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Joining hands for health


Material Information

Joining hands for health Caring and sharing at Christmas time
Abbreviated Title:
Joining hands for health
Physical Description:
24 p. ; 28 cm.
Ministry of Health ( Publisher )
Ministry of Health, Health Education Division
Place of Publication:
Nassau, Bahamas
completely irregular


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


Statement of Responsibility:
Ministry of Health

Record Information

Source Institution:
College of The Bahamas
Holding Location:
College of The Bahamas
Rights Management:
All rights reserved by the source institution.
System ID:

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I I I I I TABLE OF CONTENTS PAGE 1 TO YOUR GOOD HEAL TH ................................................................................................................. 1 2. EDITORIAL........................................................................................................................................... 2 3. COUNTING THE COST ................ ,....................................................................................................... 2 4. CHRISTMAS FARE ............................................................................................................................. 4 5. A WORD TO PARENTS....................................................................................................................... 8 6. POT POURRI................................... ..................................................................................................... 9 7. HAPPENINGS IN THE DIVISION ........................................................................................................ 12 8. AIDS UPDATE ..................................................................................................................................... 16 9. XIII WORLD CONFERENCE ON HEALTH EDUCATION.................................................................... 19 10. KEYNOTE ADDRESS BY DR. HIROSHI NAKAJIMA ......................................................................... 20 11. EVALUATION....................................................................................................................................... 23


TO YOUR GOOD HEALTH "Christmas ... is the season to be jolly." How some of us dread the season while others look forward to it with great excitement and expectation of fun, food, fellowship and gifts. The cynics among us would add, it is a time when too many people commit themselves to unnecessary ex pense, spend foolishly and throw all caution to the winds. Christmas is indeed a time to be "jolly." It is that time of year when christians all over the world celebrate and reflect on the birth of the Christ child, the saviour of the world. It can't though have been a particularly easy time for his earthly parents. They must have been physically exhausted from their long journey and emotionally worn out from the worry of wondering whether they would finrl suitable accommodation for the birth of their first child. All too often today, parents, especially mothers, contin ue to be physically and emotionally worn out with the pre parations which have come to associated with Christmas. How healthful is the added stress of jostling crowds of christmas shoppers in all the plazas, looking out for pick pockets and thieves, crawling along in the stagnant traffic then preparing the "feasts" which have become an inevi table part of the Christmas scenario? The merchants, it would seem, have so much fun at our expense. They stock their shops with most attractive and enticing merchandise, promote their goods by commenting on "how slow business is" and wait for us to "clean them out." Every year we walk into the trap. We, it seems, become infected with the Christmas virus spend wildly whether we can afford to or not, have fun, then play "catch up" for the next three to six months. Can we really have fun and fellowship at Christmas while maintaining a sense of sanity? Of course we can, and many of us do, you also can IF you wish. Decide on a budget within your means and stick to it. Decide on a healthful menu, plan and prepare it. Following is some information which should help you to achieve a happy yuletide season with only a small dent in your pocket book and no extra bulges to your body. Having acnieved your goal, think of how exhilarat1:1d you will feel and how determined you will be to do better next year! Now that you have decided on your budget, make a list of the gifts you require and follow it. If you have to buy a gift for an infant, up to 18 months old, buy a large colourful toy which he/she can safely enjoy. One which he/she can hold with both hands, bang, wave, drop, suck, cuddle. When buying gifts for small children, bear in mind that their natural curiosity compels them to investigate everything, especially how things are put together. It is wise therefore to give something that can be easily pulled apart and later put together again. Older children, eight years and over, may enjoy an edu cational game, a book, a record, a tape, an article of cloth ing, or jewelry, depending on their need and personality. It goes without saying that gifts should be selected on the basis of how much the donor can afford and the per sonality of the recipient. Christmas wouldn't be Christmas without parties, lots of glorious, tempting, delectable foods laden with dangerous saturated fats, calories and cholesterol, not to mention the alcohol which is potentially lethal. No wonder we are only half alive at the end of the season! If you wish to be vibrantly alive not only at the end of this season but for the next and subsequent seasons, seriously consider eating in moderation, eat smaller por tions, until you feel just full rather than uncomfortably full, to the extent that you have to loosen your belt, shirt, pants. If you drink alcoholic beverages, reduce the size and number of drinks you take. That way, you not only stay awake to appreciate the beauty of your surroundings but can also look forward to the new year without the worry of having to "catch up" economically and "lose weight." You can do it if you really try. Here's wishing you a happy and healthful holiday season.


EDITORIAL This edition of Joining Hands For Health is different. Hopefully in this its sixth year it is even more interesting and informative than when it made its debut at Christmas, 1983. Over the years there have inevitably been many changes both outside and within the family of the Ministry of Health. As the magazine prepares to go to print, the annual workshop for Family Island Health Services gets underway. This year they will be without the familiar face of Dr. Peter Diggory, Director of CAREC, who died sud denly earlier this year. This year also, the workshop will be apprised of ttie ongoing health and nutrition survey. They results are ea gerly awaited and will form the basis of more precisely directed health promotional programmes. At the international level, a new Director General has taken over at the helm of the World Health Organization (WHO) in the person of Dr. Hiroshi Nakajima. At the local level, a new hospital administrator Mr. Ste phen Campion, has been appointed to the Princess Mar garet Hospital. Negotiations towards the building of two new hospitals in keeping with the medical needs of The Bahamas in the 21st century are proceeding. As 1988, draws to a close and once again the country braces itself for the assault of Christmas, we dare to sug gest caution, vigilance and care. We wish for all a most enjoyable and healthy holiday. May the joy, promise of peace and good will to all which heralded the first Christmas be yours not only at this time but throughout the new year. COUNTING THE COST The well known Human Relations, expert, Abraham Maslow, in describing human behaviour, and what moti vates individuals to act in the way they do, explains moti vation in terms of a ladder (hierachy of needs). At the Jowest level there are the basic (physiological) needs, food, shelter, clothing, sex, while at the highest level is the need for the individual to reach for what is for him/her, the stars; a desire to become all that they are capable of becoming (self actualisation). Inevitably, these needs change from time to time de pending on the prevailing environment. The individual must satisfy needs at the lower level before he/she can move up. At any one time there is one over-riding need in the life of any individual. While the need for food, shelter and clothing are essen tial to human life, daily living and well being, contrary to popular belief, the need for sex is not and has never been, essential to daily living and well being. Sexual intercourse (sex) is essential for the continuation of the human race. However, with advances in science and technology, the advent of in vitrio fertilisation (test tube babies) surrogate parenting and sperm banks, the human race can now be propagated without the conventional act of sexual inter-2 course. In truth and in fact, the need for sex is an inner drive which every individual can control. Recognising and taking responsibility for the conse quences of our behaviour are essential steps in acting responsibly. All parents should strive to teach their chil dren how to do so by example and in discussion. Once again Christmas is here. It is time for Junkanoo, parties, goodwill. It is one of those times when we are anxious to show our "love" for others, when we let down our defences and get careless. It is also a time when we go in search of excitement and thrills, when we dare our selves and others, to act in ways in which we may not under "normal" circumstances have acted. If we understand the possible outcomes of our sexual behaviour and we are willing to accept responsibility for what we do, then we shall think before we act, rather than after or maybe not at all! Some of the results of our thrill seeking behaviours are experimenting with/using drugs and/or alcohol, excessively fast driving and sexual activity. The consequences of any


one or combination of these activities may be life long regret or premature death. One thing leads to another. How do we decide which of these consequences is least/most harmful? What price may we pay for a brief moment of fun or indiscretion? Joining Hands For Health would welcome your thoughts More specifically, some of the major consequences of on this. uncontrolled and/or unprotected sexual intercourse are: a) the development and growth of another human be ing; a life long responsibility for any and every cou ple. If, despite the preceeding arguments you are not con vinced and feel challenged or compelled to be sexually active with persons whom you have just met, do not know, do not know well or who look like a "nice person," then perhaps the men will consider not only using a condom, but using it correctly every time they have sexual inter course. The same suggestion applies to women, perhaps you will suggest and insist that your partner of the moment uses the condom correctly. Ultimately the choice is yours. b) one or more sexually transmitted disease(s), not all of them are curable, for example herpes. c) d) e) aids loss of self respect all four of the above STEP1 Hold the tip of the condom to squeeze out the air. This leaves some room for the se men when you come (ejacu late). Put the condom on the end of your erect penis. 4. Put the condom on before you enter your partner. 5. You can use a lubricant like "K-Y," "ForPlay," contraceptive gel. Lubri cants like vaseline or grease should not be used because they can cause the condom to break. &. After you come (ejacu late): a. hold onto the condom and How do you use a condom correctly? STEP 2 Keep holding the tip of the condom. Unroll it onto your erect penis ... 7. For the best protection, use a new condom, ev ery time you have sex. use a condom only once and then throw it awav. 8. All condoms sold in the U.S. meet the same standards for strength and quality. STEP 3 ... all the way down to the hair. 9. Don't store condoms for a long time in your wallet or near heat because they might break. 10. Condoms are made not to break. Used the right way, Condoms protect you very well against pregnancy, sexually transmitted diseases (V.O.), and Aids. To help prevent disease use them for vaginal, anal, or oral sex. b. pull out while your penis is still hard. Source: HERO (Health Education Resource Organisation, Baltimore, Maryland 21201, USA 3


4 Wrap the used condom securely in paper and put it in the garbage. Condoms block toilets. Children have been known to find used condoms and mistake them for balloons! Persons who are mqre adventurous and prefer non conventional sexual practices should take extra precautions, most of the consequences are applicable. Condoms are available from any Pharmacy and The Bahamas Planned Parenthood Association, East Avenue, Centreville, Nassau, at $1.00 per packet of four. Have a safe and happy Christmas. CHRISTMAS FARE In an effort to help readers minimise the extra pounds which appear to be an inevitable part of the holidays, Join ing Hands For Health is offering a number of vegetarian recipes which look and taste as delicious as the traditional Bahamian food. Vegetarian Logs Ingredients: 112 cup shelled peanuts 1 cup cooked carrots 1 cup cooked peas (pigeon, blackeye or red beans) 1 small onion, peeled and chopped 2 small tomatoes, chopped % cup milk 1 egg, beaten 112 cup breadcrumbs or farine salt and pepper to taste Stuffed Mushroom Appetizer Ingredients: 12 large mushrooms 2 tablespoons lemon juice 112 cup minced green and red sweet peppers 112 cup minced celery 112 cup minced scallions 1 teaspoon minced fresh garlic 1 envelope G. Washington Golden Broth dissolved in 112 cup water 1 tablespoon grated parmesan cheese 2 tablespoon chopped fresh parsley italian parsley sprigs. Method: 1. Pound nuts until fine 2. Mash carrots and peas 3. Lightly fry onion and tomatoes 4. Mix together all ingredients in a mixing bowl, season. 5. Shape heaped tablespoonfuls into logs or flatten and fry lightly in a mixtUi e of margarine and cooking oil, turn ing once or twice. Serve with tomato sauce or brown gravy. (Nyam News) Method: Wash mushrooms and sprinkle with lemon juice, remove and mince stems. Combine stems, peppers, celery, scal lions, and garlic in nonstick pan. Cook until tender, stirring occasionally. Fill each mushroom cap with an equal amount of stuffing; place in shallow casserole. Add broth to casserole and sprinkle mushrooms with parmesan cheese. Bake at 400F for 20 to 25 minutes. Garnish with chopped parsley and parsley sprigs and serve immedi ately. Serves 4.


Stir-Fried Green Beans with Chopped Tomatoes Ingredients: 2 tablespoons olive oil 1 lb whole green beans 4 tablespoons sliced green onions 2 teaspoons vegetarian chicken seasoning or 2 envelopes G. Washington Broth 112 teaspoon oregano 2 medium tomatoes, diced Steamed Christmas Pudding Ingredients: 112 cup soft margarine 1112 cups brown sugar, packed 2 eggs 1 teaspoon vanilla 1 cup carrots, peeled and grated 1 cup apples, peeled and grated 112 cup raisins 1 cup pecans, coarsely chopped 1 cup flour, sifted 1 teaspoon baking soda 112 teaspoon salt 1 cup fine, dry, white bread crumbs caramel sauce, recipe follows Caramel Sauce lnqredients: 112 cup packed brown sugar dash of salt 2 tablespoons margarine 1 tablespoon cornstarch 1 cup boiling water 1 teaspoon vanilla Holiday Salad Ingredients: 2 red delicious apples 112 cup grapes 1 large banana 2 tablespoons salad dressing or sour cream 1 tablespoon lemon juice salt to taste 112 cup chopped pecans Method: Heat in skillet or wok. Add green beans, stir gently with wooden spoon until beans are coated with oil. Add green onions, oregano and chicken seasoning or broth powder and continue cooking 8 to 10 minutes until vegetables are crisp. Toss in the diced tomatoes and serve hot. Note: Any combination of vegetables may be stir-fried then garnished with freshly diced tomatoes. Method: Cream butter and sugar, beat in eggs and vanilla. Stir in carrots, fruit, and nuts. Sift flour, soda, and salt, stir into creamed mixture. Add crumbs and mix well. Spoon into well-oiled 11/2 quart mold. Cover securely with mold lid or several thicknesses of waxed paper tied in place with string. Place mold on a rack in covered kettle of boiling water. (Water should come halfway up on the mold.) Steam for 3 hours. Unmold pudding onto serving plate; flame if you wish. Serve hot with warm caramel sauce. Serves 8 to 10. Method: Combine dry ingredients in small saucepan; add water. Cook until thickened and clear; stir constantly. Remove from heat; stir in butter and vanilla. (Vibrant Life) Method: 1. Dice apples. 2. Remove seeds from grapes and cut into quarters. 3. Chop banana 4. Mix together and add mixture of salad dressing, lemon juice, salt, and brown sugar. 5. Mix well and sprinkle top with the pecans. 6. Chill before serving. 4 servings


Festive Apple Crisp Ingredients: 6 large tart apples % cup brown sugar 1 cup flour 1 cup quick oats % cup chopped nutmeats 2 tablespoons brown sugar 114 cup margarine or oil 1/4 teaspoon salt Note: Any suitable fruit may be used instea

Christmas isn't Christmas without Fruit Cake. Below is a recipe for a rich non alcohol fruit cake. Non Alcohol Fruit Cake Ingredients: 2 cups flour 2 teaspoons baking powder 2 teaspoons ground cinnamon % teaspoon ground nutmeg 1;4 teaspoon ground cloves % teaspoon allspice 16oz. mixed fruits 1 cup shelled nuts 1 pk raisins 1 pk currants 1 cup orange juice 4 eggs % cup brown sugar % cup butter/margarine % cup molasses Fruit Punch Ingredients: 3 quarts orange juice 1/2 pint (1 cup) lime or lemon juice 6 medium-sized ripe bananas or 2-31b. ripe paw-paw blended 4lbs. sugar 5 quarts water Dash of Bitters (optional) Variations Substitute ginger ale for a part of the water. Add the ginger ale just before serving. Substitute 1 bottle strawberry syrup or grenadine for 1 lb. sugar and float small sprigs of black mint in the' punch bowl. Use half pineapple and half orange juice. Substitute blended (crushed) pineapple juice for ba nana or paw paw. Substitute grapefuit and pineapple juice for orange juice and one half of the water. Omit the blended fruit and include pieces of finely cut fruits such as watermelon, orange sections, ripe ba nana, paw paw. Substitue 1 quart of strong tea for a portion of the water and float thin slices of orange in the punch bowl. Did you know that the proportion of fat derived from the average Bahamian diet is the highest in the Caribbean, 33.4% and similar to that in developed countries? (Nyam News, 1987). Method: Grease and flour 3 pans. Stir together flour, baking powd er, cinnamon, nutmeg, allspice and cloves. Add fruit peels, raisins, currants, nuts, mix until well coated. In separate bowl, beat eggs until foamy. Add brown sugar, orange juice, molasses, butter. Beat till combined. Stir in fruit mix ture. Turn batter into pans, filling about % full. Bake at 300 for 2 3 hours or until cakes are done. Remove from oven. Instead of the usual sodas, beer and other drinks which you normally drink at this time but which ruin your health, why not try making a fruit punch? Method: Mix all ingredients together well. Chill and serve over cracked ice. (Make 2 gallons) If you suffer from diabetes or hypertension or both, maintaining your ideal weight at all times is critical to con trolling your condition. You can still enjoy your food over the holidays by eating small selective portions. You will have to do a trade off between one food group and anoth er. If in doubt please check at the nearest health facility. Happy healthy holidays. Sources: Vegetarianism (1988). 11503 Pierie Street Riverside, California 92515. Nyam News (1987) CFNI Vibrant Life (1988) 55 West Oak Ridge Drive Hagerstown, Maryland 21740 Spices of the World Cookbook, McGraw Hill Cookbook Co., New York. 7


A WORD TO PARENTS At Christmas we remember and celebrate the birth of the Christ Child. It is a time for family reunions and rene wal of friendships. In particular, it is a time for joyous celebration, thanksgiving and hope for babies and their parents. Annually we are treated to news of the first baby (babies) making their entry to the world on Christmas Day and New Year's Day. Recently mothers seem to be get ting younger. Unfortunately, we seldom if ever see or hear of the proud smiling father of the moment, he is either implied or worse, faceless and missing. Only mother and child. Can we then expect a special bond to develop between mother and child? Probably, but parenting is such an awe some responsibility. One which must be especially daunt ing for an inexperienced mother, who also happens to be young. Below is some advice which may help parents in their newly assumed role. BREAST FEEDING Mother, breast feed your babies for at ieast the first six months of their lives. Breast feeding is the most healthful and economic way to feed your baby. You also benefit. How does the baby benefit? Breast fed babies are healthier, happier babies than those fed on formula or other breast milk substitutes. Breast milk protects your baby from harmful germs which cause diar rhoea, colds and coughs. The more you put your baby to the breast to suckle, the more breast milk your breasts will make. From birth, your breast milk is clean, and safe for your baby to digest. If you have limited space and domestic facilities, then it is most important that you breast feed your baby; all you need is a comfortable seat, soap and water to wash your hands and nipples before you put your baby to the breast. If you are worried about your appearance, try shopping for attractive feminine brassieres (bras) that allow you to breast feed without exposing your entire breasts and which give them much needed support at this time. Enjoy shopping for night dresses and blouses and/or dresses which enable you again, to breast feed your baby without having to undress in public or in private. Fathers, encourage and support your baby's mother in breast feeding your baby. They both deserve it, you can do it if you really try. 8 DIARRHOEA Every year hundreds of children under four years, many under 12 months (one year) develop diarrhoea. Every year, diarrhoea is so serious that a number have to be admitted to the hospital. Every year, at least three children die because they were taken to the hospital too late. The table which follows shows the number of cases reported to the Public Health Department, admitted to the Princess Margaret Hospital (PMH) and deaths due to diar rhoea in children up to four years for selected years. Diarrhoea then can be very serious for young children. Health providers describe diarrhoea as "three or more loose watery stools in any one day." A very young baby has no reserves of fluids on which to call if he/she devel ops diarrhoea .. One of the main causes of diarrhoea about which we in the Ministry of Health are concerned is a virus. This is important because it means that there is no medicine to stop the Diarrhoea and fluid loss. However, the baby's health can be protected if he/she is given fluids until you the parent or guardian can take him/her to the nearest clinic/health provider. If you are breast feeding and your baby develops diar rhoea, continue to breast feed your baby; give extra fluids, for example, apple juice, coconut or plain boiled water. Take him/her to the clinic/health facility/doctor as soon as possible. Give fluids while you are waiting for health ad vice. If you are giving your baby formula, continue the feeds, but give twice as much water as you would under normal circumstances. Get help from a health professional as soon as possible. Continue to give extra fluids while wait ing for help. Follow the instructions of your health provider. TREATMENT The most effective treatment for diarrhoea is Oral Rehy dration Therapy (ORT). This is a specially prepared solu tion which prevents excessive loss of fluid which results from diarrhoea. It (ORT) does not stop diarrhoea. It saves your child's life. Give it as directed for as long as directed.


INJURIES AND ACCIDENT AL POISONINGS In December, 1986, 26 children were admitted to the PMH due to Ingestion, swallowing of dangerous fluids. Parents, please keep your chemicals out of the reach of your young ones. Further suggestions may be found in Pot Pourri below. UPPER RESPORATORY INFECTIONS (URI) These infections are the leading cause for visits to the Community Health Services as well as admission to the PMH. Any infection in a young child can quickly deteriorate into a very serious condition. If your baby seems unwell, is irritable, has a runny nose, is not eating and feels hot when you touch him/her, again, give extra fluids and get help from the nearest health facility as soon as possible. USE OF HEAL TH FACILITIES Healthy mothers and children are a building block of any healthy community. Health clinics were established to promote the health of this vital sector of society. The serv ices offered are primarily for well mothers and children. The health of the child begins with a healthy pregnant woman. Women are therefore urged to attend for ante or prenatal care as soon as they suspeet they are pregnant. They should follow the instructions of their health provider during their pregnancy. Parents are urged to take their babies to the clinics regularly as suggested by their health providers and to ensure that their babies are immunised, again, as the health provider suggests. Joining Hands For Health will be focussing on the Health of mothers and children in future issues. Until then we invite your comments. A very blessed, accident free and healthful holiday sea son to all parents and their young children. Pattern of diarrhoea in children 0-4 years (for selected years) Year Reported cases Admissions Deaths 1976 868 488 28 1980 1,143 652 20 1981 930 484 3 1982 2,306 498 3 1983 2,718 459 9 1984 1,857 430 3 1985 1,234 474 3 1986 1,486 603 15 1987 1,904 570 2 Source: Deputy Epidemiologist, Public Health Department. Ministry of Health. POT POURRI Some of us absolutely love Christmas, some of us dis like it, others of us absolutely hate it. The children love it, the merchants love it. Parents probably dread it. Hospital nurses also probably hate it because of the increase in admisions due to accidents. Our security forces no doubt fervently wish Christmas could be permanently banned because of the additional problems they encounter. For better or for worse, Christmas is here again. Whatever your feelings are, here are some REMIND ERS which we hope will help you have a safer and more enjoyable christmas time. Of course, if you have remem bered them all, then turn to another article. Protect your health and your family's health by eating defensively. Fatty, sweet foods and alcoholic beverages are the ones which will help us to take in too many calories unconsciously and in a flash. Unwanted calories are stored as fat. Extra fat means extra weight. Extra weight is a burden for the body especially the heart which is then forced to work harder. With time, the strain on the heart results in a break-down. The break-down may or may not be. repairable. Many people suffer from diabetes and hypertension (high blood pressure) and extra weight makes these con ditions worse. These people, especially hypertensives, need to watch the amount of salt they take. There is hid den salt in ham and salt meat, salted nuts, sauces and many other items which are used during the season. Fur ther, there is hidden sugar and fat in meat, puddings, sauces, beverages such as egg-nag, other egg and milk based punches, dressings, gravies, avacado pear and chocolate. 9


They are said to be hidden because the salt or fat or sugar is there but not noticeable. In the case of the salt and sugar, however, we can tell that they are present by testing. This is not the case with fat. In an attempt to reduce their intake of fat, many people trim fatty meats and discard that fat and most of the drippings from the meat itself. This is a desirable practice. It is a common belief that pork has more fat than other meats. Lean pork has no more fat than the lean of other animals. As a matter of fact it has less than the lean of prime beef. Because there is hidden fat in these foods, we should be very careful to prepare them with very little added fat. Using fewer eggs will also help to lessen the amount of hidden fat and cholesterol (fat-like, waxy sub stance which helps to thicken the walls of the blood ves sels) in our food. Among the sweets to watch out for are frostings, icings, sauces, beverages, puddings, cakes, cookies, candies and other sweets. The glazes which are put on items such as roasted meats, sweet potatoes and perhaps carrots, for example, add unnecessary sugar and fat. It is also very important that we watch the amount of sugar and sweet item such as sweetened condensed milk which we use. Most of the carbonated beverages (sodas) and boxed fruit flavoured drinks in our region are too sweet. When they are combined with sweetened condensed milk a tasty bev erage results, but the amount of unnecessary refined sug ar adds to the calorie intake. Starchy items also contribute calories. Sumptuous amounts of peas and rice, macaroni cheese, potato salad and other staple salads, fried plantains, fruit cake and jonny cake are also eaten. While it is generally recognized that starchy foods are healthier than sweet foods, we should eat them in moderation. We must also eat meat in moderation to minimize our fat intake and control the amount of protein. Protein con tributes calories by an involved process which puts a lot of strain on the kidneys. Like the heart or any other organ, an over-worked kidney will fail with time, with equally di sastrous results. Contrary to popular belief, you cannot eat meats to your "heart's content" and then follow the meal with raw pine apple which will dissolve the protein and remove it from your system. Excess protein, like excess fats, starches and alcohol will continue unwanted calories and make you fat. Being fat and overweight is unhealthy. Lastly, a word about alcohol alcohol is nearly as efficient and effective as fat in contributing calories. Here's how the alcoholic beverages measure up in cal ories: Drink Beer, Stout Wine Rum/Gin/Brandy Cocktail (Nyam News, 1987) 10 Quantity 12oz. 4oz. 1%oz. 4-6oz. No. of calories 170 112 110 140-200 FOOD SAFETY Remember that those little invisible creatures which we know as germs and which health professionals call bacteria, are always present just waiting for us to slip up. They like the same environmental conditions we do, but they multiply so much faster than we ever could. Do you realise that under favourable conditions it only takes twenty min utes for one germ to divide and become two? (Richardosn, 1974). Rather than having to store a lot of left overs, cook just sufficient for the day's needs. Serve hot foods hot and cold foods cold. PERSONAL HYGIENE Your body is a veritable hot house for germs. Always wash your hands with soap and clean water before you handle food and prepare to feed your baby if you have one. Always wash your hands with soap and clean water after you have used the toilet or changed your baby's diaper. Our body wastes (stools) contain a lot of germs which, if carried to food can be harmful. In any case, because we can never get rid of all the germs on our hands, it is most important that we wash them often especially when we are dealing with food and babies. ENVIRONMENTAL CLEANLINESS Keep your kitchen, indeed your entire house and your yard, clean. Flies, cockroaches and mice/rats only need a minute scrap of food to keep them alive. Because they do not care where they travel, they are an extremely efficient means of transportation for harmful germs. Keep them out of your house and away from your food. Mosquitoes cause ill health. They lay their eggs in and around stagnant water. If you keep your flowers in vases with water, then you should change the water at least every two or three days. If you "catch" your plants in water then change to sand. Make sure there are no empty containers which can collect water around your yard. You can use discarded tins, sinks, basins and tubs as containers for growing ei ther flowers or vegetables. Discarded tyres can be used for the same purpose. Fill with soil, plant, tend and decorate as you wish. Try growing a lime tree, for example, in a large tin can. If these suggestions are not for you then perhaps you can encourage your children to try. You will be using dis carded items in new ways while reducing the amount of garbage you have and, perhaps most importantly, protect ing your family and your neighbourhood from hazards to their health.


Some mosquitoes are especially strong. They can re main dangerous for years and withstand changes in weather conditions. Broken glass and rusty nails can be another cause of accidents. Clean up all breakages immediately. Keep your yard free of clutter especially if you have young children. GARBAGE STORAGE AND DISPOSAL Left overs pour liquid off and wrap all left overs before throwing out. Use small plastic bags, sugar, flour grits or rice bags or newspaper or an empty tin for this pur pose. Use the brown paper bags from the grocery store to store your household garbage before you dump it in the garbage tin. Wash your kitchen garbage container as least once a week. Wash your general garbage container once every two to three weeks. Keep garbage in covered container to pre vent the contents getting soggy, sour and foul smelling. HOME SAFETY Be alert at home. Try to keep your home safe and accident free not only for yourself but especially for your very young children and elderly relatives. PREVENT POISONING Keep all medicines, chemicals, for example, bleach and other household liquids such as kerosene and gasoline, out of their reach. Young children have not yet learnt the difference between what is harmful and what is not. The elderly's sense of smell and taste may be less acute than yours. PREVENT FALLS Secure throw rugs to prevent tripping up. Elderly per sons trip up easily. Run electrical and telephone cords along skirting boards or under carpets. If neither is possible, secure cord(s) with tape, again, to prevent tripping over. Avoid polishing the floor until it shines and is slippery. Wipe up all spills as soon as they occur. Not only can anyone who slips and falls be badly hurt, but the elderly easily lose their balance, fall, break a bone or two and may then be unable to move about for months afterwards. Keep matches out of the reach of small children, they learn through experimenting. They do not know how h::a.rmful matches can be. Set up the Christmas tree at a safe distance from drapes, doors and stairs if your house has them, and in a cool place in which there is least household traffic. It should not then easily ignite or be knocked over. Decorate the tree with no more than three sets of lights on any one circuit. If you buy a real tree make sure it is fresh. Make a fresh cut in the trunk to facilitate water movement through the cells. Add water to it daily to keep moisture in the tree. Make sure there are no loose bulbs or frayed wires. Turn off the lights before leaving the house and going to bed. Take down a live tree as soon as it starts to get dry (when needles begin to fall). Do not smoke near the tree. If you have an artificial tree make sure both the tree and decorations are flame resistant. (Hanna, 1984/85) DISPOSE OF USED HOUSEHOLD APPLIANCES SAFELY If you buy a new stove or refrigerator for Christmas, store or dispose of the old one(s) safely. These make excellent hiding places for young children. They can get in easily but they may be unable to get out. DISPOSE OF PLASTIC BAGS SAFELY Punch holes in or tear up plactic bags immediately after use. A child's natural curiosity drives him/her to experi ment; try it on by placing it over his/her head and face, your child could then suffocate. ROAD SAFETY You need both your hands on the steering wheel (of your vehicle) to be in control at all times. You can concen trate on only one activity at any one time. If you drive then do not drink or eat. If you are taking tranquillisers or sedatives do not drive. If you travel with your children, especially babies in your car then insist they travel in the back. Place babies in carriers (car seat) in the back. In a crash whether from the front of from the back they are much better protected. Not only will they not go through the windscreen but they should not be cut by broken glass. Although you may be an excellent driver with an excellent driving record, your fellow driver is prob ably not as good. You will then need both hands and all your wits to get you out of trouble. Do not drive if you are sleepy. Ask someone to drive or stay where you are until you feel fully awake. Better to doze off in someone's house or at the restaurant/hotel than at the wheel of a moving vehicle. 11


Additionally, do not accept a drive from anyone who is either drunk or sleepy. Maintain a safe stopping distance of the vehicle in front of you. Try to do the same with the vehicle(s) following you by touching your brakes frequently until the driver seems to be responding. Regardless of how effective your brakes are, your car will continue to be carried along by its own momentum for that split second which could make all the difference. Please remember, the faster you travel, the longer the complete stopping time. Be on the alert for the other driver. He/she may be either in too much of a hurry to get somewhere or just did not see/hear you because he/she is tired/sleepy or intoxi cated with spirits or joy. Be on the alert for the pedestrian who may be drunk, depressed or pre-occupied and is not paying attention to what is happening around him/her. PROTECT YOUR PROPERTY Lock your car everytime you leave it unattended. Leav ing it unlocked is an open invitation to anyone who may be either looking for "easy pickings" or an idler with extra time to fill. Further, lock your shopping and any other valuables in the trunk or place them under the seat where they are not highly visible. When at home, unless you wish to cater to uninvited guests, keep you and your family's movements a secret. Close and lock doors. Use lights to enable you to see what you are doing. Close drapes after dark. If you plan to go out, leave one or two lights burning. If you are away overnight or for any period, ask a trusted family member/friend to turn on/off the house lights at night/in the morning. Carry around as little money on your person as possi ble. Women shoppers should carry their handbag (purse) close ot their bodies. If you carry a shoulder bag ensure the flap is next to your body and carry it in front of you when you are in crowded places. If you can, avoid crowds. Pickpockets, like germs. love crowds. Both are swift, silent and most efficient. By the time you realise that you have been "troubled" they have gone on their merry way leaving you to suffer. Do not accept from or give a ride to, anyone you do not know well. Danger comes in many shapes, sizes and both sexes. More often than not it is very attractively packaged. Owners/managers of business places are advised to make frequent bank deposits, preferably using two or more active healthy males (Gibson, 1985/86). Christmas is a time for cleaning up, cleaning out and new starts. Perhaps you can use some of the suggestions in Pot Pourri to help you clean out old, not so good habits and adopt new/more healthful ones. Here's to wishing you peace, safety, happiness and health not only for Christmas 1988, but for all the year to come. Merry Christmas, Happy New Year. References: Gibson, A. (1985/86) Joining Hands For Health. Volume 3 No. 1 p. 8 Hanna, H. (1984/85) Joininq Hands For Health Volume 2 No. 1 p. 8 Nayam News for the Caribbean Food & Nutrition Institute (1987) B12/87 pp 1-3. Wilson, C. (1986/87) Joining Hands For Health. Volume 4 No. 1 pp. 24-26. HAPPENINGS IN THE DIVISION Over the past year, the Health Education Division of the Ministry of Health has been a beehive of activity. With very limited staff, it has managed to sustain its effort in the public education programme on AIDS. Initially this programme was informational, mainly using the mass media. More latterly, in an attempt to reach spe cific target groups, for example pregnant women, it has carried out a small survey. The results will form the basis 12 of a more specific education thrust. It has also been in the vanguard of organising, conducting and facilitating numer ous AIDS Informational activities (see AIDS update). Unfortunately, health education for the most part, con tinues to be perceived as soley "giving information." While this is an important element of the health education proc ess, it is not sufficient. One of its goals is to encourage and help people to adopt and sustain healthful behaviours.


H Jnc luoes and t 1 woi1t l S ltic m at/l e t o de t erm i ne b esl l q r IO address a b O siness and preles!> lOrtal ivomen' s gO>up on heal j h.and nu t rllion H e a lth r afrs and he. a l lh are one approa cfl to the publil: on healin issues While they a;e time consu'n'lin g t,o pfatl and moUnl, lhM can also be 0'lltram"ely :effe c t l ile i n ir'ldi vidu ats to : .cfla rige .he11lth l>enaviQurs.. Sta ff memtier& '91 Iha O [vlslQn were l ovo l ved in one s.uch :extifbitlo;m wheri !My had a bodl.h a t 1 he On.ig .O.ctiofl Fai r 0 onb'nu l ng I s ; m 1nle9r;;il sspetj in !) e lift;> of a.ny t i s 1ne wlJK:lt cari !;ee p lhe lire o i erilhusias m a nd i nn ova t 1 00 burrting O!' i i WJ'ieri lbe m al s are ali bu1 dead. Th)s year itle Depu ty Chief Health Ellucator Ba.Ibara '

The Division continued to be responsible for coordinat ing the Ministry of Health's weekly radio programme and although the quarterly journal did not appear regularly, it is still alive and made two appearances over the past year. Gradually the Division is acquiring equipment essential to its work, for example, a photocopying machine. Its line staff is gradually growing. Now, we have two typists along with an office manager. Up until June 1988, Shandalanae Edwards was the only full time Health Educator in the Division. With the return of Cheryl Thompson and Felicity Aymer, in October and November, 1988, there are now three Health Education Offi cers under the direction of a Deputy Chief Health Educa tion Officer! The Division takes this opportunity to wish all its col leagues and friends in the Ministry of Health and indeed throughout the Commonwealth of The Bahamas, a very happy and healthy Christmas. We look forward to a new year cont_inuing renewed friendships and enthusiasm in contnbuting to the national and individual health effort. A peaceful and happy Christmas! Proceedings of the Workshop held for Funeral Directors and Morticians at the Pilot House Hotel. 1) SOMETHING FUNNY HAPPENED AS I WAS LEAVING TO GET HERE! 3) THIS IS SERIOUS BUSINESS 14 2) I HOPE THEY'LL SAY IT"S OK TO HANDLE AIDS CORPSES 4) THIS IS SERIOUS BUSINESS


, I sf' j!I .t, .. .. .,; ) .I ... ..,_ > .. .. ." i i W J)EAl WI Hf 6001.E S l'l11S Tl1A!'!K YQU ALL IT WAS A MQST INTERES'flNG HALF AIDS World wltle. rmmune-Deficre11,c:y Syndrome -AH3S Oontinu,as its !ill9 nlles s swurge of< indiViduals In thl! pl'lnie of tl>iei'r Jife ali'd i'he Batiamas is no The .lal;is ar!l ind1s1Jtdable, All saJSuallY l\Ctiye ac;LuHs Ol!r ttatiles then are a lso vul nerable. 'Tbe Hur.nan rmrnunodefioJeocy Vir.us (H!V AICS Virus) ls highl'y selecwe ir:i 1iie i t gel.S aro1:1n<1, t t entm; the. bPdy .booy ll\J1d.s .. ma!ri)y blood and SeO'len and s a diseaS;e ts thrtfugl'I sex1Jal inN a a larm sounds wnen it enter-s your ttoay. Slfehfly ani;J .syst13o'IAficAlly ii Melt w/11le destroy 1ng yo1.1r body's d11te11ee, againsj illr,es s. Yo(j then haye tlitf!cufiy. Wi\h ttte slfgllles1 :iJlnMS r lq o th l!'r infe..tions J !lver 8 p.e'llod of years five qr mer!<, tiu1eUv d\1iJ'lQ' it jQb mosf effi(lently and etfecJiyely. By lhe 11me beglp it> s.vspect yo!l may bfe ill. !he iilV is l; rnit y has. lakcn over your. Dody and. trr hati !II all < nstances, it i s 1him oolY, a 111atte r ol belpre it eni'erges the Y ICtor. AIPS is ti ti ra and will be WW) us tor .as IO'W as we te. lieve Md act a s though It won 1 01 happero jo mt\" ., or, '" I t:an t get i t .'"


The good news is that, because HIV is so very selective in its choice of host, persons who are in mutually monoga mous sexual relationships, that is have one sexual partner and who do not/have not "played around" or who practice what is now widely known as "safe sex", that is, use a condom in every sexual encounter regardless of sexual preference, have nothing to fear as far as contracting AIDS. Unlike other communicable diseases, for example, mea sles, mumps, chicken pox or tuberculosis, you don't get AIDS simply by being in the company of someone who has the disease. You can hug, shake hands with, talk to anyone, indeed be in the company of anyone with this disease and have no fear of getting it. You can't get It from the toilet seat. AIDS does not "rub off." It lives and travels in warm body fluids such as blood and semen. Babies of women who carry the HIV or who have the disease, often, as it were, "inherit" the disease. They, like all persons who have the disease, require love and special care. Because the body's defences are under constant attack from the HIV, persons infected with the virus are unable to deal with infections adequately. They are at a grave physi cal and emotional disadvantage. They need special care, understanding and help not only to accept their illness but also to live as normal and meaningful lives as possible. AIDS IN THE BAHAMAS In The Bahamas AIDS affects sexually active men and women as well as the children of infected women. Over the three year period August 1985 September, 1988, for every one woman with AIDS there have been less than two men ( 1 .6) (see table 1 ). Sixty-nine per cent of those affected have been adults aged 20-49 years. Seventy-two per cent of adult AIDS sufferers were het erosexual. The incidence rate, that is the number of new cases in any one period, for The Bahamas overall, has more than doubled over the three year period from 16/100,000 to 37/100,000. The rate ranges from 10/100,000 in Andros to a stag gering 41/100,000 in New Providence, 52 in Eleuthera and 108/100,000 in Abaco. TABLE1-AIDS CASES BY SEX BAHAMAS AUG. 85 SEPT. 88 60 30 1985 1966 ofosu-Barko (1988) AIDS Up-Date 16 I 1987 1988 MAf S FBv1AfS


Table 2 shows the distribution of AIDS among adults and children while Table 3 shows the number of deaths. Table 2: Distribution of AIDS Cases among Adults and children Year Adults Children Total No. No. No. August December 1985 26 10 36 January December 1986 41 9 50 January December 1987 73 17 90 January September 1988 56 4 60 Total 196 40 236 Table 3: Number of deaths among AIDS patients Year AIDS Patients Deaths No. No. August December 36 16 44 January December 50 23 46 January December 90 44 48 January September 60 33 56 Total 236 116 49 The implications are that: (a) the mortality rate, the proportion of persons dying of the disease is 49%. Nearly half of all persons suffering from AIDS so far have died and; (b) as of October 1988, not only are there 120 persons with the disease but, more sobering, although not shown in the tables, there are 660 healthy carriers, (Ofosu-Barko, 1988) that is, persons with no symptoms but who carry the virus in their bodies. These persons all have the potential for infecting others If as has been estimated, each carrier is capable of infecting 32 others (Diggory, 1987) the pic ture is bleak unless each one of us, individually, takes active steps to safeguard ourselves. It won't be long be fore every sexually and potentially sexually active man and woman becomes infected. WHAT IS THE BAHAMAS DOING TO COMBAT AIDS? The Bahamas is attacking the AIDS problem on several levels. As an active member nation on the World Health Organization it is contributing to the global assault by par ticipating in conferences and training activities. At the time of writing activities are being planned for the first designated World Health Day, 1st December, 1988, the theme of which is, "Let's Talk About AIDS." The pur pose of this day is to rivet attention on AIDS and mobilise each member of the public into taking preventive action. At the regional level, The Bahamas contributes to the data collection process, uses the expertise of the Caribbean Epidemiological Centre (CAREC) based in Trinidad and participates in conferences. At the national level, in addition to the work being done generally in prevention, detection, monitoring and treat ment of persons with AIDS, The Bahamas has conducted a series of educational activities including an AIDS tele conference attended mainly by health professionals. Fur ther, the Ministry of Health has appointed a Standing Committee fo the Prevention and Control of AIDS. Chair man of this committee is Dr. Vernell Allen, Chief Medical Officer. Education of the public for, the prevention and con trol of AIDS is but one of the goals of this programme. The chairperson of this sub-committee is Ms. Barbara Cur tis, Deputy Chief Health Educator, Health Education Divi sion. Through the Pan American Health Organization (PAHO), the Ministry of Health has been able to acquire substantial sums of money to assist its (Ministry of Health's) various programmes of education, monitoring, surveillance and detection. Activities sponsored by the Ministry of Health's Standing Committee on AIDS and cone Jcted wholly by or in collaboration with the Health Educa tion Division include: 1) a half day awareness programme for the clergy held at the Pilot House Hotel, 11-11-87 2) a half day workshop for funeral directors and morti cians held at the Pilot House Hotel, 20-9-88 3) a three day workshop for Trainers in AIDS counselling held at the Wyndham Ambassador Beach Hotel, 26/28-10-88 All these activities were successful to the extent that they increased the groups' knowledge and understanding of the disease process. The workshop for funeral directors and morticians acted as a catalyst in the formation of an association of funeral directors. It was also successful in that this group now has a clearer understanding of the disease process of AIDS but more importantly, feels more competent and comfortable in the task of handling the corpses of AIDS patients. The three day workshop for trainers in AIDS counselling was conducted by the Division in collaboration with two counsellors for AIDSCOM. It was again very successful in that, in addition to gaining greater knowledge about AIDS, par:ticipants feel more comfortable in working with AIDS patients and their families and will be able to develop in and share those skills with their colleagues. Persons from health and allied communities, for exam ple the religious, educational, probation, prison and morti cian's associations in New Providence and the Family Is lands attended. These activities were all sponsored by the Ministry of Health's Standing Committee on AIDS in collaboration with the Pan American Health Organization (PAHO). 17


The Division has also conducted a number of small surveys to determine knowledge and attitude of selected groups with regard to AIDS. Findings would seem to indi cate that while knowledge of the existence of AIDS Is high, much more work needs to be done about under standing how the disease is spread and how it may be prevented. The Minister of Health, Honourable Dr, Norman Gay, in his opening remarks to the Train-The-Trainers AIDS Coun selling Workshop (October, 1988) quoted from an AIDSCOM publication: "Education is not enough ... if AIDS education simply means lectures, information, knowledge or the facts about AIDS, then education is not enough. People must come to accept those facts as relevant to their lives; they must have prevention products easily available; and they must receive continued support and counsel ling to protect themselves from HIV infection." How very true. In addition to the above, they must also: a) FEEL that they must act to prevent illness/further illness. b) having taken the decision to act c) follow it up with appropriate action d) have both formal and informal supports in place to al low them to maintain the appropriate action. Before all this can occur, people must be aware and knowledgeable As a first step in educating the public the Division has therefore, over the years, sought to create public aware ness and share evolving knowledge about AIDS. In this regard, articles have appeared in this journal, indeed one edition, Volume 4. No 4 1986/87 was devoted soley to AIDS. It has designed and made widely available a number of posters and leaflets as well as broadcast a series of infor mational radio spots. It has formed a cadre of speakers, predominantly physi cians, to address and respond to requests from various groups. These groups include secondary schools, private school teachers, churches and non government organisa tions. II has published a number of articles in the daily news paper and has been instrumental in establishing an AIDS information telephone hotline. Staff members have also participated in panel discussions in the community. In ad dition, other members of the health team have been acti vely involved in the AIDS public education effort. A series of community meetings both in New Provi dence and the Family Islands will be held as a followup to the Trainers workshop. 18 While continuing its informational efforts, plans are be ing made to conduct complementary activities specific to the needs of high risk and community groups. In addition to these activities, staff of the Ministry of Health continually respond to the numerous requests na tionwide from various professional, business and commu nity groups for further information on one of the most feared, frightening and devastating of diseases with which world populations have been confronted tor sometime. It will take a mammoth, concerted joint effort between health workers, scientists and individuals to effectively reverse AIDS' control over our race. We can easily do it IF we are willing to change our sexual behaviour. A fatalistic approach is not a key to success. As we approach the Christmas season, Junka noo, merriment and abandon, please remember, sexual intercourse with a partner whom you do not know well could mean AIDS. On behalf of the Ministry of Health, the Health Educa tion Division takes this opportunity to thank all those per sons with whom it has worked in the AIDS effort most sincerely and looks forward to their continuing support and co-operation in the future. May you all have a warm and blessed yuletide. AIDSCOM-AIDS Communication Prevention Cooperation is part of the United States contribution to the global fight against AIDS. AIDSCOM, along with AIDSTECH, works with specialists in developing countries to create and implement effective strategies for AIDS control. Its unique countribution is communication, condom promotion and counselling, built on a broad-based multisectoral commu nity development strategy. AlDSCOM is funded by the United States Agency for International Development (USAID), bureau for science and technology, offices of education, health and popula tion as well as by contributions from regional bureaus and USAID missions around the world. AIDSCOM works closely with WHO's global program on AIDS to ensure a coordinated global effort. References: Diggory, P. (1987) Acquired Immune Deficiency Syndrome Prevention in: Joining Hands For Health Volume 4. No. 4. p. 6. Ofosu-Barko, K. ( 1988) AIDS Up-Date. Train-The-Trainers Manual.


XIII WORLD CONFERENCE ON HEALTH EDUCATION Every three years, the International Union for Health Education (IUHE),. holds a conference. This year, the 13th world conference, jointly organised by the IUHE, the Centre for Disease Control (CDC) the National Centre for Health Education (NGHE) and the United States Host Committee, and co-sponsored by the World Health Orga nisation (WHO) the United Nations Children's Fund (UNI CEF) and the Pan American Health Organisation (PAHO) was held in Houston, Texas USA, 28 August -2 Septem ber (1988) under the theme "Participation for all in Health." More then 1,000 participants including health educators, physicians, nurses, journalists and social scientists from countries throughout the world met to explore "how health education tools can improve not only what society, science and government can offer in health programs., but also what people can do for their own care and that of their families and communities." Conference proceedings were conducted in English, French and Spanish with simultaneous translation during the opening, plenary, general assembly and closing ses sions. A variety of practitioners, both old and new, pre sented on such topics as maternal and child health, nutri tion, cardiovascular health, family planning, AIDS, substance abuse, cancer, oral health, healthy older peo ple, smoking and infectious diseases. Participants were able to attend an exhibit and trade show as well as meet the representatives of organisations and suppliers for the latest in the state-of-the-art resources in health education. Participants were able to visit the sights of Houston as well as treated to a round of social activities. A special feature of this conference was the programme designed for international visitors. This programme allowed them to take part in various educational activities, for example, workshops, short courses, seminars, short term field placements or study tours with local health educators in over 20 cities throughout North America. The goals of the Conference were threefold and aimed at: 1. reducing and eliminating leading risk factors, preventa ble injury, illness and premature death through accele rated diffusion of effective health education, commu nication strategies and technologies. 2. forming an effective and balanced network with other sectors including education, public health, health care and allied disciplines through professional collabora tion ... 3. extending the benefits of health promotion and educa tion to vulnerable groups ... by examining innovative strategies and special problems in selected populations and by emphasising the needs of less developed coun tries, poor people, refugee populations and target groups such as infants, children and youth, women and the elderly. The keynote address was given by Dr. Hiroshi Nakajima the newly elected Director General of the World Health Organization. Dr. Nakajima urged health educators to forge new alliances for improved health action and stressed that health for all can only be achieved by partici pation of all. "We must build working alliances with the mass communication sector, with health educators in schools, with professional and community organizations with business, with labour groups and unions", he added. He challenged health educators to tackle the AIDS pan demic through information and education, "our only an swer at present" to stop further spread of the disease: "I can challenge each one of you to prove the worth of your profession in this undertaking," he said. "Most of the world's major health problems and prema ture deaths are preventable through changes in human behaviour and at low cost," the WHO Director-General told the 1 ,500 health educators present. Citing a recent report by the U.S. Surgeon General which indicates that diet and food habits are implicated in two-thirds of all deaths in the United States, Dr. Nakajima added: "We know conclusively that no-smoking, careful driving, appropriate dietary habits, low salt and fat intake, no more than moderate alcohol consumption and physical exercise, will have a profound impact on the health of every individual, including the elderly." Among the success stories of health education, the Di rector-General of WHO referred to the dramatic fall in heart disease in certain developed countries as a result of changing behaviour and ways of life, declining lung cancer rates for men as they give up smoking, and a leap forward in worldwide child immunization coverage from less than 5% to more than 50% in ten years. Dr. Nakajima de scribed these results as "an illustration of the combined and synergistic of education, technology and man agement." In his address, he also pointed to the "limitations" of health education and to the challenges facing health educators in both developed and developing nations. "Why", he asked, "do birthrates remain so high in many nations, with consequent health problems and a high inci dence of infant and maternal deaths? Why is the promo tion of breast-feeding, with its innumerable benefits, such a problem? Why is alcohol consumption increasing in so many countries?." 19


In his concluding remarks, Dr. Nakajima said: "What we need now is determination, courage and foresight. Health is a product of social action and not just a result of medi cal care." The four sub-themes addressed at the Conference were: Involving People and Community Supporting Community Access Involving The Total Health System Gaining lntersectoral Support. Joining Hands For Health will discuss each of these four sub-themes in future editions. Sources: Invitation to Attend brochure, XIII World Conference on Health Education (1988). WHO Press Release (1988). Please note: The full text of Dr. Hiroshi Nakajima's address may be found below XIII World Conference on Health Education Houston, 28 August -2 September 1988 20 Keynote address by Dr. Hiroshi Nakaj:itna Director-General World Health Organization Mayor Whitmire, Officers and Delegates of the International Union for Health Education, Honoured Guests, I would like to thank you very sincerely for the invitation to take part in this ceremony to mark the opening of the XIII World Conference on Health Education. It is fitting that I am present today, for what is one of my first official tasks as Director-General of WHO, since our Organization has worked closely with the International Union for Health Edu cation for many years. I would also note that both organizations have survived 40 turbulent year!:i with encouraging development testi mony to our commitment and our faith that the well-being of mankind is mankind's highest value.


People are the true measure of success of policies and programmes individuals, families and communities. At the same time people are also the determinants of suc cess. Experience teaches us, both in the most sophisticat ed cities and the most remote villages, that when people act with determination and understanding in pursuit of goals they deem essential, success is achieved. Miracles happen. Previously insoluble problems are solved and non-existent resources are mobilized. It is thus most appropriate that "participation" is your keynote theme. But we must deal with the concept of participation honestly. It means much more than compli ance with a physician's prescription or the dutiful contribu tion of labour or money to projects superimposed upon a community by some master plan. True participation begins when the people involved decide what needs to be done, and particularly what needs to be done first. Perceived needs may frequently be at variance with the data of epidemiology. But if we ignore perceived needs, then we do so at our peril. We need not only to persuade the people to accept the professional's wisdom, but atso the professional to understand the people's wisdom. The task of the educator for health is to achieve consensus, for health educators must function as an effective link be tween people, professionals and policy makers. Forty years ago, the drafters of the WHO Constitution freed us forever from the tyranny of disease as the sole determinant of health; the mental and social aspects of positive health have been given equal importance. The Alma-Ata Declaration, ten years ago, imposed upon us the discipline of a deadline in time for health action. Taken together, they clearly point to the essential role of health education and communication. No longer is there room for doubt. An educated public ls essential to the achievement of health goals. Effective ed ucation and communication are indispensable to create this educated public. We must recognize that most of the world's major health problems and premature deaths are preventable through changes in human behaviour and at low cost. We have the know-how and technology but they have to be transformed into effective action at the community level. Parents and families, properly supported, could save two thirds of the 14 million children who die every year if only they were properly informed and motivated. Immuni zation alone could save 3 million lives and another 3 million deaths a year could be prevented by oral rehydra tion, a simple and cheap technology. A recent report by the U.S. Surgeon General indicated that diet and food habits are implicated in two-thirds of all deaths in the Unit ed States. A study just completed in India has shown that about 600,000 Indians die from tobacco-related diseases a year; the worldwide total, as estimated by WHO, is 2.5 million deaths per year. We know conclusively that no-smoking, careful driving, appropriate dietary habits, low salt and fat intake, no more than moderate alcohol consumption and physical exercise, will have a profound impact on the health of every individual, including the elderly. An apt slogan,"AIDS don't die from ignorance'', can be applied to practically every other health problem. We could simply say: Alas, if only people knew. But, as you all know well, it is not as simple as that. Let us not allow ourselves the luxury of victim-blaming. Society must make it possible for people to live healthy lives. A grand alliance of people, policy-makers and health professionals is necessary. Health educators must use a// the means of commu nication and social skills at their disposal. Only thus can they help to create a healthy social climate, ensure sup portive policies, and influence attitudes and values. Only thus can they empower people with knowledge and the relevant health skills to improve their own health. Much progress has been achieved in the field of health education during the last four decades. A strong body of scientific knowledge has been developed, enriching both the theory and practice of health education. There are, in most parts of the world, a significant number of well trained health education specialists and a network of train ing institutions. In most countries, an infrastructure to sup port health education exists, though often it may ;iot be strong enough. There have been success stories, where health educa tion has played a unique role, in such areas as cardiovas cular health, smoking and health and road safety. The dramatic fall in deaths from ischaemic heart disease in a number of developed countries bears testimony to educa tion's part in changing lifestyle behaviour. In the USA, for instance, deaths from ischaemic heart disease declined by 35% between 1970 and 1980 and in the UK these de clined by 12% in males between 1975 and 1985. The decline in lung cancer rates for males, or the falling death rates from motor vehicle accidents, illustrate the positive effects of a combination of education and legislation. i'n recent years there have been a significant number of initiatives taken in Europe and in WHO's Eastern Mediter ranean and South-East Asia regions in health education for school-age children. With persistent education cam paigns, child immunization coverage in the developing world has in 10 years leapt from less then 5% to more than 50%, saving the lives of about 1.5 million children in 1987 alone an illustration of the combined and syner gistic effects of education, technology and management. 21


In defined populations, particularly certain groups, there have been marked positive changes in be haviour brought about by strong educational campaigns on AIDS. This provides an example of a massive educational effort, national and global, combining skills in counselling, modern communication, social marketing and community organization. Having acknowledged these strengths, we need also to recognize our limitations. The future presents many prob lems in both developed and developing nations. We need to ask ourselves: Why do birthrates remain high in many nations for example the population increases by about 15 million per year in India with consequent health problems and a high incidence of infant and maternal deaths? Why is the promotion of breast-feeding, with its innumerable benefits, such a problem? Despite convincing proof of their effectiveness, why are there still so few strong health education curricula in schools? If the methods of health education are sound, why are cardiovascular disease and hypertension increas ing in some countries in Eastern Europe and many devel oping nations? Why is alcohol consumption increasing in so many countries? Why has the promotion of health and safety in the workplace continued to be difficult for health educators? These questions can be answered only by accelerating, expanding and intensifying health education efforts. We should aim at large-scale mobilization of societal forces for health development. Enhancing individual knowledge and understanding alone is not enough; a favourable social climate and adequate support systems are necessary. Heightened awareness for health, among policy makers and public alike, must be transformed into policies, legis lative support and resource allocation for health. The sys tem should be able to respond and effectively satisfy the demand for healthful living created by health education and health communication. How may health educators react to meet these chal lenges? First, build alliances and networks. New alliances must be forged to provide the impetus for health action. We must build working alliances with the mass communication sector, with educators in schools, with and community organizations, with business, with labour groups and unions. We must break away from our isola tion and strive to win partners in our struggle for health promotion. In terms of our conference theme health for all can only be achieved by participation of all. The health educator must become an effective advocate for health at all levels. We must strengthen our activities to debate and negotiate with administrators in order to obtain policy and resource support. We must influence organized 22 groups so that effective lobby support is achieved. We must become vigorous champions of the importance of health education, for central to the whole "Health For All" strategy is advocacy. We must increase the scale of our operations in order to promote greater individual and community self-reliance and involvement in health. We need not remain timid in our aspirations and isolated in our action. We should no longer be satisfied with modest local successes. We should reach out and expand our activities. The impact of health education can be multiplied if the nation as a whole and its leaders become actively involved. This will require greater mobilization of resources and greater exploitation of sources of funds, at national and international levels, as well as at the local level. Policy makers and resource allocators need to be persuaded. To accomplish this, health education must embrace all the modern tools of communication and social action. Ef fective use must be made of radio, television, newspapers and magazines to inform an increasingly more literate population. Advances in the field of informatics and com puter system networks must be harnessed into supporting clearly formulated strategies. The skills of social marketing must be understood and pragmatically exploited. Above all you as health educators should be providing leadership in the field for other members of the health team who have been media-shy. Training of the health educator must be strengthened. The health educator of the future will require not only thor ough grounding in education, but also in communication, use of mass media, marketing and advocacy, as well as skill in the administration of programmes and resources. As ot 1 August 1988 a cumulative total of over 108,000 cases of AIDS were reported to WHO from 140 countries. It is estimated that the actual number is more than twice that figure and is steadily increasing. While the severity of this deadly disease has mobilized researchers round the world to an unprecedented degree, our only answer at present is to inform and educate the people and change human behaviour. This is an enormous task. I challenge each one of you to prove the worth of your profession in this undertaking. The time has now come to galvanize our efforts. The knowledge and technology already exist. What we need now is determination, courage and foresight. Health is a product of social action and not just a result of medical care. Active community participation and supportive social policies are necessary tor progress in health. And herein lies your challenge.


Finally, I challenge you to challenge us. Bring to the international organizations, the bilateral organizations, and others, your plans to improve health through communica tion and involvement of all sectors of the society. We are pledged, by the documents we live by, to give health edu cation the chance it has long deserved. For WHO, I promise you that the vital importance of be recognized and assure you that we will give your field the priority it so richly warrants and the world so badly needs. EVALUATION Help UB to make the newsletter as interesting and informative as possible. Plell..'le complete, detach and return this short evaluation form to the Health Education Division, Nassau, Bahamas.. Tick the most appropriate response. 1. How did you find the newsletter? a) very interesting b) interesting c) somewhat interesting d) uninteresting e) did not read 2. W llB there any article of particular interest to you? Yrso Noa If yes, please give title ................................................................................................................................................ 3. What changes, if any, would you like to riee? ........ ....................................... ...... -- ............................... ................. ,. ................................................................................................................................. ........... w. 4. What topics would you like in future issues? ........................................................................................................... 5. Would you like to contribute to this newsletter? YesO Noa If yes, please give name and address. Name: ........................................................................................................................................................................... Address:Thank you for your c1HJperation! Please complete, detach and return this short evaluation form to the Health Education Division, Nassau. Bahamas. 23


Members of the public Education Sub-Committee on AIDS discussing progress and strategy at one of their regular meetings. Left to Right Dr. Timothy McCARTNEY Mr. Edward ELLIS Mrs. Barbara CURTIS Ms. Dale CLARKE (partially seen) Ms. Chandalanae EDWARDS {hidden) Ms. Azella MAJOR Dr. Sonja LUNN Other members not seen includ: Mrs. Inez BARNETT Ms. Sandra COLEBY Ms. Paula FERGUSON Ms. Pat FRANCIS Mr. Pat HANLAN Ms. Jewel MAJOR Ms. DOROTHY PHILLIPS Bishop Harcourt PINDER 24 Psychologist, Sandilands Rehabilitation Centre (SRC) Director, Bahamas nformation Services (BIS) Deputy Chief Health Education Officer, Health Education Division, Ministry of Health. Typist, Health Education Division Ministry of Health. Health Education Officer, Health Education Division, Ministry of Health. National Health Education Council (HEC) Women's Groups, National Health Education Council Comprehensive Clinic, Ministry of Health. Health Aide, Health Education Division Executive Director, Bahamas Planned Parenthood Association. Men's Organizations. Deputy Permanent Secretary, Ministry of Health. National Health Education Council HEALTH EDUCATION DIVISION MOSKO BUILDING MOUNT ROYAL AVENUE P.O. BOX-9111 NASSAU BAHAMAS


Produced and Edited by FELICITY AYMER Health Education Division Ministry of Health Nassau, Bahamas Maniscript Typed by YVETIE SMITH Health Education Division



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