Joining hands for health: caring and sharing at Easter time (Vol 4: no. 2)


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Joining hands for health: caring and sharing at Easter time (Vol 4: no. 2)
Abbreviated Title:
Joining hands for health
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31 p. : 28 cm.
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Public Hospital Authority
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Nassau, Bahamas
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Health care--Bahamas.   ( lcsh )
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Caribbean Area

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College of The Bahamas
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TABLEOFCONTENTSEditorial Where Do Babies Come FromleilaFountain & Catherine Wilson BreastisBestMarcel Johnson Paediatrician and MotherEvetBenjamin-Peet Growth Development and Early Childhood StimulationPaulRoberts Baby'sTeethAre Important :..MunirRashadImmunisation Felicity Aymer Understanding Diarrhoea Percival McNeil ChristmasinGrand Bahama..Up-Date Felicity AymerTheGooseGotFatDwight AllenTheOverweight Problem Patrick Whitfield Nutrition and Cancer Cancer Society Bahamas Diabetic AssociationinPictures..AIDS-,A Progress Report Felicity Aymer &RosaMaeBainEvaluation About the Contributors Editorial Committee .Page22561011131416252629303131Inside Back Inside Back


EDITORIAL ursing()I.. 5 1987 TheEaster editionofJoining Hands For Health dealsinthe main, with the careofthe young child under the ageofone year, a critical periodinthe lifeofevery individ ual.Atthisage the childhasdeveloped very few defences against the many infectious agents which liveinand co-existinourenvironment.Thebabyistherefore especiallyatriskofdeveloping diseases which can lead to serious illness, disabling conditions and death. Protecting the health and lifeofthe nation's babiesisoneofthe priority areas within the MinistryofHealth and should be the chief concernofevery parent.Thiscan best be done through promotionofexclusive breastfeeding by every motherofevery childforat least the firstfourmonthsoflife.Ina society in which more than halfofall mothers are single andinwhich parentsworkoutside the home,thismay well not be practical. A reviewofthe situation though, may reveal that more women, given the active supportofhealth providers, couldinfact give babies breast milk exclusivelyforatleast the first four monthsoftheir child's life. Perhaps mothers may wish to consider negotiating with employers to facilitate breastfeeding. A commitment to sustaineduseofan effective methodofchild spacing wouldgoa longwayto reduce employers' reluctance to provide practical and much needed facilitiessuchaslonger paid maternity leave, nurseries attached tobusinesshouses, flexible working hoursformothersofvery young children under the ageofsix months.Basicimmunization coverage by the ageoftwelve months, safe transportation to gether with loving, caring parents are only someofthe other essential needsofevery young child.Thebabywhoisheldinone arm while the parent tries to control the ve hicle with the otherismost vulnerable. Bumper stickers warning "Babyaboard"isno insurance against rear-end collision.Thebabywhotravels in the armsofthe front seat passengerisequallyatrisk.Babies aremuchsaferinspecial seats/carriers on the back seat where they arelesslikely to be thrown through the windscreen. For those readers with other interests, we have begun to focus on health promo tion,ofadults. However, health promotion really beginsininfancy andthiswill be dealt withina systematic and detailedwayinthe next and subsequentissues.


WHEREDOBABffiS COMEFROM?LEILAFOUNTAINANDCATHERINE WILSONA question frequentty askedbyusamong ourselves whenweweregrowingup andattimes whenwefelt themoodwas rightwewould dare to askourparents was''Wheredobabies come from?" Living in small neighbourhoods, it was very easytoknowall the womenwhobecame pregnant. It was also easytoobserve themastheir bellies grew. The common description was "sheiscarrying ababy"or" she big",or"heavy".Wewouldwatch those belliesgrowandgrowandgrowuntil it seemedasthough they would burst.Howdid the babies get in their mother's bellies?Howwill theygetout?Wewould wonder.Atthis stagewewould askourmothers,"Howwill the babies come?" The babies theywouldsay, comebyplane,byboatorstork."Howdid theygetin their mother's bellies?" andMamawould always say, ''When youaregrownyou will know".'Wellmama;howthe mangetto be the daddy?"Mymotherwouldrespond quickly, ''That's man and woman business". The questions continued inourminds,"ifbabies camebyplanes and boats,whywas it necessaryforthe mothertobeputtobedfornine days in closed rooms, curtains drawn, lights dimmed, frequentvisitsfrom the midwife, the bush bathformother andbabyontheninth day, the midwife,orgrannyasshewas called taking thebabyfora stroll around the house nine times, firstexposuretothe sunlight and the outside world?" You would think thatifbabies camebyplanesorboats that they werealreadyexposed. "But,ifmama sayso,it's so".Ifnew babies were broughtbythe stork, planeortheboat,whywas it necessary to transport the pregnantmothertoNassaubyboattohave her baby?Ourbest sourceofinformation came from theanimals.Living in a farming environment and having hogs,goats,chickens and other animalswhowere notawareofourcurious minds and unanswered questions haditsadvantages.Anotherquestion emerged whenattimes it wasnecessarytoassistmother with difficult deliveriesofthese ani mals.Weretheir deliveries similarordifferent to thehumanmother? Thereareno limits to the questionsinthe minds of children.Wecan also appreciate the dilemmaofparentswhofound themselves faced with questions they were/arenotcapableofanswering,forwhatever reason.Ourgeneration was capableofasking questions. We were givenfewanswers, andforthe most part those few answers were untrue.Thisnew generationismore curious and more fortu nate, isn'tit?MARCELJOHNSONIntrodudionToday, only a small percentageofBahamian moth ers breastfeed their babies,thusbottte-feedingseemsto be theorderofthe day.Manymothers feel that itismore convenienttobottte-feed, however, concomittant2with bottte-feeding are the high costofartificial feeds and thedangerofinfection. Between1978and 1983,ofall the reportedcasesofdiarrhoea in young children, twentytwoto twenty ninepercent were admitted to thePrincessMargaret


Breastmilk issogood!Hospital. Infant feeding practices are significant factors which contribute tothisproblem.Thisarticle will focusonpreparationforbreastfeeding, advantages, constraints and mythsaboutbreastfeeding, weaning and feeding from the family pot.PreparationforbreastfeedingEvery mother should be encouraged and well pre pared to breastfeed her baby. Ideally this preparation should begininearly pregnancy.Thebreasts enlarge during pregnancy, therefore itisadvisableforthe preg nant woman toweara well-fitting bra. Special maternitybrasare available and should bewornforsupport and comfort. Hygieneofthe breastsisvery important.Themothershouldwash her breasts daily,drythem carefully andrubthe nipples gently with vaseline, lotion, lanolin cream or baby oil to keep them soft and supple. During thisprocess,the nipples should be pulled out between the fingers to make them stand out and to prevent soreness when breastfeeding. Towards the endofher pregnancy the woman may observe a thin, yellowish fluid coming from her nipples.Thisfluidiscalled colostrum.Thisshould be squeezed from the breast from the thirty fourth weekofpregnancy.The expressingofthe colostrum enablesthe milktoflowmore easily.AdvantagesofbreastfeedingThebest milkforanewbornbabyisbreast milk. Recent information agrees that breastfeedingismost de sirableforboth mother and infant from a nutritional and emotional/psychological stance. Studies show that even motherswhoarepoorlynourished provide enough milkofgoodquality and only the vitamin content may belowifthe mother's are vitamin deficient. Breast milkisconvenient and needs no preparation. Breast milkischeaper than artificial milk. Itcostsmuchlesstoprovide a nutritious mealforthe preg nant mother thantofeed thebabyon artificial milk. Breast feeding promotes bonding.Thisisthe close relationship between the mother and baby. Breast milkispractically sterile and it also prevents thebabyfrom getting manyofthe infectionstowhich young babiesaresoprone. Breastfeeding aids involutionofthe uterus.Themore vigorously thebabysucks,thegreaterthe supplyofbreast milk. Ninety fivepercentofmothers can successfully breastfeed their babies.Womenwhobreastfeed their babies may have no periods (amenorhoea) during the time. A reliable birth spacing methodishighly recom mended.Ifa mother has flatorinverted nipples, breastfeed ing may seem virtually impossible. Itispossible, however,foreven this mothertobreastfeedifsheprepares herself during pregnancy using someofthestepsmentioned above.Wearinga breast shield should also help. A mother with twins can also breastfeed her babies.Thebabies' sucking stimulates the breasts to produce the milksothere will be sufficient milkforoneorboth babies.CONSTRAINTS/MYTHSABOUTBREASTFEEDINGThereareafewconstraints to breastfeeding.Thesearepsychiatric disorders, severe epilepsy and infections. Itisanoldmyth that breastfeedingcausesthe breaststosag.Thisisnottrue. Agoodsupportive bra helps the breaststoremain fuller and rounderforalongerperiodoftime.Thequalityofbreast milkisnot determinedbyitsappearance.3


Weaningandfeeding fromthefamilypotWeaningisthe gradual introductionoffoods other than milk to the infant's diet.Thismilk could be either humanorcow's. Breast milkisobviously more desirable.Theinfant should be completely breastfedforthe firstfourmonthsoflife.Atfourmonthsofage the mother may begin intro ducing weaning foods.Shemay begin with thick cereal mixed with milk and some brown sugar added to sweet en.Thecereal should be fed tobabyfrom a cup and spoon. Itisimportant to remember that weaningisa grad ual processsothe mother should begin using a littleofeachfoodata time.Shecouldusethe homemade ce reals,forexample, cornmeal, creamofwheat, oats.Usetwotothree teaspoonsful initially thengradually increase the amount.Bythe time thebabyissix months he/she should be havingfourouncesofcereal twice daily.Atthis time (four months), fruit should be introduced. It could either be mashedorjuiced.Themother can give thebabymashed fruitorfruit pureed in a blender.Shecan alternate the fruit with juice. Fruit can be given twice daily.Whenintroducing weaning foods, motbers should re member that itisimportant to introduce each newfoodslowlyoverthe periodofa week toallowthe baby to become accustomed to new tastes and to be able to detectanyallergies easily. 4FeedingfromthefamilypotBythe time the childissix monthsoldhe/sheisreadytobe introduced tofoodfrom the family pot.Themother should mix a varietyoffoodfrom thesixfood groups to ensuregoodnutrition.Thisembodies theuseofthe multi-mix concept.Themeal should always begin with a staple. Itisimportant to give well cooked mixturesofstaplefoods (eg. rice, macaro!1i, potato, grits) peas and beans with theskinsremoved,foodfrom animals (eg. eggs,meat,milk, fish, cheese) dark, green leafyoryellowvegetables (eg. broccoli, carrots, pumpkin, spinach).Thefoodshould be moistened with margarineorgravy.Fruitsand fruit juices will complete the meal. About six tablespoonsful should be givenatsix monthsofage.Thefoodshould be taken from the familypot,mashed with aforkand rubbed through a strainer. If the mother has a blendershecan puree thefoodinher blender. For a six month oldbabythe mother shouldusetwotablespoonsfulofweaning mixture. A seven-month-old can havefourtablespoons of weaning mixture.Theamount should gradually beIncreasedasthe child gets older.Bythe time the childisnine monthsofagethe'multimixes' can be chopped coarsely to encouragetheinfanttochew.largeramounts should be given and fruits contin ued. Breastfeeding should be continued.Bythe time the childistwelve monthsofage she/he should be eating mostofthe foods cooked for the restofthe family. During weaning, the mother should not givethechildfoodwith high seasonings.Sheshouldallowthe childtodevelop his/herowntaste. Peppers andspicesarenot recommended. Itisimportant that the mother observes high stan dardsofpersonal hygiene and domestic cleanliness, thorough hand washing before preparingfoodand feedingbabyiscritical to his/her health. Itishoped thatthisinformation will encourage more mothers to breast feed their babies andatthesametime helptoreduce the incidenceofdiarrhoeainthe community. Knowledgeofbreast feeding and positive ap proaches to breast feeding and weaning will enableTheBahamasasa community to make greater and more ef fective strides towards attainingourgoalof"Health For AllByTheYear2000".


PAEDIATRICIANANDMOTHER ) EVETBENJAMIN-PEETFirstofall, letmesay that whatever profession any womanhas,weall have one basic thingincommon -weare females/women/mothers.Theexcitementofbeing pre gnant with a wanted childisuniversal and I was no exception.After the first three monthsofmorningsicknessand cravingforlong forgotten foods, my equilibrium was re-es tablished and I functionedasanormalworking PaediatricResident with my24hourormore on-call rotations.Mygreatest fears were whether my child would be healthy and normal the gender was unimportant mostofusare aware that the riskofhaving offspringwhoareillormal formed appears to be greaterforwomeninthe medical world. Needless tosay,my anxiety was allayed when our beautiful daughter arrivedinthisworld on Friday, the sixth of December, 1985. Her father arrived on thesceneone hour before delivery after having taken two aeroplaneswitha most unwanted delay between flights. He was andstillisthe proudest fatherintown. Having gone through labour, Inowrealize that thepainonly disappears when the babyisborn Pethidinemakesone drowsy enough to sleep between the contractions,whilstyourcoach and the breathing exercises allow your mind to concentrate on something more pleasant. Itwasworth it all when I was able to hold my beautiful Princessinmy arms hereshewasinthe landofstrange giantswith only one familiar heart MINE! MOTHER! Enter the next phase, feeding breastfeeding!Whoever said it was going to beeasy?Initially, it was absolute ly painful and I evengotcracked nipples; but knowing the proven advantagesofbreastfeeding, I persevered. When I could not bear the painofsuckling, I resorted to expressing the milk into a bottle.Mypersistence paidoffbecause after afewweeks, the pain andsorenessdisappeared and I be gan to reallyenioythe nurturing process. Vinette was 3.15 kgatbirth but doubled her weightbythe timeshewas four months andshedeveloped rapidly, attaining someofher milestones before the standard ages.Shewas breastfedforsixmonths and would have continuedforlonger but the pressuresofResidency and studyingforfinal examinations were not conducive to the prolongationofthis rewarding experience.Shewent through her colicky phase and responded well to being walked to and fro;daddywas proficientatthat!Shereceived her primary immunizations without squealing andhascontinued to feed and develop in a very healthy manner.Shewas introduced to fruitsatage four months, thenasshegrewolder, other foods were added.Sheisgiven natural foodsasopposed to preservedfoodstuff and these are pureed in a blenderbefore eating. Herfoodiscooked without seasoning andshegets no sugarinher orange juice.Sheisnowone year andsevenweeks old and weighs11.8kg.Sheiswalking, running (calling), climbing and speaking in longsentences,with inflections, but I haven't masteredthe meaningsofher languageasyet. Having been through the processofpregnancy and childbirth andnowgoing through her stagesofdevel opment, I certainly have a better insightinmy chosen pro fession and I know I will be a better Paediatrician and mother becauseofmy unique combination.5


GROWTH., DEVELOPMENTANDEARLY CHILDHOOD STIMULATIONPAUL ROBERTSTheassessmentofdevelopment necessitates akeenobservationanda basic knowledgeofthe normal age rangesatwhich children achieve given milestones. TableI.TableI:Agerangesatwhich milestonesarereachedFailuretogainweightortoincrease heightorlengthmaybe the first indicationsoffailuretothriveormalnu trition.Itisalso importanttorealise that when plotsofmeasurementsonsuccessive occasions cross percentilelines(thatislinesonthegrowthchart), though they remaininthe normal range, that thismaybe an early indication that 'somethingisgoingwrong'andthat more experienced ad vice should be sought. In the event that theageofa childis n9t known, informationofthe child'sgrowthand well-being maybederived from plottinghisweightagainst his' height.Wheregrowthcharts arenotavailable the following formulaeareusefulforestimating the predicted weight or heightofa childata given age.l.Predictedweight(wt.)Ibsforage(3-12months). wt.=[,age (months)+11]Ibs.2.Predicted ht.(ins.)fromage(2-14years). ht.= [(2Y2 x age)+30]ins.3.Predicted wt.(Ibs)asa functionofht. ; wt.(Ibs)=[48+ (l.i-23) x Ibs.4. Predicted adult ht. FormulaofTanner et al (Relates Ht.at3 yrs.toexpected adult height)IAdultht.(cm)=l.27x htJ+54.9cm(male).Adultht.(cm)=l.29x htJ+42.3cm(female).0-2 0-32 33-5 5-98-129-129-119-119-12 12-149-1514-21Age(months) Smiles Holds up head Reachesforobjects Turns to soundSitsalone Creeps Walks with support Drinks from cup Attemptstofeed self Pincer grasp Says 2-3 words Walks alone 2WordSentences Milestone The termgrowthisusedtoindicate an increase inbabysize which results from an increase in the number and, or, sizeofindividual cells which make up the body.Growthanddevelopment are continuous processes in each individualandoccur in anorderlysequenceforev eryone. There are, however,greatvariations in these processesfromoneindividualtoanother. These variations are duetohereditary and environmental factors. Both growthanddevelopment beginatconception and continue to ma turity. Those..charts which are available, provide useful guidelinesforgrowth.Growthcurvesvaryfrom onepopulation toanotherasa resultofa numberofinteracting factors,forexample race (Orientals and Indians are gener ally smaller than Caucasians and Africans. There are also race differencesasseenbycomparing the largesizesofmembersofthe Bantu tribe with the smallnessofmembersofthe Pygmy tribe); sex (boys are generally bigger than girls and each show periodsofaccelerated growth);geographical factors (populationsatsealevel generallygrowlargerandata faster rate thandopopulations at high alti tudes); socio-economic factors(asanitary environment,adequate nutrition and health care enhance growth and de velopment); psycho-social factors(achild deprivedoflove, affection and interpersonal interactions will show growth and developmental delay). Itisalso important to note that variations occur in each population (small parents will gen erally have small children). From thegrowthcharts one may find that a child's headgrowthislagging behind the other parameters; this may be an indicationofmicrocephaly (small head) whichisassociated with mental retardation. An increase in headgrowthofmore than one centimeter in circumferenceperweekmay indicate hydrocephalus (water-head), which re quires a shunt operation to reduce flUid accumulation ond intracranial pressureinorderto prevent mental retardation and destructionofbraintissue.Development, on theotherhand, signifies maturationoforgansystems,the acquisitionofskillsand the ability toadapttochanging situations.Growthand developmentofchildren may easily befollowedbymedical and paramedical perSonnel. Growthisfollowedbysimply measuring weight, heightorlength, and head circumference.Themeasurements are plotted ontoagrowthchart(asseenona child health Passport), from which an impressionofhowa childisgrowing, in relationtowhatisexpectedfora given populationofchildrenofthe same age, can be made. See fig.I.6


alMotorItshould be realised that thereisa wide rangeof'normal'indevelopmentalterms,forexample, some ,childrenwalkasearlyasseven to eight mon'thswhile otherswalkat fifteen months. Development may be divided into four major categories:i)Gross (head control, roIling over, walking).ii)Fine (more controlled and skilled movements, e.g. hand to mouth, pincer grasp, writing)blSocial-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 (acquisitionofwords and using them meaningfully to commu nicate).d)Cognitive functioning (conceptionofthe environment andhowone relates toit,e.g. turns to sound, foHows objects visually, explores objects,useskey to wind toy). Any childwhoislagging behindinall (global delay) orinoneormoreofthefourareas should be evaluated in great detail both physically and developmentally toobviateany treatable causeforthe delay. A numberofdevelopmental screeningtestsofvarying complexities have been developed. Perhaps the most com monlyusedoftheseisthe Denver Development ScreeningTest,whichtestsallfourdevelopment categories.Atthe end of each test oneisabletoconclude the levelatwhich a childisfunctioningforeach category.Theresultsofthe screeningtestswill enable one to deviseearly stimulation programmes to suit the needofeach individual child, emphasizing the categoryorcategories in which the childisfound to be deficient. Developmentisgreatly influencedbyenvironmental factors which may significantly modify hereditary factors. Down's Syndrome,forexample,isa disease due to chro mosomal anomalies andis-associatedwith'global delay. Manysuchchildren,ifstimulated early, i.e. are shown a great dealoflove, patience and assistanceinlearning and acquiringskills,may become self sufficient and managesimplejobs to support themselves (some children with Down's Syndrome have been reported to have acquiredskillsin advanced mathematics). Environment may also greatly influence the devel opmentofa 'normal' child. Children raised in an inade quate environment, e.g. an hostel where thereisa shortageofpersonnel and lackofindividual attention,ora deprived home setting, may show evidenceofpsychomotor retarda tion after monthsoryearsofneglect. Sub-standard nutrition also plays a role in delayed development: severe malnu trition over a prolonged period may cause permanent handicap.Mostofthese 'normal' children will, however, 'catch-up' developmentally once the environment improves and adequate stimulationisinitiated. Children raised in 'optimal' environments realise their developmental potentials earlier, are usually ambitious and lead successful lives.Theimportanceofmonitoring growth and devel opment and instituting early childhood stimulation cannot be over-emphasized.Thesemay help to reduce family fears and anxiety, improve the well-beingofaffected children and reduce the expenditureofindividual familiesaswellasatthe national level.Baselinedataonwhichtomonitortheinfant'sprogressiscollededbytheNurseandDodoratallbabyclinics.BaselinedatabeingcollededbyNurseatinfant'sfirstvisit.7


co ICARIBBEANGROWTHCHART (WEIGHTFORAGE)I 22 oz-. -221 .... Nam._ .......................................... &AJ/" Oat.of birth. ............................ --?n--,,------19 l/iai ---.---1818 ". -----I-------...... ----.......J1717 ",, oZ r__I---------------------.... -2 16 .16 --I--I------I-----.... -..... -------.i: 15 15ffiti<.!) -_I----.... ----------I--I-r--.....14........14--....UIUI ------?I-........... -----I--.... -----.... _.. 13....13V ",,'"----------f-fI-.,--__""'!:.... .-I---I--f---12I-I-__ I--I-_______ ", _______ -,.... ___ I-______12-I---f-f---.II. .. I--'"..II to---I--..... --7k --I-... .--"..;;;........ ---I-----..7........ ..,10 10. -I-------7--"7-f-I--I--:;---I--------I-I--;......::.. --" 1-" 9 9 .... f...... _--t:I-----I----I--------f-.I--1----.... f-----/'_....... ...... CI) 8 .,'I"""""'io""'" .",,.,8.... 2 --I---I --". -I-r------,;::._..... I--I----I-I---to--_ .c V ......... u: 7 .-e' ,, IL384060 ----:,? ----.::" ---.-------006 / ..," ): ...J ....gj -f-VI-I---L-------------I----------!c5: ,.'05 _... =-""=':'1____ '__ __ --4:5262728 29 3031 324th YEAR 5thYEAR4/-,/ .'0 ___ ________ ...... __I-___ f0 3 / ..'. 13t4 15161718192021 222324 3rdYEAR 2 .'..WATCHTHE DIRECTIC*OF THE ...2. LINE SHOWINQTHE CHILds QROWTM oI2 35 67 I 910II I IIIIII2ndYEAR .-. z 1000 DANIERVERY AGE IN MONTHS "'"DlNMROUI I ..(E:'RCARIBKAN FOOD a NUTRITIONINSTITUTE (MHO /WHO) .-M


CLINICVISITSDateswhenappointmentsgivenAgestobringchildbytheclinicstoclinicSchedule I XReschedule I X1 month 2 months 3 months l--4 months 5 months 6 months 9 months12months15months18months21months24months30months42months54months TAKE HOMEGROWTH CHART HealthCentreRegd.No.ChiId'sNameDateofbirthMother'sname:Guardian'sname(ifotherthanmother):Wherethechildlives(Address)BROTHERSANDSISTERSYear Boy/ Year Boy/ofRemarks of RemarksBirthGirlBirthGirl I =Keptappointment;X=DidnotkeepappointmentHOME,HOSPITALORDOCTORVISITSSUGGESTEDFEEDINGSCHEDULE FOR THE FIRSTYEAROF UFEDateRemarks/DiagnosisInitia1 DateRemarks/DiagnosisInitiaI ,"',or, I ,""',', I l..,.'<', I II "IJIm I iIDITHI II IDITHI I. "IJITHS I 9IDITItS IID _ItS11IIDITHS I12 IUIlIS I IZATlONSLANDMARKSOFDEVELOPMENTNormalAqeRanqeBalancesheadat--months3-6monthsFirsttoothat--months5-8monthsSittingwithoutsupport__months 5-11 months Abletowalk fewsteps--months 12-15 months Abletospeak4-5singlewords__months 15-21 monthsToilettrainedmonths24-36months--WHOOPINGCOUGH,TETANUSPOLIOMYELITISWhentoANDDIPHTHERIAGet Date GivenOateGivenThreeFirstdosedosesby7mths.SeconddoseatleastThirddose1 mth. apart.Firstbooster18mths.Second booster3-6yrs.TUBERCULOSIS(BCG)MEASLESRUBELLA(birthor3 months) (9to15months) (9to15months) Date Given Date Given Date Given OlllJllitrs16.1-->.;\;'IWI\"J\11\JA\Jr;;; I illI1\ rwr;;; ... ; f.'-r'D;p:..;k9t9 '} :'11:@"t .,I :", '"'Jr.JJ.(/!J : :.0."1: ';.y('-..9':,4.-,t,l-0


BABY'STEETHAREIMPORTANTMUNIRRASHADDental health careisan area thathaslong been ne glectedbythe general public.Thisis :especially true when it comestodealing with infants. 'Mostparentsand/orguardians are notawarethat ba bies suffer from a numb.erofdental problems that can be preventedifcertain basic measures are taken. Dental problems startininfancy,asearlyasage six months when the"baby"ordeciduous teeth start to erupt.Thisphenomenon, commonly knownas"teething" can be and very oftenis,painful to the young child.Thesymptomsvaryfrom moderatetosevere paininthe areaofthe gums where a toothisstartingtoerupt, along with slight swelling and rednessofthe gums and slight to moderate fever.Theproblemofteething can be dealt with quite easily since the treatmentisconfinedtorelieving the symptoms that often accompany the teething process,forexample, rubbing the gums with soothing agentssuchasora-gelorgiving thebabypain relieverssuchasbaby aspirin. Itisnotuncommonforthe infanttobe given a pacifierorsomethingtochew on during the teething processasthishelps the erupting teeth to break through thegumsmore readily.Oncethe teeth start to erupt, the child's mother should be concerned with keeping thesebabyteeth healthy.Aslongasteeth are present, dental cariesisa potential prob lem and will start whenever the factors that lead to decay Itiswell known that the mouth harbours a varietyofbacteria that, given thepropersubstances to feed on, namely sugar, can produce acids thatwearawaythe enamelofthe teeth and initiate the processofdecay. When toothdecClYorcariesstarts,the process continuesuntil itisstopped either by a dentist filling the toothorbycomplete destructionofthe tooth,abscessformation and eventuallossofthe tooth.Oneofthe most destructive formsofdental decayisthe phenomenon knownasNURSING BOTILE SYN DROME.Thissyndromeisalso knownasNursing Bottle Caries, Baby Bottle Caries, Bottle Mouth Syndrome,NightBottle Syndrome, Nursing Mouth and Prolonged Nursing Habit. Itisseenin infants from one to four yearsofage andisa distinct patternofdecay involving the deciduous upper anterior teeth (incisors andcuspids)upper andlowerfirst molars andlowercuspids (both upper andlowerteeth).Themost common denominator in allcasesofnursing bottle syndromeisthe fact that the babies were allowed to10goto sleep with a bottle propped up in their mouths, a problem whichisvery common here inTheBahamas. A studydonein1985atthePrincessMargaretHospitalrevealed35%ofall childrenfouryearsoryoungerwhohadtohave dental extractionswerevictimsofnursing bottle syndrome.Thisfigureishigh when compared with a worldwideincidenceofeightpercent. It should be noted that babieswhowere breastfeddidnot present with this problem.Theproblemofnursing bottle syndrome can bepreventedifthe following measures are taken:1.Mothers should breastfeed their babiesforatleastfourtosix months.2.From birth, mothers should hold their infantswhilefeeding.(Thisisautomatic incasesofbreastfeed ing).3.If the child falls asleep while feeding, burpandplace in bed.4.Start brushing the teethassoonasthey erupt.5.Discontinue bottle feedingassoonasthechildcan drink from a cup (twelve to fifteenmonths).6.Usea supplemental fluoride rinseifnaturalfluo-rideisnot in thewatersupply.7.Restrict the child's intakeofsugar.8.Watchforearlysignsofcaries.9.Start regular dentalvisitsforthe child frombetween eighteen and twentyfourmonthsofage.Oneother factor that has to be consideredasleadingtodentai decayisthe resistance of the host (teeth) todecay. Teeth which havelowcalcium content are moresusceptible to decay. Prenatal careofthe mother, especiallyinthe areaofnutrition, plays a very important part inwhetherachild's teeth will be susceptible to decay.Apregnant womanwhoisnot getting an adequate supplyofcalciumand phosphorous can give birth to a childwhoisdeficient in these minerals which aresoessentialforthe properdevelopmentofbones and teeth. Pre and post-natalcareistherefore necessary in the preventionofdental problemsinboth mother and child.Aslongasinfants have teeth, they are subject todecayjustasthe teethofolderchildren are subject todecay.Treatment can be very expensive. Prematurelossofbabyteeth can leadtoorthodontic problems in theteenageyears. Preventionisthe key and parentsmustassumetheprimary responsibility in preventing dental decayintheirchildrenbybecoming informedofpreventivemeasuresandimplementing them.


Whatan excellent first birthday presentforany child!Mr.Henry SMITH,WHO/PAHO'sImmunizationOfficerworking fromCAREC'sOffices in Trinidad,visitsTheBahamasannually to carry out Immunization Audit-Monitoring and evaluating the national immunisation programme.Lastyear, a visit toGrandBahama was included inhisitinerary. He was accompaniedbyMrs. Fredricka Sands, Immunization CoordinatorforTheBahamas and Medical Officer,KenOfosu-Barko on the visit.TheWorldHealth Organisation (WHO)hassetasitsgoal, the achievementofcertain basic acceptable levelsofhealthforall people comprisingitsmembershipbytheyear2000(Health For AllByTheYear 2000).Theselevels will obviously differ from countrytocountry, but oneoftheWorldHealth Organisation's sub-goalsisthe availabilityofimmunisation services to all childrenbythe year 1990.TheBahamasiswell on the way.Theservices are available, but theymustbe used consistentlyifweare to prevent out breaks and the possible serious complicationsofthese pre ventable diseases. Theremustbe adequate suppliesofvaccines bothatthe national and clinic levels to ensure that every child re quiring immunisation can receive his/her injection at the timeofattendanceatthe local clinic. Target populations in each areamustbe accurately identified and monitored.Thecold chainmustbe effectively maintained frombeginning to end manufacturer to child. subdivision throughoutTheBahamashasreceived basic im munisation protectionbythe ageoftwelve months.IMMUNISATIONIMr.HenrySmith(CAREC)ona visittoWest End Clinic,StaHNursesandMrs.V.Poitier,Eight Mile Rock ClinicGrandBahama.togetherwithMrs.F.SandsandMr.HenrySmith(CAREC).FELICITYAYMERThethemeforWorldHealth Daythisyear, 7th April,1987,deals with Immunisation.TheSlogan, Immunisation; AChanceFor Every Child. Community Nursing Services/Na Immunisation Programme officials have appointed acommitteeto plan suitable activitiesinobservanceoftheday.Thecommittee, comprising ClinicImmunisation Co-ordinators,the Senior Nursing Officer, CNS; Medical Officer,PHD;Health Educator, under the chairmanshipoftheNa Immunisation Co-ordinator, have been meeting regularly.A poster competition among high schoolsinNewProvidenceisbeing organised and School Nurses will givetalksonthe importance and relevanceofearly childhoodimmunisationto the child's health in all senior schools duringtheweek 6-10th, April.11TheBahamas can be. justly proudofitsoverall immuni coverage.Overthe past seven years, coveragehasimproved from35%in1979 to86%in 1985,. Figuresfor1986 are presently unavailable.Ourgoalfor1987is90%,thatis,nine outofevery ten babies born should have completedbasic immunisation (protection) against diptheria, tetanus,whooping cough, poliomyelitis (polio), measles,mumpsand rubella (German Measles)bythe ageoftwelvemonths.TheHon. MinisterofHealth, Dr.NormanGay,inpresentingawardsatthe Ann's Town Clinicatthe,culmination of ImmunisationMonthlast year, challenged health workerstoachieve a national coverageof90%in1987. Achievingthepresent coverage(86%atthe endof1985)hasnotbeeneasy.It has required the sustained, committed service of many categoriesofhealth workers. If the healthofthe nation's childrenistobe guaranteed, then each health workermustcontinue to be vigilantinmaintaining his/her efforts to ensure that every child in every settlement and


ArrivingatthebusyEight Mile Rock Clinic. f StaHNurse,Dr.KavolaandMr.SmithattheEight Mile Rock Clinic, G.B. Lefttoright:CNSPearlineHepburnandVeronicaPoitier(G.B.), Dr.Fernander,Mr.SmithandMrs.F.Sands,Nat.ImmunizationCo-ordinator.ArrivalattheClinic,lefttoright:Drs.KenOfosu-Barko(N.P.)andFernander,NursesPearlineHepburnandVeronicaPoitier,andMr.HenrySmith.12


UNDERSTANDINGDIARRHOEAPERCIVAL McNEILIntrodudionDiarrhoeal Disease continuestobe a major health care problem in the paediatricagegroupin The Bahamas.Mostcasesoccur between January and ofeachyearwith about 50% of casesoccurring in infants(lessthan 1yearofage).Inspiteofthe introductionoforal rehydration fluid there remains considerable serious illness and death fromthiscondition. Itisthereforeofutmost importance that health-care workers and otherswhocareforchildrenhavea sound working understandingofthisconditionandwhatcan bedonetoimprove the outcome in the affected infant.DefinitionGastroenteritisisthe term loosely appliedtothe condition which involves the occurrenceof three ormore loose stoolsperday; vomitingmayormay not be present.Itismost commonly causedbya virus andassuchthereisusually no specific cure.Thevirus damages the inner liningofthe small bowel where cells responsible for the breakdown and absorptionofsugars are lo cated.Thecells most easily damaged are those responsibleforthe breakdown and absorptionofmilk sugar, lactose. If the sugar remains unprocessed then itstaysinsidethe bowel and pulls along with it extrawaterwhich appears on the outsideasdiarrhoea.Anti-diarrhoeal MedicinesMost prescribed medicines have no effect on this processat all.lomotiland donnagel are medicines that slow upthemovementofthe bowelssothat fluid continues to belostinside the bowel. There may then be abdominal distensionand it does not run outasfrequently.Inaddition,10motil can be responsiblefordrowsiness, fever and breath ing difficulty (from respiratory depression).Thebindingagents,kaolin and pectin,donothing to reduce the fluidlossinside the bowel which often continuesforabout 5days.Thereasonforthis continuedlossisthat new cells re place those which have been damagedbythe virus, andthesenew cells are secretory in function (thatisthey can only lose fluid into the bowel) and they take about five days to maturebywhich time they are able to breakdownand absorb sugars.Ofcourse, in practical terms, all cells are not damagedatthe same time, neitherdoall the newcellsachieve maturityatthe same time,sothat diarrhoea may last anywhere from threetosevenormore days.ManagementWhatgastroenteritis management amountstoisthe supportofthe patient until healing occurs. Again, from a practical pointofview,twoquestionsmustbe answered:1)Isthere a secondary bacterial infection?(eg:earinfection, bronchopneumoniaorgeneralizedbloodinfec tionasinsepsis).Thiscanbelikenedtothe process where one gets a wound, e.g. a laceration, which canbeeither cleanorsecondarily infected.Onlyifthereissecondary bacterial infection will antibioticsbeofassistance.Asmuchaspossible, the clinician should attempttomake a judgementofthis since some antij,iotics, particularly ampicillinandtosome extent amoxil, canpromote diarrhoea. Itisimportanttorealize also, that ex ceptforthe immediate newborn period, bacteriaarealways present in the stool, and these are usually,E.Coli. Bacteria canbecontained within the bowel lumen (and essentially remain outside the body), they can in vade thebowelwall,egocausingbloodand mucus from destructionofcells,orthey can causesepsisbygaining accesstothe blood-stream. Antibiotic treatmentishelpfulonlywhen thereisevidenceofinvasive diseaseand/orsepsis.The infantorchild with gastroenteritis and fever shouldbeassessedbythe health-careworkerassoonaspossible. 2)Isthere Dehydration? There are manysignsand symptomsofdehydration, butforteaching purposes, the simplest methodofdetectionisprobably the abdonimalskinturgoratthe levelofthe umbilicus.Theparentisin structedtorun the thumb and forefinger horizontally to wards each otheratthe levelofthe navel andtonote whether theskinpinches up easilyornot this should be demonstrated; in the event that thereisdehydration'with the skin being loose, the parent should be shownwhattheskinshould feel like in the hydrated state; this canbedemonstratedbystretching theskinand repeating the attempttopinchitupasbefore.Onceparents are abletoassessdehydration, then they are able to monitorfluid replacement.Theonly other essential ingredientisthat expert help(inthe formofhealth-care workers experienced in the assessment and managementofill children, with the toolsofintravenous fluids andifnecessary, intravenous antibiotics), must be available around the clock.Thegreatchallengetothe managementofdiar rhoeal disease on a nationalscaleistosoelevate the knowledgeofthe parent so that interventionistimely and morbidityislow.Theeven greater challengeistogetmotherstobreastfeed their newborn infantssothat diarrhoeal disease itselfisprevented in the most vulnera bleagegroup(those infants 3 monthsofageorless).Inaddition thela-lechemodelofa "lay-person based" support network, where a friendorneighbour has the knowledgetohelp another, woulddomuchtohelpusachieveourgoals.13


CHRISTMASINGRAND BAHAMAStaffofthe Hawksbill Clinic held a partyfortheir patients.Theevent, held outdoors, was a greatsuccessandisto be held annually.Fromlefttoright:Dr.NEHRU-DMOHawksbillClinic;SNOSylviaDAVISRMH:HospitalAdministratorMichaelaSTORR;CNCharlesPRAn:standingextremeleft,"Entertainmentwillbeheldoverthere,willyoujoinus?"heseemstobesayingtooneoftheguests.TheRand'sannualChristmasPartywasheldo,n18thDecember,1986.Traditionallyphysiciansandsenioradministratorsserve/waitontables.14Thisyear,staHwereverypleasantlysurprisedtohavethe"bigshots"fromNassauamongthem.TheCMO,dressedfortheoccasion,seemstobeenjoyi"gthepartyasmuchasanyoneelse.




FELICITYAYMERdVery best wishes,Mr.Permanent Secretary, mayyoucontinue to enjoy your extra-curricular activities. Joining Hands For Health extends a warm welcome to you,Mr.T urnquestandsincerely hopes youwillbeable tocopeeffectively with the complexitiesandcompeting forces within this Ministry. Dr. lileth SANDARANwhojoined the staffofthePublic Health DepartmentinDecember, 1986.Dr.Sandaranworksinthe Maternal andChildHealth Services, Ann's TownClinic.She has akeeninterestinReproductive Health. WALTERS,Senior House Officer,PMH.Dr.Walters joined the staff on1stJuly,1986.Wewish youanenjoyable stayatthe hospitalDr.Walters.Nursing Auxiliary Donnella THOMPSON totheCarmichael Road Clinicontransfer from thePrincessMargaretHospital. RaynorBURROWSto The Ann's TownClinic.ChenaSCOTTandInzaWEllSto theBlueHillRoadClinic.JanetGIBSONandShaneNEElEYtoTheCoconutGroveClinic.These five nurseswhograduatedrecently,joinedThe Community Nursing Serviceson15thDecember,1986. Staff Nurse GinaBENNETTto the Coconut Grove Clinicon10th November, 1986. Nurse Bennett,formerlyGina Gibson, hasbeenawayfor the past fifteenyears.She completedherbasic educationinthe UnitedKingdomandstayedonto trainasa nurseattheRoyalIsleofWight SchoolonNursing. She then did a degree courseinOrganisational BehaviouratBulmersheCollege,Reading, before completing the Health VisitorCourse.Joining Hands For Health hopes that youwillnotonlyenjoy the challenges inherentinCommunity NursinginThe Bahamas but also that youwillcontinue tolabourinthatpartofthe Vineyard for many years. Goodluckandvery best wishes, Nurse Bennett. After leaving the MinistryofEducationin197,3, Mr. T umquest servedinThe MinistryofExtemal Affaini, later Foreign Affairs, the Officeofthe Prime Minister ClOd asActing Secretary to the Cabinet. Mr. T umquest has a BachelorofArts (second class honours)inGeographyfrom the UniversityofSwansea, Wales; a DiplomainEducation, UniversityofSouthhamp ton;andMasterofArts (lntemational Affairs) from Carle ton University, Ottawa,Canada.16 A memberofthe BoardofAbilities UnlimitedandKiwanian, Mr. T umquestismarried to the formerRuth Adderley, ateacheratthe School for the Deafandthey have twoteenagechildren -a sonanda daughter.UP-DATEWELCOMEMr. T umquest co-authored a textbook for Junior High Schools, titled 'Civics For The. Bahamas' duringhissojouminthe MinistryofEducation wherehehas workedinthe classroomandinadministration. He hasattendedshort training coursesinIntemationallawandmatters pertainingto the lawofthe Sea.Inaddition tohiscivic involvement,Mr.T urnquest enjoys travelling, swimmingandreading. Tothe MinistryofHealth, Permanent Secretary,HARCOURTTURNQUEST,with effect 5th January, 1987. Mr. T umquest hashadalongcareerinthePublicService haYing startedasa special Student TeacherinJan uary,1960,whilestillcompletinghisbasic education.laterthat year, Mr. T umquestwasappointed actingHeadTeacheratthe Buckley's Public School, Deadman's Cay,longIsland,wherehewent to school, for theyearinbetweenattaining the Cambridge School Certificateandat tending theGovemmentHigh SchoolinNewProv'denceona BahamasGovemmentScholarship. At theGovemment High Schoolheobtained the General CertificateofEducation (london)atadvancedlevelinthree History,GeographyandEnglish literature.


Tothe Sandilands RehabilitationCentre:-Facilitators included Mrs. IreneCOAKLEY,Judith MINNISandMarinaSANDS.-Dr.K.SARPAVARAPU,Registrar,on22ndFebruary, 1987. -SisterLucillePAYNE,N.O.2-Mrs.PaulineROLLE.Joining Hands for Health wishes you allpleasantand productive timesinyourareas.-Sylvia RAHMING, Janitresstothe Ann's TownClinic.-TheClinics shouldnowgenerally look cleaner,moreattractiveandbettermaintained with the employmentof Handyman FredrickSEARS.Mr.Searsjoined thestaffof the MinistryofHealthinDecemberandiskeptbusyserving the clinicsinNewProvidence. Todatenursingstaffareverypleasedwithhisattitudeandabilityto work.Mayhecontinueashe has begun.WELCOMEBACK.-Dr.Joseph CALASCOwhoreturned to The MinistryofHealth,1stJanuary,1987,nowservinginthe Public Health Department with major responsibilityforChild Healthatthe CoconutGroveClinic effective2ndFeb ruary, 1987.Dr.Calascoworkedinthe Paediatric Department,PMHfor manyyearspriortoleaving to furtherhismedicaleducation M. MED (Paediatrics)atthe University College, Gallway, Ireland.SomereadersmayrememberDr.Calasco as,amongotherthings, editorofBahamaMed, the Journalofthe Medical AssociationofThe Ba hamas. CONGRATULATIONS-Dr.CarlosMULRAINonyour promotion to Acting Deputy Chief Medical Officer effective1st.September, 1986.Inaddition tohisresponsibilities for Family Island Health Servicesareaddedthose for Primary/Community Services throughout the Commonwealth.-MissDaphneMOUNTSonyour promotion to Trainee Executive Officer, MinistryofHealth(Headquarters),22nd. December,1986.CONTINUING EDUCATION. -A fourweekOrthopaedicCoursewasrecently con ductedatBain's House, PMH. The following nurses fromthePMHattended:-SNWarrenKNOWLES,NO2 Jestina FERGUSON,SNThelmaELLISandTCNMaryRAMSEY.-A Role Base Coursewasheldoverthe period 24th, November,1986March,1987.Participants from thePMHincluded Sisters, FlorindaCLARK,YvonneBULLARD,Roselean STRACHANandMarleaseWALKER.Groupofparticipantslefttorightfrontrow:Mrs.IreneCoakleyandRoseStrachan(PMH), CNPhllaberthaCarter(C.G.C.),RubyWard(SRC),MarinaSands(PMH),AntoinetteOutten(A.T.C.),Mrs.Bullard,JudyMinnis(PMH),ShirleyDavis(BHRC),MaureenWalker(PMH);backrowlefttoright,ChenoaRolle(SRC), Clarke(PMH),Ms.Hepburn(PMH),Mrs.FayeRodmell(Tutor)andMs.Aranha(SRC).-NOs1 NellieMARSHALLandPatsy MORRISwereamongthose Bahamian students travelling totheUWI,Mona,JamaicaCampus to pursue the Certificate CourseinNursing AdministrationinSeptemberlast. JoiningHandsFor Health you both every successinyourstudies. A seminar,conductedbythePublic Service TrainingCentreoftheDepartmentofPublic Personnel(DPP),washeldatSRCovertheweek2nd-6thFebruary,1987forClerksandFiling Assistants. TheSRCtakes this opportunitytoagainexpressitsappreciationtothePublic Service T raining Centreformaking this training course possible. -Ms. Mercia STRACHAN, PharmacistattheSRCisamongthose Pharmacists travelling to Nairobi, Kenya, East Africa, toattendthefourth Commonwealth Pharma ceutical AssociationConferencethis year. -SN Julian MULLINGS hos completed a course In OrthopaedicNursinginScotlandandresumed dutiesatthePMH8th January,1987.NodoubtNurse Mullingsisgladtobehome,awayfrom the coldweatherwhich -The National Drug Council,appointedby the Prime MinisterofThe Bahamas through the MinisterofHealth,inFebruary,1985,helditsfirst Conference for FamilyIslandmembers 16th-18th November,1986attheWyndhamAmbassadorBeach Hotel,underthe theme, Sharing Knowledge For Action. Theconferencewasarrangedinconjunction with the Pan American Health Organisation (PAHO) with funding from the United Nations Fund for 17


Drug Abuse Control (UNFDAC).Themain speaker,Mr.Peter Bell, Executive Director and co-founderofthe Minnesota Institute on Black Chemical Abuse, courtesyofthe United States Information Services(USIS),addressed Community-based Prevention Programmes.Mr.Bell spoke to societies' double standards to wards alcoholuseand recommended the re-establish mentofchannelsofcommunication, cultural norms and values and making known the consequencesofalcohol/drugsubstanceuse.Societies' unequivocal position re garding alcoholusehe said,hasbeen notedasan ef fective motivational aid in prevention and treatmentofabuse.Thisin additiontothe traditional demonstrationofcaring, concern and love should underpin any prevention programme. Representatives attended from every Family Island except Acklins andRumCay. They included Educators, Health Professionals, Customs and Immigration Officers, Church leaders, parents, volunteers, youth workers and school peer counsellors.Theneedfora Family Life Education Programme in corporating clear values and the acquisitionofdecision makingskills,from kindergarten through grade12,was repeatedly enunciatedbydelegates. It was felt that the Church,asa body, coulddomuchmore to help com munities redefine their values andsethealthful standardsforliving.Outofthe conference emerged many resolutions and recommendations.Moreinformation may be ob tained fromTheNational Drug Council. Telephone 322 2308or322-2309,P.O. Box N-1023, Nassau, Bahamas.A varietyofresource materialisavailable at the Council's Offices (Resource Centre).*TheEleventh Annual WorkshopforFamily Island health workers took placeatthe Pilot House Hotel,EastBay Street, 19-21 November, 1986.Mostly "F:I:workerS. In andMrs.Bacchus-Governor'sHarbour(DMO&Dentist).18 h L. fromNewProvidenceandFamily Islands,righttoleftfrontrow,Miss H.Bowen-retiredDON,Ms.B.Ford-deputyDON, Ms.D.Philipo -FASMin. ofHealthandDr.NehruDMO,GrandBahama.TheWorkshop, co-sponsoredbythe Ministry of Health and thePanAmericanlWoridHealth Organiza tion was,asusual well patronisedbyhealth workersinNewProvidence. Presenters included physiciansandnurses. They shared working experiences within theCommonwealthofTheBahamas and thewiderCaribbean region. Dr. Peter DIGGORY, DirectorofCAREC;Dr.Hugh WYNTER, DepartmentofObstetrics and Gynaecologyatthe UWI, SchoolofMedicine, Mona,Jamaicaand Dr. Deanna ASHLEY MinistryofHealth,Jamaicawerepresenters from the Caribbean.TheMedical AssociationofTheBahamas helditsannual Conference 4th-6th February, 1987, attheParadise Towers Hotel, their theme, CareoftheAcutelyIII.Ashas become traditional, a numberofeminentspecislists fromabroadvisited, some deliveredpapers. Local consultant specialists also took port.Theconference was officially openedbythe Hon.MinisterofHealth.ThePresidentofthe Association,Dr.Eugene NEWRY delivered a searching soliloquyonsome realissuesfacing members and medicineaspracticed inThe.Bahamasinterms of,forexample,vyingforresourcesforthe hospital.Therecently appointed Permanent SecretaryMr.Harcourt TURNQUEST was introduced to thegroupduring theSession.TheMinistryofTransport and LocalGovernment,throughitsRoad Traffic Department, conducted aMotorVehicle Injury Workshop,27-28November,1986.Themajor resource personfortheworkshopwas Dr. Peter DIGGORY, DirectorofCAREC.Thiswas a multi-sectoral workshop includingparticipants from the MinistriesofWorks, Tourism andHealth;TheRoyal Bahamas Police Force; non-governmentagenciesTour Car and Jitney Operators andthebusinesssector Insurance Companies. It wassponsored


bythe MinistryofTransportandthe PAHO.Inhiswelcomingremarks, MinisterGaytold thegroupthat motorinjuryprevention was, worldwide, a public health problemof growing concernandwarranting the coordinatedeffortsofallagencies, those involvedand/oraffected.Traumadue to injuryandviolence he saidwasthe leading cause ofdeathanddisabilityintheagegroup15-45yearsinThe Bahamas.Asthereisonaverageonecarfor every four personsandonevehicle to every two persons, therisksofinjuryarehigh.TheMinisterofTransportandLocal Government,theHon. Philip Bethel saidinhisopeningaddressthattheRoad Traffic Safety Committee,anongoing multi-sec toral committee,wasformedin1973for the purposeofraisingpublic consciousnessonissues relative toroadus ageandsecuring positive responses. He also voicedhisconcernaboutthe effectsofsubstance useonroadusersespeciallyatweekends. He suggested that emphasisbegiven to waysofproviding effective driver education bearinginmind that the accident rateinThe Bahamaswasamongoneofthe highestinthe region.FROMTHEWORKSHOP:1.Inaddition to the individual financialandhuman costs inherentintraffic accidents, therearealso increasing strainsandcostsonthe health serviceandlossofproductivity which adversely affects the nationaleconomy.2.The patternoftraffic accidents seems to have shiftedawayfrom theyoungeragegrouptoanolderagegroupwhohavetraditionallybeenmore careful. Con sequentlytherehasbeenanincreaseinclaims-previously fifteenpermonth, since July1986therehavebeen nineteenperweekend! Insurance premiumswillundoubtedly rise since 74<: per$1isnowbeing paidinclaims. Theideaofin creasing incentives for accident free driverswasnot favourably received by the Insurance Company's rep resentative.3.The urgencyofcollectingdataonwhichtobaseeducational programmes,togetherwith a revisionoftheroadtraffic{awslregu{ations, especially those relatingto drunk driversandstrict law enforcementweresomeofthe recommendationsofthe workshop. CHANGE AND???MissCleopatraFERGUSON, Senior Nursing Officer responsibleforthe Health Aide Programme sinceitsinceptionin1982hasbeentransferred to administra tive duties within the MinistryofHealth. Housedinrenovatedaccommodationinthe Royal VictoriaGardens,Miss Ferguson's responsibilitiesnowincludeManpowerPlanningandSystems Review.Sheisalso secretary to theManagementCommittee within the MinistryofHealth.ThisCommittee which com prisesheadsofthe various departments/institutions within the MinistryofHealth meets regularlytoshareplansandevaluate progress. Joining Hands for Health wishesMissFerguson every successinher"new"duties. Mr. AndilLARODA,Senior Nursing Officer responsi bleforteaching the Clinical Nurse trainees within the DepartmentofNursing Education hasbeentrans ferredtothe PrincessMargaretHospitalwhereheisassistinginthe Administration Department. Again Joining Hands for Health wishes Mr. Laroda every successinhis"new"duties. Four Staff Nurses:ShaureenBASTIAN,Valencia GIBSON,AnnaMaeMOSSandFlorentia WILSONhavebeentransferred from the CNStothe PMH. From thePMHtothe CNShavecomeSN CathyBRIDGEWATER(District Nursing);DaphneFERGUSON (CoconutGroveClinic);TerryROLLEandDaphneWILSON (FoxHillClinic).CNElizabethROLLEhas completed a stintinMooresIslandandisnowservinginthe School Health Serv ice.Wearegladtohaveyou backinNassau Ms. Rolleandlook forwardtohearingaboutsomeofyourexperiencesinMooresIsland. CN Brenda COXhadnowgonetoMooresIsland.CNCarlottaKLASShasbeenservinginthe FamilyIslands,MangroveCay, Andros,andSanSalvador.SheisnowbackinNassau;welook forwardtohearing from you also, Mrs. Klass.HAHelenKELLYhasbeentransferred from the FamilyIslandstothe School Health Services, January 1987.HAJenniferROLLEhasbeentransferred from Steven ton, Exuma,tothe CoconutGroveClinic,NewProvidence.HABessieMaeMcKENZIE hasgonetoSteventon from CoconutGroveClinic.SNDulciePRAIT hasbeentransferred from theSRCtoAnn's Town Clinic. GOODBYE:PermanentSecretaryLuther EmersonSMITHwhowastransferred to the MinistryofWorksattheendoflast year. AnumberofemployeesmissMr. Smith'smanagementstyle but realisedthatthe businessoflivinginvo-Ivesmovement.19


toMs. EthelynBURROWS Assistant Cook; Mrs. ViolaBUTLER Nursing OfficerIIandMr. Nigel McPHEE Porter. The Nurses' AssociationofThe Bahamas helditsAnnual electionsinDecemberlast. Elected to serveforthenexttwoyearperiodwere:SirGeraldawardslongservicecertificatetoNOViolaButler.LadyCashpresentslongWallace.Joining Hands For Health wishes you allmanyyearsofhealthful, satisfying, active, retirement. The Police Bandaddedspirittotheoccasion. The following Staff Nurseshaveresigned fromthePMH -EmilyDORSETIE, 8th December,1986;CharlotteJOHNSONandWinnifredALLEYNE-31De cember,1986; -Karen PINDER, 16 January,1987;andCharleneDiggis-McPHEE,29January,1987.Mrs. Loleta SWEETING -SeniorHousekeeper; Ms. EthelynWALLACEKitchen Supervisor; Mrs. Thelma TheGovernor-General,SirGeraldandLady CashpaidtheirannualvisittoSandilands Rehabilitation Centre 19 December,1986.From all reports,theeventwaswellattendedbystaffandpatients.Fiveemployeeswhoretired fromthepublic service(SRC)in1986wereawardedcertificates for long services:SectionofthegroupfortheG.Go'sannualvisit t4t) theSRC. It istraditionaltopresentgiftsat Pa!ients oftheSRCpresenttheGovernor-GeneralwithaChristmasgift.20Mrs. Sonia Carey-GIBSON Finance Setcion, MinistryofHealth (Headquarters) has lefttheMinistry for the privatesector, effective 14 February,1987.Very best wishesforyoursuccess Mrs. Gibson.Wewish Mr. Smitheverysuccessihhisnewministry.'Nhoknowshemayonedayreturntothe MinistryofHealth.


Ms.Ernestine DOUGLAS,TUTORONE, President; Ms. Juanita GREEN, HolidayInnHotel,1st.Vice President;Ms.EvelynALFRED,Private Duty Nursing,2ndVice President; Ms. BernadetteELLIS;Ambulatory Dept.PMH,Secretary;Ms.SandraJOHNSON,Private Duty Nursing, Assistant Secretary; Ms. Castella BOWlEG,TUTORONE, Treasurer; Ms. Pearl RAHMING, CatholicDiocese School Health Programme, Assistant Treasurer. Chairpersonsofcommittees:1.Ms.Marina SANDS, Ambulatory DepartmentPMH,EducationandResearch;2.Ms.PatriciaBETHEL,BumsUnit,PMH,Social Wel fareandEconomics; 3.Ms.Pamrica FERGUSON, Infectious Diseases,PMH,Practice4.Ms.Brezetta KING, Registrar.TheHealth Inspectorateofthe DepartmentofEnvironmental Health Services has finally moved from their time-worn premisesinSchool Lanetomorespacious,comfortableandattractive officesinNassau Court. Officers occupy the recently renovated two storey building behind the MinistryofEconomic Af fairs formerly the homeofthe Government High School -andshouldnowbeableto work with greater vigourinsurroundings which more accurately reflect environmental health.CONGRATULATIONSMrs.OlgaBROWN, Chief Executive Officer, Ministry of Healthonthe birthofyour sixth grandchild, a grand daughter. Mrs. Brownissimply exuding radi anceinhergrandmotherhood! Shouldwebeen vious?VISITORSAmong the many visitors to the MinistryofHealth, in vited to provide technical assistanceoverthe past four months havebeen:-Dr.Peter DIGGORYandMr. HenrySMITHboth fromCAREC.Dr.DeannaASHLEYto review the National Pro gramme for the ControlofDiarrhoeal Diseases.Mr.GordonSMITHJohns Hopkins Medical School.BothDr.DiggoryandMr.GordonSmith collaboratedina Trauma WorkshopatthePMH25,26Novem ber, 1987.MissPatricia BRANDON, PAHO'sAreaAdvisorInHealth Educationtothe Health Education Division.FROMTHECANCERSOCIETYOFTHEBAHAMASInresponse to the increasingneedforgreaterawarenessandeducationaboutcancerthroughout The Bahamas, theCancerSocietyofThe Bahamasismaking planstoestablish Society branchesinthe FamilyIslands. The Central Eleuthera Branchwasthe firsttobeformedinOctober1986,andthe Branchishard at work. PresidentisMs. CorinneSands. The Freeport Branch shouldbefunctioning by theendofFebruaryandplansforAbaco,Exuma, InaguaandAndrosareunderway. "After a very productiveyearin1986,the Societyislookingforwardto1987",says PresidentMs.Sonia Dames.'Weshallbehappyto provide speakersaboutcancerforcommunitygroupmeetings, church groups, service clubs, schools, business houses." Per sons interestedinobtaining informationoncancer,tshirts ,orinbecoming membersofthe Society which meetsonthesecondTuesdayineachmonthat5:30p.m.atSt.Matthew's Hall,cancontact the Societyat324-1063or324-2429.CancermonthwillbeobservedinMay. Please listen! watchoutformoreinformationasMayapproaches.FROMTHEPRINCESSMARGARETHOSPITALWELCOME: TOTHEDIETARYSERVICES:Ms. TheresaHEPBURNwhohasbeenassignedtothe Ambulatory Department to work with diabeticpatients. Miss HepburnobtainedaB.Sc.inNutrition/Die tetics from the Prairie View University, MinnesotaandcompletedtherequiredoneyearinternshipinT rin idad. Trainee Dietician Netterkate GIBSON. Joining Hands For Health welcomes you both to thelargefamilyofhealth providersandhopes youwillfind agreatdealofsatisfactioninyour jobs. WELCOMEBACK:SNOConstance COMERYafterbeingawayfrom du tiesonthe maternitywordbecauseofillness.CONGRATULATIONS: TCN ElviraPRAnofthePMHoncompletionofthirtyyearsintheprofessionofnursingandonreceiving theawardfor most outstanding employee fortheyear1986.Dr.Ronald KNOWlESon your electiontoserveasHeadofDepartment, Internal Medicine.Dr.BernardNOnAGE,onyourelectiontoserveasHeadofDepartment ObstetricsandGynaecology. Dr. WinstonCAMPBELL,ENTConsultantasActingHeadofDepartment Surgery for athree-yearperiod beginning 12 January,1987.AllotherHeadsofDepartment remain unchanged.21


"__'!S!'I!8c.ert\\\c.Cl\euomonbnuu\\0 P.M.H. l30yearsservice)Aninformation booth relative to clinic schedules and general information wassetup in the waiting areaforthe pharmacy late last year. A significant numberofpeople inTheBahamas suffer with hypertensionand/ordiabetes both chronic non-communicable diseases. Compliance regarding medication and diet are key factors insuccessfulcon trol. Special hypertensive and diabetic clinicstomonitorthose patientswhoare coping with their condition fairly satisfactorily have been introduced and are well attended.InJanuary 1986, a special hypertensive clin ic began, since then there have been 2,418 patientvisits.InMay1986the diabetic clinic was started and since that time there have been646patientvisits.Both clinics areheld twice weekly Tuesday and :l\UfS00'l'Of"'1penem;wes,eonesa0'lonaf\OO'ja\\emoon\OfQ\aoe\ks. 133,811119,943 130,246 49,79047,63553,13331,274 46,166 48,765 214,875213,734232,162TotalThevolumeofpatients using the Ambulatory Depart mentisstaggering:GeneralPractice Clinic (GPC) AccidentandEmergency(AlE)Specialty ClinicsA measles outbreakin1984may have accountedforthe numbers attending the GPCin1984. On30thMarch, 1985 feesforall servicesatthe PMH wereincreased.Thiswould no doubt accountforthe fallin patient visits.SinceMay,1985, exclusive facilitiesforCivilServantsand the Comprehensive Clincis have been operatio nal.Thebreakdownisasfollows:Drs.Patrick WHITFIELD, Eugene GRAY and other phy sicians together with a dietician presently comprisetheteamwhichistobeexpandedtoinclude0healthed \l<:.a\or,'Hor\..erand0\ prevent the introductionofthe health educationprogramme plannedforthese patients but all possibilitiesarebeing actively explored. Hopefully a progressreportcan be given in the next edition.SirGeraldCashconcludinghisannualChristmasvisittotheP.M.H.Thenumberofpatientvisits(GPC)for1986isrising.Approximately50%ofpatientsseeninAlEaresurgicalcasesrequiring stitches/operations, manytheresultofviolence and injury. Joining Hands For Health was sorry to hearofthe illnessofDr. Earle FARRINGTON, Consultant and HeadofTheDepartmentofSurgery. Dr. Farrington became very ill while on holiday in theUStoward the end oi: October, 1986.Weare indeed pleased to hear heison the mend, although recoveryisa slow and tedious process.Welookforwardto seeing you soon Dr. Farrington.ComprehensiveClinicCivil Servants1985(May-Dec)19865,8278,2687,351 20,947 A SocialWorkerhas been assigned to the Accident and Emergency department,tofacilitate screeningofpatientswhomay be unable to payforthe medical services they require.Thisservice became fully opera tional in January 1986 andisavailableMonday Friday 9a.m. 4p.m.198449,790patients there were 25,501(51%)Surgicalcases198547,625patients there were23,306(49%)Surgicalcases1986 53,133 patients there were 25,310 (48%)Surgicalcases.22


Twoconcerns of health providersatthe institutionare(1)misuseof the services by the public:aninformation boothinthe waitingareaof the Pharmacy has therefore been establishedinanattempt toencouragemore effectiveuseof the Ambulatory Services.(2)Sickchildren being takento the GPC byanoldersibling. Health providersareverydisturbed because theyareneitherSuretheyareelic ifing accurate historiesnorthat basic information relative to necessary action leading to quick restorationofthe sickchild'shealthisbeing understoodandactedon.Thislatterisa concern of health providers throughout the systemandhasbeenthe topic of more thanoneradio programme. Comments?MichaelNewton-AmbulanceDept.MostoutstandingmaleathleteP.M.H.SportsDay,Nov.1986-Presentation Nov.1986.Ms.EurekaDelanceyPHYS'O-Dept.Most outstandIng femaleathleteP.M.H.SportsDay,Nov.1986.FROMTHEFAMILY ISLANDS*Dr.H.Patel has assumed duties as Medical Officerinthe newlycreateddistrictofSteventon, Exuma. Hewillalso be responsible for the Exuma Cays. Seven new clinicsareproposedfor the following areas under a Health Infrastructure Project between the National Insurance Boardandthe MinistryofHealth. are:MangroveCay, Fresh CreekandNicholls TowninAndros; Simms, Long Island; Marsh Harbour, Abaco; Port Home,CatIsland; Majors Cay, Crooked Island -inaneffort to furtherupgradetherangeof health services available to residentsinthe Family Islandsandinpursuanceofthe statedgoalofHealth ForAllBythe Year2000(HFA/2000) through the mediumofPrimary Health Care. *CN.BarbaraHEPBURN,Marsh Harbour,Abacohadtheunenviable pleasureofdelivering triplets, two boysanda girl, prematurelyinlate October, 1986. The boys weighed 4Ibs.12ozs.and4lbs. 6 ozs.; the girl 3Ibs.Motherandbabiesweretransferred toNewProvidenceshortly afterwardswherethe triplets remainedinhospital forsometime. Nurse Hepburn reported that theywereall "doing well".*TCNGloria STRACHAN,RockSound, Eleuthera, reportedthat a Clean-up Campaignwasscheduled for lateNovemberinanticipationofcleanandaesthetically pleasing surroundings for Christmas.*Doyou know that therearetwenty health districts throughout the Family Islands? A Medical Officer residesinthefollowingareas.GrandBahama, Andros, Eleutherathreeeachisland; Exuma, Abaco, Long Island twoeachisland;CatIsland, Acklins,BiminiandBerry Islands,oneeachisland.VITAL STATISTICSBirthsStaff MidwifeH.DILLETTE,a daughter. Staff NurseShereneROLLEa son, bornon28Jan uary, 1987. Staff NurseV.SAUNDERS adaughteralso bornon28January,1987.Allnurses workatthe Rand Memorial Hospital,GrandBahama. Senior House Officer,PMHEarlCAMPBEll.SNPatrice KINGofthe DNS a daughter, October, 1986.SNLola KNOWlES, School Health Services, a son,November, 1986.Mrs. Angela COLEBROOK, Secretary to the Acting Deputy Chief Medical Officer, a soninJanuary,1987.CNAllison Brown SANDS, Palmetto Point, Eleuthera, adaughterCielle Alyssa,25February, 1987. Cielleisbreastfed. Sheisthe second childofherparentsandthe sixth grandchildofMrs.OlgaBROWN, MinistryofHealth.23


Marriages:-Weddingbellsrang for *HA AnnaSANDS,Dental DepartmentPMH,and MarineSeamanChristopherRUSSElLoftheRoyalBahamasDefence forceonSaturday 20December,1986. Anna worked for ashorttimeintheHealthEducationDivision before transferring totheDental Depart ment/PMH. WewishAnna and Christopher a longandmutually rewarding life together. Mayyougrowinlove, friendship andtrust.Weddingbellsalsopealed forthefollowingnursesatthePMH.TCNJestinaTOOTEandSamuelKNOWLES27July,1986.SNCarolyn THOMPSON andRev.KeithRUSSElL1stNovember, 1986.SNJenniferSAUNDERSandClementKING15No vember, 1986.SNUnaMariaBUTLERand Garth BAIN15thNovember,1986.SNJuanita JACKSON and RogerMILLER22November, 1986.SNJoanna WOODSIDE and WesleyARCHER6December,1986.TCNLeathicaSEYMOURandRev.Garnet KING 6 December, 1986.24TCNWilmaPRAnRMHandProsecutorWilliam MOSS 25 October 1986inGrandBahama.JoiningHandsfor Healthwishesthesecouplesmanyyearsof weddedbliss.DeathsOur condolencestothefollowingnursesatthePMH.NAOlive GIBSONonthedeath of herdaughter,16December, 1986.SNIcelynSWEETING,TCNsEulaKEMPandValderineJONESonthedeath of their mother, 5Jan-uary, 1987.SNBeatriceARTHURonthedeath of hermother "\.987 SNLindaWHITEHEADonthedeath of hermother4 January, 1987.6January,1987.NO 2 Therma FOUlKESonthedeathofhersister18January,1987.SNVeronica fERGUSONonthedeath ofherbrother 20 January, 1987. Condolencesalsoto: SNO MaggieMOSS,CNRosaMaeBAINandMiS.HannahGRAY,Health InformationUnitonthedeath of their father, EdwardGODET(Sr.)on6thJanuary, 1987. Mr. GODET hadbeenailing forsometimeandhad lasped into acoma.Hewaslovinglycaredforbyhisfamily athome.Mr.JohnTHOMPSON Hospital Administrator(PMHonthedeath ofhisfather,JohnTHOMPSON,Se nior. Mrs.ElizabethSWEETING,Internal Auditor/Accounts, Ministry of Health nowintheDEHS,onthedeathof her mother.Dr.PerryGOMEZ,Consultant,Internal Medicine.! CommunicableDiseasesonthedeath ofhisfather,Mr.ReubenGOMEZ, a friend oftheHealthEducation Division. District Nurse ThirzraDEAN,onthedeathofherfather. May God grantyoustrengthandcomfortinyourtimeofneed.


THEGOOSEGOTFATDWIGHTALLENThose ot uswhoare concerned with health and fitness,ifonly marginally, knowofthe potential damage \n overindulging in eating and drinking. For manyofustoo,asChristmas approachecf,the goose was indeedgettingfat. And with Christmas, the glazed ham, turkey,fruitcakeand booze all gone, the gooseisindeed fatter.Theairisnow filled with moans. '/Ve feel tired.We havecravingsforall those delicious and dangerously fattening foods. Worstofall, clothesjustdon't fit.But,thereisno need to moan and groan,ifsometing doesnotfit,thereiscertainly no need to force it. Thereisaplacetosolveall your woes. That place, a health/fitnesscentre.Withoutmuchthought, mostofuscan thinkofatleastthreespasorgyms on the island. There are manymoreand the services offeredateach are accordinglyvaried.Much talkhasalways existed about local fitnesscentres,someinthe formofadvertisements, othersbyword of mouth from satisfiedordissatisfied customers.At"Joining Hands For Health", the decision was made todispell,asforaspossible, misconceptions and investigatethesecentres.COSTFirston the listformanyiscost.Membership feesseemfairly standardized and are commensurate withamenitiesavailable. Thirty to forty dollars gives onemonth'senrollmentatall the local centres and most re quirec1ientsto declare,inadvance, any injuries suffered prior to enrollment.Nonerequire advance medical ex amination. However,atone centre, a doctorispartofthestaff and an examinationisgivenatthe timeofen rollment at no additional charge. An individually tailored programme may be designedatthe timeofenrollmentatall centres.Noneoffer specific beginner's pro grammes .. fACILITIESThehoursofoperation range from five thirty in the morning to ten o'clockatnight,Mondayto Friday, Sat urdays eight to twelve,withhour long aerobicsclassesalmost every hour.Onecentre offers a specialclassforobese personsat7:30p.m.Asforaerobic act1vity, one may find a"nofrills" routine focusing more on pureexerciseor doncerciseroul1nes. For those persons wanting more than an aerobics routine, weight training and other machines existatall centresatpre-arranged intervals;useofthese maybesupervised. Uniquely offeredbyone centreiselectronic video monitoring. Dietary counsellingisavailableatmost centres and additionally, one may find physical therapy and special programmesforthose 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,atadditional cost,atone centre. All centres haveatleasttwotrained instructors, allofwhomnotonlyseementhusiatic, but someofwhom are also living testimonies, having followed the path from overweight clienttosuperfit instructor.CLIENTELEJustwhogoes to a fitness centre?Personsrange inagefifteen to seventy years; mostly women, but the male enrollmentison the rise. For thoseofyounotsold, you can visit and have fulluseofall servicesatleast once. Additionally, some centresofferdaily and weekly rates andofcourse, thereisanaddedincentiveofannual ratesforthose prepared to make the long range commitment. Anyone dreading the lackofself-discipline may en rollatthe centre that requires,asa partofthe mem bership contract, attendanceatleast three(3)timesperweek.So,let'sgetthe goosedowntosize before summer rolls in. Remember, the healthier you are, the better you willlookand feel, thelongeryou will last!25


PATRICK WHITFIELDTHE OVERWEIGHTPROBLEMlifestyle factorssuchasa sedentary lifestyle, over eating (especially carbohydratesorfat) excessiveconsumptionofbeer and a belief that exercise will automat ically result in weightloss,are also important.Inthe Caribbean, prosperityhaslong beenassociated with being overweight.Thismay well have started during infancy when the chubbier ababywas the more healthy he/she was perceived to be.Otherperceptions encountered in the community include a belief that fat women preferfatmenaspartners and vice versa. overweightatoneyearhave a greater propensity to be overweight than the normal weight infant. Breast-fed ba bies arelesssusceptibletobecoming overweight than babies fed high calorie infant feeds.Manyparent's first responsetoa crying infantisto feed, however,inlater life this predisposestooral satisfactionasa response tostressand manifests itself in peoplewhoeatorsmokemore cigarettes when understress.IncidenceThisisdifficulttocompute primarilyasa resultofinadequate data. However, in theU.SA,health person nel estimate that approximately twenty fivepercentoftheir populationisoverweight.Norecent Caribbean fig ures exist.DefinitionIIAnoverweight person has abodyweightabove. the normalorIdesirable' levelatwhich the greatest lon gevity can be The normalor'desirable' weightofan individualisderived from an ideal weight which in tumiscalculated from insurance data that relate sizetomorbidity and mortality(sicknessand death). Usingsuchcharts, obesity may then be definedasweightoffifteentotwentypercent more than the idealbodyweight. In almost all populations, more women are overweightthan menatany given age.Thefrequencyofoverweight individuals increases uptoage40-55in men and40-60in women.HormonalFadorsTheseprobablyaccountforthe higher incidence of obesity in women.ContributingFadorsAlthough more knowledge about obesityisbe;inggained daily, much researchisneededtosolve essential piecesofthe puzzle that are missing. Information thatisavailable includes:1.GeneticComponentThere are many studies to suggest that obesity runs in families, buthowoften thisistruly duetogeneticsasopposedtosocio-cultural forces and over-feedingisun certain.Whilethereisindeed an exceedingly raregroupofgenetic disorders where obesityisoneofthe compo nentsofthe particular disorder these includeAIIstrom's syndrome and Prader-Willi Syndrome it should be stressed that the weight gain in these disordersissecondarytomore prominent complaints. A genetic substrate whichissaid to interact with en vironmental factors has been postulated. Evidenceforthiscomes from studies on twins which show a greater re semblance in adiposity (fattytissue)between monozygoticthon twin.ithotisjdenticoJosopposedto bring twins.2. Socio-CulturalFadorsInmostcasesofsimple obesity, overfeeding during infancy storts the process. Ithasbeen shown that infantsAtthe menarche, during pregnancy andatthemenopause, an increase inbodyweight occurs. Most women will also gain-fiveto seven pounds permanenflyaftereach pregnancy.Oralcontraceptives arealsothoughttoplaya role either through salt and water retention propertiesorbecauseofthe increased appetite that sometimes occurs.OrganicFadorsa) Endocrine abnormalities.Thesetend to berare,and when suchconditionsdoarise, the weight gainisusually small andresultsin an abnormal distributionoffat,forexample obesityofthetrunkasin Cushing's disease.b)HypothalamicCauses.Trauma, malignancyandinflammatory diseaseofthe hypothalamus are rarecausesofobesity.Thisformofobesityisassociated with distinct clinical manifestations.Theseinclude changes due to raised intracranialpressure, endocrine imbalance andavarietyof neurological and psychological disturbances.The RisksObesityisimplicatedinthreeofthe five majorcausesofdeathinthe Caribbean; these are cardiovas cular disease, cerebrovascular disease and diabetesmellitus.Hypertension and diabetes also accountforsignifi cant morbidity.26


Hypertensionisthree times more commoninthe overweight individualandtheriskof diabetesisincreased four-fold.Otherimportant complications of obesityinclude; gallstones, gout, osteoarthritis (especially hipsandknees), menstrual irregularities,infertility,increasedsurgicalrisks,decreased exercise tole'ranceandlowerbackpain.TreatmentTherearefour modes of treatment currentlyinuse,thoughtwo of themarenow declininginpopularity:a)ChangingDietaryHabitsThisinvolves daily calorie restrictionandeating onlyatregular meal times.Thisobviously precludes snacking. Dietingisnot a very successful means of long term weight loss because the weight lossisonly maintained foraslong as the particular dietisbeing followed. Most times these diets cannotbemaintained indefinitely for a numberofreasonsincluding healthrisks.Underlyingthisform of therapyismotivation unlessoneistruly motivated to lose weight then failureis,unfortunately, inevitable. Much workisbeingdoneon behaviour modification, including rec ognizing the cues which trigger overeatingincer tain people.Theoneconstant factoristhatifmore caloriesareingested thanareexpended, then the excess caloriesareconverted to fat.b)Regular Exert;se Exercise by itselfwillnot resultinsubstantial weightloss.Therearefor example,onehundred caloriesinonecan of soda;inorderto bum off one hundred caloriesonewould have to walk for one hourorplay tennis for halfanhour. Exercise though,isimportantinmaintaining muscle toneandoffersanalternative to eatingordrinking. For exercise tobehelpful,oneshould exerciseatleast three times weeklyandatleast halfanhourpersession.3.AnoredicDrugs (Appetite Suppresants)Thesearedeclininginpopularity basically becauseofside effects. Most of these drugs haveanamphetamine(speed)baseoramphetamine-like base,andside effects include increased pulse rate, nervousness, psy choses, hypertension, strokeandaddiction.Assoonasoneceases to take the tablets a rebound increaseinappetite seems to occur with subsequent weight gain. These drugsarenolonger usedinmostofNorth Americaandarebecoming increasinglytaboointhe Caribbe an. Special note should alsobemadeabouttaking di uretics (water tablets) for weight loss.Inaddition to dis turbing the normal physiologyofbody fluids these drugs also have significant side effects which include diabetes, hypokalemia, gout, impotenceandto some extent can contribute to cardiovascular morbidity.4.SurgeryThisisalso becoming increasingly unpopular. Formsofsurgery include various gastro-intestinal by-passoperations, suction removaloffatandthe gross practiceofwiring the individual's jaws shut.PrognosisThisisnot very good. The cure rateisapproxi mately thirtypercent. The reasons for thisareunclear, but failureofmotivationandinadequate forms of treat mentareprobably important.PreventionThisisby for the easiestandmost successful formoftreatment. Health Educationisvery important hereandthe following shouldbestressed:1. ObesityisQserious disability. 2. Weigh regular/yond keep within /iheen percentofyour ideal body weight. 3.Noagegroupisexemptanditisespecially important to avoid obesitydUIing infancyandchildhood. 4. Achangeineating habitsandregular exercisearethe only healthy meansoflong term weight loss. Calorie Intake Calculation Your weight x 15=calorie intake which maintains pre sent weight. e.g. 1851Ibs.=2775calories subtract600calories/day to lose 1lb.week. subtract1200calories/day to lose 2 IbsJweek.27


28HEIGHTAN[)WEIGHTTABLEFORWOMENWEIGHT IN KILOGRAMSANDPOUNDS ACCORDING TOFRAMEININDOORCLOTHING WEIGHING 5LBS.HeightSmallFrame Medium Frame Large Frame Feet Inchesem.Ibs. kg. Ibs. kg. Ibs. kg.4'9" 148102-11146.4-50.6109-12149.6-55.1118-13153.7-59.8 4'10" 150 103-113 46.7-51.3111-12350.3-55.9 120-13454.4-60.9 4'1l" 152 104-115 47.1-52.1 113-126 51.1-57.0 122-137 55.2-61.9 -S-O" 155 106-118 48.1-53.6 115-129 52.2-58.6 125-140 56.8-63.6 S"F'rS7 I!08-!2148.8-54.6118-13253.2-596728-743/57.8-64.6 5'2" 160111-12450.3-56.2121-13554.9-61.2 131-14759.4-66.7 5'3" 162 114-127 51.4-57.3 124-138 55.9-62.3134-15160.5-68.1 5'4" 165 117-130 53.0-58.9127-14157.5-63.3 137-155 62.0-70.2 5'5" 168 120-133 54.6-6G.5 130-144 59.2-65.5 140-15963.7-72.4 5'6" 170 123-136 55.7-61.6 133-147 60.2-66.6 143-16364.8-73.8 5'7" 173 126-139 57.3-63.2 136-150 61.8-68.2 146-16766.4-75.9 S-8" 175 129-142 58.3-64.2 139-153 62.8-69.2 149-17067.4-76.9 5'9" 178 132-14560.0-65.9142-156 64.5-70.9 152-17369.0-78.6 5'10" 180 135-148 61.0-66.9 145-159 65.6-71.9 155-176 70.1-79.65' 11" 182138-15162.1-68.0 148-16266.6-73.0158-179 71.2-80.7 Adapted from: MetropolitanLifeInsurance Company, 1983 Metropolitan Height and Weight TableforWomenHEIGHTANI)WEIGHTTABLEFORMENWEIGHTINKILOGRAMSANDPOUNDS ACCORDING TOFRAMEININDOORCLOTHING WEIGHING 5LBS.Height Small Frame Medium Frame Large Frame Feet kg. Ibs. kg. 5' 1" 158 128-134 58.3-61.0131-14159.6-64.2 138-15062.8-68.3 5'2" 160 130-136, 59.0-61.7 133-143 60.3-64.9 140-15363.5-69.45' 3" 162 132-138 59.7-62.4 135-145 61.0-65.6 142-15664.2-70.55' 4" 165 134-140 60.8-63.5 137-148 62.1-67.0 144-16065.3-72.5 5'5" 168 136-142 61.8-64.6139-15163.2-68.7 146-16466.4-74.75' 6" 171138-145 62.9-66.2 142-154 64.8-70.3 149-16868.0-76.85' 7" 173 140-148 63.6-67.3 145-157 65.9-71.4 152-172 69.1-78.25' 8" 175142-15164.3-68.3 148-160 66.9-72.4 155-176 70.1-79.6 5'9" 178 144-15465.4-70.0151-16368.6-74.0158-180 71.8-81.85' 10" 180 146-157 66.1-71.0 154-166 69.7-75.1 161-18472.8-83.35' 11" 183 149-160 67'.7-72.7 157-170 71.3-77.2 164-18874.5-85.46' 0" 185 152-164 68.7-74.1 160-174 72.4-78.6 168-19275.9-86.86' 1" 188 155-168 70.3-76.2 164-178 74.4-80.7 172-19778.0-89.46' 2" 190 150-172 71.4-77.2 167-182 75.4-82.2176-20279.4-91.2 6'3" 193 162-176 3.5-79.8 171-187 77.6-84.8 181-207 82.1-93.9 Adapted from: Metropolitan Life Insurance Company. 1983 Metropolitan Height and Weight TableforMen Extract from: Nutritional CareofPatients with Obesity, Diabetes and Hypertension CFNI/PAHO 1986.


NUTRITION AND CANCER: A COMMON SENSEAPPROACHCANCERSOCIETYOFTHEBAHAMASExtensive researchisunderwayto evaluateandclarifythe role dietandnutrition playinthe devel opment of cancer.At this point, no direct cause-and-effectrelationship has been proved, though statistics show that some foods may increaseordecrease therisksfor certain typesofcancer. Evidence indicates that peoplemightreduce their cancerriskby observing the following recommendations:1.AVOIDOBESITYIndividuals40%ormore overweight increase theirriskof colon, breast, prostate, gallbladder, ovary,anduterine cancers. People with weight problems should consult their physician to determine their best body weight, since their medical conditionandbody buildmustbetaken into account. Physicians can recommend a suitable dietandexercise regime to help maintainanappropriate weight.2.CUTDOWNONTOTALFATINTAKE.A diet highinfat maybea factorinthe devel opment of certain cancers, particularly breast, colonandprostate.Inaddition, by avoiding fatty foods, peoplearebetterableto control body weight. 3.EATMOREHIGHFIBERFOODSSUCHASWHOLEGRAINCEREALS,FRUITSANDVEGETABLES.Regular consumption of cereals, freshfruitsandveg etablesisrecommended. Studies suggest that diets highinfiber may help to reduce theriskof colon cancer. Furthermore, foods highinfiber contentarea whole some substitute for foods highinfat. 4. INCLUDEFOODSRICHINVITAMINSA AND CINYOURDAILYDIET.People should includeintheir diet dark greenanddeepyellow fresh vegetablesandfruits,suchascarrots, spinach, pumpkins, sapodillaassourcesofvitaminA;andoranges, grapefruit, cherriesandred peppers forvitaminC.These foods may help lowerriskfor cancersofthe larynx, oesphagusandthe lung. The excess useofvitamin A supplementsisnot recommended becauseofpossible toxicity. 5.INCLUDECRUCIFEROUSVEGETABLESINYOURDIET.Certain vegetablesinthe cruciferous family cabbage,broccoli, brussel sprouts,andcauliflower may help prevent certain cancers from developing. Researchisinprogress to determine how these foods may protect against cancer. Cruciferous vegetableshave flowerswithfour leavesinthe patternofa cross. 6.EATMODERATELYOFSALT-CURED,SMOKEDANDNITRITE-CUREDFOODS.Inareasofthe world where salt-curedandsmoked foodsareeaten frequentty, thereismore incidenceofcancerofthe oesophagusandstomach. The American food industry has developed new processes to avoid possible cancer-causing by-products. 7.KEEPALCOHOL CONSUMPTIONMODERATE,IFYOUDODRINKThe heavy useofalcohol, especially when accompa nied by cigarette smokingorsmokeless tobacco, increas esriskof ofthe mouth, oesophagusandliver.29


JOY-Etoile,AnsonandHedda.AnsonFernander-ashepherdboyRosebudBell, adiabeticofmorethantwentyyearswastheonly"adult"toperform.HertributetoGod,life,friends,health:aheart-warmingrenditionofMy Tribute.The Youth Club wisheditsguests, mostly adult,olderdiabetics"goodhealth" insteadofthe usual seasonal wish.Dr.Cecil BethelandMrs.JaneenMcCartney,Internal MedicineandChief Dietician, bothofthePrincess(PMH)MargaretHospitalaremost active behindthescenesinthe Association.GreaseDance.BAHAMASDIABETIC:ASSOCIATIONINPICTURES \";':.'A ...' \, '.,"."'..,o.!'.,"--/to.,,\" "1,_'A I -.... I /" '. ... /.r. Dr.PatrickRoberts,HeadofDepartment, Paudiatrics, Princess(PMH)MargaretHospital,enjoyinga mc)mentofrelaxationaftertheConcertseenwiththe younSlest performer,MindyPinder(patientofDr.Roberts).TheBahamasDiabetic Associationcelebratesitsfirst birthdayinMarch(1987).ItsYouth Clubpresenteda ChristmasConcertinDecember,plannedand by members, mostly diabetics, ranginginagefrom seven to twenty four years.30Castlefttoright-AlphosoSymonette,Emceefortheprogramme;LutinaHanna;Thompson;;EtoilePinder;MindyPinder;DaleThompson;HeddaKnowles;Kimberly;Jackiedavis;AnsonFe!rnanderandCarlosJanure.


AIDS -A PROGRESS REPORTFELICITY AYMERANDROSA MAE BAINAIDSAcquired Immune Deficiency Syndrome-thatmostfeared and frightening condition whichiscapableofdestroyingthe body's immunesystem(the body's defencesagainstinfection)sothat patients suffer frequent boutsofseriousillnessfrom infections which are ordinarily minorandwhichisfatalinmore than halfofallcases,istransmittedinoneofthreeways:.1)sexual intercourse homosexualand/orhetero sexual (the main modeoftransmission)2)contaminated blood transfusion and intravenoussubstanceuse3)during the processofchildbirth -a pregnant woman infecting her unborn child.Bahamian SceneInTheBahamas, the compilationofdata on AIDSbeganinAugust, 1985 with the acquisition,bythe BloodBank(PMH),ofequipment which permitted blood testing forthevirus whichcausesthe disease. Transmissionofthediseasebymeansofbloodtransfusion thereforeshouldnot occur.(Testingwas instituted in Freeport onemonthlater,inSeptember, 1985).Mode of transmissionThemajor modeofspread here inTheBahamasisbvsexualintercourseforadults and in children, at, dur orshortly after birth from infected mothers.PrevalenceAIDShasbeen diagnosed in persons from the fol lowing islands: Abaco, Bimini, Eleuthera, Exuma,GrandBahama,NewProvidence and total eightysix,thirty sixin1985and fiftyin1986. Up to31stDecember, 1986, there have been thirty six deaths in additionto one hundred and five personswhohave tested positiveforthe AIDS virus twentyin1985and eightY fivefor1986.Thelatterdonot nec essarily have the disease. Pleasenote:-itisestimated that,forevery one caseofAIDS thatisdiagnosed, there areatleast twenty five personswhocarry the dis ease have tested positiveforthe AIDS virus. While only a small numberofpersonswhotest pos itiveforAIDS will develop the disease, these persons ALL carry the virus and can infect others through the exchangeofbodyfluids, thatissemenand blood.ManifestationsofAIDSThesymptoms most oftenseenhere inTheBahamasarerapid weightloss;chronic diarrhoea,skinchanges (patchy discolouration, flaking,dryskin)beginning on the legs and spreadmg over the whole body, thrush infectionofthe throat, tuberculosis and inflammationofthe brain (identified on post mortem examination).Warningsignsinclude: night sweating, rapid, unex plained weightloss-(incentral Africa where AIDSaffects both men and women equally the diseaseisknownasSLIMS disease), persistent diarrhoea (two weeks and longer).PreventionIt cannot be stressed often enough that any personwhoissexually activeisatriskofcontractinganysex-------------------------------------------------------------------------------------EVALUATIONHelpustomakethenewsletterasinterestingandinformativeaspossible. Please complete, detach andreturnthis short evaluation form to the Health Education Division, Ministry of Health,Nassau, Bahamas. Tickthemostappropriateresponse.1.How did you findthenewsletter? a) veryinterestingb)interestingc)somewhatinterestingd)uninterestinge) didnotread2.Wasthereanyarticleofparticularinterestto you?YesDNoDIfyes, please givetitle. 3.Whatchanges,ifany, would youliketo see?.............................................................................................................................................................................................................4.Whattopics would youlikeinfutureissues? 5. Would you like tocontributetothisnewsletter?YesDNoDIfyes, please givenameandaddress. Name: Address: .Thankyouforyourco-operation!AHappyandJoyousEaster.31


ually transmitted disease, includingAIDS.Themore sex ual partners thatanindividual has, thegreaterarehis/ her chancesofcontractingoneormoreofthese diseases. Each sexually active person can minimise/eliminate therisksby:1.limitinghis/her sexual partners to one. 2. getting to know the partner well,BEFOREsex ual intercourse occurs. 3. maintaining high standardsofpersonal health with regar.d to, for example, nutrition, exeircise, rest, recreationandstress reduction. For those whofindthese rules too therisksmaybereducedby:1.use of a barrier method e.g. condom for men along with a water-based spermicidaljellysuchasKoromex Cream during the sex act re,gard lessofsexual preferenceandpractice 2. reducing the number of sexual partners 3. maintaining high standardsofpersonalhecllth.. AIDS., likeall other sexually transmitted diseases e.g. gonorrhoea, syphilis, chlamdyia, herpes,is transmittEtd by "the exchange of body fluids" semen, vaginal/cervi cal secretions -asa result of close bodycontadandNOT by meansofcasual contact, thatisshaking hands orevenlivinginthe same houseasa person who ei therhas/orcarries the disease. Taealtilent ofpatientwith AIDSA weeldyclinicfor patientsandcontacts withAIDSisnow heldatthePMH.Regular follow-upisdone. Patients who require hospitalisationarenursedina specialwardandstaff maintain strict barrier nursing practices.Todate, thereisno documented to show that health care attendants have contracted the disease as a result of their occupation. Dentistsarecon sideredatlowrisk.WhateveryoneshouldknowaboutAIDS1.AIDSiscaused by avirusthereispresentlynovaccine to prevent, no effective treatmentnorcure. 2. TheAIDSviruslivesinsemenandblood. 3. The diseaseisspread through a) sexualintercourse analandvaginal -withaninfectedpartnerb)contaminated blood sharing ofneedles usually by intravenous drug users.4.Themore sexual partners an individual hasthegreaterarehis/her chances for contractingthedisease. 5.Allpersons whose testsarepositive for thediseasearecarriersandcan infect their sexualpertner(s). 6. Most people who have thevirusdon't knowtheyhaveit.7.AIDSdevelops slowly, over a period oftwotofiveyears;inchildren infected at/duringbirth,theperiodisusually months 8.AIDSisfatal. 9.AIDSisnot transmitted during normal socialcontactandisinfact hard to catch unless themanorwoman has many sexual partners. 10. Oral sexwithaninfected person could berisky.11.Proper useofa condom during the sex actofferssomedegreeofprotection. 12. Givingandreceiving bloodissafe. 13. Prostitutesandusers of base housesareamongthe highriskgroupsinTheBahamas. 14. Any person having his/her ears piercedshouldensure than or,lly unusedorsterile equipmentisused.P.O.BOXN-3729NASSAU,BAHAMAS.32


EN,Dwight Felicity ,RosaMaeNJAMIN-PEET,EvetFOUNTAIN,leila JOHNSON, MarcelRASHADMunirROBERTS,PaulWILSON,CatherineWHITFiElD,Patrick 'McNEil, PercivalPhotographscourtesy of:FelicityAYMERKenOfosu-BARKOLyallBETHElAudreyDEVEAUXAshward FERGUSON StephanieCARROllHarcourtPINDERDonna SMITH-DIALABOUTTHECONTRIBUTORSisa Health Education Officer, MinistryofHealth.isa Health Education Officer, MinistryofHealth and Editorisa Community Nurse, Community Nursing Services, with responsibilitiesforCom municablediseases.isa mother and Paediatricianinprivate practice.isa Community Nurse workinginthe Carmichael Road area.isa Community Nurse presently workinginthe Community Nursing programmeinthe DepartmentofNursing Education.isthe Senior Dental Officer, Dental Department PMH.isa Consultant Paediatrician, General Practice Clinic, PMH.isa Community Nurse, Community Nursing Services, Carmichael Road Clinic.isa ConsultantinFamily Medicine and the officerinchargeofthe General Prac tice Clinic, PMH.isa Consultant Paediatrician at theThePrincess Hospital and the Co-ordi natorofthe National Committeeforthe ControlofDiarrhoealDiseases.Mr. Anthony Brown, Audio Visual Section, PMH. Dr.KenBarko, Editorial Committee Mrs. Jewel Flowers, Rand Memorial Hospital Mrs. Pamela Pinder, PindersCustomsBrokerageEDITORIAL COMMITfEEHealth Education Division (Editor) Public Health DepartmentTheCounsellors National Insurance Board ArchitectDahamasAssociationofLife&Health InsurersHealth Education Council Broadcasting CorporationofTheBahamas