETANUS POLIOMYELITIS When to AND DIPHTHERIA Get Date Given Date Given Three First dose doses by 7 mths Second dose at 1 east Third dose 1 mth. apart. Fi rs t booster 18 mths. Second booster 3-6 yrs. TUBERCULOSIS (BCG) MEASLES RUBELLA (birth or 3 months) (9 to 15 months) (9 to 15 months) Date Given Date Given Date Given LANDMARKS OF DEVELOPMENT Normal Aqe Ranqe Balances head at months 3-6 months --First tooth at months 5-8 months --Sitting without support --months 5-11 months Able to walk few steps months 12-15 months --Able to speak 4-5 single words months 15-21 months --Toi let trained months 24-36 months --

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BABY'S TEETH ARE IMPORTANT MUNIR RASHAD Dental health care is an area that has long been ne glected by the general public. This is :especially true when it comes to dealing with infants. Most parents and/ or guardians are not aware that ba bies suffer from a numQ.er of dental problems that can be prevented if certain basic measures are taken. Dental problems start in infancy, as early as age six months when the "baby" or deciduous teeth start to erupt. This phenomenon, commonly known as "teething" can be and very often is, painful to the young child. The symptoms vary from moderate to severe pain in the area of the gums where a tooth is starting to erupt, along with slight swelling and redness of the gums and slight to moderate fever. The problem of teething can be dealt with quite easily since the treatment is confined to relieving the symptoms that often accompany the teething process, for example, rubbing the gums with soothing agents such as ora-gel or giving the baby pain relievers such as baby aspirin. It is not uncommon for the infant to be given a pacifier or something to chew on during the teething process as this helps the erupting teeth to break through the gums more readily. Once the teeth start to erupt, the child's mother should be concerned with keeping these baby teeth healthy. As long as teeth are present, dental caries is a potential prob lem and will start whenever the factors that lead to decay are present. It is well known that the mouth harbours a variety of bacteria that, given the proper substances to feed on, namely sugar, can produce acids that wear away the enamel of the teeth and initiate the process of decay. When tooth decay or caries starts, the process contin ues until it is stopped either by a dentist filling the tooth or by complete destruction of the tooth, abscess formation and eventual loss of the tooth. One of the most destructive forms of dental decay is the phenomenon known as NURSING BOTILE SYN DROME. This syndrome is also known as Nursing Bottle Caries, Baby Bottle Caries, Bottle Mouth Syndrome, Night Bottle Syndrome, Nursing Mouth and Prolonged Nursing Habit. It is seen in infants from one to four years of age and is a distinct pattern of decay involving the deciduous upper anterior teeth (incisors and cuspids) upper and lower first molars and lower cuspids (both upper and lower teeth). The most common denominator in all cases of nursing bottle syndrome is the fact that the babies were allowed to 10 go to sleep with a bottle propped up in their mouths, a problem which is very common here in The Bahamas. A study done in 1985 at the Princess Margaret Hospital revealed 35 % of all children four years or younger who had to have dental extractions were victims of nursing bottle syndrome. This figure is high when compared with a world wide incidence of eight per cent. It should be noted that babies who were breastfed did not present with this problem. The problem of nursing bottle syndrome can be pre vented if the following measures are taken: 1. Mothers should breastfeed their babies for at least four to six months. 2. From birth, mothers should hold their infants while feeding. (This is automatic in cases of breastfeed ing). 3. If the child falls asleep while feeding, burp and place in bed. 4. Start brushing the teeth as soon as they erupt. 5. Discontinue bottle feeding as soon as the child can drink from a cup (twelve to fifteen months). 6. Use a supplemental fluoride rinse if natural fluo-ride is not in the water supply. 7. Restrict the child's intake of sugar. 8. Watch for early signs of caries. 9. Start regular dental visits for the child from be tween eighteen and twenty four months of age. One other factor that has to be considered as leading to dentai decay isthe resistance of the host (teeth) to de cay. Teeth which have low calcium content are more susceptible to decay. Prenatal care of the mother, especially in the area of nutrition, plays a very important part in whether a child's teeth will be susceptible to decay. A pregnant woman who is not getting an adequate supply of calcium and phosphorous can give birth to a child who is deficient in these minerals which are so essential for the proper development of bones and teeth. Pre and post-natal care is therefore necessary in the prevention of dental problems in both mother and child. As long as infants have teeth, they are subject to de cay just as the teeth of older children are subject to decay. Treatment can be very expensive. Premature loss of baby teeth can lead to orthodontic problems in the teenage years. Prevention is the key and parents must assume the primary responsibility in preventing dental decay in their children by becoming informed of preventive measures and implementing them.

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IMMUNISATION FELICITY AYMER The theme for World Health Day this year, 7th April, 1987, deals with Immunisation. The Slogan, Immunisation; A Chance For Every Child. Community Nursing Services/Na tional Immunisation Programme officials have appointed a committee to plan suitable activities i n observance of the day. The committee, comprising Clinic Immunisation Co-or dinators, the Senior Nursing Officer, CNS; Medical Officer PHO; Health Educator, under the chairmanship of the Na tional Immunisation Co-ordinator, have been meeting regu larly. A poster competition among high schools in New Providence is being organised and School Nurses will give talks on the importance and relevance of early childhood immunisation to the child's health in all senior schools during the week 6lOth, April. The Bahamas can be; justly proud of its overall immunisation coverage. Over the past seven years, coverage has improved from 35% in 1979 to 86% in 1985 Figures for 1986 are presently unavailable. Our goal for 1987 is 90%, that is, nine out of every ten babies born should have com pleted basic immunisation (protection) against diptheria, tetanus, whooping cough, poliomyelitis (polio), measles, mumps and rubella (German Measles) by the age of twelve months. The Hon. Minister of Health, Dr. Norman Gay, in presenting awards at the Ann's Town Clinic at the culmination of Immunisation Month last year, challenged health workers to achieve a national coverage of 90% in 1987. Achieving the present coverage (86% at the end of 1985) has not been easy. It has required the sustained, committed service of many categories of health workers. If the health of the nation's children is to be guaranteed, then each health worker must continue to be vigilant in maintaining his/her efforts to ensure that every child in every settlement and subdivision throughout The Bahamas has received basic im munisation protection by the age of twelve months. What an excellent first birthday present for any child! Target populations in each area must be accurately identified and monitored. The cold chain must be effectively maintained from beginning to end manufacturer to child. There must be adequate supplies of vaccines both at the national and clinic levels to ensure that every child re quiring immunisation can receive his/her injection at the time of attendance at the local clinic The World Health Organisation (WHO) has set as its goal, the achievement of certain basic acceptable levels of health for all people comprising its membership by the year 2000 (Health For All By The Year 2000). These levels will obviously differ from country to country, but one of the World Health Organisation's sub-goals is the availability of immunisation services to all children by the year 1990. The Bahamas is well on the way. The services are available, but they must be used consistently if we are to prevent out breaks and the possible serious complications of these pre ventable diseases. Mr. Henry SMITH, WHO/PAHO's Immunization Officer working from CAREC's Offices in Trinidad, visits The Bahamas annually to carry out Immunization Audit-Monitoring and evaluating the national immunisation programme. Last year, a visit to Grand Bahama was included in his itinerary. He was accompanied by Mrs. Fredricka Sands, Immunization Coordinator for The Bahamas and Medical Officer, Ken Ofosu-Barko on the visit. Mr. Henry Smith (CAREC) on a visit to West End Clinic, Staff Nurses and Mrs. V. Poitier, Eight Mile Rock Clinic Grand Bahama. together with Mrs. F. Sands and Mr. Henry Smith (CAREC). 11

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Staff Nurse, Dr. Kavola and Mr. Smith at the Eight Mile Rock Clinic, G.B. Left to right: CNS Pearline Hepburn and Veronica Poitier (G.8.), Dr. Fernander, Mr. Smith and Mrs. F. Sands, Nat. Immunization Co-ordinator. 12 Arriving at the busy Eight Mile Rock Clinic. Arrival at the Clinic, left to right: Drs. Ken Ofosu-Barko (N.P.) and Fernander, Nurses Pearline Hepburn and Ve ronica Poitier, and Mr. Henry Smith.

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UNDERSTANDING DIARRHOEA PERCIVAL McNEIL Introduction Diarrhoeal Disease continues to be a major health care problem in the paediatric age group in The Bahamas. Most cases occur between January and of each year with about 50% of cases occurring in infants (less than 1 year of age). In spite of the introduction of oral rehydration fluid there remains considerable serious illness and death from this condition. It is therefore of utmost importance that health-care workers and others who care for children have a sound working understanding of this condition and what can be done to improve the outcome in the affected infant. Definition Gastroenteritis is the term loosely applied to the condition which involves the occurrence of three or mo re loose stools per day; vomiting may or may not be present. It is most commonly caused by a virus and as such there is usually no specific cure. The virus damages the inner lining of the small bowel where cells responsible for the breakdown and absorption of sugars are lo cated. The cells most easily damaged are those responsi ble for the breakdown and absorption of milk sugar, lactose. If the sugar remains unprocessed then it stays inside the bowel and pulls along with it extra water which appears on the outside as diarrhoea. Anti-diarrhoeal Medicines Most prescribed medicines have no effect on this process at all. Lomotil and donnagel are medicines that slow up the movement of the bowels so that fluid continues to be lost inside the bowel. There may then be abdominal distension and it does not run out as frequently. In addition, lo motil can be responsible for drowsiness, fever and breath ing difficulty (from respiratory depression). The binding agents, kaolin and pectin, do nothing to reduce the fluid loss inside the bowel which often continues for about 5 days. The reason for this continued loss is that new cells re place those which have been damaged by the virus, and these new cells are secretory in function (that is they can only lose fluid into the bowel) and they take about five days to mature by which time they are able to break down and absorb sugars. Of course, in practical terms, all cells are not damaged at the same time, neither do all the new cells achieve maturity at the same time, so that diarrhoea may last anywhere from three to seven or more days. Management What gastroenteritis management amounts to is the support of the patient until healing occurs. Again, from a practical point of view, two questions must be answered: 1) Is there a secondary bacterial infection? (eg: ear infection, bronchopneumonia or generalized blood infec tion as in sepsis). This can be likened to the process where one gets a wound, e.g. a laceration, which can be either clean or secondarily infected. Only if there is secondary bacterial infection will antibiotics be of assistance. As much as possible, the clinician should attempt to make a judgement of this since some antil>iotics, par ticularly ampicillin and to some extent amoxi{, can promote diarrhoea. It is important to realize also, that ex cept for the immediate newborn period, bacteria are always present in the stool, and these are usually, E. Coli. Bacteria can be contained within the bowel lumen (and essentially remain outside the body), they can in vade the bowel wall, eg. causing blood and mucus from destruction of cells, or they can cause sepsis by gaining access to the blood-stream. Antibiotic treatment is helpful only when there is evidence of invasive disease and/ or sepsis. The infant or child with gastroenteritis and fever should be assessed by the health-care worker as soon as possible. 2) Is there Dehydration? There are many signs and symptoms of dehydration, but for teaching purposes, the simplest method of detection is probably the abdonimal skin turgor at the level of the umbilicus. The parent is in structed to run the thumb and forefinger horizontally to wards each other at the level of the navel and to note whether the skin pinches up easily or not this should be demonstrated; in the event that there is dehydration with the skin being loose, the parent should be shown what the skin should feel like in the hydrated state; this can be demonstrated by stretching the skin and repeating the attempt to pinch it up as before. Once parents are able to assess dehydration, then they are able to monitor fluid replacement. The only other essential ingredient is that expert help (in the form of health-care workers experienced in the assessment and management of ill children, with the tools of intravenous fluids and if necessary, intravenous antibiotics), must be available around the clock. The great challenge to the management of diar rhoeal disease on a national scale is to so elevate the knowledge of the parent so that intervention is timely and morbidity is low. The even greater challenge is to get mothers to breastfeed their newborn infants so that diarrhoeal disease itself is prevented in the most vulnera ble age group (those infants 3 months of age or less). In addition the La-Leche model of a "lay-person based" support network, where a friend or neighbour has the knowledge to help another, would do much to help us achieve our goals. 13

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CHRISTMAS IN GRAND BAHAMA Staff of the Hawksbill Clinic held a party for their pa tients The event held outdoors was a great success and is to be hel d annually From left to right: Dr. NEHRU-DMO Hawksbill Clinic; SNO Sylvia DAVIS RMH: Hospital Administrator Michaela STORR; CN Charles PRATI: standing extreme left, "Entertainment will be held over there, will you ioin us?" he seems to be saying to one of the guests. The Rand's annual Christmas Party was held 0 1 n 18th December, 1986. Traditionally physicians and senior administrators serve/wait on tables. 14 This year, staff were very pleasantly surprised to have the "big shots" from Nassau among them. The CMO, dressed for the occasion, seems to be enioyi11g the party as much as anyone else.

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Past PS Luther Smith i s enioying his unique position among the nurses and the food. A lso taking time out to express appreciation to staff for their hard work, dedicated service and extend yuletide greetings was DON lronaca Morri s Dressed for service and intent on making a success of their change in role -right to left: Assistant Hospital Administrator Herbert Brown, DON lronaca Morris, Hos pital Administrator, Michaela Storr. 1 5

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UP-DATE FELICITY AYMER WELCOME To the Ministry of Health, Permanent Secretary, HARCOURT TURNQUEST, with effect 5th January, 1987. Mr. Tumquest has had a long career in the Public Serv ice having started as a special Student Teacher in Jan uary, 1960, while still completing his basic education. Later that year, Mr. T urnquest was appointed acting Head Teacher at the Buckley's Public School, Deadman's Cay, Long Island, where he went to school, for the year in between attaining the Cambridge School Certificate and at tending the Government High School in New Prov idence on a Bahamas Government Scholarship. At the Govern ment High School he obtained the General Certificate of Education (London) at advanced level in three subjects History, Geography and English Literature. Mr. T urnquest has a Bachelor of Arts (second class honours) in Geography from the University of Swansea, Wales; a Diploma in Education, University of Southhamp ton; and Master of Arts (International Affairs) from Carle ton University, Ottawa, Canada. Mr. T urnquest co-authored a textbook for Junior High Schools, titled 'Civics For The Bahamas' during his sojourn in the Ministry of Education where he has worked in the classroom and in administration. He has attended short training courses in International Law and matters pertaining to th e Law of the Sea. After leaving the Ministry of Education in 197 3, Mr. T urnquest served in The Ministry of External Affain;, later Foreign Affairs, the Office of the Prime Minister cmd as Acting Secretary to the Cabinet. A member of the Board of Abilities Unlimited and Kiwanian, Mr. T urnquest is married to the forme r Ruth Adderley, a teacher at the School for the Deaf and they have two teenage children -a son and a daughter. In addition to his civic involvement, Mr. T urnquest enjoys travelling, swimming and reading. 1 6 Joining Hands For Health extends a warm welcome to you, Mr. T urnquest and sincerely hopes you will be able to cope effectively with the complexities and competing forces within this Ministry. Very best wishes, Mr. Permanent Secretary, may you continue to enjoy your extra-curricular activities. staff Nurse Gina BENNETI to the Coconut Grove Clinic on 10th November, 1986. Nurse Bennett, formerly Gina Gibson, has been away for the past fifteen years. She completed her basic education in the United King dom and stayed on to train as a nurse at the Royal Isle of Wight School on Nursing. She then did a degree course in Organisational Behaviour at Bulmershe College, Reading, before completing the Health Visitor Course. Joining Hands For Health hopes that you will not only enjoy the challenges inherent in Community Nursing in The Bahamas but also that you will continue to labour in that part of the Vineyard for many years. Good luck and very best wishes, Nurse Bennett. Nursing Auxiliary Donnella THOMPSON to the Carmichael Road Clinic on transfer from the Princess Margaret Hospital Raynor BURROWS to The Ann's Town Clinic. chena SCOTT and lnza WELLS to the Blue Hill Road Clinic. Janet GIBSON and Shane NEELEY to The Coconut Grove Clinic. These five nurses who graduated recently, joined The Community Nursing Services on 15th December, 1986. or. Lileth SANDARAN who joined the staff of the Public Health Department in December, 1986. Dr. Sandaran works in the Maternal and Child Health Services, Ann's Town Clinic. She has a keen in terest in Reproductive Health. or-: "Claudia WALTERS, Senior House Officer, PMH. Dr. Walters joined the staff on 1st July, 1986. We wish you an enjoyable stay at the hospital Dr. Walters.

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To the Sandilands Rehabilitation Centre:or. K. SARPAVARAPU, Registrar, on 22nd February, 1987. sister Lucille PAYNE, N.0.2 Mrs. Pauline ROLLE. Joining Hands for Health wishes you all pleasant and productive times in your areas. Sylvia RAHMING, Janitress to the Ann's Town Clinic. The Clinics should now generally look cleaner, more attractive and better maintained with the employ ment of Handyman Fredrick SEARS. Mr. Sears joined the staff of the Ministry of Health in December and is kept busy serving the clinics in New Providence. To date nursing staff are very pleased with his attitude and abili ty to work. May he continue as he has begun. WELCOME BACK. or. Joseph CALASCO who returned to The Ministry of Health, 1st January, 1987, now serving in the Public Health Department with major responsibility for Child Health at the Coconut Grove Clinic effective 2nd February, 1987. Dr. Calasco worked in the Paediatric Department, PMH for many years prior to leaving to further his med ical education M. MED (Paediatrics) at the University College, Gallway, Ireland. Some readers may remember Dr. Calasco as, among other things, editor of Bahama Med, the Journal of the Medical Association of The Ba hamas. CONGRATULATIONS *Dr. Carlos MULRAIN on your promotion to Acting Deputy Chief Medical Officer effective 1st. September, 1986. In addition to his responsibilities for Family Island Health Services are added those for Primary/Community Services throughout the Commonwealth. *Miss Daphne MOUNTS on your promotion to Trainee Executive Officer, Ministry of Health (Headquar ters\, 22nd. December, 1986. CONTINUING EDUCATION. A four week Orthopaedic Course was recently con ducted at Bain's House, PMH. The following nurses from the PMH attended:SN Warren KNOWLES, NO 2 Jestine FERGUSON, SN Thelma ELLIS and TCN Mary RAMSEY. A Role Base Course was held over the period 24th, November, 1986 March, 1987. Participants from the PMH included Sisters, Florinda CLARK, Yvonne BULLARD, Roselean STRACHAN and Marlease WALKER. Facilitators included Mrs. Irene COAKLEY, Judith MINNIS and Marina SANDS. Group of participants left to right front row: Mrs. Irene Coakley and Rose Strachan (PMH), CN Phllabertha Car ter (C.G.C.), Ruby Ward (SRC), Marina Sands (PMH), An toinette Outten (A.T.C.), Mrs. Bullard, Judy Minnis (PMH), Shirley Davis (BHRC), Maureen Walker (PMH); back row left to right, Chenoa Rolle (SRC), Clarke (PMH), Ms. Hepburn (PMH), Mrs. Faye Rodmell (Tutor) and Ms. Aranha (SRC). *NOs 1 Nellie MARSHALL and Patsy MORRIS were among those Bahamian students travelling to the UWI, Mona, Jamaica Campus to pursue the Certificate Course in Nursing Administration in September last. Joining Hands For Health you both every success in your studies. A seminar, conducted by the Public Service Training Centre of the Department of Public Personnel (OPP), was held at SRC over the week 2nd-6th February, 1987 for Clerks and Filing Assistants. The SRC takes this opportunity to again express its appreciation to the Public Service Training Centre for making this training course possible. *Ms. Mercia STRACHAN, Pharmacist at the SRC is among those Pharmacists travelling to Nairobi, Kenya, East Africa, to attend the fourth Commonwealth Pharma ceutical Association Conference this year. *SN Julian MULLINGS hos completed a course m Orthopaedic Nursing in Scotland and resumed duties at the PMH 8th January, 1987. No doubt Nurse Mullings is glad to be home, away from the cold weather which The National Drug Council, appointed by the Prime Minister of The Bahamas through the Minister of Health, in February, 1985, held its first Conference for Family Island members 16th-18th November, 1986 at the Wyndham Ambassador Beach Hotel, under the theme, Sharing Knowledge For Action. The conference was arranged in conjunction with the Pan American Health Organisation (PAHO) with funding from the United Nations Fund for 17

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Drug Abuse Control (UNFDAC). The main speaker, Mr. Peter Bell, Executive Director and co-founder of the Minnesota Institute on Black Chemical Abuse, courtesy of the United States Information Services (USIS), addressed Community-based Prevention Programmes. Mr. Bell spoke to societies' double standards towards alcohol use and recommended the re-establish ment of channels of communication, cultural norms a 1 nd values and making known the consequences of alcohol / drug substance use. Societies unequivocal position r egarding alcohol use he s aid has been noted as an ef fective motivational aid in prevention and treatment of abuse. This in addition to the traditional demonstration of caring, concern and love should underpin any prevent ion programme. Representatives attended from every Family Island except Acklins and Rum Cay. They included Educators, Health Professionals, Customs and Immigration Officers, Church leaders, parents, volunteers, youth workers and school peer counsellors. The need for a Family Life Education Programme incorporating clear values and the acquisition of decision making skills, from kindergarten through grade 12, was repeatedly enunciated by delegates. It was felt that the Church, as a body, could do much more to help com munities redefine their values and set healthful standards for living. Out of the conference emerged many resolutions and recommendations. More information may be ob t ained from The National Drug Council. Telephone 322-2308 or 322-2309, P. 0. Box N-1023, Nassau Bahamas. A variety of resource material is available at the Council's Offices (Resource Centre). The Eleventh Annual Workshop for Family Island health workers took p l ace at the Pilot House Hotel East Bay Street, 19-21 November, 1986. Mostly F:1: heahit" worice..S. In foregrouncCl>r: and Mrs. Bacchus -Governor's Harbour (DMO & Dentist). 18 from New Providence and Family Islands, right to left front row, Miss H. Bowen -retired DON, Ms. B. Ford -deputy DON, Ms. D. Philipo FAS Min. of Health and Dr. Nehru DMO, Grand Bahama. The Workshop, co-sponsored by the Ministry of Health and the Pan American/World Health Organiza tion was, as usual well patronised by health workers in New Providence. Presenters included physicians and nurses. They shared working experiences within the Commonwealth of The Bahamas and the wider Caribbean region. Dr. Peter DIGGORY, Director of CAREC; Dr. Hugh WYNTER, Department of Obstetrics and Gynaeco logy at the UWI, School of Medicine, Mona, Jamaica and Dr. Deanna ASHLEY Ministry of Health, Jamaica were presenters from the Caribbean. The Medical Association of The Bahamas held its annual Conference 4th-6th February, 1987, at the Paradise Towers Hotel, their theme, Care of the Acutely Ill. As has become traditional, a number of eminent specislists from abroad visited some delivered papers. Local consultant specialists also took port. The conference was officially opened by the Hon. Minister of Health. The President of the Assoc i ation, Dr. Eugene NEWRY delivered a searching s oliloquy on some real issues facing members and medicine as practiced in The Bahamas in terms of, for example, vying for resources for the hospital. The recently appointed Permanent Secretary Mr. Harcourt TURNQUEST was introduced to the group during the Session The Ministry of Transport and Local Government, through its Road Traffic Department, conducted a Motor Vehicle Injury Workshop, 27-28 November, 1986. The major resource person for the workshop was Dr. Peter DIGGORY, Director of CAREC. This was a multi-sectoral workshop including participants from the Ministries of Works, Tourism and Health; The Royal Bahamas Police Force; non-government agencies Tour Car and Jitney Operators and the business sector Insurance Companies. It was sponsored

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by the Ministry of Transport and the PAHO. In his wel coming remarks, Minister Gay told the group that motor injury prevention was, worldwide, a public health prob lem of growing concern and warranting the coordinated efforts of all agencies, those involved and/or affected. Trauma due to injury and violence he said was the leading cause of death and disability in the age group 15-45 years in The Bahamas. As there is on average one car for every four persons and one vehicle to every two persons, the risks of injury are high. The Minister of Transport and Local Government, the Hon. Philip Bethel said in his opening address thar the Road Traffic Safety Committee, an ongoing multi-sec toral committee, was formed in 1973 for the purpose of raising public consciousness on issue s relative to road us age and securing positive responses. He also voiced his concern about the effects of substance use on road users especially at weekends. He suggested that emphasis be given to ways of providing effective driv e r educatio n bearing in mind that the accident rate in The Bahamas was among one of the highest in the region. FROM THE WORKSHOP : 1. In addition to the individual financial and human costs inherent in traffic accidents there are also increasing strains and costs on the health service and loss of productivity which adversely affects the national economy. 2. The pattern of traffic accidents seems to have shifted away from the younger age group to an older age group who have traditionally been more careful. Con sequently there has been an increase in claims -pre viously fifteen per month, since July 1986 there have been nineteen per week end! Insurance premiums will undoubtedly rise since 7 4<; per $1 is now being paid in claims. The idea of in creasing incentives for accident free drivers was not favourably received by the Insurance Company's rep resentative 3. The urgency o f collecting data on which to base edu cational programmes, together with a revision of the road traffic laws/regulat i ons especially those relating to drunk drivers and strict law enforcement were some of the recommendations of the workshop. CHANGE AND??? Miss Cleopatra FERGUSON, Senior Nursing Officer responsible for the Health Aide Programme since its inception in 1982 has been transferred to administra tive duties within the Ministry of Health. Housed in renovated accommodation in the Royal Victoria Gardens, Miss Ferguson's responsibilities now include Manpower Planning and Systems Review. She is also secretary to the Management Committee within the Ministry of Health This Committee which com prises heads of the various departments/institutions within the Ministry of Health meets regularly to share plans and evaluate progress. Joining Hands for Health wishes Miss Ferguson every success in her "new" duties Mr. Andil LARODA Senior Nursing Officer responsi ble for teaching the Clinical Nurse trainees within the Department of Nursing Education has been trans ferred to the Princess Margaret Hospital where he is assisting in the Administration Department. Again Joining Hands for Health wishes Mr. Laroda every success in his "new" duties Four Staff Nurses: Shaureen BASTIAN, Valencia GIBSON, Anna Mae MOSS and Florentia WILSON have been transferred from the CNS to the PMH. From the PMH to the CNS have come SN Cathy BRIDGEWATER (District Nursing); Daphne FERGUSON (Coconut Grove Clinic}; Terry ROLLE and Daphne WILSON (Fox Hill Clinic). CN Elizabeth ROLLE has completed a stint in Moores Island and is now serving in the School Health Serv ice. We are glad to have you back in Nassau Ms. Rolle and look forward to hearing about some of your experiences in Moores Island CN Brenda COX had now gone to Moores Island. CN Carlotta KLASS has been serving in the Family Is lands Mangrove Cay, Andros, and San Salvador. She is now back in Nassau; we look forward to hearing from you also, Mrs. Klass HA Helen KELLY has been transferred from the Family Islands to the School Health Services January 1987. HA Jennife r ROLLE has been transferred from Steven ton, Exuma to the Coconut Grove Clinic New Providence HA Bessie Mae McKENZIE has gone to Steventon from Coconut Grove Clinic SN Dulcie PRATT has been transferred from the SRC to Ann's Town Clinic. GOODBYE : *Permanent Secretary Luther Emerson SMITH who was transferred to the Ministry of Works at the end of last year. A number of employees miss Mr. Smith's management style but realised that the business of living invo lves movement. 19

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We wish Mr Smith every success i h his new m inistry. Who knows he may one day r eturn to the M inistry of Health Mrs. Sonia Carey GIBSON F i nance Setc i oo Ministry of Health (Headquarters) has left the Ministry for the pr i vate sector effect i ve 14 February, 1987 Very best w i shes for your success Mrs. Gibson The follow ing Staff Nurses have resigned from the PMH Emily DORSETIE, 8th December 1986 ; Char lotte JOHNSON and Winnifred ALLEYNE -31 December, 1986; -Ka r en PINDER, 16 January, 1987 ; and Charlene D i gg is-McPHEE, 29 January 1987 It is traditional to presen t gifts at Christmas. Pa!ients of the SRC present the Governor-General with a Chri stmas g ift. Sedion of the group for the G.G.'s annual visit the SRC. 20 The Governor-General, Sir Gerald and Lady Cash paid their annual visit to Sandilands Rehabilit ation Centre 19 December, 1986. From all reports, the event was well attended by staff and patients. Five employees who retired from the public service (SRC) in 1986 were awarded certificates for long services: Mrs. Loleta SWEETING Senior Housekeeper; Ms. Ethelyn WALLACE -Kitchen Supervisor ; Mrs. Thelma BURROWS Assistant Cook ; Mrs. Viola BUTLER Nursing Officer II and Mr. Nigel McPHEE Porter Joining Hands For Health wishes you all many years of healthful, s at isfying, act i ve retirement. The Police Band added spirit to the occasion Lady Cash presents long Wallace. to Ms. Ethelyn Sir Gerald awards long service certificate to NO Viola Butler. The Nurses' Association of The Bahamas held its An nual elections in December last. Elected to serve for the next two year period were:

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Ms. Ernestine DOUGLAS, TUTOR ONE, President; Ms. Juanita GREEN, Holiday Inn Hotel, 1st. Vice President, Ms. Evelyn ALFRED, Private Duty Nursing, 2nd Vice President; Ms. Bernadette ELLIS; Ambulatory Dept. PMH, Secretary; Ms. Sandra JOHNSON, Private Duty Nursing, Assistant Secretary; Ms. Castello BOWLEG, TUTOR ONE, Treasurer; Ms. Pearl RAHMING, Catho lic Diocese School Health Programme, Assistant T reasurer Chairpersons of committees : 1 Ms. Marina SANDS, Ambulatory Department PMH, Education and Research; 2. Ms. Patricia BETHEL, Bums Unit, PMH, Social Wel fare and Economics; 3 Ms. Pamrica FERGUSON Infectious Diseases, PMH, Pract ice 4. Ms. Brezett a KING, Reg istra r The Health Inspectorate of the Department of Envi ronmental Health Services has finally moved from their time-worn premises in School Lane to more spacious, comfortable and attractive offices in Nassau Court. Officers occupy the recently renovated two storey building behind the Ministry of Economic Affairs formerly the home of the Government High School -and should now be able to work with greater vigour in surroundings which more accurately reflect environmental health. CONGRATULATIONS Mrs. Olga BROWN, Chief Executive Officer, Ministry of Health on the birth of your sixth grandchild, a grand daughter. Mrs. Brown is simply exuding radi ance in her grandmotherhood! Should we be en vious? VISITORS Among the many visitors to the Ministry of Health, invited to provide technical assistance over the past four months have been:-Dr. Peter DIGGORY and Mr. Henry SMITH b o th from CAREC. Dr. Deanna ASHLEY to review the National Pro gramme for the Control of Diarrhoeal Diseases. Mr Gordon SMITH Johns Hopkins Medical School. Both Dr. Diggory and Mr. Gordon Smith collaborated in a Trauma Workshop at the PMH 25, 26 Novem ber, 1987. Miss Patricia BRANDON, PAHO's Area Advisor in Health Education to the Health Education Division. FROM THE CANCER SOCIETY OF THE BAHAMAS In response to the increasing need for greater awareness and education about cancer throughout The Bahomos, the Cancer Society of The Bahamas is making plans to establish Society branches in the Family Is lands. The Central Eleuthera Branch was the first to be formed in October 1986, and the Branch is hard at work. President is Ms Corinne Sands. The Freeport Branch should be functioning by the end of February and plans for Abaco, Exuma, lnagua and Andros are underway "After a very productive year in 1986, the Society i s look i ng forward to 1987", says President Ms. Sonia Dames 'We shall be happy to provide speakers about cancer for community group meetings church groups, service clubs, schools business houses ." Persons i nterested in obtai n i ng information on can cer, ts hirts or i n becomi ng members o f th e S ocie ty which meets on the second T u esday in e a ch mon th at 5:30 p. m a t St. Matthew's H all, can contact the Society at 324-1063 or 324-2429. Cancer month will be observed in May. Please listen/ watch out for m o re information as May approaches. FROM THE PRINCESS MARGARET HOSPITAL WELCOME: TO THE DIETARY SERVICES: Ms. Theresa HEPBURN who has been assigned to the Ambulatory Department to work with diabetic patients. Miss Hepburn obtained a B.Sc. in Nutrition/Die tetics from the Prairie View University, Minnesota and completed the required one year internship in T rin idad. Trainee Dietician Netterkate GIBSON. Joining Hands For Health welcomes you both to the large family of health providers and hopes you will find a great deal of satisfaction in your jobs. WELCOME BACK: SNO Constance COMERY after being away from du ties on the mat e rnity w a rd because of illne s s CONGRATULATIONS : TCN Elvira PRATI of the PMH on completion of th i rty years in the profession of nursing and on receiving the award for most outstanding employee for the year 1986. Dr Ronald KNOWLES on your election to serve as Head of Department, Internal Medicine. Dr. Bernard NOTI AGE, on your election to serve as Head of Deportment Obstetrics and Gynaecology. Dr. Winston CAMPBELL, ENT Consultant as Acting Head of Department Surgery for a three-year period beginning 12 January, 1987. All other Heads of Department remain unchanged. 21

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..... ............. -<.en\t\c.G\e uom GO'fe\'t\OT GeneTa\ ()t\ h\s bnua\ 'f\s\\ \() P.M.H. l30 years service) Sir Gerald Cash concluding his annual Christmas visit to the P.M.H. 22 Joining Hands For Health was sorry to hear of the ill ness of Dr. Earle FARRINGTON, Consultant and Head of The Deportment of Surgery. Dr. Farrington became very ill while on holiday in the US toward the end of October, 1986. We are indeed pleased to hear he is on the mend, although recovery is a slow and tedious process. We look forward to seeing you soon Dr. Farrington. A Social Worker has been assigned to the Accident and Emergency deportment, to facilitate screening of patients who may be unable to pay for the medical services they require This service became fully opera tional in January 1986 and is available Monday Friday 9a.m. 4p.m. An information booth relative to clinic schedules and general information was set up in the waiting area for the pharmacy late last year. A significant number of people in The Bahamas suffer with hypertension and/or diabetes both chronic non-communicable diseases Compliance regarding medication and diet are key factors in successful con trol. Special hypertensive and diabetic clinics to mon itor those patients who are coping with their condition fairly satisfactorily hove been introduced and are well attended. In January 1986, a special hypertensive clin ic began, since then there have been 2,418 patien t visits. In May 1986 the diabetic clinic was started and since that time there have been 646 patient visits. B oth clinics are held twic e weekly Tuesday and :nutsOa-y 'tot n-ypenenswes, 'N ecmestla-y ona T-f\ 00'1 o\\emoon \or d\obe\\c.s. Ors. Patrick WHITFIELD, Eugene GRAY and other physicians together with a dietician presently comprise the team which is to be expanded to include o health ed uc.o\or, soc.\ o\ -wo'""-er and o\ Sp
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Two concerns of health providers at the institution are (1) misuse of the services by the public : an information booth in the waiting area of the Pharmacy has therefore been established in an attempt to encourage more effective use of the Ambulatory Services (2) Sick children being taken to the GPC by an older sibling Health providers are very disturbed because they are neither sure they are elic iting accurate histories nor that basic information relative to n ecessary action leading to quick restoration of the sick child's health is being understood and acted on. This latter i s a concern of health providers throughout the system and has been the topic of more than one radio programme Comments? Michael Newton Ambulance Dept. Most outstanding male athlete P.M.H. Sports Day, Nov. 1986 -Presentation Nov. 1986. Ms. Eureka Delancey PHYSIO-Dept. Most outstanding female athlete P.M.H. Sports Day, Nov. 1986. FROM THE FAMILY ISLANDS *Dr. H Patel has assumed duties as Medical Officer in the newly created district of Steventon, Exuma. He will also be responsible for the Exuma Cays. Seven new clinics are proposed for the following areas under a Health Infrastructure Project between the National Insurance Boord and the Ministry of Health ore: Mangrove Cay, Fresh Creek and Nicholls Town in Andros; Simms, Long Island; Marsh Harbour, Abaco; Port Home, Cat Island; Majors Cay, Crooked Island -in an effort to further upgrade the range of health services available to residents in the Family Islands and in pursuance of the stated goal of Health For All By the Year 2000 (HFA/2000) through the medium of Primary Health Care. *CN. Barbara HEPBURN, Marsh Harbour, Abaco had the unenviable pleasure of delivering triplets, two boys and a girl, prematurely in late October, 1986. The boys weighed 4 lbs 12 ozs and 41bs. 6 ozs.; the girl 3 lbs. Mother and babies were transferred to New Providence shortly afterwards where the triplets remained in hospital for some time. Nurse Hepburn reported that they were all "doing well". *TCN Gloria STRACHAN, Rock Sound, Eleuthero, reported that a Clean-up Campaign was scheduled for late November in anticipation of clean and aesthetically pleasing surroundings for Christmas. *Do you know that there are twenty health districts throughout the Family Islands? A Medical Officer resides in the following areas. Grand Bahama, Andros, Eleuthera three each island; Exuma, Abaco, Long Island two each island; Cat Island, Acklins, Bimini and Berry Islands, one each island VITAL STATISTICS Births Staff Midwife H. DILLETTE, a daughter. Staff Nurse Sherene ROLLE a son, born on 2 8 Jan uary, 1987. Staff Nurse V. SAUNDERS a daughter also born on 28 January, 1987. All nurses work at the Rand Memorial Hospital, Grand Bahama Senior House Officer, PMH Earl CAMPBELL. SN Patrice KING of the DNS a daughter, October, 1986. SN Lola KNOWLES, School Health Services, a son, November, 1986 Mrs. Angela COLEBROOK, Secretary to the Acting Deputy Chief Medical Officer, a son in January, 1987. CN Allison Brown SANDS, Palmetto Point, Eleuthera, a daughter Cielle Alyssa, 25 February, 1987. Cielle is breast fed. She is the second child of her parents and the sixth grandchild of Mrs. Olga BROWN, Ministry of Health. 23

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Marriages:-Wedding bells rang for HA Anna SANDS, Dental Department PMH, and Marine Seaman Christopher RUSSELL of the Royal Bahamas Defence Force on Saturday 20 December, 1986. Anna worked for a short time in the Health Education Division before transferring to the Dental Depart ment/PMH We wish Anna and Christopher a long and mutually rewarding life together. May you grow in love, friendship and trust. Wedding bells also pealed for the following nurses at the PMH. 24 TCN Jestina TOOTE and Samuel KNOWLES 27 July, 1986. SN Carolyn THOMPSON and Rev. Keith RUSSELL 1st November, 1986. SN Jennifer SAUNDERS and Clement KING 15 November, 1986. SN Una Maria BUTLER and Garth BAIN 15th November, 1986. SN Juanita JACKSON and Roger MILLER 22 November, 1986. SN Joanna WOODSIDE and Wesley ARCHER 6 December, 1986. TCN Leathica SEYMOUR and Rev. Garnet KING 6 December, 1986 TCN Wilma PRATI RMH and Prosecutor William MOSS 25 October 1986 in Grand Bahama. Joining Hands for Health wishes these couples many years of wedded bliss. Deaths Our condolences to the following nurses at the PMH. NA Olive GIBSON on the death of her daughter, 16 December, 1986. SN lcelyn SWEETING, TCNs Eula KEMP and Yal derine JONES on the death of their mother, 5 Jan-uary, 1987. SN Beatrice ARTHUR on the death of her mother SN Linda WHITEHEAD on the death of her mother 4 January, 1987. 6 January, 1987. NO 1 The(ma FOULKES on the death of her sister 18 January, 1987. SN Veronica FERGUSON on the death of her brother 20 January, 1987. Condolences also to: SNO Maggie MOSS, CN Rosa Mae BAIN and Mis. Hannah GRAY, Health Information Unit on the death of their father, Edward GODET (Sr.) on 6th January, 1987. Mr. GODET had been ailing for some time and had lasped into a coma. He was lovingly cared for by his family at home. Mr. John THOMPSON Hospital Administrator (PMH on the death of his father, John THOMPSON, Se nior Mrs. Elizabeth SWEETING, Internal Auditor/ Accounts, Ministry of Health now in the DEHS, on the death of her mother. Dr. Perry GOMEZ, Consultant, Internal Medi6neJ Communicable Diseases on the death of his father, Mr. Reuben GOMEZ, a friend of the Health Educa tion Division District Nurse Thirzra DEAN, on the death of her father. May God grant you strength and comfort 1n your time of need

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THE GOOSE GOT FAT DWIGHT ALLEN Those of us who are concerned with health and fitness, if only marginally, know of the potential damage \ n overindulging in eating and drinking. For many of us too, as Christmas approac h ed, the go o se w a s indeed getting fat. And with Christmas, the glazed ham, turkey, fruit cake and booze all gone, the goose is indeed fat ter. The air is now filled with moans. 'Ne feel tired. We still h ave cravings for all those delicious and dangerously fattening foods Worst of all, clothes just don't fit. But, there is no need to moan and groan, if someting does not fit there is certainly no need to force it. There is a place t o solve all your woes. That place, a health/fitness centre Without much thought, most of us can think of at least three spas or gyms on the island. There are many more and the services offered at each are accordingly varied. Much talk has always existed about local fitness centres, s ome in the form of advertisements, others by wor d of mouth from satisfied or dissatisfied customers. At "Join ing Hands For Health", the decision was made to dispell, as far as possible, misconceptions and investigate these centres COST First o n the list for many is cost. Membership fees seem fairly standardized and are commensurate with a menit ies available. Thirty to forty dollars gives one m onth's enrollment at all the local centres and most re qui r e clients to declare in advance any i njur ies suffered prior to enrollment None require advance med i ca l ex a mination Howev er, at one centre a docto r i s part of the staff a nd a n e x amination i s given a t the time of en r oll m ent at no addit i onal charge. An i ndividually tailo r ed prog r amme m a y be des i gned at the t ime of enrollment at all c entres None offer specific beginner's pro grammes FACILITIES The hours of operation range from f i ve thirty in the morning to ten o'clock at night, Monday to Friday, Sat urdays eight to twelve, with hour long aerobics classes almost every hour. One centre offers a special class for obese persons at 7:30 p.m. As for aerobic ac:tlvi\y, one may find a "no frills" routine focusing more on pure exercise or doncercise rovfine.s For those persons wanting more than an aerobics routine, weight training and other machines exist at all centres at pre-arranged intervals; use of these may be supervised. Uniquely offered by one centre is electronic video monitoring. Dietary counselling is available at most centres and additionally, one may find physical therapy and special programmes for those with sprains, dislocations and car diovascular conditions including stroke victims. Lockers and showers are standard Whirlpools, sau nas and steamrooms may also be found and massages are available, at additional cost, at one centre. All centres have at least two trained instructors, all of whom not only seem enthusiatic, but some of whom are also living testimonies, having followed the path from overweight client to superfit instructor. CLIENTELE Just who goes to a fitness centre? Persons range in age fifteen to seventy years; mostly women, but the male enrollment is on the rise For those of you not sold, you can visit and have full use of all services at least once Additionally, some centres offer daily and weekly rates and of course, there is an added incentive of annual rates for those prepared to make the long range commitment. Anyone dreading the lack of self-discipline may en roll a t the centre that requires, as a part of the mem bers hip contract, attendance at least three (3) times per week So, let's get the goose down to size before summer rolls in. Remember, the healthier you are the better you will look and feel, the longer you will last! 25

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THE OVERWEIGHT P ROBLEM PATRICK WHITFIELD Definition "An overweight person has a body weight above the normal or 'desirable' level at which the greatest lon gevity can be The normal or 'desirable' weight of an individual is derived from an ideal weight which in tum is calculated from insurance data that relate size to morbidity and mortality (sickness and death). Using such charts, obesity may then be defined as weight of fifteen to twenty per cent more than the ideal body weight. Incidence This is difficult to compute primarily as a result of inadequate data. However, in the U.SA, heahh person nel estimate that approximately twenty five per cent of their population is overweight. No recent Caribbean fig ures exist. In almost all populations, more women are overweight than men at any given age. The frequency of overweight individuals increases up to age 40-55 in men and 40-60 in women. Contributing Fadors Although more knowledge about obesity is be : ing gained daily, much research is needed to solve essential pieces of the puzzle that are missing. Information that is available includes: 1. Genetic Component There are many studies to suggest that obesity runs in families, but how often this is truly due to genetics as opposed to socio-cultural forces and over-feeding is un certain. While there is indeed an exceedingly rare group of genetic disorders where obesity is one of the compo nents of the particular disorder these include All strom' s syndrome and Prader-Willi Syndrome it should be stressed that the weight gain in these disorders is secondary to more prominent complaints. A genetic substrate which is said to interact with en vironmental factors has been postulated. Evidence for this comes from studies on twins which show a greater resemblance in adi posity ( fatty tissue) between monozygot i c than di.zygotic that is idenJ:icoJ as o pposed to sibring twins. 2. Socio-Cultural Fadors In most coses of simple obesity, overfeeding during infancy starts the process. It hos been shown that infants 26 overweight at one year have a greater propensity to be overweight than the normal weight infant. Breast-fed ba bies are less susceptible to becoming overweight than babies fed high calorie infant feeds. Many parent's first response to a crying infant is to feed, however, in later life this predisposes to oral satisfaction as a response to stress and manifests itself in people who eat or smoke more cigarettes when under stress. In the Caribbean, prosperity has long beenassociated with being overweight. This may well have started during infancy when the chubbier a baby was the more healthy he/she was perceived to be. Other perceptions encountered in the community include a belief that fat women prefer fat men as partners and vice versa. Lifestyle factors such as a sedentary lifestyle, over eating (especially carbohydrates or fat) excessive con sumption of beer and a belief that exercise will automat ically result in weight loss, are also important. Hormonal Fadors These probably account for the higher incidence of obesity in women. At the menarche, during pregnancy and at the menopause, an increase in body weight occurs. Most women will cilso gain five to seven pounds permanently after each pregnancy. Oral contraceptives are also thought to play a role either through salt and water retention properties or because of the increased appetite that sometimes occurs. Organic Fadors a) Endocrine abnormalities. These tend to be rare, and such conditions do arise, the weight gain is usually small and results in an abnormal distribution of fat, for example obesity of the trunk as in Cushing's disease. b) Hypothalamic Causes. Trauma, malignancy and inflammatory disease of the hypothalamus are rare causes of obesity. This form of obesity is associated with distinct clinical manifestations. These include changes due to raised intracranial pressu re, endocrine i mbalance and a variety of neurological and psychological disturbances. The Risks Obesity is implicated in three of the five major causes of death in the Caribbean; these are cardiovas cular disease, cerebrovascular disease and diabetes melli tus. Hypertension and diabetes also account for signifi cant morbidity

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Hypertension is three times more common in the overweight individual and the risk of diabetes is increased four-fold Other important complications of obesity include; gallstones, gout, osteoarthritis (especially hips and knees}, menstrual irregularities, infertility, increased surgical risks, decreased exercise tole rance and lower back pain. Treatment There are four modes of treatment currently in use, though two of them are now declining in popularity: a) Changing Dietary Habits This involves daily calorie restriction and eating only at regular meal times. This obviously precludes snacking. Dieting is not a very successful means of long term weight loss because the weight loss is only maintained for as long as the particular diet is being followed. Most times these diets cannot be maintained indefinitely for a number of reasons in cluding health risks. Underlying this form of therapy is motivation unless one is truly motivated to lose weight then failure is, unfortunately, inevitable. Much work is being done on behaviour modification, including rec ognizing the cues which trigger overeating in cer tain people. The one constant factor is that if more calories are ingested than are expended, then the excess calories are converted to fat. b) Regular E xerdse Exercise by itself will not result in substantial weight loss. There are for example, one hundred calories in one can of soda; in order to bum off one hundred calories one would have to walk for one hour or play tennis for half an hour. Exercise though, is important in maintaining muscle tone and offers an alternative to eating or drinking. For exercise to be helpful, one should exercise at least three times weekly and at least half an hour per session. 3. Anoredic Drugs (Appetite Suppresants) These are declining in popularity basically because of side effects Most of these drugs have an amphetamine (speed) base or amphetamine-like base, and side effects include increased pulse rate, nervousness, psy choses, hypertension, stroke and addiction. As soon as one ceases to take the tablets a rebound increase in appetite seems to occur with subsequent weight gain. These drugs are no longer used in most of North America and are becoming increasingly taboo in the Caribbe an. Special note should also be made about taking di uretics (water tablets) for weight loss. In addition to dis turbing the normal physiology of body fluids these drugs also have significant side effects which include diabetes, hypokalemia, gout, impotence and to some extent can contribute to cardiovascular morbidity. 4. Surgery This is also becoming increasingly unpopular. Forms of surgery include various gastro-intestinal by-pass operations, suction removal of fat and the gross practice of wiring the individual's jaws shut. Prognosis This is not very good. The cure rate is approxi mately thirty per cent. The reasons for this are unclear, but failure of motivation and inadequate forms of treat ment are probably important. Prevention This is by far the easiest and most successful form of treatment. Health Education is very important here and the following should be stressed: 1 Obesity is o serious disability 2 Weigh regularly a n d keep within per cent of your ideal body weight. 3. No age group is exempt and it is especially important to avoid obesity du1 ing infancy and childhood. 4. A change in eating habits and regular exercise are the only healthy means of long term weight loss. Calorie Intake Calculation Your weight x 15 = calorie intake which maintains pre sent weight. e.g. 1851 lbs. = 2775 calories subtract 600 calories/day to lo.se 1 lb. week. subtract 1200 calories/day to lose 2 lbslweek. 27

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28 HEIGHT ANC> WEIGHT TABLE FOR WOMEN WEIGH T I N KILOGRAMS AND POUNDS ACCORD ING TO FRAM E IN INDOOR CLOTH ING WEIGH ING 5 LBS. He i ght Small Frame Med ium Frame Large Frame F e et Inches c m l b s kg. l b s k g l b s 4 9 148 102-lll 46.4 -50. 6 109-121 4 9 6 -55. l 118-131 4 10" 150 103 -113 4 6 7 -51.3 lll-123 50.3 -55. 9 120-134 4 11" 152 104 -115 47 1 52 l 1131 2 6 5 1 1 -57. 0 122 1 3 7 5 O 155 106 -118 48.1-53. 6 115129 52 2 -58. 6 125 1 4 0 I S"' f' f 5 7 I 1 08 1 2 1 48 8 54 6 I llB 1 32 5 3 .2-596 7 2 8 7 43 5 2 160 lll124 5 0 3 -56. 2 121135 54 9-61 2 131147 5 3 162 114-127 51. 4 -57. 3 124 138 5 5 9 62 3 134 -151 5 4 165 117130 53 0 -58. 9 127 -141 57. 5 -63. 3 137 155 5 5 168 120 133 54. 6 -6G. 5 130 144 59. 2-65.5 140 159 5 6 170 123 136 5 5 .7 -61.6 133 147 60. 2 -66. 6 143 163 5 7 173 126 139 57. 3 -63. 2 136-150 61.868.2 1 4 6 167 5 8" 175 129 142 58. 3 -64. 2 139 153 62 8 -69. 2 149 170 5 9 178 132 145 60. 0 65.9 142-156 64. 5 -70. 9 152 1 7 3 5 1 0 180 135 148 6 1 0 -66. 9 145 159 65. 6 -71. 9 155176 5 11" 182 138 -151 62. 1 -68. 0 148-162 66. 6 73 0 lj8-179 Adapted from : Metropol i tan Life Insurance Company 1983 Metropol i tan He i g h t and Weight Table for Women HEIGHT ANI> WEIGHT TABLE FOR MEN WEIGHT IN KILOGRAMS AND POUNDS ACCORDING TO FRAME IN INDOOR CLOTHING WEIGHING 5 LBS. kg. 5 3 7 -59. 8 54. 4 -60. 9 55. 2 -61. 9 56. 8 -63. 6 57.8-64. 6 59. 4 -66. 7 60. 5 -68. 1 62 0 -70. 2 63. 7 -72. 4 64. 8 -73. 8 66. 4 -75. 9 6 7 4 -76. 9 69. 0 -78. 6 70. 1 -79. 6 71. 2 -80. 7 Height Small Fram e Medium Frame Lorge Frame Feet Inches cm. lbs. k g lbs. kg. 5 l 158 128 134 58. 3-61 0 131-141 59. 6 64.2 5' 2 160 130 136 59. 0-61.7 133 143 60. 3 -64. 9 5' 3 162 132 138 59.7-62.4 135 145 61. 0 65.6 5 4 165 134-140 6 0 .8-63. 5 137 148 62. 1 -67.0 5 5" 168 136-142 61.8-64. 6 139 -151 63. 2 -68.7 5' 6" 171 138 145 62.9-66. 2 142-154 64.8-70. 3 5' 7" 173 140-148 6 3 .6-67. 3 145 157 65. 9-71.4 5' 8" 175 142 -151 64. 3-68.3 148-160 66.9-72.4 5' 9" 178 144-154 65.4-70. 0 151-163 68. 6 -74. 0 5' 10" 180 146 157 66. 1 71.0 154 166 69.7 -75. l 5' 11" 183 149 160 67. 7 -72.7 157-170 71.3-77 2 6' O 185 152 164 68.7-74. 1 160-174 72.4-78. 6 6' l 188 155 168 70.3-76. 2 164 178 74.4-80.7 6 2" 190 150-172 71.4 -77. 2 167 182 75.4 -82. 2 6' 3 193 162-176 3.5 -79. 8 171-187 77.6-84. 8 Adopted from : Metropolitan Life Insurance Company 1983 Metropolitan He i ght and Weight Table for Men lbs. kg. 138 150 62. 8 -68. 3 140 153 63. 5 69.4 142 156 64. 2 -70. 5 144 160 65.3-72.5 146-164 66.4-74. 7 149-168 68.0-76. 8 152 172 69. 1-78 2 155 176 70. 1-79 6 158-180 71.8-81.8 161184 72.8 83.3 164-188 74.5-85.4 168-192 75.9-86. 8 172-197 78.0-89.4 176 -202 79.4 -91. 2 181-207 82. 1 -93. 9 Extract from : Nutrit i onal Core of Patients w ith Obes i ty D i abetes and Hypertension CFNl / PAHO 1986 I

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NUTRITION AND CANCER: A COMMON SENSE APPROACH CANCER SOCIETY OF THE BAHAMAS Extensive research is under way to evaluate and clarify the role diet and nutrition play in the devel opment of cancer. At this point, no direct cause-and-effect relationship has been proved, though statistics show that some foods may increase or decrease the risks for certain types of cancer Evidence indicates that people might reduce their cancer risk by observing the following recommendations: 1. AVOID OBESITY Individuals 40% or more overweight increase their risk of colon, breast, prostate, gallbladder, ovary, and uterine cancers. People with weight problems should consult their physician to determine their best body weight, since their medical condition and body build must be taken into account. Physicians can recommend a suitable diet and exercise regime to help maintain an appropriate weight. 2. CUT DOWN ON TOTAL FAT INTAKE. A diet high in fat may be a factor in the devel opment of certain cancers, particularly breast, colon and prostate In addition, by avoiding fatty foods, people are better able to control body weight. 3. EAT MORE HIGH FIBER FOODS SUCH AS WHOLE GRAIN CEREALS, FRUITS AND VEGETABLES. Regular consumption of cereals, fresh fruits and veg etables is recommended. Studies suggest that diets high in fiber may help to reduce the risk of colon cancer. Furthermore, foods high in fiber content are a whole some substitute for foods high in fat. 4. INCLUDE FOODS RICH IN VITAMINS A AND C IN YOUR DAILY DIET. People should include in their diet dark green and deep yellow fresh vegetables and fruits, such as carrots, spinach, pumpkins, sapodilla as sources of vitamin A; and oranges, grapefruit, cherries and red peppers for vitamin C. These foods may help lower risk for cancers of the larynx, oesphagus and the lung. The excess use of vitamin A supplements is not recommended because of possible toxicity. 5. INCLUDE CRUCIFEROUS VEGETABLES IN YOUR DIET. Certain vegetables in the cruciferous family cab bage, broccoli, brussel sprouts, and cauliflower may help prevent certain cancers from developing. Research is in progress to determine how these foods may protect against cancer. Cruciferous vegetables have flowers with four leaves in the pattern of a cross. 6 EAT MODERATELY OF SALT-CURED, SMOKED AND NITRITE-CURED FOODS. In areas of the world where salt-cured and smoked foods are eaten frequently, there is more incidence of cancer of the oesophagus and stomach The American food industry has developed new processes to avoid possible cancer-causing by-products. 7. KEEP ALCOHOL CONSUMPTION MODERATE, IF YOU DO DRINK The heavy use of alcohol, especially when accompa nied by cigarette smoking or smokeless tobacco, increas es risk of of the mouth, oesophagus and liver. 29

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BAHAMAS DIABETIC: ASSOCIATION IN PICTURES The Bahamas Diabetic Association celebrates its first birthday in March (1987). Its Youth Club presented a Christmas Concert in December, planned and by members, mostly diabetics, ranging in age from seven to twenty four years. Cast left to right -Alphoso Symonette, Emcee for the programme; Lutina Hanna; Thompson;; Etoile Pinder; Mindy Pinder; Dale Thompson; Hedda Knowles; Kimberly; Jackie davis; Anson fe!rnander and Carlos Janure. \ < \ >. :: >-: < "--,.. ... p r J } ,,_ f> B ,.. ._... ...... r' Dr. Patrick Roberts, Head of Department, Paudiatrlcs, Princess (PMH) Margaret Hospital, enjoying a mc>ment of relaxation after the Concert seen with the youns1est per former, Mindy Pinder (patient of Dr. Roberts). Grease Dance. 30 JOY Etoile, Anson and Hedda. Anson Fernander -a shepherd boy. Rosebud Bell, a diabetic of more than twenty years was the only "adult'' to perform. Her tribute to God, life, friends, health; a heart-warming rendition of My Trib ute. The Youth Club wished its guests, mostly adult, older diabetics "good health" instead of the usual seasond wish. Dr. Cecil Bethel and Mrs. Janeen McCartney, Inter nal Medicine and Chief Dietician, both of the Princess (PMH) Margaret Hospital are most active behind the scenes in the Association.

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AIDS -A PROGRESS REPORT FELICITY AYMER AND ROSA MAE BAIN AIDS Acquired Immune Deficiency Syndrome -that most feared and frightening condition which is capable of destroying the body's immune system (the body's defences against infection) so that patients suffer frequent bouts of serious illness from infections which are ordinarily minor and which is fatal in more than half of all cases, is transmitted in one of three ways:. 1) sexual intercourse homosexual and/or hetero sexual (the main mode of transmission) 2) contaminated blood transfusion and intravenous substance use 3) during the process of childbirth -a pregnant woman infecting her unborn child. Bahamian Scene In The Bahamas, the compilation of data on AIDS began in August, 1985 with the acquisition, by the Blood Bank (PMH), of equipment which permitted blood testing for the virus which causes the disease. Transmission of the disease by means of blood transfusion therefore should not occur. (Testing was instituted in Freeport one month later, in September, 1985). Mode of transmission The major mode of spread here in The Bahamas is bv sexual intercourse for adults and in children, at, dur or shortly after birth from infected mothers. Prevalence AIDS has been diagnosed in persons from the fol lowing islands: Abaco, Bimini, Eleuthera, Exuma, Grand Bahama, New Providence and total eighty six, thirty six m 1985 and fifty in 1986. Up to 31st December, 1986, there have been thirty six deaths in addition to one hundred and five persons who have tested positive for the AIDS virus twenty in 1985 and eight}five for 1986. The latter do not nec essarily have the disease. Please note:-it is estimated that, for every one case of AIDS that is diagnosed, there are at least twenty five persons who carry the dis ease have tested positive for the AIDS virus. While only a small number of persons who test pos itive for AIDS will develop the disease, these persons ALL carry the virus and can infect others through the exchange of body fluids, that is semen and blood. Manifestations of AIDS The symptoms most often seen here in The Bahamas are rapid weight loss; chronic diarrhoea, skin changes (patchy discolouration, flaking, dry skin) beginning on the legs and spreading over the whole body, thrush infection of the throat, tuberculosis and inflammation of the brain (identified on post mortem examination). Warning signs include: night sweating, rapid, unex plained weight loss -(in central Africa where AIDS affects both men and women equally the disease is known as SLIMS disease}, persistent diarrhoea (two weeks and longer). Prevention It cannot be stressed often enough that any person who is sexually active is at risk of contracting any sex------------------------------------------------------------------------------------EVALUATION Help us to make the newsletter as interesting and informative as possible. Please complete, detach and return this short evaluation form to the Health Education Division Ministry of Health, Nassau, Bahamas. Tick the most appropriate response. 1. How did you find the newsletter? a) very interesting b) interesting c) somewhat interesting d) uninteresting e) did not read 2. Was there any article of particular interest to you? Yeso Noo If yes, please give title ........... .... .... ... ......... ... ....... .............. .... ..... ......... .... .... ........... .... ....... ...... .............. ...... ...... 3. What changes, if any, would you like to see? .................. ................. .... .............. ......... ........................... .............................................. ......................................................... 4. What topics would you like in future issues? ...... ... .. .... .................... ...... ...... .... ....... .............. ................... : ... ... . 5. Would you like to contribute to this newsletter? YesoNoo If yes, please give name and address. Name: ... ... ............. .... ......... ... ...... .... ...... .......... ........ ..... ... ......... ........... ....... ... ..................... ...... ........... ..... .... ...... Address : .... ....................................... .................. ...... .................... ...... ........ ......... .... ........... .......... ............................ Thank you for your co-operation! A Happy and Joyous Easter. 31

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ually transmitted disease, including AIDS. The more sex ual partners that an individual has, the greater are his/ her chances of contracting one or more of these diseases. Each sexually active person can minimise/eliminate the risks by: 1. limiting his/her sexual partners to one. 2. getting to know the partner well, BEFORE sex ual intercourse occurs. 3. maintaining high standards of personal health with regar.d to, for example, nutrition, exe rcise, rest, recreation and stress reduction. For those who find these rules too the risks may be reduced by: 1. use of a barrier method e.g. condom for men along with a water-based spermicidal jelly such as Koromex Cream during the sex act re1gard less of sexual preference and practice 2. reducing the number of sexual partners 3. maintaining high standards of personal hec 1lth. AIDS, like all other sexually transmitted diseases e.g. gonorrhoea, syphilis, chlamdyia, herpes, is transmittEtd by "the exchange of body fluids" semen, vaginal/cervi cal secretions -as a result of close body contadt and NOT by means of casual contact, that is shaking hands or even living in the same house as a person who ei ther has/ or carries the disease. Taealment of patient with AIDS A weekly clinic for patients and contacts with AIDS is now held at the PMH. Regular follow-up is done. Patients who require hospitalisation are nursed in a special ward and staff maintain strict barrier nursing practices. To date, there is no documented to show that health care attendants have contracted the disease as a result of their occupation. Dentists are con sidered at low risk. What everyone should know about AIDS 1. AIDS is caused by a virus there is presently no vaccine to prevent, no effective treatment nor cure. 2. The AIDS virus lives in semen and blood. 3. The disease is spread through a) sexual inter course anal and vaginal -with an infected partner b) contaminated blood sharing of needles usually by intravenous drug users. 4. The more sexual partners an individual has the greater are his/her chances for contracting the disease. 5. All persons whose tests are positive for the dis ease are carriers and can infect their sexual pcrt ner(s). 6. Most people who have the virus don't know they have it. 7. AIDS develops slowly, over a period of two to five years; in children infected at/during birth, the period is usually months. 8. AIDS is fatal. 9. AIDS is not transmitted during normal social con tact and is in fact hard to catch unless the man or woman has many sexual partners. 10. Oral sex with an infected person could be risky. 11. Proper use of a condom during the sex act offers some degree of protection. 12. Giving and receiving blood is safe. 13. Prostitutes and users of base houses are among the high risk groups in The Bahamas. 14. Any person having his/her ears pierced should ensure than or;tly unused or sterile equipment is used. : : ':::::':::::iii !ii iii 32

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ALLEN, Dwight AYMER, Felicity BAIN, Rosa Mae BENJAMIN-PEET, Evet FOUNTAIN, Leila JOHNSON, Marcel RASHAD Munir ROBERTS, Paul WILSON, Catherine WHITFIELD, Patrick McNEIL, Percival Photographs courtesy of: Felicity AYMER Ken Ofosu BARKO Lyall BETHEL Audrey DEVEAUX Ashward FERGUSON Stephanie CARROLL Harcourt PINDER Donna SMITHDIAL ABOUT THE CONTRIBUTORS is a Health Education Officer, Ministry of Health. is a Health Education Officer, Ministry of Health and Editor is a Community Nurse, Community Nursing Services, with responsibilities for Com municable diseases. is a mother and Paediatrician in private practice. is a Community Nurse working in the Carmichael Road area. is a Community Nurse presently working in the Community Nursing programme in the Department of Nursing Education is the Senior Dental Officer, Dental Department PMH. is a Consultant Paediatrician, General Practice Clinic, PMH. is a Community Nurse, Community Nursing Services, Carmichael Road Clinic. is a Consultant in Family Medicine and the officer in charge of the General Prac tice Clinic, PMH. is a Consultant Paediatrician at the The Princess Hospital and the Co-ordi nator of the National Committee for the Control of Diarrhoeal Diseases. Mr. Anthony Brown, Audio Visual Section, PMH. Dr Ken Barko Editorial Committee Mrs. Jewel Flowers, Rand Memorial Hospital Mrs. Pamela Pinder, Pinders Customs Brokerage EDITORIAL COMMITIEE Health Education Division (Editor) Public Health Department The Counsellors National Insurance Board Architect Dah amas Assoc iation of Life & Health Insurers Health Education Council Broadcasting Corporation of The Bahamas

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--HEAL TH CARE PROVIDERS LET'S BLAZE A TRAIL GO FOR SAFETY Cover Design by: THEOPHILUS THO M PSON LESLIE JOHNSON ASHWARD FERGUSON IN 1987 NASSAU, BAHAMAS


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