Joining hands for health: caring and sharing at Summer time

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Joining hands for health: caring and sharing at Summer time
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Joining hands for health
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Public Hospital Authority
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Public Hospital Authority
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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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Volume 4-No.31986/87JOININGHANDSFORHEALTHCARING AND SHARINGAT SUMMER TIME

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TABLEOFCONTENTSPageMenof The Bahamas Side Burns Editorial .2MenatWork (pictures) 3Isthe Male Superior?KenOfosu-Barko 4OnBeing A Father Basil Smith 5 Male Sexuality Ronald Patterson 6HowItAllBegan Roosevelt Finlayson 8 The Husband Who Cares Greg Burrows 8 You're Not AManUnless Gregory Coleby 9 The More Sweethearts Marcel Lightbourne10Is There A Formula..? Lyall Bethel 9RealMenDon't Cry Edward Hutchetson11Husband Dictator,.. : Leader? Rudolph Cartwright11Power Cyril Peet12Proof of Manhood Endric Deleveaux12Up-Date Felicity Aymer13A Spiritual PerspectiveOnManliness Lyall Bethel19Impotence Patrick Whitfield21"Evaluation....................................................................................................................23About The Contributors................................................................................................................ Inside Back Cover

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MENOFWHOMTHEBAHAMASCANBETRULYPROUD IN(,I I,\; 1 I. .\ L.\\I"IWN"TM w.. ,-WHA1YOU IN ???)UE: /JUL21 ., t

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Recovery following accidents canbea long and arduous process. Learning to use hands.Healthissomuch more than the absenceofdiseaSEand disability.Ithastodowith the individual's abilitytcmaintainaneven keelinever-quickening maelstrom.Promoting health encouraging seemingly healthypeoplEtoremain healthy entails providing a milieu/environmen which allows themtotake the necessary steps that end. Today, behaviour, individualandcommunity perhaps the single most important factorin health and quality of life. What the youngmenare ismeansofimproving their quality of life. Both and their familiesaswellassociety will needtoactivell seek the solutions which will enable memberstofindthEbalanceandslow downifnot stop the maelstrom A strong male figureinmore families is urgentll needed. Someof the contributors have personallyresolvedtoeffect a change. abuse, sexual abuse, some with inordinatelyaggressivEbehaviour, accidents and injury are the leading cause0death and disabilityinthe 15-44 age group formen.Ii 'to"R Occupational therapy.Their recurring theme was/is a search for suitable role models, clear societal guidelinesandstandards of behav iour at the personal, social and emotional levels.EDITORIALCaring and Sharinginthe Summer Time, 1987, has attempted to look at someofthe concernsofyoung men in New Providence. These concerns, although not primari ly with healthinits narrower sense (physical and mental aspects)dohave profouncrimplications not only for their own but also for the health of the communitiesinwhich they live, work and play.2Contrary to popular belief,menare not the stronger sex. The wastage rate of unborn and newly born male infantsismuch higher than for females. Worldwidethenumberofyears any mancanexpecttolive are less than for women. The problems which they faceandareexpected to solve would seemingly contributetotheir earlier death.Inaddition, they are now faced with a revolutioninthe roleofthe sexes with which they are trying to come to terms. Some respond with antisocial behaviour, substance

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MENATWORKEmployment, having a job.istraditionally a very important aspect of every man's psyche. The ill-effects of unemployment to the individual are well-known.. ;,.4Crews of2,onetodrive and operate crane, the othertoInstall lights, B.E.C. Manual sawing at construction site. :r;;.c',_ A grueling but very pleasanl job? R.B.P. Band 'working'al Fl. mingo Gardens layingofcornerstone ceremony. \Ii>,. EmployeeofB.E.C. erecting street lIgnls. Careful useofprotec tive gloves. Using electric saw, Carpenter's shopPMH. Jl lIylngthefloorfortheflamingo (iaroens Clinic. "'"",,,W0i '--Developing photographic film. (Mike Bullard,PMH) "-Motor mechanic Important person In today'll motoring society.Relautlon-a gameof dominoes necessaryfor everyone's health and well-being.3

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ISTHEMALEREALLYTHESUPERIORSEX?KEN OFOSU-BARKO TABLE 1 I know what conclusion you may be comingtoor might have come to, but I know one thing, and itisthat the sexes are supposed to be complementary or is itcomplimentary? The will, intellect and emotions are attributesinmenand women which, when combinedinthe right proportions and in that order can produce some fascinating results. The man is said to have his will and the woman herway.What do you say about the intellect and emotions? sis ignore the terms if you don't understand). The man on the other hand is likely to retire from active servicebychoice, through the effect of drugs for example or other wise (Shakespeare says alcohol increases desire but low ers performance).71FEMALE77.678.877.4797779.17773.2 79.565MALE 71.4 70.6 70.7726973.17167.772.7Life Expectancy at birth (years)' Bahamas COUNTRY Denmark France Italy Netherlands Portugal SwedenUKYugoslavia Norway On the intellectual front,ithas been said that "the first mantothrow a blow is the one that has run outofideas".Ifso does this offer a possible explanationastowhy the maleisusually the aggressor?Isit becauseheeasily runs out of ideas or that he simply refusestousehis intellect? Are there any implications? Or wasPlatojustified in saying that "mightisright"? Demographically, the female outlives the male.InThe Bahamas, whereas life expectation at birth (the number of years one is expected to live when he/sheisborn, consid ering certain assumptions) for males is65years while that for the female is71years, 1979-81 (see table 1), this appears to be the picture in nearly all parts of the world.Isthis a reflection of the intrinsic qualities of the sexes or isitmerely a plot to eliminate the men quickly?Isthis a possi ble reason why the female is said to be emotionally more stable and to cope better with stress than her male coun terpart, or vice versa? Let us turn our attention to the reproductive potential of the sexes.Itisanestablished medical fact that, as the woman grows older, her chances of giving birth to a baby with a defect increases. Could thisbethe reason why she has an in-built regulatory mechanism to shut off the repro ductive potential at a certain age while the male continues to pump out the scavengers? I am told that women claim that the stuff from the older men is better, or is it rather their performance? Can this claimbesubstantiated?Inthe genito-urinary system, the male uses one organ for multiple functions whire the female's organs are differ entiated. According to the theory of the evolutionists and the biologists what does thisimply? According to Biblical sources, the woman was made after her boss, the man. The first question is this, is a later version always better than (an improvement on)the,first or earlier version? the protagonists of the theory of evolu tion advocate that the more highly differentiated the orga nism, the more advanced itis.Ifit were so then men would consider this a grievous fault and grievously would they answer the opposite sex. Comparing the sexes invariably arouses emotions. This is justifiably so because in any situation where one runs the risk of being judged as inferior, weak, bad, one has the right (legal or otherwise) to stand to his or her defence. Based on this premise, I do not intend to pass any jUdgement, but to present some interesting facts for your consideration. Another observation is that once the female starts active service she potentially remainsinthat state until death, (unless some obstetrician terminates this service iatrogenically through a procedure likeLeFort's colpocle'Ref: Walter Hubrich The response of Hospital todemographic social and morbidity changes in society:Int.J.Health Planning and Management Vol.1No.4July-Sept. 1986 pg.291.4

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ON BEING A FATHERBASIL SMI.1H Parenthood comes with natural, instinctive ease tomostofus,yetfew ofusallow ourselvestotake thisremarkablycomplex and responsible role for granted.Beinga parent involves far more than getting the kidsreadyforschool, paying the fees, providing foodandshelter.Itinvolves taking charge of a frail, highly vulnerableandveryimpressionable spiritatthe momentofthe dramaticentry into our world, nurturing his/her growth andguidinghis/her development through countless stages fortheeighteen orsoyearsittakes a childtobecomeanadult.Ofcourse,itnot beinganideal worldinwhichwelessthanperfect humans live,itdoesn't always work out thatway.Thefact does remain, however, thatishowitshouldbe,evenour instincts tellusso.Bystanding back and observing my own children forexample,I have been struckbythe importanceofexampleinraisingchildren.Itisbythis method that cultures survive,manyfeatures remaining intact for centuries. Thismarksoneofthe most strikingandimportant distinguishingdifferences between manandanimal. Genetic inheritance accountsforthe instinctive awarenesswhichmankind and animals have about many things.Noonehastoteachaninfant of any species how tosuckle,for example. That informationissupplied throughthechainof genetic inheritance. But whilethefoodtowhichtheyoung suckling takesinlater life continuestobedictatedbygenetic factorsin al7limals, inman, cultural inheritance takes over.Forthat reason cows eat grassnomatterhowold they get, whileinhumans Indians eat curryandItalians eat pasta. Italians raisedinIndia probably willregardcurryasa dietary stapleandvice versainthe caseofIndians raised as Italians.Evenbeforehecould read the name,mysoncouldrecognizethe pictures ofmyfavourite jazz musicians. Hewouldseethemonthealbums which I played most frequently,ask their name and then throw them backondemand.Itdeveloped intoanimpressive parlour trick andprobablyset the first course of direction for his future ad venturesinthe wonderful worldofmusic. There is such a bewildering range of information,tastes,opinions, values, ideas, philosophies which onehastoimparttoone's child.Inmy own case I concludedthattherelationship which would best enablemetoimpartthemost useful information with maximum credibility wasmoreinthe line with being a friendandless with being alawmaker. I treat my children likemybuddiesasfar as possible, without losing track of the need for firmness fromtimetotime to ensure their conformitytocertain patterns. Children learn of the world through the eyes, ears and experiences of their parents. They do thisbytheuseof questions, thousands and thousands of questions. The parent who does not make timetolistentothose questionsand provide carefully considered answersisdepriving his/hl3r children of the single most influential method of Wehumans are resourcefulandchildrensode prived Will find other sourcesofinformation, but chances are that somewhere down the road the parent guiltyofsuch neglect will have causetoreflect "that childislike Fl strangertome.I can't understand it." Children also like to share their experiencesand im pressions of life with their parents. That daily grind about whichweadultsbecome blase isa continuing adventure for a child.Eachday brings new challenges, impressions and experiences. Emotions growandarestimulatedasthe childshares the gift of friendshipinthe school yard. Challenges are metandgrappled withinthe classroom. Listeningtoour children relate the little successes and disappointments of their day at school offers a valu able windowtotheir lives. These listeninganddiscussion responsibilitiesofpar enthood form the basisofa crucial bond between parent and growing child.Onthis bondisbuilt the success of the parentasrole model.Ithas oftenbeenbemoaned thatintoday's Bahamas thereisa shortage of positive male role models. The most important ofalltherolemodels a child can have are the twoheorshehasasparents.Inmany Bahamian families the male parentisabsent, a situation which leaves a void whichisparticularly difficulttofill.Mychildren composed a little song some years agoofwhich Iamparticularly proud,itiscalled "Hanging Out".Itislongonlyrics.Itsimply goes: "We're hanging out, Hanging out, Hanging out with daddy, Hanging out, hanging out, Hanging out with dad."Itisa song for Saturdaysinparticular, the entire day which I dedicate to spending with them. Among the regu lar activitiesweshareisa triptothe movies. My sonisquite a movie buffandmonitors the pro grammes and ratings for us.Aslongasa movie with a general ratingisintown,weare there rollinginthe aisles with a house full of children. It isanexperience which I enjoy as muchasthey. The real reason for going to the moviessofaithfullyinthis age of watch-'em-at-home videoisthat I think the social exposureisgood for them. Nothingcanreplace the warm magic of watching Stephen Spielberg's Gooniesina theatre crammed with shrieking children. I recommendit!Of course thereismuch more to fatherhood than friendship, role modellingandSaturday afternoonatthe movies. Essentially fatherhoodisa roleina synergistic relationship whichisalso enlightening for the fatherasfor the child. The rewards more than compensate for the burden of responsibility whichitimposes.5

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MALESEXUALIITRONALD PATTERSON Early DevelopmentThe human embryoorfoetus of both sexes, developsinanidentical fashion for the first two monthsofpregnancy,Only thereafterdoanatomicalandphysiological devel opment divergetoresultinthe formationofthe maleandfemale types, TheXXfemale chromosomeorXYmale chromo some, established at the timeofconception, directsthedevelopmentofeither ovary,inthe case of the female, or testes,inthe case of the male,Iftestes develop, their hormonal secretions elicitthedevelopmentofthe male secondary sex characteristics, collectively knownasthe male phenotype,Onthe other hand,ifanovary develops orifthe testes that developinthe maledonot effectively secrete certain hormonal substancesatthis very early stage of foetal life, the anatomical development of female sex characteristics will usually occur.Family responsibility of r.lale AsFather:-provider -toensure thatfamily members are well housed and fed and children edu catedinaccordance with the basic rights of the childasidentifiedinthe United Na tions' Declarationonthe Rights of Chil dren. Companionandplaymate to wifeandchil dren, spending time with theminfamily outings, allowing children special time with himontheirownandtogether,asa group,toenable themtoexperience a healthy male role figure.AsHusband:-loverandsweethearttohis other half, A fulfilling sexual relationship is a basic com ponent of a healthy marital relationship,AsFriendandCompanion:-sharing with his wife's joysaswellasserious difficulties arising from her other life, that of work. Communicationisthe keytoa good marital relationship.Responsibility during pregnancyDuring this important period, the man's emotional, fi nancial and other elements of supportareessential. They involve his attending prenatal visitsandbirthing-room classes with his wifeorpartnersothathemay better understand the full complexity of the pregnancy and labour processandhis wife's reactiontoit.His presence during the labouranddelivery processcanalsobeextendedtocaesarian section deliveriesinselected situations. Equallyimportantly,hemust guard against outside sexual activity. The adverse consequences of thiscanin clude premature labour, miscarriage, premature rupture of6membranes or the wife's waterbagandserious transmis siontothe foetusormother, of a variety of infectious agents suchasherpes, human papilloma virus (thevirusassociated with cervical cancer), gonorrhea, syphilis,chlamydia, the AIDS virus and numerous other sexuallytransmitted diseases.Inthe event that outside sexual activity cannot be avoided, condom use during coitus (sexualintercourse)ismandatory,AtpUbertyMale sexuality boys experience a suddenanddramatic increaseinlibido (sexual urges) whichissecondarytothe high production of the male hormone testosterone; malesingeneral reach the peak of their sexual reactivity and potencyatseventeentoeighteen years ofage,Unprotected sexual activity at this time has resultedinalarming teenage pregnancy ratesaswellassexually transmitted diseasesandtheir serious complications,Bythe time amanisover forty, the quality ofsexualpleasure has often beguntochange noticeably. Afterthefifties, the ageing process has profound effects on thefrequency of orgasmandthe length of the refractoryperiod, thatistosay, the lengthoftime requiredtohavepenile erection after orgasm progressively increases, Thereisconsiderable speculation regarding theexistence of a "male" menopause. The malehormonechanges are gradualascomparedwiththe abruptcessation of ovarian female hormone functioninginwomenandthereissome evidencetoindicate that this processinmen may begin much later,inthe mid-fifties, versusagefortytofiftyinwomen,Insomementhis time oflifeisaccompaniedbydepression, irritability, lackofenergyandsexual difficulties, Apart from his lowered male hormone levelsinhismid-fifties, a man also beginstofacetheidea ofdeathandisconfronted with his limitations.Ifheisnotpossessedofenough resourcesandstrength, depressionandanXiety may become manifest during this period.Impotence and avoidance of sexareoften a part of thissituation. Replacement testosterone treatment is helpfulinsome cases.Asfarasthe purely sexual functionsareconcerned, some men compensatefortheir age-related declineinsexualitybyseeking outandcreating intensely stimulating erotic situations, fantasiesandpartners.Ofsignificance, more direct stimulation of his genitalsbyhiswifeor partnerisusually increasingly necessarytocreatearousal and erection. Other menbycontrast, succumbandcease having sexual intercourseintheir fiftiesandsixties,Onthe contrary, women tendtowant moresexratherthan less as they approach middleageandbeyondandtheir responsiveness becomes only slightly lessrapidandintense. ..

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5 5Thewifemayfinditdifficulttobegenerous, seductiveandresponsiveifshe interprets her husband's decliningsexualvigourasasignof rejection.Itis therefore mandatorythatsuchcouples recognize that normal age-relatedsexualchangesdooccur, that they are not identical forhusbandandwife but rather theyarea productoftheageingprocessandnot ofthequalityoftheirlove.Finally,male sexual dysfunction among couplesofallagescanbea source of serious marital or relationshipdifficulties.Some of the common sexual dysfunctions involveimpotence and premature ejaculation.Itisimperativethat professional treatmentbesought, since therapycanbeextremely successfulandgratifying particularly forprematureejaCUlation.Masters and Johnson (renownedfortheirworkonhuman sexuality) diagnose amanasaprematureejaculator ifhereaches orgasm beforehiswifedoesmorethan fifty percent of the time. Consequencesofsexualpromiscuityin marriage or relationshipTherising incidence of sexually transmitted diseaseshasheightened the incidenceofpelvic inflammatory disease(PID),refers to a clinical syndrome of infection thatisinitiallytransmittedbythe male during sexual inter90urse tothevaginaandcervix of the female, which then causesaninflammatory responseinadjacent tissues including theuterus,the fallopian tubes, the ovariesandthe abdominalcavity.IntheUSA,PIDoccursinabout850,000womeneachyear,requiring more than212,000hospital admissionsand115,000surgical proceedures.1\1 A!...L f'LLV ILUl\(;Ai\JS Theeconomic loss resulting from this infectionisestimatedtobeapproximately 2.7 billion dollars annually. Thiscostincludes managementofhospital in-patientsandoutpatients,includinglongterm consequencesofPIDto thefemalesuchasrecurrentandtroublesome abdominal pelvicpain,ectopic (tubal) pregnancy, infertilityandadhesionsor scar tissue formation involvingthefallopian tubes.Theincreased incidence of ectopic pregnancy cases carryingwith it the risk of fatal internal bleedinganddeathisanother feared complication ofPIDandreflects the increased number of cases ofPIDinthisageof sexual indiscretion. A major complicationofsexually transmitted disease is both female as wellasmale infertility.Inthefemale,alterationanddamage of thetUbescausedbysexually transmitted infectionisa major cause of female infertility, whileinthe male thereisdamagetothe male sexual organsandsimilar infectionscanbea signifi cant factorinlow sperm countandconsequent male infer tility.FEMALEPELVIC OIlGANS Cervical cancer among womenisnow felttobea sexually transmitted disease, a direct result of sexual in discretionanddirectly related,ina significant number of cases,tothe number of sexual partnersoneither side.Infact, the incidenceofcervical cancerinvirginsorincou ,pies who havehadlifetime limited number of sexual part ners is quiterare.Of particular interest, mostofthe sexually transmitted infections causing the above problemcanbevery silent and unsuspectingtoeventhemost carefulandobservant person whileonthe other hand internal damagefromthem progressesinmany cases undetected until itistoo late. While barrier contraceptive methods suchascon doms, spermicidal creamsandthevaginal sponge offer some protection, theseareindeed limitedandthe best approach shouldbepreventionbysexual responsibility and discretionbyboth maleandfemale. Finally, this article wouldbeincomplete without a ref erencetodruguse,theserious consequences of which are vividly known to most readers.Ofinterestisthe fact that many ofthe sexually transmitted disease complica tions including AIDS are substantially higherinthis group.References: YFieldrnan:-Sexually Transmitted Disease, Churchill Livingstone H Singer Kaplan: The New sex Therapy, New York Times. OBSTET Gynecol Survey OBSTET GynecolDeCherney; Polan: Reproductive Surgery, Year BookMedical Pub lishers.7

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HOWITALL BEGANROOSEVELTFINLAYSONInDecember 1981, duringtheChristmas season, a groupofyoungmenand women from Carew Street, offMt.Royal Avenue, came together for a reunion. The feel ings generated during that reunion,asthey reflectedonthe "good old days," were very special and warm. A few days after the reunion, while visiting the home of Edwin and Edith Davis, former residentsofCarew Street. they continuedtotalk about those "good old days."Itwas dur ing this discussion with the Davises that they began to focus not onlyonCarew Street, but the wide community of the Valley or Centreville. The result of this dicussion was the birth ofanidea for a community-wide reunioninthe Centreville area.Itwas the first dayofAugust, 1982 when a group of past and present residentsofthe Centreville area metatthe Burning Pot Restauranttodiscuss this ideaofa Cen treville reunion. They decided that they wanted todosomething special andinfact they wanted this reuniontobea Festival. During that first meeting the feeling of toge therness was strong and sweet. Everybody wanted to make a contribution to the Centreville Festival.Itwas Lin da Fitzgerald who cameupwith the name"CentrevilleinOctober" anditwas Raphael Munningsof"Funky Nas sau" fame who developed the festival logo highlighting the junkanoo drum and cowbells. Linda and Raphael have put their personal stampsonthe festival andintheir own way helped to makeitspecial. The first festival was heldovera three day periodin1982 andin1983.In1984 the festival's format was ex panded to a full week. Last year, 1986,theformat had been expanded further to include a full monthofactivities. "Our main aim in organizing these festivitiesistoprovideanopportunity for past and present residentsofthecommunity to get togetherina spirit of brotherliness.Weaim tohavea great time togetheraswesavour thememories of the "good old days," says Roosevelt Finlayson. But thereisalso a seriousobjectiveofthese festivalsandthatisto raise funds for scholarshipsatthe CollegeofTheBahamas for students from the area. Since the first festivalwehave madeanimportant statement about the benefits which are achieved when a community comes together without regard for politicalorreligious differences. Personsinseveral parts of thisisland have watched usandhavefollowed our leadbyestablishing festivalsintheir respective communities.Inorder to keep the public's interestandsupport,theCentrevilleinOctober Festival must continue to grow.Themajor challenge beforeusisto encourage greater partici pation by all sectorsofthe community.Aswe looktothefuture perhapsitisfittingtoreflectonanidea developed during a recent discussion which I had with Raphael Munnings,DonHunt and Phillip Munroe. Their ideaisthatweshould capitalizeonthe positivefeelings generated by the Festival and organize a seriesofsporting and cultural activities throughout the vear.Thefestival, they feel should then becometheannual climaxofthese year round activities. Year round activities are definitely neededinourcommunity butofcourse this requires a much greater effortbythe organizing committee. Butweallknow thatwehavemore than enough talented peopleinor from the areatoattain this goal. Thereforeleteachofusmake a commit menttothis ideaofyear round activities. THEHUSBAND WHO CARES.ISAWHIMPGREG BURROWSThe term "whimp" though notanofficial wordinour language nonetheless conjures up a pictureofsomeone whoisweak,inbondage and not assuming his proper role and functioninarelationship orinsocietyatlarge.Inthis ageofsupposed enlightenment,itsometimes seems strange that the viewexpressed the husband who cares for his wife and who playsanactiveroleinhis domestic lifeisa whimp -issoprevalent,andthat thereissomething wrong or degrading or "unmanly" about(1)caring for your wife(2)helping with domestic duties. The first aspect of caring for one's wifeasbeinginany way negativeisabsolutely ridiculous and nothing shortofbar baric. Marriage fundamentally shouldbebasedonmutual caring and affection between committed marital partners. The person who cannotloveor care forhiswifeissurely someone who does not understand loveandmost likely does not love himself.8The second aspectofhelping with domestic dutiesiswhere many menhaveproblems. Someofustendtothinkthat the only form of workweshoulddoisour jobs.Thisperhaps wouldbeexcusable to a degreeifour womendidnot go out to work also, yet,weseem to expectthemtowork from 8:30 a.m. to 5:00 p.m.andstilldoallthedomestic chores, bring up the children and provide discipline and spiritual leadership. Thisisabuseinthehighestdegree. Thereisnothing degrading about domesticchoresbeing done by men. All honest workishonourableandprofitable. The real criterion may,however,beeitherlaziness, selfishness oranextreme bondage tounrealisticrelationship stereotypes whichinour society, tendstooppress our female population. Jesusgaveof himself (rememberhewas male)showing us that true manhoodisbuiltongiving ourselves for the betterment of others.We,therefore,asmencanbefree to care, freetohelp our wives.Indoingsoweshowwhat REAL manhoodisall about.

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YOU'RENOTAREALMANUNLESSWhenever and wherever promiscuityinmarried menoccurs,it mustbeseen that one of the fundamental principlesofthe marriage vow has been violated. Marriage ispromiseor commitmentoftheir lives to each other.Inour society, young men are looking for role modelsandwith such a decayinour morals, we are constantly searching for someone whom we can emulate. When wefinda man who keeps his word, is honest and faithfultohiswife,weshould not hesitatetopoint him outassomeonetoholdinhigh esteem.WeinThe Bahamas often claimtobea christiannationand with that background, I would liketoquote fromtheBible as it relates to a husband cheatingonhis wife. Matthew 5:27-28 Jesus says, "Ye have heard that it wassaidbythem of old, 'thou shalt not commit adultery. But Isayunto you, that whosoever looketh on a woman to lust after her hath committed adultery with her alreadyinhisGREGORY COLEBYDownthrough the ages, man has alwayssoughtto Cheating on one'swifeis called adultery and adul-achieveesteem for himselfbyflaunting his masculinity, teryissin. God will punish wrong andwewill not escape ifresultinginpromiscuity outside the marital relationship.Inwepersistinthis practise.manysocieties today it would appear that promiscuity istheorder of the day. The myth that you are not a man Another biblical passage frequently used at weddingunlessyoucheatonyour wife mustbedestroyed as it has ceremonies also depicts quite clearly how God intendedtakena very serious and detrimental tollonthe sanctity ofour marriages to become, one bond which leavesnoroom marriage and family life. for a husbandtofind the time and purposeto'pursue another woman. Mark 10:6-9 which relates to the unionofAdam and Eve by God, Jesus says, "But from the begin ningofthe creation God made them male and female. For this cause shall a man leave his father and mother and cleave to his wife. And they twain shall be one flesh;sothen they are no more twain but one flesh.Wha'ttherefore God hath joined together, let not man put asunder." The oneness means simply that the unit is now bonded togeth er for life, and only death should sever this union. There fore men were not given the right to break this union. Men of The Bahamas canbemenbybeing solely committed to the one woman thathehas takentobe his wife.Ittakes a mantobe truetohis word, but one who cheats on his wife does not earn the right tobecalled a man. A man who possesses strong convictions, principles, high morals, love and commitment to his wife and disre gards the now common adage that "you're not a man unless you cheatonyour wife"istruly someone who can really be called a man.THE MORE THE SWEETHEARTS, THE BIGGER AND BETTER THEMANMARCEL L1GHTBOURNEThis isaninteresting topic and, I suppose, the vast majority of men would lovetoliveina world where their fantasy of having as many women as they can afford to serve them and satisfy their every desire could be rea lised. I believe the Islamicwor.ldstill allows a man to enjoyuptothree wives if hecanadequately maintain them.Inancient Biblical times, many of the patriarchs enjoyed the luxury of multiple partners. Even though polygamyislegallyforbiddeninwestern societies, many transgress the systembymarrying more than once, while still legally at tached to the first partner. Finally, there is the guy (with or without a legal spouse) who fools around with as many women ashecan manage. The mentality, of course, which spawns this type of behaviour is basedonthe same assumption that the topic suggests, "The more sweethearts, the bigger and bettertheman." One must ask oneself the question, is manhood or manliness determined by the number of women a man can boast of having? Is this a valid criteriontoproveman hood or is there some other? This may be a valid assumption, ifit is based purely on basic human logic, instinct or desires; but notifitisbasedonthe inexorable law of God. Manhood, accordingtothat law does not dependonthe number of women a man can boast of having, but rather, how wellhehas been able to discipline himself to remain true to a higher law or promise, a commitment.Heis lessthan a man who givesinto every whim or desire. He has violated one of the fundamental principles of man hood that of self-discipline.Ifa man cannot control himself, his habits and desir es, that does not make him a bigger man, but a fool. My judgement is that, basedonthe high law 9f man hood, one becomes more manly by demonstrating his abil ity to adhere to the law of one man, one woman, and to show his originality and creativity as time passes. To be able to measure up to the Herculean task of keeping that one woman happy and satisfied, whether it be for ten or forty years of marriage, as long as God permits such a union to endure, that surelyisthe quintessence of man hood.9

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ISTHEREA FORMULAFORDATING?LVALLBETHELI remember when I was growingup,I often came across magazines advertising booksonhowtopickupgirls/women. Although I never made the effort to obtain such books, I could well imagine the well-seasoned Cas sanova with hypnotic stare and eloquent words falling off his lips ensnaring some unwary lass with his well oiled speech.Asa little boy I would often wonder "was there some secret formula that a man could usetodraw the female totally withinhisembrace?Didhehavetorunhisfingers through her hairashelooked her straightintheeyesandpledged his undying lovetoher or was there something else?" Luckily,ata very young age I was able to separate Hollywood from real life.Inour performance oriented so cietysomany men fall into the trapofbeing (or rather pretending to. be) macho that they miss the pointofbeing real. To think that a woman will likemeifIactina certain way orifI use a certain formula, or "rap", says. thatifI desire the security of a relationship I cannotbemyself. Furtheritimplies thatifI let a woman knowmefor who Iamwithout my "lines" she will rejectme.It also dehuma nizes the womaninthatitassumes sheisa mindless robot designedtorespondtothe right combination of words. The individual seeking a formulaisactually tryingtohide behinditbecauseofhis fear of rejection.Hedoesn't wanttofail orbeturned downsoheseeks a tried-and true method that will guarantee him resultsinordertoprotect his fragile ego. A womanisa sensitive, caring being.Shewant. to know that my love for herispersonalized.She dOesn't want to know that she is oneofthemany suckers who has fallen for some ageless lines.IfI assume that a "for mula" will make her mine, I presuppose a number of things. I presuppose that variables suchasattraction, physical appearance and individual preference havenobearingina woman's responsetome.I presupposethat she will respond the way the formula expects hertorespond, and that she is hopelessly subjecttoits magic. The formula-seeker fails to realize thatnotwo women are alike .. Having grownupintwo different backgrounds with different role models and teachers, I realize thatno10two women think and respond alike. A womanmustbeseenasanindividual with feelings, capableofa varietyofresponses. The real man mustbewilling to bare himselfashetrulyis,fully cognizant of her capacitytorejecthimwithoutfeeling that itisanaffronttohis manhood. Why?Becausesooner or later she will discoverthereal fellow withoutthe protectionofhis lines and well-oiled speech. Of courseyouwill fumble and grope for somethingtosay ifitisthe first time orso,but then again, thatistobeexpected -youdon't really knowtheindividual!Youdon'tknow their likes and dislikes, or their interests. Thehollywood star you maybetryingtoemulatehadhisproblemsinreal lifeaswell.Itisimportanttobeabletodistinguish betweenthephilosophy that the movie, the soap opera,oreventhelatest songisteaching;andtherealworld.Intherealworld don't expect hertobesmitten by the first coupleof.Iines you speak, becauseinreal life she won'tbefollowingsome script. Starting off with a normal lowkeyrelationshipcantake much of the anxiety and pressure off themale.Lether make a response after you have shown hertherealyou. That wayyouwon't havetolive a lie for thedurationofthe relationship. Note carefully, Iamnot saying that a formulaorcleverrapwon'tsucceed,onthecontrary,itworks almostona daily basis.Itworksonthe young girl anxious toknowwhat it is like tobeinlove.Onthe young womangettingoninage who has been saving herself for PrinceCharming orMr.Right.Ontheolder woman who just wants a man to court her whetherheisusinghislines ornot.Thenofcourse thereisthe "lady" who will acceptyou,linesorno lines. Not the type of ladyyouare lookingtocourt. The man must realize that, for the ultimategoodofboth parties,itisbestifhecourts herashimself,withhisown heartfelt words, forassoonasshe recoversfromherswoon (that she succumbedtofromhis"magic formula") she willbeawakenedtothe fake thatwonher heartbyinsincere means,andshe willbeanything but pleasant.Arelationship purchasedatsocheap a price probablyisn'tworth the priceyoupaid forit.

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REALMEN DON'T CRYEDWARD HUTCHETSONtMysonwillbethree years old this weekandalreadyheisdevelopinganaversiontotears.Hissister, who isoneyear and three months older, has to bear a constantbombardmentof the phrase "fifa face, fifa face, fifa face"whenevershe hasanissuetocry about. "Fifa face" isshortfor"fix your face".Thequestion arises, "Howcana male child not yetthreeknow that thereissomething wrong with sheddingtearsinthe open? The fact that there is nothing wrongwithshedding tears pUblicly has nothingtodowith hisknOWledgethat a person has to "fifa face" whenever cry.Hasthe writer gone astray? The topic is "Real mendon'tcry."Onecold hard fact about the little boy aforementionedisthatwheneverhecrieshedoes itinprivate, somewhereawayfrom whomever or whatever caused his tears toflow.Ashis father, Iamknownasone whoisnot afraid tocryinpublic or let the tears flow wherever or whenevertheycome, but I cannot imagine why this little personisalreadycultivating the myth for himself that, "REALMENDONT CRY?"Realmendon't cry -onthe outside.Allmen,real or unreal,cry.Men who are real live. Men who areunreal-die, but these deaths are mostly unseen.Wehide behind the stiff upper lip the determination not to yield. It's a guarantee thatwewillsaywhatwethink but never whatwefeel. That feeling, thatisa partofbeing unafraid,ofbeing mistaken formen.Real men don't cry But howcana three year old know? Will he have to experience for himself what his father should already know? Know!tothe degree thathewantstoshare day by day that, "it's okay, it's alright to cry." 'causemennot afraidtoface their tears will neverbeafraidtodie. Die to the myths and traditional lies that keep men boundinchains, that separate fathers from sons and add anguish to precious days. Come here my son, take Daddy's hand There'ssomuch I have tosay,About tears, about fears, about real men who care even when their tears getintheway.HUSBANDDICTATORORRESPONSmLELEADER?RUDOLPH CARTWRIGHTItismy sincere beliefandconviction that a husbandshouldbea responsible leader and not a dictatorinthehome.The ideaofa husband behavingasifhewere a dictatorinhis home has come out of misunderstanding thedutyof a wife to obey her husband.Inother words, the English word obey (perform the biddingof,dowhat oneistold) has taken on the unfortunate connotationofa sla ve/master relationship. But this is not what it shouldbeatall.Itsimply means that a wife should subordinate herselftotheauthority of her husbandinthose areas which affectthewelfare ofthe marriage and the family. Thereisno personal stigma associated with this. Subordinationisa part of her life,asit is of all our lives. The husband ac cepts the loving submission of his wife while heinturn loves her. Therefore, if and when a husband hastoinsist or demand this submission,hehas failed badly.Itisfalse to think that because the husbandisthe leader,heis morally or spiritually better than the wife, thatheis more clever or more able. This does not follow. The husband's responsibilityisvestedinthe fact thatheis husband and father, not because of any intrinsic merit. Heishead because of the nature ofthe situation. The authority of the head ofthe houseislimited to matters affecting the welfare of the family. For him to act likeanancient monarch wouldbea sad prostitution of his God-given statusasleader.(continued on next page)11

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(continued from preceding page)I of a husband who triedtoregulate even his wife's ideas. Whenhecould not persuadeher,heordered her and when this did not work,hecontemplated divorce on the grounds that shehadviolated his authority! This might seem crazy but there are cases of husb:mds who trytoregulate their wives'religious convictions, their choices of friends, their recreational activities, their hair styles and soon.These are clear cases of violation of personal freedom. The husband should demonstrate his loving lead ership by giving himself, for his wife's welfare, financially, mentally, physically and emotionally,atalltimes. The hus band should exercise his authoritysothat it will neitherbeobnoxioustoher nor stifleher,but ratherinways that allow her ample opportunity to execise her own leadership abilitiesinthe welfare of the familv.Inproviding good leadership,thehusband willdelegate authority. Thisisthe only way that thingscanrunsmoothly and efficientlyinthe home. The executivewhocannot, or will not delegate authority has no placeinleadership atalland the sameistrueofa husband.Atthesame time tbe husband who tries to lead a familybydetermining what his children and wife will weareveryday,what willbeonthe menu, andwhowill do thehousework,does not understand the true meaningofleadership.Asa leaderinthe home the husbandcanstriveforhis fulfillmentinone of two ways.Hecanbludgeonthepersonality of his wife until she submitstohis everywhim,or he can serveandstrive for her welfareandhappinesssothat she will want to treathimlike akinginthehome.POWERISDEMONSTRATEDBYABUSINCiYOURWIFECYRILPEElThereisno truthinthestatement that powerisdem onstrated by abusing your wife, althoughinThe Bahamas this conceptisacceptedastruth. Because of this,wehave a distorted idea ofhowweshould relatetowomen. Therefore when the time for marriage comeswedon't know howtotreat our wives.Webelieve thatthehome and children are her responsibility alone.Allwehavetodoisgo to work, bring the moneyin,two-timeifwechooseto,use abusive language,andbeat hertokeep herinline. Letting her know that "Iamtheboss"isessential.Wethen conclude that ifwedoallthese thingswearedoing a good job.Itmay sound harsh but that's the wayitis.The myth about this statementisthat abusive power and love do not go handinhand. Today,wefind that more and more women are not goingtostand for thissothey leave. When amanaccepts his wifeashisequal,hewill learn that she is not his slave but his best friendandlover. Those who believeintheGodoftheBible, under stand the "one flesh concept" -Eph.5:13 "For this cause a man shall leave his motherandfather and shall cleave to his wife;andthe two shall become one flesh." Can a man then, hate his ownself?No,hetakes good care of himself.Wemust conclude then, that any sortofabuseina marriagebythe husband,isnot rightandhasnoplace. True love between a husbandandwife will inevi tably bring out the bestineach party. The wife must feel freetoexpress her feelings. She is a masterpiece, won de!1ully made byGod for ustoenjoy. She fills thevoid that madeuslonely.Weare complementedbyherandshe meets our emotional, spiritual,socialandsexual needs. Marriage when workedat,isheavenonearth and youmethere is nothing else likeit.12For thoseofus who havehadthe opportunitytolearnfrom other people's mistakes,weneed not repeatthosemistakes:-1.Ifwife beatingwasa partofour growing-up,letusnot follow suit but instead learntolovedearlyand passionately. Treat herasyour queenandshe will treatyouasher king.2.Ifwegrew up thinking that two-timing isnormal,this does not makeitright.Ittakes a,goodman,a big man, amanwhoisintotal controlofhimselftolove and cherish only one womanaslongasshe lives. Letusnotbethe super power of whom shemustbeafraid, but instead, the super loverandfriendwhoseesonly her and wants only the best forher.I love my wife and Iamworkingonourmarriagewhich canbedifficultattimes,but,looking atit,wehavea wonderful relationship. Marriageisa twenty-four hourjoband it takes hard worktomakeita good and betterlife.The most important ingredient I have foundisChrist.Hemustbeandisthe centreofour livesandthisisalsotrueindividually. I relyonHis help eachday.Everydaydoesnot come up roses, but when the difficult timescome,I have a great source of strength to draw on. I feel a great senseofaccomplishmentandhappiness when Iammeeting her needs loveiskind,gentle,patient andissweet heavenonearth. Love your wife, eachandevery day,bea trueandhonest lover.

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PROOF OF MANHOODENDRIC DELEVEAUXTodojustice to this topic, proofofmanhood liesinthenumberof women who bear him children, one mustfirstconsiderthe following questions: What is manhood?Isittheabilitytofather a -child or is it the ability to shoulderone'sresponsibility or indeed,toberesponsible forone'sactions?Inoursociety, the part theallimportant ego playsmustbetaken into account not onlyinrespect of thisparticularissue butinmany others, particularlyasfarasthesexuality of our people is concerned. The fulfillment ofegotisticdesiresisthe paramount reason forthepersistenceof this wayofthinking and thusthepersistence ofthismyth,particularly among those who are least able toaffordit.Under the circumstances, thereareseveral basic factorswhichought tobeconsidered (this listisbynomeansexhaustive)in any discussion of the conceptofmanhood.Theseinclude financial factors, support factorsanddevelopmentalfactors. The end result of each particular situationissubjecttothe interaction of eachofthese factors.Itshouldalsobenoted that each groupoffactors exerts asphereof influenceoneach other factor. Undoubtedly, the most important individualinthese situations is the child produced by such unions, whetherheisregardedassuch or not. The financial considerationsbeginwith prenatal careandextendfarinto the future.Themanwho views the female bearing him children assimplya machine for producing offspring often failstoensurethat his child receives the competentandtotal carethathe/she deserves.Insuch circumstancesthewoman isoftenlefttoprovide both for herselfandher unborn/newbornchild; the entire burden fallsonher;except for the precious little provided for by the courts. This financialdearthisnormally just the beginning of a lifetimeofmalnu trition, neglect,' abuse, depravity, inabilitytotake maximum advantage ofthe academic and vocational opportunities provided,thus failuretoreach a full potential and almost inevitably, a maladjusted life is more oftenthannot,theoutcome of thisbelief. For both the mother and the child, society has tradi tionally viewed themasoutcasts and less than desirable, however, they are much more accepted today. While the stigma is,toa large extent gone, there is still a continuing lackofsupport for these persons, by their familiesaswellasbythe society at large. The emotional trauma of giving birth to a child under conditions of uncertainty, possible rejectionbyboth her family and the father of her unborn child often scars the mother for life and also has a pro found effectonthe childinlater life. Again the questionis,"WhatlWho is a man?" Can therebeany justificationinthe subjection of two individuals to such a lifetime simplytosatisfy one's ego? The birth ofthe child is merely the beginning ofthe dilemma. What about the growth of the child, the journey through childhood, adolescence, and early adulthood? WhatlWhoisa man?Ishethe one who setsupthe situa tion which leads to an inferiority complex in his child? What/Who is a man?Ishe one who glories in the frustra tions of his child's dreams being dashed to the ground simply because he does not receive the emotional and financial support thathedeserves? WhatlWhoisa real man?Isheone who realizes that his child will probably never realize his/her full potential and yet still plods along producing other siblings which he cannot or will not sup port? What realmanisthere who will, afterallconsider ations, permit his child to experience life under these cir cumstances whether or nothecares for its mother? Whatisthe proof of manhood, a biological function oranatti tude of social responsibility. What doyouthink?13

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UP-DATEFELICITY AYMERWELCOME:-Tothe Staff of thePMHthe following interns: Evaneth McPHEE, Marco WEECH, Williamson CHEA, Selbourne GOODE, Department of Medicine; Melanie COOPER, Arlington McKINNEY, Larry SANDS, Michael SUE, Department of Surgery; FrankBARTLEn,Cherilyn HANNA, Shelton MINon,Shanthini RAJASSORIAR, Department of Ob stetrics and Gynaecology; Patrick CARGILL, Joseph MARZOUCA, Gwendolyn McDEIGN, Department of Paediatrics whoallstartedon30th March, 1987. Very best wishes for a successful and satisfying tour of duty Doctors.Tothe Staff ofthe SRC Ms. Emma COLACO, Occupational Therapist who rejoined the staff at the beginning of February.Ms.Rochelle JOHNSON, Trainee Assistant Clinical Psychologist;Mr.Alex KREMENEZKY to the DepartmentofEnvi ronmental Health Services.Mr.Kremenezky arrivedinNassauon28th May and took up his appointmenton1stJune. Hewill functionasConsultantinthe Management of Solid Waste Collection and Disposal and Trainingtothe Department over the next three years withMr.Michael Turner, Asst. Director, DEHSashis local counterpart. Congratulations:-Dr.Charles Diggisonsuccessful completionoffur ther studiesinSurgery. Welcome backtothePMH.Ms.Cleopatra FERGUSONonyour promotion, Act ing First Assistant Secretary, Ministry of Health.Mr.Andil LaRODAonyour promotion. Acting First Assistant Secretary, MinistryofHealth. To the following officersinalldepartments/institutions of the Ministry (of Health)ontheir promotiontoSenior Clerk, effective 1stApril, 1987. Gloria ANDREWS, Glynis ARMBRISTER, Denice BROWN, Anita BURROWS, Gretchen DAVIS (D.E.H.S.); Altamese HALL (PAHOIWHO); Levada HORTON, Kendall JOHNSON, Jill MACKEY, Gabriel O'BRIEN, Cleora ROLLE, Doretta ROLLE, Brian SEYMOUR, Sonia THOMPSON. Nursing Officer 2 Elizabeth ROLLE, SchoolHealthServices, Janice BROOKES, Post Natal ServiceandCatherine WILSON, CarmichaelRoadClinicoftheCNS attended the Management ImprovementCourse2 held at the Public Service Training Centre. Health Aides in the Community HealthServices(CHS) formerly knownasthe Public HealthDepartment are being encouragedtoupgrade theirknowledge and skills. Both Helen KELLY (SchoolHealthMrs. Velma BURROWS, Chief Physiotherapist,PMHispresently attendinganeight week courseinthetreatment of Cerebral Palsyandother neurological conditions at Bobath (Western CerebralPalsy)Centre, London, England. Nursing Officer 2 Margaret CURRY,PMH,iscurrently upgrading her nursing skillsinOncology(cancer)at the UniversityofMiamiona one yearin-serviceaward, courtesy the PAHO, beginning January1987.Nursinq Officer 2 Pamrica FERGUSON,PMH,recently attended a courseinInfection ControlattheCAREC, Trinidad. This was a two week course30thMarch 10th April andwasmade possiblebythePAHO. Nursing Officer Clarminda HENDFIELD,PMHisupgrading her skillsindealing with patients withburnsand those who need plastic surgery, at theQueenVictoria Hospital,Kent. England. Nurse Henfield willbeaway foroneyear,untilMarch, 1988. Staff Nurses Albertha BAIN, School HealthServicesand Angelique COAKLEYofThe Ann's TownClinic,recently attended a one week course -RefresherWork Improvement 3atthePublic ServiceTraining Centre, Arawak Cay. The main instructor attheworkshop wasJohnTHOMPSON, a Registered Nurse at the OrthopaedicHospital, Scotland;Drs.Willard ThompsonandLeonGibsonservedaslecturers. The workshop was coordinatedbyRNJulian Mullings and Training Officer Barbara ThurstonofthePMH.Twenty-one persons nine Orthopaedic Department, six Physiotherapy, two Occupational Therapy,andfourfrom the Nursing Department participated. Continuing Education A four week workshop, 2-30th January, 1987,intheapplication of specific casts with attentiontothe extent and position of the cast as wellastechniques used,wasconducted at the Princess Margaret Hospital.Mr.Moses DEVEAUX, Medical Records Officer SRC, on your promotion to Assistant Hospital Administrator in the same institution. 14

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Services)andWillamae SEARS (Coconut Grove Clinic) spent two weeksinthe Eye Wing of thePMHlearninganddevelopingtheir capabilitiesineye testingtechniques. Michelle CLARKE (Ann's Town Clinic)andAlvira JOHNSON (Blue Hill Road Clinic) spent some timeintheLaboratory (PMH) one day per week for fiveweeksbeing exposed to and learning the work.NursingAuxiliaries Rowena RILEY (Blue HillRoadClinic) and Dorothy SAUNDERS (Coconut Grove Clinic) attended the one week course Basic Work Improvement 1at the Public Service TrainingCentre.Dr.Donald COOPER, Assistant DirectorofEnvironmentalHealth Services, Public AnalystLaboratory,andMr.Carlton SMITH, Health Inspector, Freeport,GrandBahama, recently (22-27/4/87) dttended a Sub-Regional workshopinChemical Safety. The ac tiVity which took placeinTrinidad was sponsoredbytheCaribbeanEpidemiological Centre (CAREC). Par ticipants,allprogramme managers, numbered about twenty and inclUding those from The Bahamas, Barbados,Canada, Trinidadandthe United States.Mr.Glenn ARCHER, Director, DEHS, ","tended a Consultative Meeting oftheInternational Devel opment Bank (I.D.8.)inWashingtonDC13-15May,1987,atwhich environmental issues were discussed.THEDEPARTMENTOFCHILD HEALTH (PMH)together with the Management Committee for Children with Specific Disabilities presented a lectureandworkshoponChild Sexual Abuseandthe Need for Prevention and Recognition,atthe Nassau Beach HotelonFridayandSaturday, 1st,2ndMay.The lecture and workshop were given/heldbyDrs.MargaretMcHugh, Paediatricianat tr:91 Bellevue Hospital, New York and Director of the Child Abuse Team andDr.Elizabeth Krents, Programme Directorofthe Child Abuse and Disabled Children's Programme, Lexington CentreInc.New York. Child Abuse, seemingly a growing probleminTheBahamas,warrant specific techniques.Dr.McHugh sharedsomeexperiences whileDr.Krents ideas for programme development. Nursing Officer Frederika SANDS(NP)andVeronica. POITIER (GB) attended the annual manager's meetingfor the Extended ProgrammeofImmunisation (EPI) heldinSt.Lucie 4-8 May this year. Highlightsofthe meeting includedpresentations from the rep resentatives of the Centre for Disease Control (CDC) Atlanta, Georgia,onmeaslesandrubella vaccina tions, the optimum age at whichtoadminister.Inadditiontothe managers of the various Caribbean programmes, there were also representatives from Rotary International whichispresently involvedina programmetohelpinthe eradication of polio globally;United Nations Children and Education Fund (UNICEF); the Pan American Health Organisation (PAHO); the United States Agency for International Development (USAID); the Canadian International Development Agency (CIDA). Territories achieving 100% immunisation coverage (DPT/Polio) were the British Virgin Islands, Montserrat,St.Kitts/Nevis. Anti gua reported 96% coverage. Jamaica has exceeded 50% coverage. Belizeisthe first English speaking Caribbean territorytohold a National ImmunisationDay.Whileonthe subject of Immunisation; The poster competition held among senior high schoolsinNew Providence yielded a total of twenty-one posters from seven schools;L.W.Young Junior/Senior High,A.F.Adderley Senior,St.Augustine's College, Queen's College,S1.Anne's School,R.M.Bailey Senior High School andC.C.Sweeting Senior High School.WinningPosterThe winning poster was a joint effort fromL.W.Young Junior/Senior High School with secondandthird winners coming fromSt.Augustine's College. Judges comprisedMr.Eddie Minnis, Artist;Mr.Patrick Moss head of the Art Department,C.H.Reeves Junior High School;Dr.F.Mahmood, Acting Medical Officer of Health, Com munity Health Services; Mrs. Evelin Prescod, Community Nursing Services and Mrs. Barbara Curtis, Senior Health Education Officer. Awards were presented to the winners by the Hon. Minister of Health,Dr.Norman GayonWednesday af ternoon 8th April, 1987. A television set, courtesy Island T.V. was presented to St. Augustine's College first and second runnersup,Art Supplies were giventothe winning school(L.W.Young). Plaquesandribbons were giventoallwinners and three students who received Honourable MentionSt.Augustine's College (one) Queen's College (one)A.F.Adderley (one).15

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Response to the competition was encouraging and the quality of posters submitted pleasingly high.Itisenvi saged that this willbeanannual affair. Joining Hands for Health wishes to join its colleagues within the Ministry of Health in extending grateful thankstoall participating schools, teachers and students,aswellasthose corporate citizens who made donationsincash and kind and of course the judges.* *Staff Nurse Eldora BENEBY ofthePMHtransferred to the Ministry of Education SchoolAttendanceOfficer.Ms.Nora DAVIS, Senior Clerk DEHS hasbeentransferred from the Blue HillRoadDepottotheAccounts Section of the Department and is nowresponsible for issuing bills (private businesses) forgarbagecollection. Ruth WILLIAMS, Rock Sound, EleutheratoBlueHillRoadClinic. Bernadette YOUNG, Cat Island to CarmichaelRoadClinic.* *InApril:-*Hazelly ROLLE, KempsBay,AndrostoBlueHillRoadClinic.SNPeggy SANDS has been transferred fromKempsBay, South Andros.Ms.Janet HALL, Executive Officer continuesonherorientation programmeandisnowintheadministration departmentofthePMHafter havingdonea "short stint"atthe SRC.ThestaffofSRCJanet,takes this opportunitytoreiterate their thankstoyou,sayhowmuch they enjoyed your presenceandwishyouevery success.CNGina BENNETIisrelieving (foronemonth)atDeadman's Cay,LongIsland.*Health Aides(eNS)transferred inMarch:-Melanie HENFIELD from Nicholl's Town, AndrostoAnns' Town Clinic. Mavis PRATT, SmithsBay,Cat IslandtoAnns'TownClinic. Priscilla ROLLE, Black Point, Exuma toCoconutGrove Clinic.PosterDisplay Fifty posters submitted from the area schools (Marsh Harbour, Dundas Town and Murphy Town) were displayed in the Dove Plaza creatingan"art gallery effect". The display wasonview to the public from 10 a.m. until 2 p.m. on World HealthDay,7th April. Health workersincentral Abaca organised a number of activities in observanceofWorld HealthDay,1987.(Nursing Officer Barbara RECKLEY andSNLolita PRATT,SNBernice SMITH and TCN Judy Mae HUNT provided blood pressure measurement servicesinMarsh Harbour and Dundas Town. They included1.a poster display2.free blood pressure assessments3.information in the form of literature on various aspects of health and highlight ing immunisation.4.immunisation survey coverageinone private school. ,On a lighter note, the Acting Medical Officer of Health hosted his hard working committee to lunch shortly af terwards. Thank you very muchDr.Mahmood for your thoughtfulness. It was a pleasant and welcome surprise! From Central Abaco comes the following report:**Get wellsoon:-Dr.Syed KALAMUDDIN (dentist,PMH)Retirement.Ms.Ellen DEVEAUX, Medical Records Officer(SRC)has retired from the public service afterseventeenyears. Joining Hands for Health along withthestaffofSRCwish you many yearsofhealthy, active retirement.Dr.Glen BENEBY, Anaesthelogist, AssistantMedicalStaff Co-ordinator (PMH) Sister Rose THOMPSON Nursing Officerincharge of the Outpatient Department, (PMH).* *CHANGE AND??? Mrs. Janet COX, Assistant Secretary, Ministry of Health has left the service(1June, 1987) Mrs. Sonia ROSE, Administrative Cadet, Ministry of Health has also left the Service(1June, 1987).CNElla Mae THERVILLE (Ann's Town Clinic) left service31st March, 1987.N.O.Winifred ELSON (San Salvador) left the serv ice in early April, 1987. Joining Hands For Health wishes you all every suc cessinyour new ventures. Public response to these efforts was encouraging. Welcomeback:-Mrs. Val LOCKHART, First Assistant Secretary Min istry of Health has left the service andispresently working at the National Insurance Boardinthe ca pacity of Training Officer.*Dr.Earl FARRINGTON Consultant SurgeonPMHafter a long illness.16

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Winston Sweeting DeputyHealthInspector-._ i.l1.---_ HartwellAmbrlsterInsectControl Officer (DEHS)outinthe field,pouring"Abate",insecticidetocontrolmosquetoes,inrainwater barrel!.During the month of January (12-16) a seminar was conducted for the Health Aides and Health Assistantsinthe Division. The seminar dealt with General Prin ciples of Food Inspection and the proposed regula tions for food and general sanitation. Over the period 11-13 February, a short seminar for Vector Control Officers focu-ssing on the role of vec tor control in promotion of a sate environment was held by the Division. A special visit to Ba/moral Island to ascertain sanita tion standards and determine measures to be taken to conditions occurredinApril and was made by officers McCoy, Burrows, Simms and Laing. Health Inspectors and trainee Health Inspectors en rolledinthe Environmental Health Associate de-17inclusive of Vector Control,are now housed under the same roof. This should facilitate and improve their operations. Officers are very pleased with their surroundings which more accurately reflect their terms of reference.LivingstoneHepburn Chief Health Inspector JuniorHighSchoolsinNew Providence,inattemptingtomakeup the deficit of organised health educationactivitiesintheir schools plan a health weekeachyear.During this time students are exposed totopicalandother relevant (to them) health issuesthrougha variety of guest speakers. This year theS.C.McPhersonJunior High School, Baillou Hill RoadincludedNurse Jacintha AUSTEN (School HealthServices)ontheir guest list.Shewasinvited to address Maturation and Menstruationwith girlsinselected grades.Alsoparticipatinginthe week's activities was HealthEducationOfficer Felicity AYMER who spoketotwogroupsofstudents (on separate occasions)onNutritiondeveloping healthy eating habits.Inpursuanceofits goalofHealth For All. By TheYear2000through the mediumofPrimary HealthCare,theMinistry of Health is proceeding apaceinitsprogramme of establishing primary health carefacilities(centres)inThe Bahamas.Comerstonelaying and ground breaking ceremoniesfortwocentreinNew Providence, Flamingo Gardens(CarmichaelRoad area) and Elizabeth Estates East,(offPrince Charles Drive) took place within a week,Wednesday29th April and Tuesday 5th May, andoneinMajor'sKey,Crooked Islandon20th May,1987.ThetwoCentresinNew Providence are beingbuiltbythe National Insurance Board while the Ma jor'sKeyCentreisbeing built by the Ministry ofHealth.AllCentres willbeoperated by the Ministry ofHealthandwill offer promotive, preventive and curativeservices at the primary levelinaddition to the traditional Maternal and Child Health Services offeredinNewProvidence. Both Ministers of Health and Housing/National Insurance officiated at the cornerstonelaying ceremoniesinNew Providence.AnotherCentreisinthe pipeline for New Providence,FlemingStreet area, while several are planned fornumerousFamily Islands.Groundbreaking ceremony for the extension to theKelly'sPsychiatric Ward took placeonWednesday13thMay at the SRC. The Hon. Minister of Health,Dr.NormanGay, officiated. Congratulations to the SRC on achieving third placeattheSpecial Olympics held at the ThomasA.RobinsonTrack and Field Stadium, Oakes Field,inMay,1987.Competitors included teamsofspecial childrenfromthe SRC's Child and I\dolescent Centre. 8\a pledon School for the Mentally Retarded and Free port's special school.Fromthe DEHS The Health Inspectorate Division moved into new and more spacious officesinNassau Courtinearly February. They occupy both floors of the building behind the Ministry of Economic Affairs. All sections,

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Preventive Maintenanceofvehicles, espec18l1y thecostlygarbagecollectiontrucks.abling preventiveaswell as routine maintenanceofitsvehicles.Atthedepot, all Ministry of Health vehicles except Ambu lances are serviced.The area \I tobeexpandedtoallowfor. Godfrey Strachan, Superintendentofthe Garage Section (DEHS), Mr. Strachan has beenwiththe Dept.forthe past elev en years.Hehas a staff comprisingtwenty-twomen and one female clerk.gree programme at the College of The Bahamas wentona field trip to Grand Bahama where they visited Franklin Chemicals, Syntex, Barco and the air monitoring station at Hawksbill Primary School. Class lecturer is Edwin STRAvHAN, Deputy DirectoratEn vironmental Health Services. A series of lectures to Primary School children deal ing with the role of the Department and problems associated with garbage was startedinApril. Officers are involvedinteachinginthe Community Nurses' programme(ONE)and the Health Aide programme. Viewers of TV 13 might have seen the documentary dealing with the problemofindustrial pollutiononThursday21st May, 1987 at 8 p.m. The programme sought to apprise viewers ofthe situationasit exists and the efforts being madebythe Ministry to monitor and reduce, where possible andifnecessary, the effects of pollution.Anepidemiological survey i!i underway together with ambient air-monitoringinthe area of the Hawksbill Industrial Park. Monitoringona daily basis has revealed that pollut ion levels detected are within internationally accepted limits, that while the level of sulphur dioxide varies with the wind and would probably account for symp toms of which the c;chool populationinthe area com plain, thereisno evidencetodate to suggest that thisiseither lite-threatening or a permanent threat to health. The equipment used has been acquiredandinstalled at a cost of $200,000.Mr.Larry SmithofthePALhas been reassigned to Freeport to ensure moreaccurate and effective monitoringattheenvironment and assessment of any risks. .... Forty new garbage bins have been placedonBay Street between Victoria Avenue and George Street. The Department has added elevennewvehiclestoits fleet, six20cubic yard packerstobeusedinits garbage collection services (domestic and business), tworollon/off trucks equipped with detachable containers and three flat bed trucks. Accordingtothe Han. Minister of Health, "this means that on average 240 tons of garbage per week willbe'collected" andheenvisages therefore a cleaner environ ment. A computer has been installed to strengthen the de partment's capability in rendering accounts to business houses for their garbage collection and also to compile dataontheir collection programme throughout the island. The Blue Hill Road Depot is toberenovated to allow for a larger vehicle maintenance bay area thereby en-18Office space as wellasfacilitiesandamentitiestorthe workers willbeexpanded. FROM GRAND BAHAMAAshas become traditionalonthis island, Aprilwasobservedashealth month,tocoincide with WorldHealthDay (7th April). A series of activities was designedtopromote various aspectsofhealth. Theseincluded:-A pageant, floatandtalent show(3rdApril) Anything-a-thon, special T-shirts were soldtothefiftypersons who took part (4th April). Staff, families, friends rode bicycles, skated, jogged for health. A health food cookout at the Williamstown.Beach,from noon until...AIItood soldwaspreparedbya healthful method, boiling and broiling. These included salads, juices including carrot juice, local produceegocassava, sweet/irish potatoes, yam, boiled/roasted corn, eddie, boiled/broiledfishand chicken.

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ERRATA from the Editor Deaths: Joining Hands For Health apologises for intimating a Measles outbreakin1984. This occurredinthe pre vious year, 1983. Under the caption "from the Princess Margaret Hos pital", it waserroneously stated that dietician There sa Hepburn obtained her degree from Prairie View University, Minnesota. Miss Hepburn obtained her degree from the College of St. Benedicts; Minnesota. Our sincere apologies Miss Hepburn. With reference to the final articleinthe last edition, AIDS A progress Report, the authors apologise for having omitted to acknOWledge the source of the sta tistics quoted with regard to numbers of cases and contacts of AIDS. These statistics were very kindly provided by the Acting Medical Officer of Health, Dr. Farhat Mahmood and reflect the numbers reported to the PHD. Sincerest apologies on all counts and thank you for drawing these errors to our attention. ** Deepest Sympathy is extended to TCN Hellen MAJOR (PMH) on the death of her hus band TCN Barbara Burrown (PHM) on the death of her husbandSNDeanne HOLLAND, Gregory Town, on the tragic death of her two year old son. The family of Mrs. Ethel McSweeney, formerly clerkinthe Health Information Unit. Mrs. McSweeney diedonTuesday 26th, May at the PMH after a short illness. She leaves her husband, three year old daughter and many other relatives. May God grant you strengthinyour time of sorrow. ** Marriage (New lives) Wedding bells rang for the following:H.A.Bessie CURTIS (nee McKenzie) formerly work ing at the Coconut Grove Clinic now at Steventon, Exuma.H.A.Lilian PYFROM (nee Munnings) Dr. Howard COOPER, House Officer, PHM. in March. Dr. Barrington NELSON, House Officer,PSYChiatry,to SN DarvilleinApril. Stephanie ROLLE and Wilfred DELANCEY on 4th April. Mrs. Rolle-DELANCEY is the Accountant, DEHS, while Mr. Delancey is a computer programmerinthe Ministry of Finance. Joining Hands For Health wishes all these young couples many years of successful married life. April 5th, the staff ioined nurses in worshipping at the11a.m. service of the First Baptist Church. Talks to schools on Immunisation by Community Nurses (on 6th April). Information booths on diet, nutrition and the impor tance of immunisation, in keeping with the theme Immunisation; a chance for every child, were set up. April 7th, World Health Day, observed byalllocal Clinics, whileMr. Sam Aymer PAHO's representativeinThe Bahamas appeared on Medical Line, ZNS3.This was also T-Shirt day. April 8th and 9th, Nurses' Forum anannual event Nurses address different aspects of nursing. This year they focussed on the importance of Immunisa tion as they spoke to ante-natal mothers attending the Clinics. April 11th World Health Day Fair. April 24th Well Baby Contest at the Eight Mile Rock Clinic. Awards were presented by Mrs.M.Storr, Hospital Administrator and Mrs.L.Knowles, PNO Rand Me morial Hospitaltothe winners of the Essay and Postercompetition. The month's activities culminated with a staff picnic held at Barberry Beach on 2nd May and wasa thankyougesture to the staff.From the CaribbeanA group of persons interestedinSports/Physical Activities and Medicine from around the Caribbean, met recently in Trinidad to discuss the feasibility of establishing a Caribbean Sports Medicine Associa tion. Territories represented at this meeting included Antigua and Barbuda, The Bahamas (Dr.P.Whit field) Barbados, Curacao, Jamaica, Puerto Rico and Trinidad and Tobago; response was positive. The group is currently working on establishing a secretariat,working out all the details as well as a source of fundingisinherentinsuch a venture. Governmentsofvarious territories will be invitedtoplay a role. Other plans include further training of membersinsports medicine and setting of standards for coaches. Trinidad is chairing the working committee.VITALSTATISTICSBirths(New arrivals) Congratulations to Maxwell and Keva NEWBOLD onthebirth of their son Mathaniel LeArchronon11th March,1987.Mathaniel weighedinat61b20zinthe presenceofa very proud father. Keva (Mrs. Newbold) is the ClerklTypistinthe Division.The birthing process went well, Mathaniel initially fully breastfed,is now partially breast fed. The family is doing"justgreat" and Mrs. Newbold has that air of "fulfillment" about her!19

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A SPIRITUAL PERSPECTIVE ON MANLINESSLYALL BETHELInthis day andage when everyone isanexpertonwhat a real man is, any child growing up with the philoso phiesprevalentinour society today is suretobe hope lessly confused.Hehears that "real men don't cry", but also that the latest studies show that cryingisone of the best ways to relieve stress.Hehears that his masculinity is dependentonwhetherhelikes quiche ornot.Hehears that a man who cares for his familyandplaysanactive partinfamily lifeisa whimp as opposedtotherealman who runs around and cheatsonhis wife. But waityousay! I've never heard that preached to anyone!Myresponse to that is that although itisnever taught verbally, theactionsof myriads of Bahamian men have been teaching the youth of this nationina much LOUDER, more persuasive voice. Perhaps a young man sees his father beat his mother while they are havinganargument (which of course putsanend to the argument)andsothe child learns thatinorder to m'aintain controlhemust beat his wife into sub mission. Withnochallengetohis viewsheremains the same small, insipid, narrow-minded manhewas before. His insistenceonbeing rightnomatter how wrongheis,stunts any potential for growth as he refusestoallow healthy disagreements with his wifetostrengthen his char acter. Or perhapshehearsinthe locker room, from menheadmires and whose very words are gospel, that the proof of one's manhood liesinthe number of women who can bear him children. And so his impressionable mind ab sorbs this egocentric nonsenseandhesets out blindlytoruin, perhaps for life, some gullible love-starved teenager with no thought as to how the child his child his responsibility willberaised, supported, educated. No!No! A thousand timesno!Surely these ideas of manhood gleaned from the misadventures of a few narcis sistic men are not worth even a second thought, for their authority lies within themselvesandtheir misguided expe riences. But what then is a man?Isthere a guide onmanli ness?Isthere another patterntobefollowed besides one's father or uncle, who may or may notbea good example? Thankfully thereis!When I look atmyVolkswagen, or whatever type of car I might be drivingandI wonder how I can get the best out of my car, I don't talktoa boat specialist, or to a lawn-mower specialist,oreventothe Ford Motor Company. I talk to the company that manufac turers and sells Volkswagens they know its capabilities, they built its engine and they know its individual partsandhow they function. They are not guessingatany stage. They know precisely what conditions they builtitfor and they include all such detailsinthe manual.Weasmenare in a similar situation.20The Bible, the book thatwerevereasGod'sverywords,inthis christian heritageofours,isour 'auto'manual from the 'auto-maker', andittellsushowwecangetthe best mileageascost-efficientlyaspossible.Itswordsare rootedinthe authority ofGodwho knows forwhatpurposehemade us. With thisasour premise then, letustrytogleanfromthe scriptures what manisand for what purposesheexists.InIsaiah 43:7welearn that God mademantobring God glory.InGenesis (the book of beginnings) 1:26welearn that when God made manHemadehimwith three very distinct properties:1)He made man unique -inthat, ofalltheanimalsthathecreated, man alone was createdinGod'simage!Man's capacitytothink,toreasonandtomakechoicesare a direct reflection of the attributes ofHiscreator.Manisnotananimal thatisincapableofmaking rationalchoices that affect his life!2)Hemade mantorule responsiblyoverallthingsthat affect his environment. Ortoputitanotherway,man's original and basic programmingistobringGodglory by ruling responsiblyandsoreflect (or ratherimitate)God's image, God's characterinhim.Understandingthistruthwecan see why the writerofthe bookofProverbssays that the husband who does not takecareofhiswifeand his homeisworse thananinfidel.3)God's purpose for man is to multiply himself,although perhaps now the injunctionismoresointhe spiri tual sense thatisreplicating one's lifeinothers,ormaking disciples (Matthew 28:19andIITimothy 2:2). However, not until one correlates the truthofIsaiah43:7andGenesis 1 :26-28 with Ephesians 2:10canonefully grasp the whole reason for man's existencefromGod's pointofview the only pointofview thatmattersinthe longrun.Ephesians 2:10 says "For wearehis(God's)workmanship createdinChrist JesusTODOGOODWORKS.Welearn therefore that man was madetobringGodglorybyallowing Godtofashionhiminto the perfectmanthat hecanbethrough Christ's influence.Wesee this premise restatedinthe book ofJeremiah29:11which says "For I know the plans that I haveforyoudeclares The Lord, planstoprosper you and nottoharrryou, plans to give you hopeanda future." God de-,ires al

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mentoreachtheirfullpotentialtolive upright, honest livesinrelationtothemselvesandothers. But sinful men thatweare,wedon't believeinGod's good purposes orinourpotential.Thisrebellion toward what Godistryingtoaccomplishinus,orsin,asGod callsit,obstructs His purposesinfashioningusinto REAL MEN. Sin always makesuslessaspeople.IfI tell a lie I become a liar andGodnevermeantmetobea liar. If I steal something I become athiefandGodhas better purposes formethantobeathief.IfI decide to take another man's wife to fulfillmyownselfishdesires, I totally crush that family's chance ofsurvivalandbecome a pathetic little man always lyingandhidingmydeeds from others. God has nobler aspirationsforme.Whatthen are wetodoaspeople eagertobecomeMENthatis,menasGod intendedustobe? Mustwetrytostayathome with our wivesandtrytomakeupourmindstostopcheating? For some this might meet withsuccess,butnodoubt for the majority such a courseofactionisdoomedtofailure. For such men, lack of selfdisciplinehassoconditioned them -to a life of instant self gratification that they cannot break free of the cycle.Ifweunite ourselves with Christ we would find ourselvesabletoresist the tendencytosin because of Jesus'enablingandso live above the temptation.Weasmales,inour questtobemenofsubstance (menwhoaremeninbody, soulandspirit) needtorecognizeoursinful nature for the hindrance thatitisanduniteourselveswith Christ for His enabling.Butbefore a life of wholenesscanbeginbyusunitingourselveswithChrist,wemust cometoGodonHisterms.Havingrealized thatweare utterly incapable of maintainingthetype of life that God desires ofus,and that oursinA. AsA..STOM'5Un..to(UI!>T-I'"e,.....ci.........c.)' +0 .... 50 we."50,.......c........C"ot'c.. ,... .... plrb<;,u.I"\'"tol....Alo4of'SIJ"l-in,''''''.....O-c.,O""'S puts a separation betweenusand God (Isaiah59:1and2)we need to cometoGod, the one whohasbeen wronged and agreeonHis terms of reconciliation.Infact,inthe first chapterofthe book of Isaiah God saystomankindinverse18"COME LETUSREASON TOGETHER" or rather, "Letusagreeonthese things, even though your sins are as obvious andasglaringtomeasscarlet and crimsonI,God, will make youasclean and as pure beforemeas snow andaswool.Wesee then that God and man's reasoning together involves two things:a)the man must fully acknowledge before God thatheisa sinner and that his sins are offensive to God.b)God himself will correct the state of man's sinful condition beforeHimonce the man acknowledges his sins and turns from them. God has fulfilled his part of the bar gain (or testamentasit is most often called by us)inthatHehas provided Christ as the propitiation(IJohn 1:2)or rather a substituteinpayment for our sins. Through Christ Jesus He has madeuswhiteassnow, cleaned the slate sotospeak. The verse immediately following the covenan tial agreement between man and God, verse19,explains that a life of wholeness can only begin whenweconsent to God's terms of agreement and obey Him. But the onusisonusto accept this payment for our sinsasthe gift from God thatitis(Ephesians 2:8,9) andtoreceiveitfreely from God. The Bible says, "But to as many people as received Christtothose people God gave the right, the privilege,tobecome the sons of God. It will always be my prayer that men will tear off the shackles and false security of trying to maintain a macho image before their equally insecure peers,tolet God Himself fashion them into exemplary fathers, husbands, single per sons and leaders. Men of whom the women of this countrycanbeproud." .. g.....,.W""........"'Cod."'n)woo0. ... tSuiSO-.......Q..St-o.....'-......."''''L.+0......'-pu.Hof!:t,N..,........:l.0...v,c..mr.0"'50 ..
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IMPOTENCE(ERECTILEDYSFUNCTION)-CAUSESANDEFFECTSPATRICK WHITFIELDIntroductionErectile dysfunction (impotence) canbea major prob lem for the affected man and his partner. Impotence, pow erlessness or helplessness, conjures up the mostnegative, unmanly and often derogatory picture of manliness. No man who is worth his saltCQuld/shouldbeimpotent (sexually powerless) and few if any would admit such in adequacy. During the 1960s, studies suggested that ninety per cent of men with erectile dysfunction and who were other wise healthy was of psychological origin. However, it is currently being argued that today the opposite is true and organic causes are now more common. Thorough evaluation of all men with erectile dysfunc tion is essential. After evaluation, a combined approach of treatment of organic causes and therapy for psychological causes or impact can be initiated. Since many cases can be linked to either a definite organic or a specific psycho logical cause, many cases can have a positive outcomeifevaluated by a physician.Inaddition,aswill be outlined later, erectile dysfunction mightbeanearly warning sign of an even more sinister disorder, therefore evaluation and early medical intervention can be critical.Causes:1.Psychological:a)Stress at home and/or at workb)depression impotence might be one of the early signs.2.Organica)drug induced some diuretics (water tablets) beta-blockers (drugs commonly used for treating high blood pressure) some centrally acting anti-hyper tensives -XSalcohol (frequent regular use of alcohol) -XScigarette smoking (frequent regular smoking). newer generation of anti-hypertensive drugsseemtoalleviate this problem.b)hypogonadism(abnormality of the testes) thisisa condition with which the childisborn. The testes which manufacture the male hormone, testosterone, are poorly developed.c)atherosclerosis of the penile arteries -hardeningof the blood vessels servingthepenis. Thisisthought tobeone of the morecommoncauses of erectile dysfunctioninmen over fiftyyears.Atherosclerosis of the penile arteries,aswithanywhere elseinthe body, is associated withfourriskfactors; these are:i.hyperlipidermia (abnormal deposits of fattytis-sue, grossly over-weight)ii.cigarette smoking iii. hypertensioniv.diabetes mellitus The more risk factors one possesses, the greaterthechance of developing impotence. Managementofatherosclerosis of the penile arteriesisthe sameasfor any other part of the body.d)diabetes mellitus this is true especiallyinpoorlycontrolled diabetics.e)renal (kidney) failure, advanced cancerf)previous vasectomy (severing of the spermtransporting tubes) or prostatectomy (partial removal ofenlargedgland behind the bladderinthemale). A small proportionofthese patients sometimesgoonto have erectile dysfunction.Effects:This depends on whether and when the patientseeksprofessional help. Men are reluctant to discuss impotence and many present only after profound distress toboththemselves and their partners. The effects are felt by both partners and areasfollows: Drug reactionisan important cause simply be cause of the fact that the treatmentisso easy just stop the drug. This is found commonly with anti-hypertensive drugs especially diuretics and beta-blockers. However, the22Female Partnera)Depression many times this is becausesheblames herself for theproblem

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c)Drug Abuseb)Anxietyc)Infidelityandtherefore feels sfle ISinade quate and physically unattractive. thisisoften manifested somati cally (by physical disorders)andcan presenttothe physician with a variable number of complaints including insomnia, lack of appe tite, weakness, headaches, chest pain, fatigue, tiredness. Thiscanalso have repercussionsathome with other members of the family and at work where thereisin creased irritabilityanda lack of concentration. thiscanbeduetosexual dissat isfaction and the female partner then looks elsewhere. abuse which inevitably makes the situation worse. the most common drugs used are alcohol, cigarettes, marijuanaandcocaine. Cigarettes are especially bad because nicotine is a vaso constrictor (constricts blood ves sels) and can exacerbate the al ready compromised blood flow in the small penile arteries. Having a cocktail and a cigarette maybethe worst thing a middle-aged man with borderline impotence can do prior to attempting inter course.d)Sexual Deviants this is manifestedby rape, voyeurism, masochism, sa dism, homicides.SummaryImpotence isanimportant problem in the community. While psychological factors are often the primary cause,(continuedonnext page)MalePartnera)Depressionb)Anxiety this occurs because manymenblame themselvesandseethem selvesasinadequate thereby set tingupa vicious cycle whichineffect makes the entire situation worse. this can also lead to somatic symptoms which usually include headaches, backache, nausea, fatigueandchest pains. Anothermanifestationof thestresscausedbyimpotenceisdruge)Infidelityf)Aphrodisiacs this often results when the man triestoprove his masculinity. (Love vine and five fingers) these offer a transient effect only, if any. They also delay the inevi table and canbeparticularly dan gerous if erectile dysfunction isanearly symptom of a life-threat ening disease.------------------------------------------------------------------------------------EVALUATIONHelpustomakethenewsletterasinterestingandinfonnative as possible.Pleasecomplete. detach andreturnthisshortevaluationform totheHealthEducation Division,MinistryofHealth,Nassau.BahamasTickthemostappropriateresponse.1.How did you findthenewsletter?a) veryinterestingb)interestingc)somewhatinterestingd)uninterestinge)didnotread2.Wasthereanyarticleofparticularinteresttoyou?YesDNoD3.4.5.IfI .t'tl-.yes,pease glve 1e.. .Whatchanges,ifany,would youliketosee?Whattopics wouldyoulikeinfutureissues? Would youliketocontributetothisnewsletter?YesONoDIfyes,pleasegivenameandaddress. Name: Address:.. ................................................................Thankyouforyourco-operation!23

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(continued from preceding page)organic causes are justasfrequentandequally or more important. For this reason, medical help shouldbesought earlyinorder to get quick intervention. The later the man/couple seek(s) help, the more com plex the treatment,asby that time it will involve a great deal of psychological counselling for both partners,inaddition to the treatment of any organic cause. The best success rates are associated withearlyintervention. Individuals nowadays therefore neednotexpose themselvestosuch emotional trauma becauseofa disorder whichinsomany casesiseasily treatable.P.O.BOXN-3729NASSAU,BAHAMAS.24

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ABOUTTHECONTRIBUTORSFelicity AYMERisa Health Education Officer, Ministry of Health and Editor.LyallBETHELisan Accounts Executive, The Counsellors, a Public Relations firm and a member of the Editorial Committee.GregBURROWSisa Banker.Heisalso a husbandandfather. Stanley BURNSIDEisan Artist, LectureratThe College of The Bahamas and well known cartoonist. Rudolph CARTWRIGHT;sthemanagerof Caribbean Tile Supplies and Contractors Ltd. Gregory COLEBYisanemployeeina law firm. Endric DELEVEAUXisa Computer Salesman Roosevelt FINLAYSONisthe Vice President, Marketing Services, British American CompanyofThe Bahamas Ltd.anda founding memberofCentrevilleinOctober.EdwardHUTCHETSONisa Motor Mechanic, marriedandthe father of two young children. Marcel L1GHTBOURNEisanEvangelist.KenOfosu-BARKOisa Medical Officer, Community Health Servicesandmember of the Editorial Committee. Ronald PATIERSONisthe Director, Advanced Fertility, Gynaecology and Obstetrics Services, Doctors' Hospital. Cyril PEETisanInsurance Salesman. Basil SMITHisthe Vice President, The Counsellors, a Public Relations Firm. Patrick WHITFIELDisaConsultantinFamily Medicine and Physicianincharge of the General Practice Clinic,PMH.Photographs:-CourtesyofAnthony Brown, Audio Visual Section, PMH; Lyall Bethell; Bahamas Information Services andDr.Ofosu-BARKO.

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RUDOLPH CARTWRIGHT MARCEL L1GHTBOURNE CYRIL PEET ENDRIC DELEVEAUX GREGORY COLEBYLYALLBETHEL./ .EDWARD HUTCHESON GREGORY BURROWS