September 25, 2016 By
September 18, 2016 By
“Alcoholism is a devastating, potentially fatal disease. The primary symptom of having it is telling everyone – including yourself – that you are not an alcoholic.” – Herbert L Gravitz & Julie D Bowden
In school, we’re taught that an important aspect of taking a patient’s history is asking about whether they smoke cigarettes or drink alcohol. And then we’re expected to quantify the person’s cigarette or alcohol use. How much? How often? When did you first start? And invariably most people try to lowball their usage. It’s only after a bit of careful prodding that the truth comes out – or at least something close enough to the truth.
While the legality of alcohol in our culture might not suggest it – cigarettes and alcohol are two of the most potent psychoactive substances. So not surprisingly, we’ve been taught about our role as doctors in counselling patients to quit smoking or to reduce their alcohol intake.
This past rotation in family medicine, we learnt about the five A’s of intervention and the five R’s of motivation. I am sure that each of us, even if we are not doctors, will encounter persons who abuse alcohol and this approach can prove useful.
In trying to motivate a patient to make a change in their behaviour, it’s important to explain to them how the change is relevant to them personally, to talk about the risks of their current behaviour, to educate the patient about the potential rewards of change, and to address possible roadblocks they might encounter while trying to change. And the final R is repetition – doctors should try to respectfully repeat the five R’s each visit to try to motivate their patient to make the changes to live a healthier life.
Let’s take alcohol abuse as an example where the five R’s can be used to motivate a person to cut down on their drinking.
In terms of relevancy to the person, there should be a discussion about how cutting down their alcohol consumption would directly impact their life – it could save them money, improve their quality of life, and if they’re pregnant, it would increase their chances of having a healthy baby. Each person is different, and there will be different issues that are relevant to them and it is important for their doctor to discuss those issues with them in a respectful, non-confrontational manner. Maybe friends can be more casual…but certainly not confrontational!
In terms of risks, there are long-term and short-term risks of alcohol abuse. In the short-term, risks include disruption of sleep, blackouts and a whole host of others. In the long-term, all that assault on your liver can lead to cirrhosis, liver failure and eventually death. Alcohol abuse is one of the most common causes of pancreatitis which comes along with its own range of complications. And then there are all of the emotion risks that come along with alcohol abuse. Long-term over-consumption of alcohol can significantly increase your risk for depression. And I’m sure by now, especially in a country with one of the highest suicide-rates in the world, we’re well aware of the link between depression and suicide. The discussion of risks isn’t meant to be a scare-tactic, it’s supposed to be a frank discussion where the abuser is made aware of the risks and where their perception of those risks is explored.
In terms of rewards, there are all of the health rewards – add on more than a couple of years to your lifespan. And of course, then there’s all of that money that you can save. And for each patient, there are specific areas where their alcohol abuse is causing a problem, so there should be a discussion about how those problems might be ameliorated by cutting down the drinking.
And of course, change is never easy – if it was, they probably wouldn’t have had to come up with five R’s to motivate people. But that brings us to the fourth R: roadblocks. There should be a discussion with the person about possible hurdles they’ll have to face on the road to change and the patient and doctor should come up with strategies on how to handle those problems when they arise. They may suffer withdrawal symptoms, or they may live in an environment that encourages their alcohol abuse.
The final R is repetition. As I mentioned before, doctors should try to respectfully repeat the 5 R’s each visit to try to motivate their patient to make then changes to live a healthier life. Concerned friends and family members should also do the same.
Alcohol abuse is a problem in our country. With alcohol, and I suppose most things in life, moderation is key. Our health professionals have a duty to their patients to motivate them to make the changes towards moderation. And so do we as ordinary citizens.
September 4, 2016 By
“Just saying “no” prevents teenage pregnancy the way ‘Have a nice day’ cures chronic depression.” – Faye Wattleton
Once again – but unfortunately for all the wrong reasons – the issue of children bearing children is in the air. And it should be – it’s still a major public health concern because of the risks posed to both the young mom and her developing baby.
During my time in obstetrics, I’ve also seen some very young mothers – teenagers, still in school. Some of them with family supporting them; others very much alone.
In Guyana, it was clear that I possibly lived a sheltered life since I remember being surprised when a few years ago (2013), I’d read that according to a report by the United Nations Population Fund (UNFPA), Guyana had the second highest rate of adolescent pregnancy in both the Caribbean and South America: 97 out of every 1000 girls between the ages of 15 and 19 were giving birth. I hadn’t seen this either in my village or at QC. Recently, I read of a 17-year-old Guyanese girl giving birth to her third child!
But here at Port of Spain General Hospital, at least the teenage mother-to-be’s I was seeing were those that made it to clinic for their antenatal checkups. Going by the figures of teenage pregnancies, it would seem like there are so many more pregnant teens that never get to go to those checkups.
Trinidad reported that they had 2500 teenage pregnancies in 2015, compared with our 3000 (with half of Trinidad’s population!) for 2013.
And missing those checkups is dangerous for both the mother and her baby. As I’d mentioned before, it’s incredibly important for pregnant women to have regular antenatal checkups so that the doctors will be able to deal with any of the myriad complications that can arise during pregnancy. And it’s doubly important for teenage mothers to get those checkups because there are so many extra complications that can happen due to their age.
Pregnant teenagers are at a higher risk of developing pre-eclampsia, a condition with high blood pressure, kidney damage, liver damage and a host of other complications that can progress to eclamptic seizures. They are also more likely to go into pre-term labour and deliver premature babies. Since teens often become pregnant before their bones are finished growing, their pelvises (‘hips’) aren’t usually wide enough, and a c-section often becomes necessary.
One of the requirements for this rotation was for us to accompany a patient to the Medical Social Worker. And after our visit, it was patently obvious why it was necessary. It was eye-opening and it certainly put things into perspective for us – suddenly complaining about the trials and travails of medical school seemed petty compared to those of several of our patients.
We were forced to confront the harsh reality of abuse and incest that some young women have to face. And according to the social worker, those aren’t rare cases.
She explained to us that as doctors, we’re not just supposed to treat the patient and move on – we’re supposed to be advocates for our patients. And in cases where the patient is a pregnant minor, we’re expected to call the Child Protective Unit right away.
The state and nation must move away from the “blame the girl” syndrome and recognise its duty to protect its girls. They are people too.
The report cited above has some good advice for us in the Caribbean: it called for a “…new approach (which) must target the circumstances, conditions, norms, values, and structural forces that perpetuate adolescent pregnancies on the one hand and isolate and marginalise pregnant girls on the other. Girls need to have access to both sexual and reproductive health services and to information.”
August 28, 2016 By
“A man without ethics is a wild beast loosed upon this world.” – Albert Camus
Another year of schooling is about to start – at all levels – primary, secondary, and tertiary. I’ve been in school for most of my life (now, there’s a sad thought!) and over the course of my schooling, I’ve had so many different types of teachers. I’ve had the ones that go about their jobs like they truly love what they’re doing, and the ones that seem to go through the day like teaching is a burden.
But no matter what their teaching attitudes or stance might’ve been, I’ve learnt a lot from our teachers. Teachers teach more than just the subjects on the curriculum like Science or Math – and while they mightn’t realise it, they teach ethics as well. Their behaviour impacts their students strongly. And of course, it’s always best to lead by example, so we’re most likely to do as our teachers do, rather than as they say.
Much of my personal values and sense of ethics is a product of the influence of my school teachers. Of course, the major chunk consists of values directly instilled into me by my parents, but on some level, I have been influenced by my teachers.
My current value system is a hybrid of what I’ve been taught at home and whatever modifications my experiences have forced me to make.
And I realised how damaging it could’ve been if I had teachers whose values and sense of ethics were not that stellar. What if I had teachers that throw things and scream at their students, calling them names, belittling them?
If a student didn’t have a strong personal value system or positive role models, they could easily accept that sort of behaviour as being okay, or acceptable. And they might carry over that type of behaviour to the way they handle their patients when they become doctors.
Our teachers have great powers; they have the most interaction with us, especially during our young, impressionable years, when we’re still forming our opinions of the things around us and deciding how we want to fit into society.
More emphasis should probably be placed, when training teachers, about their role in moulding the values of their students. They have to be made to appreciate that values can only be transmitted in action – not just words.
Things like the importance of confidentiality and the importance of privacy could be emphasised by the teachers so that when the students leave the school system, they’ll be able to function like adults who are capable of respecting their peers.
Now in medical school, we’re having classes on ethics and professionalism. They’re trying to teach us to be the type of doctors we would like to take care of us – empathetic, kind, caring doctors. But is it too late? For many, those early formative years are when our characters get moulded. If that solid foundation wasn’t built all those years ago, can these classes now make a difference? For the sake of our healthcare, I certainly hope that they can.
Our teachers can hold great sway over how we might turn out at the end of our tenure at school; they could be the difference between whether we become successful professionals, or whether we go about our jobs in a very unprofessional manner. We need a solid foundation in professionalism, and our teachers can give us that, hopefully by their actions and not just their words.
August 21, 2016 By
I learned three important things in college – to use a library, to memorise quickly and visually, to drop asleep at any time given a horizontal surface and fifteen minutes. ~Agnes DeMille
With the recent release of CAPE and CSEC results, many students have collected their last high school ‘report card’ and soon colleges will be full of newly-minted freshmen. It takes me back to my first year at UWI: everything was so new and exciting – and a bit intimidating. It was a whole new ballgame – full of different rules and new players.
There were some students already with degrees, who were already comfortable with the whole university shtick. And then there were callow students like me who were “fresh” out of high school. And maybe we now know the origin of “freshmen”?
But now I’m in my fourth year, and I can’t believe how fast time has passed. I’m happy to say I’ve learnt a lot the past couple of years in university – and not just about anatomy. One of the most important lessons I learnt was about “stick-to-it-ivness”. The only way you can be guaranteed success is if you stick to things – even if they’re not going perfectly at the moment. You can’t just chuck it in at the first sign of trouble or even at the first indication that the road ahead has more bumps and pot-holes than my street in Guyana.
There’s that old cliché that says the measure of a person isn’t how many times they fall, but instead how many times they get back up again. And as with most clichés, it’s true. The greatest moments are those times when you can scrape yourself from the floor, rise up again after being faced with a seemingly insurmountable problem – and then prevail.
At every step of your life there will be new problems, problems that seem like the most difficult thing in the world to deal with. But if you stick to things and not just jump off and abandon ship, the end-result will be so worth it all.
I can’t emphasise enough, the importance of setting realistic goals and specific deadlines for achieving those goals. And this assumes you set goals and not just drift, right? Especially for students, nearing the end of the semester when the teachers start to pile on those assignments. It gets really easy to lose track of what needs to be done. Taking the time to plan ahead for what needs to be done really saves time in the long run – especially if you’re a serial procrastinator like I am.
By managing your time better and setting goals and deadlines, you can avoid those last minute frantic all-nighters that are most times rather counterproductive. Especially on the nerves!
But it’s not all work and no play either – I think it’s important to reward ourselves every now and again even if it’s just with little things. I mean, it’s not that we should be constantly patting ourselves on the back for every single thing we do. But sometimes it’s nice to give ourselves a little treat for achieving our goals.
And lastly, the best advice I can give to the incoming college freshmen is that they should try to enjoy college. It truly is a wonderful time. And of course, it’s the last “hurrah” before adulthood and its accompanying responsibilities truly set in.
August 14, 2016 By
We are all now connected by the Internet, like neurons in a giant brain. – Stephen Hawking
In today’s world, to get a message heard half-way across the world you just need to tap at a couple of buttons without ever having to bother your vocal cords. And obviously it’s great – we can now reconnect with people we may not have seen in years.
But with every message we send, every picture we post, every thought we share with the world around us, we’re opening up ourselves to the world. We’re letting everyone in. We’re putting ourselves out there for the world to applaud us, appreciate us, to critique us, to judge us.
And at every stage of our lives we’re at different stages of maturity. Every day, we grow a little, we learn a little bit more, we gain a bit more experience. So something I might feel confident about posting on a social media site today, I might cringe with embarrassment about next year. Or some thoughtless comment I might have made for the world to see might offend my future boss, or co-workers.
It’s a delicate balance trying to maintain links with the people around you without putting too much of yourself out there.
It’s just too easy to share every detail of your life on the Internet. Tons of people are taking pictures of their food and sharing them on Instagram every second of the day. People are also posting insightful status updates such as “Eating roti”. Food photography seems extremely difficult. It’s definitely harder to get flattering lighting for a plate of curry (duck or otherwise!) than for a person.
All of these apps can be great for letting people know about what we’re doing every day, keeping everyone updated, but it probably should be used in moderation. It gets to be a bit much – overwhelming even. Do you have to let everyone see what you’ve eaten every day? Do you have to tell everyone that you’ve just made a sandwich?
It’s getting so much easier to infringe on everyone’s personal space. Maybe you should send someone a message on Skype before you randomly call them. They could still be in their pyjamas or in the middle of something important. It’s a bit like barging right into someone’s house and expecting them to entertain you with absolutely no warning.
It’s a new world out there. With every software update, with every launch of some new social media platform, we have to adjust to this new way for us to share what’s going on with our lives.
So before you open yourself to the world and share every detail about your life, think about the amount of people your message might actually be reaching – it’s probably a lot more than you originally envisioned. Censor yourself a little bit – not that you shouldn’t have freedom of speech, but you should probably be more aware of your ‘time and place’ and what kind of image you want to project of yourself to the world.
The Internet is giving us great power, and with great power comes great responsibility, so use the Internet (and the power it give us) responsibly.
August 7, 2016 By
“To keep the body in good health is a duty… otherwise we shall not be able to keep our mind strong and clear.”
– Gautama the Buddha
Last week in one of our Family Medicine clerkship classes, we discussed the concepts of “Heath behaviour” and “illness behaviour” which I believe may be useful to the general reader.
Heath behaviour refers to any action a person undertakes to promote, maintain, or protect health. And illness behaviour refers to the actions taken when sick to get better.
It made me remember that at the beginning of med school I was struck by how finely balanced all our regulatory systems are, ensuring that all of the processes in our body are in sync. And by how elaborate our immune system is to prevent us from getting sick all of the time. There are an awful lot of bacteria and viruses out there launching attacks on us, but we don’t spend every waking moment sick, do we? That’s because our immune system is fighting off the invaders all the time.
And I realised how much we take these things for granted. We eat what we want, when we want, not caring about what the nutritional content of the food or our irregular eating times might be doing to our bodies. Or we adopt a sedentary, couch potato lifestyle. And while we take in the car every 3000 miles for the oil and filter change, we don’t make regular check-ups with our doctor just to check that the systems are OK. Until we get sick, that is. We place more importance on our illness behaviour than our health behaviour.
But being healthy isn’t just about being physically healthy. The WHO defines health as, “Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” And you’d be surprised as to how many “physical” illnesses are cause by “mental” disequilibrium.
There might be interminable arguments by philosophers about where the mind might be located but there’s no question mental health is as important for normal-functioning as any of the other aspects of health. Mental health is defined as “a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” (OK…that one’s from the text! But it’s pretty complete.)
What about social health…we are social beings, aren’t we? Well that deals with your lifestyle choices. Do you want to die early from lung cancer? Then by all means, keep chain-smoking those cigarettes. But secondary smoking is even deadlier to those around. So just quit! Smoking and drinking excessive amounts of alcohol are all lifestyle choices that you should say no to, if you (or those around you) want to stay healthy. Remember alcohol and domestic violence are highly correlated in our culture.
Other decisions you can make about your lifestyle are about the food you each. Eat smarter, eat healthier. In Guyana, we’re at high risk for diseases like hypertension and diabetes. These diseases don’t have absolute cures, just ways to manage the illness. So let’s take preventive measures to prevent ourselves from getting these diseases.
Let’s try adjusting our health behaviour, because prevention is always better than cure!
July 24, 2016 By
So the past few weeks I’ve gotten into “The Bachelorette”. I know, I know, reality TV, really? But there’s a reason why it’s so addicting – they know exactly what buttons to press, what “drama” to create to make it just so easy to fall into. And even though the only reason I got into the Bachelorette was because I’d seen another show, UnReal, where they gave the scoop about what really goes on behind the scenes in these shows. In other words, how they manipulate the contestants to create drama, I was still sucked into it.
At another level, the productions demonstrate how the hegemony in which we all swim – like fishes in an ocean – and we don’t even realise there is something enveloping us and within which we are forced to exist. All the projections of what is proper and right become “common sense” and we don’t even question it. That’s the way it is!
Looking at the show it was very interesting to see the types of male stereotypes being played out. You had two types of guys – the ripped, muscle-y, “manly” men and the smaller, sensitive guys (maybe you can tell which types of guys lasted longer in the competition).
But it allowed me to see the types of boxes guys have to fit into. The dates the guys had to go on revolved around some variation of stereotypically “manly” things. They had to saddle on firemen gear, put out fires, hack their way through walls with a fireaxe to “save” the bachelorette.
I’ve written before about how even at the school level, there’s this pressure on boys to be cool and “manly”. Maybe that’s one of the reasons girls keep out-performing boys in school? While the boys have to find time for cricket and other sports and keeping up the façade of being ‘too cool to study’, it’s fine for girls to pop open a textbook, sit in a corner to study and get all wound up over wanting to do well for exams. Boys seem to have to use that time to keep up with the latest video games and generally do other ‘boy things’.
But boys (and all of us) have to take the time to think about the type of person we want to be today, five years from now, and even 10 years from now. Is it worth spending so much time to ‘fit in’ if you become someone that even you can’t recognise?
Being the “macho man”, not showing any weakness, these are all things that have traditionally been expected of men. And it’s not healthy. Boys get hurt – girls aren’t the only ones who need to cry. We need to tell our sons that it’s okay for them to be expressive, that it’s okay for them to cry, that it’s okay for them to ask for help. Doing those things doesn’t make them a “sissy”.
Take a quiet moment to think about whether the things you do, or the things you want to do, are things that you truly want or whether it’s what everybody else is doing. Don’t be afraid to flow against the tide, to be your own person, to captain your own destiny.
July 10, 2016 By
“We have to continually be jumping off cliffs and developing our wings on the way down.” – Kurt Vonnegut
I’ve always enjoyed plays…even though in Guyana most of us read plays rather than see them. I guess I was saved by having a good imagination – and given to even reading stage directions! But it says much about my disposition that one of the things I remember from studying plays is that the phrase “winging it” has a theatrical origin.
Seems there were always one actor or another who’d be busy cramming their lines at the last minute, as they “waited in the wings” of the stage before getting their prompt. They were “winging it”!!
We’ve all been in situations where we’ve just had to just wing it. You know…just doing something on the fly. Sometimes we even put ourselves into those situations – by procrastinating and leaving everything to the last minute then bluff our way through a test or a presentation.
As students we do that a lot, usually patting ourselves on the back for pulling another fast one over our teachers. I don’t think we ever really got away with those slapdash attempts though, somehow I think our teachers knew. Maybe because our presentations were full of gems such as “Umm… well…umm…and then….like….yes well”. Faultless elocution, that.
But of course, one can never, ever prepare oneself for all the contingencies of life. And inevitably we find ourselves in a situation where, despite our preparation, we have to just improvise our way out of the problem. In those instances, we have to try to be a bit more flexible, to be willing to accept things for being what they are, instead of how we want them to be. And once we don’t spend time panicking about why this is happening to us, but rather think up a new plan of action, we might be surprised that the end result might be better than expected.
But it really goes back to your preparation. While you mightn’t have anticipated the exact problem in front of you, the same facts you imbibed will just have to be redeployed in a different way to come up with a solution. And this is what we call “creativity”. So we should always expect the unexpected and start preparing ourselves to have to think on the spot or make quick decisions, outside the “box” we usually create for ourselves.
And every day we’re thrust into new and unexpected situations. We could show up at a meeting, expecting other people to take charge, but for whatever reason, they just can’t. We could be the ones who step up to the plate. We can adapt to the new role of leader and sometimes we’ll find that it’s a position we thrive in.
And of course there are the little improvisations we make every day. Singing a song and can’t remember all of the lyrics? Most of us just make up new ones. Do the new lyrics always make perfect sense? Nope, but that’s fine since half of the pop lyrics out there don’t make sense anyway – and you can always “go nasal”!!!
But improvisation can be difficult if you’re set in your ways or if you completely spazz out if things aren’t going completely to plan. It’s good to plan ahead, don’t get me wrong – I love planning and making nice organised, colour-coded timetables – but it’s when you put more importance on following the exact letter of the plan than doing the actual task, that things become problematic.
Remember the advice of old Robert Burns – “The best laid schemes of mice and men aft gang aft agley (oft goes awry)”. So go with your gut feeling – the answer’s already there.
July 3, 2016 By
If recent, the topic of “feminism” has come up quite a bit in conversation with my female friends. And I have a feeling it’ll keep coming up again, and again and again, especially as we’re stepping out of the relative bubble of school and into the everyday world.
I tend to look back at my old articles – either to see if/how much my opinions have changed, or for inspiration as I stare bleakly at an empty page and a blinking cursor. And I found one article from two years ago, where I wrote about “feminism today”. In the first paragraph I wrote about how this new wave of “feminism” casts the modern woman as this man-hating, alpha devoid of traditional “feminine” qualities and that it was ironic that Gloria Steinem, one of the founders of the modern feminism movement was about as “feminine” as you can get. But of recent, Gloria Steinem herself has been one of my sources of frustration.
Back in February, she suggested that young female voters were supporting Bernie because ‘the boys are with Bernie’. It broke my heart to hear someone I looked up to suggest that all female millennials were voting using their ovaries instead of their brains. And just the day before, on the campaign trail for Hilary, Madeline Albright whipped out her old saying “there’s a special place in hell for women who don’t help each other” while extorting young women that they have to vote for Hilary. And while it’s true that we should be trying to build each other up and not tear each other down, it shouldn’t mean that we should automatically side with whatever candidate has the same reproductive parts as us. That’s not feminism.
Being able to exert your right to cast your vote for a candidate that you think would best run your country, wasn’t always an option for women. Now that we have that right, we can vote for whoever we want, we aren’t obligated to vote along gender-lines.
Feminism isn’t supposed to be like the position of the Sith from Star Wars- “if you’re not with me, you’re against me.” Feminism is just saying that females should play a greater role in defining what “femininity” is all about. But this pseudo-feminism thing, where a woman who chooses to be a stay-at-home mom is treated as being less of a feminist than a woman who chooses to be a career woman? That’s nonsense.
The whole point is CHOICE. That’s what feminism means to me – wanting EQUALITY OF CHOICE not wanting some utopian “equality”. Especially when to be “equal” is being equated with being “identical”. Females can be equal to males without being identical to males or their roles.
All I want is to be free to choose to go to college and get a job or to be free to choose to get married early and start a family. To me, when if I’m told that no, girls can’t be doctors – that’s when I have a problem.
As I’m spending more time in the “real world” and growing up, so to speak, I’m becoming more and more acutely aware of all the boxes people try to put you in.
There are expectations of me based off of my gender, of my race, off of my nationality. And spending the past month or so in the Obstetrics and Gynaecology rotation, after seeing female patients from all walks of life, I’ve had a lot to think about the expectations placed on females. And this new wave of “feminism”, it doesn’t allow you a way out of the box, it just paints the box a different colour and slaps on a different set of expectations.
I haven’t figured out how to deal with all of the different expectations pulling me in ten directions at once, and perhaps I never will. But I do know, that I don’t like being crammed into someone’s arbitrary box, so if I end up being a “career-woman”, or if I end up working part-time somewhere or if I end up being a stay-at-home mom, that’s perfectly alright with me, once I’m the one making the choice.