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HEALTHCARE In this issue ....

Cardiac care - British Heart Foundation Kidney care - Kidney Research UK Vegetarian Care Home For The Elderly - Meera Nursing Home Help for the elderly - Help the aged Eye care - Association of Optometrists Lloydspharmacy - Role of community pharmacy Helping smokers quit - Camden PCT Child obesity & healthy eating - Hillingdon PCT Adult obesity - Association for the study of Obesity A heart healthy diet - South Asian Health Foundation Choose and Book - Luton PCT

Healthy lifestyle - At the heart of the matter.

March 2007 ÂŁ1.50

Picture courtesy: British Heart Foundation

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HEALTHCARE

Healthy Living - time to make choices.

We are well into the year 2007 and perhaps some of us can look back and pat ourselves on our backs for keeping our resolutions to lead healthier lives . To the non-starters and those vanquished by the rigours of sustaining a fitness regime, I say, keep trying and don’t give up. It is worth the effort.

Despite negative reports about the state of the nation’s health system we are fortunate to have a number of organisations that work hard towards keeping the nation healthy. Over the decades there have been big improvements in health and life expectancy.

Standards of living, improved health education, better nutrition and better housing are within easy reach of most of us. There have been important advances in medicine and technology. And those advances have been made freely available to all through the NHS. Many advances have been achieved as a result of actions taken by local authorities. Several primary care trusts have elaborate health initiatives in place, community pharmacies are increasingly taking on a frontline role, many charities render crucial services in preventing disease and managing long term illnesses.

There are a number of health initiatives specifically created to meet the growing needs of the Asian community, prone as they are to ailments like cardiac diseases and diabetes, and this is a very welcome step indeed.

Despite all these advances there is new ground to be covered as new problems come to the fore. We are faced with an increasing rise in the overweight and obese population in the UK. Obesity among children is widespread and that is cause for concern. The UK has an ageing population. We have a declining proportion of the population aged under 16 and an increasing proportion aged 65 and over. These are some of the new challenges that confront us. So, how should we respond to them? I do not have solutions to the ills that plague our society but I do believe that the answer, to a large extent, lies with the individual and the lifestyle choices that we make. The government has taken steps to provide quality and personalised healthcare and is working to reduce imbalances in the provision of healthcare. But on their own they amount to noth-

ing unless each individual stands resolute to lead a healthy life; collectively we can bring about a change in our society that we so desire to see.

In this edition of HEALTHCARE we have featured PCTs, charities and other healthcare bodies that are actively involved in improving healthcare in the UK. Their efforts reflect the services of several such bodies that strive tirelessly to improve the quality of our lives.

As usual Cecil Soans, our Business Development Manager, has done a sterling job in this series of healthcare specials with able assistance from the editorial and graphic departments.

I sincerely hope that the magazine makes for enjoyable reading and provides some useful guidelines to lead healthier lives.

CB Patel, Publisher / Editor, Asian Voice & Gujarat Samachar

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HEALTHCARE

Heart Attack - Doubt Kills he UK has long had a serious problem with heart disease. Despite year-on-year improvements since the 1970s, its heart disease death rate remains high compared to other developed countries.

In fact, coronary heart disease is the UK’s single biggest killer - someone suffers a heart attack every two minutes, and about one in three dies before reaching hospital. Many more heart attack victims suffer life-long debilitation because their heart muscle has been permanently damaged.

So when you consider that South Asians living in the UK have a 40-50% higher death rate from heart disease than the general population, you can understand why the BHF has for many years tried to raise awareness among the South Asian community.

Worryingly, this death rate is also declining at a slower rate among South Asians than the general population, and evidence suggests that second and third generation South Asians seem to be displaying many of the same risk characteristics as their parents and grandparents.

The BHF has initiated many programmes over the years to raise awareness among South Asians of the ways to reduce risk of heart disease – reducing salt intake, getting more exercise and quitting smoking among them.

But one area the BHF is now focusing on is right at the front-line of this crucial issue: when you are having a heart attack – how do you know and what do you do?

The BHF recently launched its ‘Doubt Kills’ campaign to help answer this question – with a specific focus on communicating the campaign to Indian, Pakistani and Bangladeshi communities in the UK. The campaign urges people not to delay calling 999 when experiencing chest pain and includes a TV and radio advert in Hindustani and Bengali languages, and print adverts in Bengali, Urdu, Gujarati and Punjabi.

The TV ads – shown on all major South Asian channels - feature a father and son playing cricket. The father develops chest pain and, rather than ignoring the pain or calling his wife, calls 999 immediately for help, and lives to make a good recovery.

To campaign was launched with a high profile event at the Brit Oval cricket ground in South London in November last year, attended by around 80 dignitaries, cardiologists, patients and celebrities.

The BHF is now spreading the message further by organising a comprehensive grass-roots outreach programme in cities that have a high South Asian population, including London, Bradford, Leicester and Birmingham.

by Dr Sandy Gupta

T

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Asian Voice - 2007 Gujarat Samachar

Dr Sandy Gupta, Consultant Cardiologist, Whipps Cross and St Bartholomew’s Hospitals, London and Chairman, BHF Strategy Committee on CVD in Ethnic Minorities

The campaign’s message is simple – if you experience pain in the centre of your chest that worries you, you should call 999 immediately. Don’t wait to see if it gets better, don’t take a rest in the hope it will go away.

And most of all, don’t call your GP to make an appointment. You may not have time for any of these actions, and time is the crucial factor when it comes to heart attacks. Evidence shows that patients treated within one to two hours of the first symptoms are twice as likely to survive as those treated within four to six hours.

Good work has been done by the NHS to significantly reduce the ‘call to needle’ time – that is, the time it takes to deliver clot-busting drugs into the patient’s bloodstream after the ambulance is called. Patients in many parts of the country now receive those drugs on the ambulance on their way to hospital. In other areas, some patients are now taken directly to specialist hospitals which can perform angioplasties – a procedure used to clear blocked arteries – within a few hours of the heart attack.

This reduced delay in providing life-saving treatment has undoubtedly saved many lives, and there is limited scope for improving this part of the equation much further.

But where we can still achieve massive improvements is by reducing the ‘pain to call’ time. Data from a national audit of heart attacks shows it takes an average of nearly 90 minutes for people to call 999 after experiencing heart attack symptoms. By the time treatment to

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HEALTHCARE restore blood flow to the heart is given, an average of 2 hours and 40 minutes have passed.

The BHF believes the high death rate from heart disease among all communities in the UK, but particularly among South Asians, could be significantly reduced if we can tackle this time lag – and we can only do this by raising awareness of the symptoms and encouraging people to call 999.

Most people in the UK are not good at recognising when they are having a heart attack, perhaps due to a widespread perception, fostered by Hollywood and Bollywood, that a heart attack is always a dramatic event, where DOUBT KILLS, Call 999 - Dr.Sandy Gupta with dignitaries at London's Brit Oval, someone suddenly collapses in agonising raising awareness about the campaign. pain clutching their heart.

Whilst this can happen, the reality is decision. a heart attack is often more subtle than that. The classic “All ambulance services in the UK are backing the tell-tale sign is central chest pain, but it doesn’t have to BHF’s campaign because we’re all in the business of savbe agonising to be potentially life-threatening. The most ing lives and we’d rather attend a false alarm than arrive common mistake people make is to assume it is inditoo late.” gestion, so anyone experiencing bad indigestion-like People are urged to visit bhf.org.uk/doubtkills for symptoms should call for help, particularly if they are not more information about how to recognise the symptoms prone to indigestion normally. of a heart attack. The BHF also has a range of free pubPeople often doubt the seriousness of the situation, lications in Urdu, Hindi, Bengali, Punjabi and Gujarati, or delay because they don’t want to make a fuss. A including booklets and DVDs about heart disease, carYouGov poll for the BHF confirmed the most common diac surgery and rehabilitation. For a list of publications reasons for people delaying calling 999 are doubt, or to order, call 0870 600 6566 or visit bhf.org.uk/publiembarrassment, not wanting to be a burden and prefercations. ring to ‘wait and see if it gets better’.

The BHF is worried there are additional barriers, such as language and cultural reasons, that may put off those from South Asian communities, particularly older people, from calling 999.

Common symptoms of a heart attack include: The campaign is being supported by a range of South Asian personalities, including comedian Sanjeev Central chest pain Bhaskar, actor Saeed Jaffrey, novelist Moni Mohsin, and The pain can spread to the arms, neck or jaw. singer Channi Singh. It has also received support from Some people can feel sick or sweaty as well as havLord Ahmed, Lord Desai, Lord Patel, Tooting MP Sadique ing chest pain.

Khan and the Mayor of Tower Hamlets, Cllr Shafique Some people can feel short of breath as well as Haque. having chest pain.

Professor Roger Boyle, National Clinical Director for

HEART ATTACK SYMPTOMS

Heart Disease and Stroke, who spoke at the Oval launch, says: "I wholeheartedly support this campaign to raise awareness of chest pain among South Asian communities.

“The crucial factor for patient survival is for a person experiencing chest pain not to delay calling for help.

Given their increased risk of heart disease, it is all the more important this advice is heeded by South Asians living in the UK." Crucially, all ambulance services across the UK have also endorsed the campaign. Richard Diment, Chief Executive of the Ambulance Service Association, says: “People need to know that we want them to call 999 if they are experiencing chest pain. It might or might not be a heart attack - but if you’re not sure, let us make that

While women can experience the classic symptoms they often experience less common symptoms than men, such as: A dull pain, ache, or ‘heavy’ feeling in the chest.

A mild discomfort in the chest that makes you feel generally unwell.

The pain in the chest can spread to the back or stomach.

Some people say that the chest pain feels like a bad episode of indigestion.

Some people can feel a bit light-headed or dizzy as well as having chest pain.

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HEALTHCARE

Kidney Disease: the silent killer affecting YOU – and how to prevent it South Asian people are up to FIVE times at greater risk of developing chronic kidney disease (CKD) than the white community.

Diabetes and high blood pressure are the two major causes of kidney disease in the Asian community. When diabetes and high blood pressure are not properly controlled, kidney disease is more likely.

Did you know that Asian people with diabetes are TEN times more likely to develop kidney failure than a white person with diabetes?

The symptoms of kidney disease often do not appear until the advanced stages of the illness – and so it is called the silent killer. Therefore it is vital to look after yourself and monitor your health early and regularly.

These are worrying facts. Kidney Research UK, the leading national charity is aiming to help these at risk communities by raising awareness into kidney disease and highlighting the importance of healthy living and looking after your kidneys. We are also funding research into the causes, prevention and treatment of kidney disease among the South Asian and minority ethnic communities. The Charity has called this initiative: ABLE - A Better Life through Education and Empowerment.

Keeping your kidneys healthy if you have Diabetes Or High Blood Pressure...

Make sure you know from your GP/Consultant what your blood pressure and blood sugar levels should be & how to monitor and control them through diet, exercise and medication: If you are diabetic, your HbA1c level should be discussed with your doctor, and should usually be less than 7%. This is blood test which is done and sent to the laboratory and checks your average sugar level in your blood over the last 3 months.

To keep your kidneys healthy, if you have diabetes, your blood pressure should be well controlled eg.130/80 (please discuss the best level for you with your Doctors Practice) General Advice to Keep Your Kidneys Healthy (if you do not have diabetes or high blood pressure)...

Ensure you maintain a healthy weight* Drink plenty of water - 2 litres a day Take regular moderate exercise for half an hour,

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by Neerja Jain RGN BSc (Hons) MSc, ABLE Development Manager, Kidney Research UK Professor John Feehally Dr Azhar Farooqi, Meeta Madhani, Davinder Nagra

five or more times a week* Make sure you have less than 6g of salt a day as any more can lead to kidney damage.

Keep fatty foods to a minimum Consume a good well balanced healthy diet including fruit & vegetables* Do not smoke* Keep your blood pressure under 140/90 if you do not have diabetes (please discuss with your Doctors Practice) If you have an immediate family member with diabetes, high blood pressure or kidney disease, go and see your GP for advice and possible screening as you often only get symptoms when it's too late. (* This means you must consult your GP/Consultant/Practice Nurse) Kidney failure is a terminal illness that has no cure. The treatment, such as dialysis and transplantation, is difficult and expensive.

Having kidney failure is devastating for both the patient and his/her family. It affects patients in many ways: physically, psychologically, socially and financially. There is a massive impact on the patient’s quality of life and their life span.

Patients may have to have a form of dialysis that requires them to go into hospital three times a week for up to 5-6 hours at a time, and this treatment can be very difficult and may leave patients feeling exhausted. Patients have to stick to a very restrictive diet: some are not allowed many fruits and vegetables, coffee, spices, and their fluid intake is usually no more than 1 litre per day.

Dialysis treatment costs the NHS around £30,000 per patient per year.

Patients can feel very depressed because of this long-term chronic illness. It can affect their ability to study, work, travel abroad, and often affects their fertility; many things that most of us take for granted.

Although kidney disease is a disease of older age, it can and does affect people, men, women and children of all ages. The problem is set to worsen as the relatively young Asian population ages.

The tragedy is that some of this kidney disease is preventable; or could at least be delayed through early detection and correct management.

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HEALTHCARE A REAL LIFE STORY Damini Vasavda (pictured overleaf on the extreme left) is 67 years old and was diagnosed with diabetes almost 20 years ago, in 1986. She has been successfully managing her diabetes during this time. You can see how she does this by watching her on our DVD “Preventing Kidney Disease: the silent killer affecting you”. However, we outline here some of the positive lifestyle changes she knew she had to make in order to keep her and her kidneys healthy…..

- Damini takes regular exercise: walking for 20 minutes every day. She also does yoga.

- Damini eats a well balanced healthy diet with plenty of fruit and vegetables. She makes her food with very little olive oil and a pinch of salt only. She rarely has fried foods and desserts only occasionally.

- Damini ensures she visits her GP at least twice a year for a check up of her diabetes and her kidneys. She also keeps appointments at the Hospital to see the Diabetes Specialist and monitors her test results.

- Damini says: “Look after yourselves by taking exercise and meals as advised by your doctor. Keep positive. If I can do it, so can you!”

Dr Farooqi, GP says: “Well done Damini, you have proved a healthy lifestyle is achievable and the DVD shows it can be fun too”.

Here is Damini, pictured on the extreme left , with other members of the ABLE DVD project team at the launch of the DVD. Back row: (Left to right) Dr Azhar Farooqi OBE, Purnima Chavda, Peer Educator, Rajiv Popat, Producer, DVD. Middle row (Left to right): Davinder Nagra, Community Development worker, Abida Hussain, Peer Educator, Reshma Bharakada, Youth worker.

Front row: Damini Vasavda, case study and featured on DVD; Neerja Jain, ABLE Project Manager, Meeta Madhani, Public Health Development Specialist.

Funding has been obtained for six ABLE research projects. The sites include Birmingham, London, and Leicester. The objectives of ABLE are: 1. To highlight the incidence of chronic kidney disease (CKD) in Minority Ethnic groups.

2. To reduce the incidence of CKD amongst such groups, and 3. Where it cannot be avoided, to ensure early referral, optimal treatment, and equality of access to dialysis and transplantation.

It is being done through programmes of education to both community and health professional groups. This is being done in partnership with local patient, community and health care professional groups. We have already secured over £1million for the first phase of this project but require much more to continue with this ground breaking and much needed work that has not been addressed before.

Results from the first two completed ABLE projects: a) West London project led by Dr Liz Lightstone, Imperial College, London The kidney function of South Asians is deteriorating at a much faster rate than that of the white community, leading them to develop irreversible and potentially terminal kidney failure.

The research finding is the world’s first indicator of ‘faster’ deterioration rates and Kidney Research UK now wishes to carry out a further 3 year project which will determine why this is the case and what are the key causes. b) Leicester project led by Professor John Feehally and Dr Azhar Farooqi.

Analysis from the research has indicated lack of knowledge regarding the cause of kidney disease. There is also confusion about risk factors for kidney impairment even amongst those at highest risk – that is, those with diabetes and high blood pressure.

The research also indicated that visual educational materials and a personalised educational approach were preferred. So, the “Peer Educator” initiative, training lay community people in kidney health promotion has been developed.

A media programme and concerted community educational programme was instituted. We developed and used specially produced information cards and a DVD, both in 6 languages.

Follow up research was done to assess the Asian Voice - 2007 Gujarat Samachar

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HEALTHCARE

Purnima Chavda, a Peer Educator at a health fair in Leicester

impact of the interventions. The DVD has been extremely well received by community and professional groups with recorded feedback. The Peer Educators have successfully given presentations, utilising the resources, to audiences from the diverse religious groups of the local South Asian community, reaching thousands of individuals.

Excellent feedback including written comments have been received.

Analysis of the research reveals that our approach has led to increased awareness, and indicates that some positive lifestyle modification is taking place.

In conclusion, innovative methods of promoting education and awareness about kidney health and kidney disease in South Asian communities have been developed.

The key messages and our educational approach are applicable not only to other South Asian communities in the UK, but also to other groups at high risk of CKD anywhere in the UK.

Editor/Publisher: CB Patel Managing Editor: Jyotsna Shah Executive Editor: Kokila Patel News Editor: Kamal Rao

Editor/Publisher: CB Patel Associate Editor: Anne Hoose

FIND OUT MORE: Resources, literature, and educational Materials available from Kidney Research UK: Kidney Research UK has generic information leaflets on kidney health and aspects of the illness – in English and suitable for the general public.

Kidney Health advice in a concertina style information card aimed at South Asian communities – available in 5 South Asian languages and English A multi-lingual DVD focusing on the South Asian communities, entitled, “Preventing Kidney Disease: the silent killer affecting you”.

The information cards and the DVD are available in Bengali, English, Gujarati, Hindi, Punjabi and Urdu.

If you would like any of these, please contact us at. www.kidneyresearchuk.org/able or contact 0845 300 1499 (local rate) /email info@kidneyresearchuk.org or contact Neerja Jain, ABLE Development Manager on 0121 244 0272.

This information and the projects have been made possible through money raised by Kidney Research UK. You can help support the work of the ABLE Programme by making a donation. Call 0800 783 2973. Registered Charity No.: 252892

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HEALTHCARE

A Heart Healthy Diet

by Mrs Jevanjot Kaur Sihra and Dr Kiran CR Patel

etting healthy involves a good lifestyle. Regular exercise and a healthy diet are the cornerstones of a healthy lifestyle and should be tried by all members of the family, regardless of age or gender.

There are many simple changes you can make to your diet to help keep your heart healthy. A heart-healthy diet works in a number of ways. For example, it may help reduce cholesterol levels and lower blood pressure. Here are some easy tips that can reduce your risk of heart disease. Enjoy a Variety of Fruit and Vegetables. Fruit and vegetables are packed with vitamins, minerals and other substances that help protect your heart. They are also packed with fibre and most are virtually fat-free.

G

General Tips for a Healthy Heart - Go for a Mediterranean-style diet, with lots of vegetables and fruits along with fish and small amounts of lean meat.

- Include some wholegrain foods in your daily diet, for example, wholegrain cereals porridge, granary bread, wholemeal Atta ,brown rice.

- Watch out for trans-fats which can also raise your cholesterol levels, found in processed foods e.g. hard margarine, pastry, cakes and biscuits, - Skip the salt -cut down on salt in yoghurt, salads and watch salt in pickles, tinned foods, Bombay mix, nuts and crisps - Watch your weight - Aim to be active every day - If you drink keep your alcohol intake within sensible limits - Avoid smoking/ Paan (betel nut chewing) We have all heard that eating fish regularly, especially oily fish which is rich in omega-3 fatty acids, can help to keep us healthy.

Where do the benefits come from?

The benefits are thought to come from the omega-3 fatty acids; docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). You can make these fatty acids in your body from a parent essential fatty acid - Alpha Linolenic Acid (ALA), found mainly in green leafy vegetables, nuts, seeds and their oils but this can be a slow process. To get the maximum benefit we should try to include oily fish which has high levels of pre-formed DHA and EPA. Which fish are oily?

The healthy oil found in fish reduces your risk of a heart attack in several different ways.

Try to include the following types of oil-rich fish in your diet once a week: Salmon Herring Sardines Mackerel Pilchards Trout Kippers Tuna (fresh tuna only).

Focus on Fats While all types of fat are high in calories, some fats can also raise cholesterol levels. The main culprit is saturated fat, and it's found in fatty meat, dairy foods, cakes,

Dr Kiran CR Patel (Consultant Cardiologist and Chairman of the South Asian Health Foundation)

Mrs Jevanjot Kaur Sihra (Registered Dietitian, Sandwell PCT)

pastries and palm oil. Easy ways to reduce your intake of this unhealthy fat eg: - Make the change to reduced-fat dairy products, e.g. semi-skimmed milk, low fat yoghurt and paneer from semi skimmed milk - Use pure cooking oil, mono or polyunsaturated, rapeseed or olive oil, sunflower or corn oil instead of ghee or butter.

Measure the amount of oil used and try to reduce the quantity used. Aim for approximately one tablespoon for 4 people in curries. Avoid frying, try to grill, bake, steam or microwave.

- Try not to add fat to atta or on chapattis keep them soft by covering with a tea cloth. Cut down on prontas, pooris, bhaturas - Use low fat cooking methods for example instead dishes such as pilau or biriyani have plain boiled rice - Trim the visible fat from meat or chicken prior to cooking e.g. in curries, kebab or tandoori - Cut down on fried snacks such as samosa and pakora - Try oven baking these instead of frying to make them healthier - Go for snacks which are low in saturated fat such as fruit, dry roasted nuts i.e. chickpeas or unsalted nuts or popcorn instead of high fat snacks eg chevda, gathia, sev or crisps.

Eat less Mithai (Indian sweetmeats), halva, barfi, gulab rasmalai, gulab jamun, jaman ladoo, cakes, biscuits, chocolate, biscuits, etc– save these only for special occasions.

If you decide to make changes, begin slowly and try a few suggestions first. You could start by snacking on a piece of fruit instead of biscuits or trying semi skimmed milk in your drinks. By gradually including more changes, your diet will help to keep your heart healthy.

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HEALTHCARE

A day in the life of a Bengali Stop Smoking Advisor...

by Becky Hirst

ipul Ghosh is employed by Camden Primary Care Trust (PCT), as a Bengali Stop Smoking Advisor for one day per week. His work aims to increase the number of Bangladeshi men accessing stop smoking services by working with the Community Stop Smoking Advisor to set up new services in locations convenient and accessible by the community.

The Bangladeshi population has really important reasons to think about stopping smoking. High rates of smoking in Bangladeshi men are associated with high rates of smoking related diseases like heart disease and this can lead to premature deaths. According to the Camden PCT "Health Equity Audit", which looks at the number of people from different ethnic groups who attend the stop smoking service, there are less Bangladeshi men attending the service than we would expect. This is why Dipul's work is so important.

D

Becky Hirst, Community Stop Smoking Advisor, Camden PCT

It is known that 44% of Bangladeshi men smoke.

This figure is high compared to the UK average of 25%.

Uptake of services to stop smoking by the Bangladeshi population is traditionally low, but those who do attend the free services are very successful at quitting. Raising awareness of local stop smoking services and why to use them is therefore really important within the Bangladeshi Community, which is why Dipul has been employed.

As part of Quit & Get Fit, Dipul Ghosh, Bengali Stop Smoking Advisor, does a carbon monoxide reading for local resident, Abdul Faruk

8.00am Dipul leaves his home in East London to travel to Camden. His trip to work usually takes about forty-five minutes so he has plenty of time to catch up on reading the news...

9.00am Dipul arrives at St Pancras Hospital, where Smokefree Camden is based. He meets with Becky Hirst, the Community Stop Smoking Advisor to catch up on the previous week and discuss the day ahead. Dipul has been working at Smokefree Camden for just over a month and is in the process of setting up several new services, including a new drop-in clinic at a local health centre.

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11.00am Dipul has a quick break whilst on his way to his next destination for the day. The job tends to involve a lot of walking and therefore keeps him fit!

Smokefree Camden is currently working with a local voluntary organisation, the Third Age Project, and Camden Council to run a 'Quit & Get Fit' project at the Samuel Lithgow Centre. These sessions offer free badminton (a favourite sport amongst the Bangladeshi community!) for men over 50, with support to stop smoking along side it. As there is some new evidence that physical activity can help to reduce cravings from nicotine withdrawal, we hope that this group will be really successful at quitting.

This type of work is part of a long history of Camden PCT working with the Bangladeshi community to promote the health of local people through sporting activity. Dipul and others are launching Quit & Get Fit so, alongside chatting to local men about giving up smoking, Dipul is interviewed for tonight's Channel S news bulletin, along with having his photograph taken for local newspapers. This project will be culminating in

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HEALTHCARE a big cross Camden badminton tournament, which will be held on this year's "No Smoking Day" on 14th March 2007.

1.00pm Dipul leaves the Samuel Lithgow Centre and sets off for the Chadswell Healthy Living Centre, where he meets with the local community after they have been to the Bangladeshi Lunch Club.

Dipul has appointments with many Bangladeshi people wanting to stop smoking. He can offer them support throughout their quit attempt, over a number of weeks. He offers information on Nicotine Replacement Therapy (NRT) and other stop smoking medications, advice on coping strategies and encourages clients to set a quit date, he also takes a Carbon Monoxide (CO) reading. CO is one of the chemicals that you breathe in from cigarette smoke. It is bad for you as it attaches onto your red blood cells, which is why smokers often get out of breath easily. In the long run it leads to smokers blood being thicker, which is harder for the heart to pump around the body and means that they are at higher risk of heart disease. The good news is that very quickly after quitting, the CO in your body will have gone. So for some smokers knowing the amount of CO in their body is a big motivation to stop, and makes them feel like they have got better after quitting.

Once he has finished his appointments, Dipul sorts out his paperwork ready for the next week and makes sure that he follows up any clients who need help to get

their NRT, or anyone who couldn't make their appointment. He also uses this time to call some people who have been referred to him for support to stop smoking and books them in for next week.

4.00pm Dipul's workday is nearly finished. He meets up again with Becky and they discuss how the sessions are going. Dipul also draws on his years of experience of working with the Bengali Tobacco Cessation Service in Tower Hamlets to help him in his work. Becky discusses with Dipul about her new ideas for advertising his sessions and attracting more people into them, Dipul gives feedback about what might encourage people to attend, based on his discussions with local people. The sessions are all in their early stages so it is important for them to discuss ways to encourage smokers to come along for support.

5.00pm After a tiring but exciting day, Dipul leaves Camden and heads home to his family. He'll be back to do more of the same in a week's time!

For further information on this work, contact Dipul Ghosh Bengali Stop Smoking Advisor on 020 7377 7632 or Becky Hirst, Community Stop Smoking Advisor on 020 7445 8603.

High rates of smoking in Bangladeshi men is leading to escalating rates of heart disease.

Dipul pointing out the dangers to a client.

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HEALTHCARE

Adult Obesity in the UK

by Dr Beckie Lang

he evidence of the obesity problem facing the UK at the present time is clear to see on every high street. Almost a quarter of adults in Britain are classified as clinically obese. In other words, the extra body fat they are carrying is likely to cause them ill-health.

With all the media attention it is easy to think of the obesity epidemic as a relatively recent phenomena, however obesity in the UK has been rising rapidly over the last few decades. In 1980, 6% of men and 8% of women were considered to be obese. Today almost 25% of men and women fall into this category. By 2025 it is predicted that 34% of men and 38% of women will be obese.

T

How do I know if I am obese?

There are a couple of ways of finding out if your health is at risk because of your weight. These are: 1. The Body Mass Index (BMI) 2. Measuring your waist.

The BMI is a simple calculation using a person’s weight (kg) and height (m) measurement as follows: BMI = weight (kg) height (m)2 The BMI figure is classified as follows based on the increased risk posed to health.

Having a BMI over 30 is closely linked to a number Classification Underweight≤ Healthy weight Overweight Obese

BMI (kg/m2) ≥ 18.5 18.5-24.9 25-29.9 ≥ 30

of serious, sometimes life threatening diseases. The good news is that a recent national survey conducted in England found that men of Indian, Bangladeshi or Pakistani origin were less likely to be obese than the general population. Pakistani women however were at higher risk of being obese than the general population.

Research has shown that people who tend to store fat around their middle are more likely to suffer from ill health than those that store it around the hips for example. The table below highlights the waist measurements used to gauge a person’s risk.

Unfortunately Pakistani and Bangladeshi men and

Men Women

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INCREASED RISK SUBSTANTIAL RISK ≥ 94 cm (37”) ≥ 102cm (40”) ≥ 80cm (32”) ≥ 88cm (35”)

Asian Voice - 2007 Gujarat Samachar

Dr Beckie Lang, Registered Public Health Nutritionist External Affairs Officer, Association for the Study of Obesity

women have been shown to be more likely to have central obesity than the general population which increases their risk of ill health.

What are the risks?

Obesity is a chronic disease which is set to overtake malnutrition and infectious diseases as causes for ill health world wide. Being obese reduces life expectancy by an average of nine years. However premature death is not the biggest problem posed by obesity. There is a profound burden of ill health associated with carrying too much body fat as shown in the table below. While some conditions are life threatening, some of those that aren’t can significantly reduce the quality of life through the individual suffering caused.

Many of the conditions listed (and these are just a few), Metabolic Mechanical Heart disease Back pain Type 2 diabetes Sleep problems Stroke Osteoarthritis Infertility Joint pain Some cancers High blood pressure

Psychosocial Social isolation Depression Low self esteem

are experienced before BMI reaches 30. Two thirds of people with a BMI of 27 or more have at least one of these conditions. There are few body systems that are not affected by obesity.

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HEALTHCARE Research has shown that obesity and cardiovascular disease are closely linked. Further evidence highlights the potential reduction in the prevalence of Type 2 diabetes if people remained within a healthy BMI. Women in their 40’s are almost 80 times more likely to develop type 2 diabetes if they have a BMI of 35 or more compared to a woman with a healthy BMI. Type 2 diabetes is prevalent within the South Asian population within the UK, some of which will be attributable to central obesity.

What causes obesity?

In theory the cause of obesity is simple: when energy taken in (food and drink) exceeds energy spent (activity), the excess energy is stored (as fat). In reality, obesity is a multifactorial condition where genetics, behavioural and environmental influences all have a role.

The genetics of obesity while a large research area has produced little hope of a reason for the epidemic.

Mutations in specific genes which impact on the appetite regulation system have been identified but their presence in the general population is almost non existent.

However there does appear to be a genetic predisposition for some people to gain weight more easily than others.

While this makes weight management more difficult, it certainly doesn’t mean that obesity is inevitable.

The effect of our current environment on our basic genetic makeup is having an impact on our ability to control our weight. Our genetic predisposition determines how we cope with our modern environment. Genetically we are programmed to store fat for times of famine. In ancient times we were well equipped to control our energy intake. We ate when we were hungry and stored energy for times of depletion. Yet our current environment is laden with high fat, energy dense foods, which are freely availbale at very low cost. Food is available 24h a day at relatively cheap prices, making it almost impossible not to be faced with an option to eat wherever you are in the UK. At the same time, technology has progressed to such a degree that we physically do less and less, from basic chores to occupational lifestyles. As a nation we are predominantly inactive.

How can I manage my weight?

Very few people with excess body fat have developed it over a short period of time. For the majority, this increase in body weight has developed slowly over a period of months and years through an imbalance between diet and activity habits. Only a small increase in excess energy every day (say of 50 calories or a plain biscuit), will lead to an annual weight gain of about 2.3kg or 5lb. It doesn’t take much.

The best way to shed the pounds therefore is to take it slowly and be realistic about what can be achieved within a certain time frame. The good news is that only a 5-10% loss of body weight can have significant benefits to health. Reductions can be seen in blood pressure, blood cholesterol levels and blood sugar levels. Plus the

risk of premature death caused by coronary disease or some cancers is also reduced.

There are a number of strategies which have been identified as being crucial to successful weight loss and then weight maintenance.

Being ready to lose weight. Unless you want to do something about your weight and are prepared to make the changes necessary to your lifestyle, it is unlikely that you will succeed. Look at why you want to lose weight and what positive changes it will make to your life.

Setting realistic goals. Begin by losing weight in small stages. Remember that only 5% weight loss can have benefits to your health.

Having a support network. Whether this is the support of a health professional, friend, family member or commercial weight loss group, make sure someone is there to help you through, to praise the successes and to help through the difficult patches.

Being active. Seek opportunities to increase your level of activity. Start slowly and gently, and build up. More importantly make sure you embark on something you enjoy. If you hate the idea of the gym then don’t use one, but if a walk in the local park gets you going then start with that.

Eating regularly. And include breakfast. Contrary to belief, skipping meals does not aid weight loss. You are more likely to grab something that won’t support your efforts than if you plan ahead and choose healthier, more balanced meals.

Increasing fruits, vegetables and whole grain foods on a daily basis. Fresh, frozen, tinned, dried or juiced. They all count. Fibrous foods also help to fill you up and reduce hunger pangs.

Reduce dietary fat. Cut down on the amount of fat used in cooking, trim visible fat off meat, grill rather than fry fatty foods, choose low fat dairy where possible.

Small, simple changes to diet and activity levels can have a profound effect on weight and wellbeing. Start with a few things first e.g. maybe aiming to eat five portions of fruits and vegetables every day for the first week, plus walking an extra ten minutes each day. Then build up gradually from there. Try not to do too much at once!

Your GP or practice nurse is always a good place to start if you want to find out if your weight is affecting your health. They will also be able to advise you on what support is available locally. More generally, there are a number of websites that provide information and support if you would like to lose weight and are not sure where to begin: The British Dietetic Association www.bdaweightwise.com The BBC Health pages www.bbc.co.uk/health/healthy_living/your_weight The British Heart Foundation www.bhf.org.uk Diabetes UK www.diabetes.org.uk Diet Trials: How to Succeed at Dieting.

Written by Lyndel Costain ISBN 0563488727 Asian Voice - 2007 Gujarat Samachar

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HEALTHCARE

Time for a body overhaul? reventable diseases are now reaching epidemic proportions in the UK. Twelve per cent of the population has been diagnosed with a disease of the heart or circulatory system, more than 2m of us are known to have diabetes and nearly a quarter (22%) of us are clinically obese. So there has never been a better time to take action and talk to your local pharmacist about a general health check up.

P

by Ian Morgan Head of Pharmacy Services, Lloydspharmacy.

Newcastle comments, “It’s virtually impossible to know that you have high blood pressure without having a test so people who are at risk of serious disease are sometimes unaware. In fact, these people are three times more likely to develop heart disease and stroke and twice as likely to die from these conditions. If you don’t know your blood pressure, or haven’t been tested recently why not come in and see us. Surely it’s worth investing 5-10

Yes, we did say ‘pharmacist’.

Since the introduction of the new pharmacy contracts, pharmacists have been taking on more and more responsibility for our health and wellbeing. In fact, Lloydspharmacy – which has more than 1,540 pharmacies nationwide – has been leading the way in offering free services in a bid to help identify possible health issues, such as diabetes and heart disease, before they get a chance to take hold.

For example, you can pop into your local Lloydspharmacy and ask for a free diabetes test (a simple pin prick is all it takes), a blood pressure check, advice on diet and exercise or even giving up smoking.

You certainly won’t be alone – to date more than 1 million people have taken advantage of a free Lloydspharmacy blood pressure test and 800 people pop in for a diabetes test on any given day. Of those, an average of 40 are found to be at risk of the disease and are referred to their GP for further investigation.

Geeta Griffin, is a pharmacist at Lloydspharmacy in Yardley, Birmingham. She says, “At Lloydspharmacy we are known for offering pioneering patient services, and the best thing is that they are available free of charge and you don’t even need to make an appointment. Currently, one in four people with diabetes in the UK don’t know that they have it and we know that Black, African, Caribbean and South Asian communities are more likely to develop the disease. Symptoms such as feeling thirsty, tired or needing the loo more often are generally not recognised by customers as warning signs so I’d urge anyone who hasn’t already been tested to come in and see us. It is so important because if diagnosed early enough, diabetes can be a very manageable condition. If, on the other hand, you don’t realise you have it you could be setting yourself up for serious problems of the heart, eyes, kidneys and nervous system in later life.”

The same goes for blood pressure. A mighty 16 million people in the UK are known to have high blood pressure, putting them at risk of stroke, heart attack and kidney disease. Ambreen Choudry of Lloydspharmacy in

14

Asian Voice - 2007 Gujarat Samachar

Ambreen Choudry (right), Lloydspharmacy, Newcastle, advising a patient

minutes of your time, if only to put your mind at rest.”

As well as offering tests, Lloydspharmacy staff can talk to you, in confidence, about any general health and lifestyle issue you may have – either in general or in relation to a prescription you are collecting. Most of their pharmacies have a designated private consultation area just for this very purpose. It might be that you would like a reminder of how best to use an asthma inhaler, or perhaps you are one of the 54% of smokers who wants to give up smoking. We can talk to you about the different support systems available – from nicotine replacement to motivation and willpower issues.

So why not pop down to your local Lloydspharmacy for a health overhaul. It could be one of the best decisions you ever made.

To find your nearest Lloydspharmacy, check out the pharmacy finder on www.lloydspharmacy.com References British Heart Foundation BBC Health National Audit Office 2002 The Annual Report of the Chief Medical Officer of the Department of Health 2001 (www.doh.gov.uk) Health Survey for England 2003. Department of Health publication available at www.dh.gov.uk

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35 years of leadership and service Britain's leading news weeklies for the Asian Community

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Along the way the group has notched up several ‘firsts’. Take Financial Voice for instance - every week it provides a birds eye view of financial markets, Currencies, Major Indices, Stock Focus, Top 10 stocks by Volume Trade and a "Alpesh's Radar" section (Alpesh Patel is a renowned city trader and also the consulting editor of Financial Voice).

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HEALTHCARE

Meera Nursing Home Ltd Vegetarian Care Home for the Elderly

by Pramod Thakkar- Director

Elderly Population With an ageing population, healthcare provision for the elderly is becoming an increasingly relevant subject in the UK. It is generally recognised that demand for care for the elderly will grow in the 21st century as the proportion of the elderly people within the total population grows. The number of people aged 85 and over are projected to grow from 1.1 million in 2001 to 2.4 million in 2031, an increase of 119% whilst over the same time period the total population of the UK is expected to grow by just 11.7%. The increase to the end of 2051 is even more striking, with a predicted increase of 252%. Projections of the number of people in nursing and residential care homes are potentially more difficult to calculate, with estimates ranging between 60% to 140% growth over the period 2001 to 2031.

Most of the first generation Ethnic Elders do not speak English and a number are illiterate in their own language (McCallum, 1990). This is one of the main problem in caring for the Ethnic Elders.

Most Ethnic Elderly and their families in the past have clung rigidly onto values derived from their country of origin, juggling these traditions against the practical demands made by life in their adopted country.

Families view dementia and depression as a natural hazard of old age. Elderly relatives may have migrated to the UK against their wishes. Due to career and business commitment of younger family members, it is difficult for the extended family to provide the necessary 24 hours care. Inappropriate demands are made on the primary care service, as the emphasis when presenting complaints is frequently on somatic symptoms, as shown in a study of Gujarati elders in Leicester (Lindesay et al, 1997). The underlying fear of the stigma of mental illness further compounds the number of sick individuals who remain unrecorded.

For Ethnic Elders, good practice for both service providers and practitioners should include an awareness of and training in culturally sensitive issues.

For Ethnic Elders

• Acute psychiatric services involving assessment and treatment should remain within mainstream psychiatric services, with ethnic awareness and sensitivity emphasised by trained staff in culturally sensitive issues.

• Efforts are made at Meera House to recruit a racial mix of multi-disciplinary staff members reflecting the population served.

• There is increased involvement and commitment by all interested stakeholders viz Management, families staff, General practitioners, Service Users and other key players in establishing best care practice for the Service Users.

Brief Description

Meera House is a vegetarian nursing home based in North-west London with a capacity of 54 beds. The care home is unusual is that it is one of the few which has identified for facilities which cater for clients with Ethnic backgrounds. It has the ambiance and is specialised in meeting the religious and cultural needs of the Asian Elderly. The Home has two units, one specialised in nursing whilst other is the EMI unit and is in the process of developing a new Learning Development Unit.

Objectives

It is the objective of Meera House to provide care to all service users to a standard of excellence which embraces fundamental principles of good care practice.

We provide an independent atmosphere and lifestyle as close as possible to what you may enjoy in your home, where you choose your own bed, your bathing times and be free to come and go as you please as long as the person in charge is informed. It provides a family atmosphere and caring staff to meet the changing needs of each and every service users, to treat them with dignity, respect their privacy and independence and catering for their dietary and cultural needs.

Staff commitment

Meera house has been accredited with ‘Investors in People Award’ since 2004. To check on the staffing performance levels the management committed to staff welfare and ensures that they are trained externally and in house. Most of our Carers speak the language of the service users and more than 50% of the carers are NVQ2 qualified.

Care Concept

Meera House is a vegetarian Care home with separate unit for Nursing & EMI. New units for Learning Disability and Sheltered accommodation are opening shortly.

M - my H -homely E - environment O - outstanding E - encourages a U - unparalled R - relaxed S - sympathetic, and where A - atmosphere which is E - every needs are met The Home can be visited at: 146-150 Stag lane, Kingsbury, London NW9 0QR. Tel: 020 8204 9140/41; Fax: 020 8206 2205 Website: www.meeranursing.com Email: info@meeranursing.com Accounts & Management: Tel: 020 8206 2211; Fax: 020 8206 0063 Email: administrator@meeranursing.com Please visit out advertisement on the back cover page.

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HEALTHCARE

Heart risks higher for South Asians

by Margie Lindsay Hillingdon Primary Care Trust

On average, a heart beats more than 100,000 times a day, pumping a total 7,200 litres of blood over 19,000 km around your body. That is enough to fill a very large paddling pool and is the same distance as travelling by air from London to Hong Kong and back. Not bad for a 300g pump about the same weight as a mango.

Despite the need to keep your heart working well, coronary heart disease (CHD) is the leading cause of death in Britain, accounting for around 300,000 deaths a year. And South Asians have a 40%–50% greater mortality from CHD compared to white Europeans.

Why are South Asians at such high risk? There is no easy answer to this question. Some think it is part genetic and part environmental. One explanation for the excess CHD mortality is attributed to the prevalence of conditions such as high cholesterol, hypertension, obesity and diabetes in South Asians. Hypertension and diabetes are two to three fold higher among South Asians than in whites in Britain Other reasons focus on lifestyles — things like a relative lack of physical activity and obesity.

People can make very simple life style changes to try to reduce their risk.

South Asians are prone to developing CHD at a younger age, often before the age of 40 in men. South acids.

Asians in general are also more likely to go late to hospital The North West London Cardiac Network following chest pain and less likely to be prescribed all of Heart2Heart User Forum is actively trying to help the the available secondary prevention medications compared South Asian community to lower the incident of heart to white Europeans. problems through awareness raising events and informaLifestyle and family history can affect your heart tion where the risks can are highlighted. health. The more you know about your risk of developing One such event was held in Ealing last year to raise heart disease, the more you can do something about it. awareness about lifestyle factors contributing to heart disYou can help your heart be ease among ethnic groups. A wide range of healthy by making the right information promoting healthy living, stop choices in life — things like eatsmoking services, support for carers and spiriing a healthy, balanced diet and tual healing, to name a few, were on offer. taking regular physical activity.

Several people who took advantage of the Ironically, diets for the varfree heart screening showed significant eviious South Asian groups are dence of risk factors of heart disease to be often perceived as healthier referred to primary care services — either to than the average UK diet. But their GP or a community dietician. fat intake is higher in South Nick Donovan, chair of the forum, said: Asians born in the UK com“Heart disease has no prejudice. It affects the pared to those who are born young, old, the healthy or infirm. It does not outside Britain. Indian snacks matter what religion or race. We are all part of and sweetmeats are notorious- South Asians have a 40%–50% greater mortality the global cardiac family. It is our duty, as ly high in sugar and fat content. from coronary heart disease compared to white aware patients, to impart our knowledge to our Europeans.

Another potential heart communities.” diet problem is the use of clarified butter or ghee in cookThe main aim of the group is to help the network ing — even by most vegetarians. The best ghee is almost develop ways to access easily the local opinions of cardiac 100% saturated fat, while lesser quality ghee can still have patients and surrounding communities, particularly those more than 50% saturated fat. Some South Asians tend to from South Asia. have low levels of fish consumption, particularly oily fish More information about the forum is available at that contain beneficial omega-3 polyunsaturated fatty www.nwlcn.co.uk.

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Asian Voice - 2007 Gujarat Samachar

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HEALTHCARE Healthy heart tips

Watching your heart

Having a heart problem can be a difficult and anxious time for people and their family and friends.

Taking positive steps to leading a healthy lifestyle will improve your health and reduce the risk of any heart problems in the future. Here are some simple tips to help maintain a healthy heart.

Don’t smoke. If you do smoke, stop. For more information and support, contact your GP or the NHS Asian Tobacco Helplines open from 1pm-9pm every Tuesday (Urdu 0800 169 0 881; Punjabi 0800 169 0 882; Hindi 0800 169 0 883; Gujarati 0800 169 0 884; Bengali 0800 169 0 885.

Maintain a healthy weight and shape by taking regular exercise and eating a healthy diet. Even being slightly overweight increases your risk of heart disease Exercise regularly for at least 30 minutes five times a week. Start now by doing what you feel you can do easily and build up gradually. Exercise has been proven to reduce substantially the risk of heart disease, as well as strengthening bones.

Stress is recognised as a risk factor in heart disease. Learn low stress ways of living and working.

Take time out of your day to relax Diet can make a big difference to your health. Eat five portions of fruit and vegetables a day. Reduce the saturated fat (animal fats) content from your diet. Try to eat fish at least three times a week, one portion of which should be oily (mackerel, sardines or similar).

Matters of the Heart (Dil Ki Baatein in Hindi) is a Bollywood-style comedy film that tells the story of Ruby, whose father has a heart attack at her henna party before her wedding. Ruby threatens to call off the ceremony unless her parents get fit.

Giving a real voice to South Asians South Asians living in Britain have around a 50% greater risk of dying prematurely from heart disease.

Yet, the voices of South Asian patients are not being effectively heard in the NHS to help improve their local heart health services.

The British Heart Foundation (BHF) and the North West London Cardiac Network (NWLCN) are jointly piloting the “Hearty Voices” training event.

South Asian (Indian, Pakistani, Bangladeshi or Srilankan) heart patients and/or their carers, living in the Brent, Ealing, Harrow or Hounslow, are being actively recruited to take part in this joint venture.

The Hearty Voices training day aims to provide participants with the necessary knowledge and skills to enable them to confidently talk about their views and those of other patients and carers to enable improvements in current and future local health services.

Participants who complete this training can use these skills to represent South Asian cardiac patients in their local areas.

For more information about the event and how to help give South Asians a real voice in heart care contact NWL Cardiac Network, Kirk House, 97-109 High Street, Yiewsley, West Drayton, Middlesex UB7 7HJ (01895 452 118; kathryn.wickham@hillingdon.nhs.uk) or visit the network’s website at www.nwlcn.co.uk.

Your doctor will be able to give you good advice on healthy lifestyles and regular checks will help identify any problems early.

Dr Rumeena Gujral, an accident and emergency doctor and part-time film maker as well as a trustee of the South Asian Health Foundation, received an award for an this all-singing, all-dancing innovation that is succeeding in educating the South Asian community about heart disease.

The film was made with the support of the South Asian Health Foundation and Pfizer UK Foundation. It has been awarded the Communication Award from the medical research charity, the BUPA Foundation.

"I wanted to raise awareness about heart problems. Causes for this include a high fat diet and a lack of exercise,” said Dr Gujral. "People can make very simple life style changes to try to reduce their risk.

The film highlights some of these easy steps.

Dr Gujral made the film because her own parents were both diagnosed in their late 40s with coronary heart disease. ”Most people in the South Asian community don't even realise they are at risk from heart disease. So the idea was to create health education that people would actually want to watch,” she said.

Her parents were “just eating a normal South Asian diet. But it was not until they had their problems that we noticed what was in the food, and the fact that as a group we tend to exercise less," said Dr Gujral.

Now her family eats traditional food, but try and swap the fried foods for more healthy alternatives and the ghee for olive oil.

Dr Gujral hopes the film will inspire better heart health by getting the message across more easily to the population who need it most.

To find out more about the film, contact South Asian Health Foundation (UK) (info@sahf.org.uk; 07802 288 182; www.sahf.org.uk).

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HEALTHCARE

Choose and Book makes life easier for patients in Luton id you know that making an appointment with a hospital doctor is much more convenient now than it used to be?

Luton teaching Primary Care Trust (tPCT) is keen to share that news with all Luton residents, and to encourage them to talk to their doctor about Choose and Book.

Choose and Book is the name of a process that makes booking some hospital appointments much easier and more convenient for the patient than used to be the case.

Now, when you need your first appointment with a hospital specialist your GP (family doctor) can give you a choice of four hospitals or clinics, and you can choose the one that suits you best. You can also choose the date and time of your appointment. You GP can give you lots of information to help you choose, and there are various ways to book your appointment, for example by telephone, via the internet or at your GP’s surgery. If you prefer to use a language other than English, interpretation services are available.

So how does Choose and Book work? When you and your GP agree that you need to see a specialist, your GP will have a list of hospitals and clinics that are suitable for your particular treatment needs. Your GP can then discuss the options with you. If you know when and where you would like to be seen, you may be able to book your appointment before you leave the surgery and you will be given the time, date and place of your appointment. If, however, you want time to think, that’s no problem. You can take your appointment request letter away with you and book your appointment later.

The NHS provides information on each of the hospitals or clinics on your list so you can decide which one you prefer. The information includes local transport details and details of whether or not the hospital has additional services that might influence your decision, such car parking, a visitor canteen or shops. You can also look at the performance ratings for each hospital. If you have problems making your choice, you might want to discuss your options with, or request more information from, Luton tPCT’s Patient Advice and Liaison Service Officer, who can be reached on Luton 709134.

Choose and Book has been available in Luton for

by Cate Lund, Communications Manager, Luton Teaching PCT

D

20

Asian Voice - 2007 Gujarat Samachar

Booking hospital appointments at the click of a mouse

some time now, and patients really appreciate the chance to make decisions about their own treatment.

There are other advantages too; Choose and Book means that you can get your appointment booked quickly.

Previously, getting a hospital appointment might have taken weeks. As one patient put it, “I would certainly recommend Choose and Book to my friends and family.

The real advantage is that you know you have an appointment straight away.”

GPs throughout Luton can now offer Choose and Book. It’s designed to make life easier for you, the patient, and to give you more choice in the way you are treated. You can get more information on Choose and Book from our Patient Advice and Liaison Service on Luton 709134, and there is also lots of information about Choose and Book at www.chooseandbook.nhs.uk.

Choose and Book can make life more simple and convenient, and perhaps take some of the stress out of being unwell. So if you need to see a specialist, why not talk to your GP and discuss your options ?

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HEALTHCARE

Surgical Treatment Options for Snoring

by Dr. Bhik Kotecha

hronic habitual snoring affects up to 40% of the adult population and may be a source of social disturbance and marital disharmony. Snoring may be “primary� or may represent, at the other end of the spectrum, obstructive sleep apnoea (OSA). Snoring is due to turbulent flow of air through the upper airway, and can arise from transient obstruction at several levels in the nose or the throat. Both snoring and OSA can lead to unrefreshing , fragmented sleep and excessive day time sleepiness. This in turn could impair day time performance at work and has been shown to increase road traffic accidents in these patients who drive. Untreated OSA can lead to an increased incidence of ischaemic heart disease ( high blood pressure, angina, arrhytmias etc.), strokes and type 2 diabetes.

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Patients presenting with snoring require accurate assessment before any form of treatment is undertaken.

Assessment should include history from patient and partner, clinical examination, a sleep study and sleep nasendoscopy (a technique that allows dynamic evaluation of the upper airway during drug-induced sleep).

The treatment option of choice in patients with moderate or severe OSA is nasal continuous positive airway pressure (CPAP). Surgical treatment is usually reserved for simple snorers or some snorers with mild OSA and can be targeted at different anatomical regions in the upper airway. Nasal abnormalities such as deviated nasal septum or nasal polyposis can be easily corrected surgically by performing septoplasty or functional endoscopic sinus surgery respectively, thus improving the upper airway and the snoring. In the oropharynx the abnormalities that contribute to obstruction are tonsillar hypertrophy or more commonly a lax soft palate. The oropharynx can be improved by performing laser assisted palatoplasty .

In recent years, minimally invasive temperature-controlled radio-frequency induced thermotherapy (RFITT) has been investigated. RFITT to the soft palate can be performed quite easily under local anaesthetic, using disposable probes in an outpatient setting. Usually two treatment sessions about 6-8 weeks apart are required.

Early results with this form of treatment are very encouraging.

Dr. Bhik Kotecha MBBCh, M.Phil., FRCS, DLO Consultant ENT Surgeon,The Essex Nuffield Hospital, Brentwood, Essex

Surgical treatment options may not be appropriate for all patients. Patient selection is of utmost importance.

Various factors may be corrected before surgery is contemplated e.g. weight loss in obese patients. Some patients may wish to try less invasive treatment modality such as Mandibular Advancement Splints. A wide range of treatments is now available at the Essex Nuffield Hospital for snoring and sleep apnoea, offering patients and their partners some help in improving their quality of life.

For more information: www.snoringmanagement.co.uk Mr Bhik Kotecha is a Consultant Ear, Nose & Throat Surgeon at: 1. Royal National Throat, Nose & Ear Hospital, London 2. Queens Hospital, Romford, Essex 3. Essex Nuffield Hospital, Brentwood, Essex 4. Bupa Hartswood Hospital, Brentwood, Essex 5. Bupa Roding Hospital, Ilford, Essex Special interest includes snoring and sleep disorders, and general ear, nose and throat problems in adults and children.

Private Secretary contact number: 01277695653 Asian Voice - 2007 Gujarat Samachar

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HEALTHCARE

Fun and effective way to tackle childhood obesity hildhood obesity in the UK has reached epidemic levels and drastic action is needed to prevent it rising further. Around 30 per cent (2.5 million) British children are overweight or obese. If current trends continue, at least one-fifth of boys and one-third of girls will be obese by 2020 according to research done by the Department of Health.

An obese child has between a 40 to 70 per cent chance of becoming an obese adult.

Preventative action is needed to help children enter adulthood without the associated obesity problems — heart disease, diabetes and high blood pressure — that could significantly shorten their lives. These are conditions particularly prevalent in the South Asian community.

One successful prevention programme is MEND — mind, exercise, nutrition and do it. Developed by Paul Sacher specialist dietitian and clinical research fellow at the Institute of Child Health, Great Ormond Street Hospital, MEND is one of Britain’s most innovative and effective obesity prevention and treatment programmes.

The scheme works with children and their families to tackle obesity and unhealthy lifestyles. Based at the Institute of Child Health, the programme was developed by a multi-disciplinary team. The research behind it was largely funded by the Department of Health, the Institute of Child Health and Sainsbury’s Supermarkets.

Sessions include interactive activities where parents and children learn effective ways to adopt healthier eating practices and increase their physical activity levels using achievable tips. The children also attend a funbased exercise session at each of the MEND sessions to improve their fitness levels and to demonstrate that exercise can be fun.

The nine week course is aimed at children aged 713 years and their parents or carers. It encourages the whole family to get involved in eating healthier and being more active. All the exercise is non-competitive and is based on popular children's games, music and sport. The main aim is to show that not all exercise is boring or unpleasant. The programme helps to improve cardiovascular fitness, muscular strength and co-ordination.

Some of the principles and methods used during the sessions are: Goals and rewards to encourage children to eat more healthily and to be more active outside of the programme.

Star charts to motivate children and allow parents to keep track of their progress.

Changing family attitudes towards healthy eating and physical activity.

by Margie Lindsay Hillingdon Primary Care Trust

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Asian Voice - 2007 Gujarat Samachar

Parents need to help create healthy eating for their children

Practical ways to remove unhealthy food triggers.

Understanding the difference between hunger and cravings and how to cope with them.

Learning how to be a healthy role model.

Other activities include a supermarket tour and a recipe-tasting evening.

Evidence shows that diets do not work and putting young children on diets can be dangerous. Weight loss is not the primary focus of MEND. The programme concentrates on eating healthy, unrefined foods and reducing the intake of foods high in fat, sugar and salt, for example white bread, chips, sugary drinks, crisps and sweets.

MEND's holistic programme was specifically designed by leading experts to combine the elements that recent scientific evidence has shown are essential to effectively overcome childhood overweight and obesity.

“We have children who drag their parents into our programmes and to start with they might sit there stonyfaced,” explains Mr. Sacher.

Sometimes, though, the answer is something as simple as portion control. “They suddenly realise they have been feeding their children an adult portion all their lives,” he says. “Any parent who realises the importance of education for their child should treat their family’s health education the same way. Why not go to a class to learn how to feed your children healthily? However much we think we know we can always pick up tips. It’s a life skill like any other,” concludes Mr. Sacher.

For information about the MEND Programmes running in Hillingdon, contact Jerry Reidy on 01895 452 097 or jerry.reidy@hillingdon.nhs.uk (put MEND in subject). To find out about MEND programmes in London and elsewhere visit MEND at www.mendprogramme.org/ or con-

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HEALTHCARE tact the MEND team on 0870 609 1405. To contact by post, write to MEND, Norvin House, Third Floor, 45-55 Commercial Street, London E1 6BD.

Personal stories Khadijah (aged 12) was obese. Her parents confirmed with a doctor that there were no medical reasons why she was obese.

“Before I did MEND, I used to be very tired and un-energetic all the time and unmotivated to do anything about it. Now I really enjoy sports," she said. Khadijah now attends regular hockey practices before school, plays tennis twice a week with a friend and has even won an athletics trophy for perform- Exercising and having fun is a good ance at the athletics recipe to help children keep their weight balanced. school day.

Khadijah’s mother is enthusiastic about the MEND programme. “I learned a lot about my child's personal needs as well as about the consequences of eating fatty and sugary foods. By applying what we learned on the MEND programme, I was able to help boost Khadijah's self confidence."

Another child, Doyelle’s (aged 12) self esteem was at an all-time low. Her lack of fitness was starting to take its toll on her behaviour; she often experienced mood swings, was depressed and unmotivated. ”I could never do my homework. When I came home from school all I wanted to do is go to bed.” Before going on MEND, Doyelle would try anything to get out of school sports days.

After seeing an advert in the local paper, Doyelle’s mother suggested that she give the MEND programme a try. Doyelle said, “I was so worried that I would not be able to do it, that I would get too tired.”

By not just focusing on the physical exercise, but also educating families on nutrition and diet, the MEND programme looks at all aspects of a child’s weight problem.

Doyelle’s mother said, “When I read the advert, I thought it was mainly going to be about exercising, but to be taught about nutrition as well was a complete bonus.”

“I'm much more aware now and I really don't like it when food companies advertise things as being low in fat but then it ends up having more sugar in it," said Doyelle.

Through her school council Doyelle has now introduced the recipe for the MEND healthy fruit shake to the dinner ladies at her school. They have started to serve it with school meals. Doyelle said, “Lots of children used to drink fizzy drinks at school, but now they all like drinking the fruit shake and when I go to get some, often it's all gone already."

Check your child’s body mass index (BMI) Body Mass Index (BMI) is a number calculated from a person’s weight and height. BMI constitutes a reliable indicator of weight status for most people, including children and teens. It does not measure body fat directly, but research has shown that it correlates to direct measures of body fat. BMI is a simple, inexpensive and easy-to-perform measure that health professionals use to determine whether a person is healthy weight or not and it can serve as an indirect alternative for other measures of body fat.

For children and teenagers, BMI is age- and sexspecific, given that the amount of body fat changes with age and differs between girls and boys.

Overweight children and adolescents may begin to experience negative health consequences during their youth; on top of that, they also put themselves at risk for weight-related health problems later in life, as they have been found to have risk factors for cardiovascular disease, including high cholesterol, elevated insulin levels and high blood pressure. Children who are overweight also face social consequences, including poor self-esteem and social discrimination.

Use the MEND BMI calculator at www.mendprogramme.org/homemenu/bmi%5Fcalculator/.

Healthy eating benefits the whole family Children in Britain eat on average only two portions of fruit and vegetables a day. One in five eat no fruit at all. Paul Sacher says: “Many parents may not fully realise the harm that can occur as a consequence of a childhood of poor nutrition. Some parents do not know what constitutes a healthy diet for themselves, let alone their children. My advice is to seek out and follow up-to-date advice from reliable sources such as health professionals and government sources. Be sceptical of nutritional advice and healthy eating initiatives seen on television and in newspapers and magazines.”

Parents should be wary of many of the food products developed specifically to appeal to children, as these tend to be high in fat, salt and sugar and many are expensive too. Among the worst examples are: sugary breakfast cereals, crisps, sugary soft drinks, children’s snack foods, takeaway and fast foods.

Parents need to establish healthy eating patterns early on in life as this can help safeguard a child’s longterm health. Parents who make poor nutritional choices for their children may expose them to the risk of obesity and potentially long-term fatal diseases such as cancer, diabetes and heart disease.

Mr Sacher believes children should be included in regular family mealtimes where they will learn social skills and experience a wider range of foods. He also suggests involving children in shopping and food preparation as they get older. This gives them the knowledge and practical skills they need to feed themselves properly in the future.

Most important of all is that parents lead by example.

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HEALTHCARE

Asians at greater risk of eye problems he nation is engulfed with messages about ways to stay healthy, with the emphasis often placed on conditions such as heart disease and cancer, yet do you give as much consideration to something as vital as your eyesight? There are two million people in the UK who are at risk of needlessly losing their sight through treatable eye conditions. These figures are particularly important to the South Asian community, where incidences of diabetes are significantly higher, and where eye diseases associated with diabetes can lead to unnecessary sight loss or visual impairment.

One in five people from the UK Asian population has been diagnosed with type 2 diabetes, compared with 3% of the general population and they are, therefore, at greater risk of diabetic eye disease - retinopathy.

Retinopathy can affect anyone who has diabetes, whether they are being treated with insulin, tablets or diet only. Retinopathy affects the blood vessels supplying the retina – the inner surface of the eye, which receives the images of things you see and passes them to the brain. Blood vessels can become blocked, leak or grow haphazardly, affecting the way the retina receives images and, if left untreated, can damage your sight.

Generally, people don’t notice any signs of retinopathy until it is well advanced. In a ‘National Service Framework for Diabetes’, the Department of Health states that by the end of 2007, 100% of diabetics should be offered screening for the early detection of diabetic retinopathy using a digital camera.

Digital imaging can improve the detection of retinopathy (disease of the retina) in many cases.

Optometrists use a digital retinal camera to take photographs of the back of the eye. They then examine the photographs on a computer looking for any problems caused by diabetes. Although the old techniques were good, these photographs will allow an easier and more detailed examination of the central retina. They also allow better quality control, since it is easy to pass the photographs electronically to someone else for a second opinion, or to check a random sample of images to cut the chances of missing diabetic eye disease.

The Association of Optometrists (AOP) advises that a person’s best defence is to have one’s eyes checked for signs of retinopathy when their diabetes is diagnosed, and then to have them screened once a year after that.

by Louise Devine

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Asian Voice - 2007 Gujarat Samachar

Louise Devine Association of Optometrists

It is important not to wait until you notice a change in your vision. Sometimes retinopathy causes no symptoms until it is well advanced; by then treatment is more difficult, so it is important to have your eyes screened every year.

The AOP’s Professional Adviser Geoff Roberson says: “Most vision loss in diabetics is preventable if detected early. As sight threatening changes can develop without the patient being aware of them, regular eye checks for people with diabetes are especially important.”

The mode of screening is done in one of three methods, depending on the area the screening programme has been implemented – fixed centres (hospitals or clinics); large number of fixed centres (community optometrists in high street practices) or mobile units. We estimate that 20-30% of digital imaging schemes will be undertaken by community optometrists.

Cataracts are also prevalent in the South Asian community. A cataract is simply the name given to a cloudy condition of the lens in your eye. As the lens becomes too cloudy, light cannot pass through it properly and so your eye is less able to see clearly. It's a bit like looking through a window which hasn't been cleaned for ages.

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HEALTHCARE Because cataracts develop slowly, you are likely to experience a gradual deterioration in your vision and may not even notice that anything is wrong until they are well advanced. Fully developed cataracts, however, will cause a significant loss of vision.

The AOP urges members of the South Asian population to put the care of their eyes high on the health agenda. Although many cataracts never develop so much that they need an operation, it is important to visit your optometrist regularly so that your eyes can be checked for any cloudiness.

The AOP’s Geoff Roberson says: “In the early stages of cataract much can be done to alleviate the symptoms of blurred and cloudy vision by changing a person’s glasses. However vision changes can happen rapidly and a check-up as soon as new symptoms develop will help minimise the effects” Cataract surgery is one of the most common and safest surgical procedures with only a small chance of complications arising and, in most cases, can be carried out under local anaesthetic on a day-case basis. When the cloudy lens has been surgically removed it is replaced by a plastic lens implanted in the eye so that it can focus properly. Once the eye has healed a change of spectacles is usually required. Occasionally your doctor will decide the eye is not suitable for a lens implant. In these cases, contact lenses or special glasses will be prescribed instead.

What are the symptoms of cataract?

Common symptoms may include the following complaints: ’I'm not seeing as well as I used to’ You may notice that your vision is blurred, or that your glasses seem dirty or scratched. ’I can’t see so well in poor light’ You may notice that your vision seems much worse in dull or dark conditions. Even wearing your glasses may not help and you may find yourself searching for a better light. ’I sometimes see double’ The cloudiness in the lens may occur in more than one place, causing a double image. ’My vision is poor in bright light’ Bright light or very sunny days may make it more difficult to see. ’I’ve noticed a change in colours’ As the cataract develops, its centre becomes more and more yellow, making colours seem dull and washed out.

Experiencing these symptoms can also be a sign of other eye problems so it is important to consult your optometrist for an eye examination.

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HEALTHCARE

Keeping healthy in later life t is well known that being physically active provides a range of health benefits to older people, including preventing coronary heart disease, helping with weight control and lowering high blood pressure. It also plays a big role in reducing the risk of falls and developing osteoporosis. Having a fall can greatly reduce your ability to stay mobile in later life. As a result, you can loose the confidence to go out and meet people or do simple things like shopping. Besides the benefits of staying active, we should all regard physical activity as a way to reach a healthy retirement, be fit for the grandchildren and keep independent as long as possible.

Yet we know that the level of physical activity declines with age. According to the 2003 Health Survey for England, 81 per cent of men and 87 per cent of women aged 55 years and over do not reach the government recommended levels of physical activity of at least 30 minutes of a moderately intense activity on five or more days a week. Also, the ‘Active People’ survey published in December 06 by Sport England showed that only 14% of men and 10.1% of women aged between 65-74 years do physical activity at least 3 days a week So, what can you do to stay healthy and thrive in later life?

Eat a smart diet, rich in fruit and vegetables, at least 5 portions a day. Minerals, vitamins and other components contained in fruit and vegetables, help lower the risk of death from heart disease, stroke and cancer.

Make sure you get enough calcium through dairy products such as milk and cheese. This will help prevent osteoporosis in later life. If you are not sure about the right intake, talk to your doctor. It is also important to eat less fatty, salty and sugary foods and drinks to keep blood pressure, diabetes and cholesterol under control.

Vitamin D (very important to for strong bones) is found in oily fish (for example mackerel, trout, salmon, sardines), eggs and liver. Sunlight is also a very good source of Vitamin D but please make sure that you wear good sun screen with UVA and UVB protection. A healthy diet should give you all the vitamins and minerals you need. Drinking lots of water will keep your body hydrated. Sometimes a feeling of dizziness is caused by dehydration.

Keep your mind active. Stay curious about life, play with the grandchildren! Stay active in the workplace if you are not yet retired. In general, it is good to be part of a group (friends, family or a social group) to keep stimulated and enjoy good company.

Besides good nutrition and a healthy brain, it is important to increase the level of daily physical activity:

by Anna D’Agostino

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Asian Voice - 2007 Gujarat Samachar

Anna D’Agostino – Minority Ethnic Elders Falls Prevention Project Officer, Help the Aged

walking, swimming, yoga, pilates, keep fit and Tai Chi are just a few examples of activities to choose from.

Weight bearing exercises such as dance, tennis and walking are particularly good if you suffer from osteoporosis.

Strength and balance exercises are proven to help reduce the risk of falls, improving muscle strength by around 25% in only 12 weeks. This is equivalent to a rejuvenation in strength of 16-20 years (Source: Exercises for Healthy Ageing by Dawn Skelton).

There are many other simple things you can do to prevent a fall, whether you are fit and active or have mobility problems or are worried about falling: Have regular eye tests (they are free if you are aged 60 or over) Check your medicines regularly with your doctor (they can make you feel dizzy, especially if you take more than four) Make sure your home is safe (good lighting, keeping the floor clear, taking care on the stairs) Exercise to keep your muscles and bones strong Keeping your feet healthy. Looking after your feet is very important as foot problems can have an impact on balance and mobility. Choose shoes that fit you well, avoiding loose or worn-out slippers or high heel sandals.

Our initiatives Help the Aged has produced the ‘Staying Steady’ leaflet which has lots of other tips on fall prevention, and tells you what to do if you have had a fall. The leaflet

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HEALTHCARE can be downloaded free of charge from our Publications in English website www.helptheaged.org.uk/slipstrips.

020 7239 1114 - (£6 + In general, always tell your GP if you have p&p). a fall. You should be offered a falls risk assessBe strong, Be ment (at your doctor’s surgery or at a local clinsteady (VHS) - English, ic) to find out if there is anything that makes Bengali, Cantonese or you more at risk of a fall.

Punjabi (with an Urdu Help the Aged has worked for years on insert). Chair-based exerprogrammes and initiatives raising awareness cises used at home or in of the risk of falls among older people. The a group in a simple rouMinority Ethnic Elders Falls Prevention protine. Available from Help gramme has consulted and responded to the the Aged Home needs of BME older people, running projects Shopping 0870 in London, Doncaster, Manchester, Leeds, 7700441 - £12 plus p&p.

Portsmouth and Birmingham. Two reports (Year 1 and Step to the Future (VHS/DVD). English and Year 2) summarising this experience and the lessons Hindi (DVD only). For more active older adults, set to learned are available on our website music in a two-level programme. Help the Aged www.helptheaged.org.uk/slipstrips Home Shopping 0870 7700441 - £12 plus p&p.

Help the Aged has also developed National Falls Awareness Day, this year on 26 June 2007. This is an opportunity for everyone – older people and organisations to raise awareness about falls, highlight the local work on falls prevention and promote healthy ageing. The day is open to anyone with an interest in falls. This year’s theme, ‘Getting out and about’ aims to encourage older people to identify HE JOIN TLARGEST local opportunities to take part in ’S ORLDfor just W physical activity and become aware of the potential hazards in nth* their environment (inside and outper mo side the home) that can increase the risk of falls. There are lots of different activities you could get involved in such as holding a rally about a lack of local services e.g. public toilets, planning a falls ** party to link other Asian older people to the local falls services or writing a letter to your local MP and Council to highlight a lack of exercise opportunities for older OZblaZeb% Call your nearest Fitness First from the selection below ?bmg^ll ?bklm f^f[^k people. If you want to know more look at www.helptheaged.org.uk LTS ! / slipstrips.

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Our resources All the resources mentioned above and more details on National Falls Awareness Day and the Minority Ethnic Falls Prevention Programme are available on our website www.helptheaged.org.uk/slipstrips.

Strength and balance exercises book for healthy ageing.

Available from Help the Aged

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HEALTHCARE

When did you last see a dentist?

by Dr Emily Champ

entists normally recommend their patients to undergo dental examinations regularly, (between 3-24 months). This is to help prevent disease in the mouth and detect problems before they arise.

Unfortunately nearly 50% of the UK population does not pay a regular visit to a dentist; most only do so when they are in pain! Because of this they end up requiring extensive treatment. Does this sound like you?

A dentist wants to help you have a healthy mouth and looks at the following to help prevent disease.

D

TEETH Your dentist will look for signs of dental decay. This is when the tooth becomes soft and forms cavities. It is caused by poor brushing and too much sugary food and drink in the diet; especially between meals. Small cavities are obviously much easier to treat by placing fillings and most of the time this will help stop further problems.

Small cavities are usually not painful so you may not know they exist. Teeth usually start to hurt when the cavities become bigger and are more likely to need treatments like root filling or even extractions.

GUMS Gum disease causes the gums around the teeth to become inflamed and bleed. You may have noticed your gums bleeding while brushing. This is not normal and should be treated immediately. Most people have gum disease but it is easily treated with better brushing and flossing between the teeth. There is a more serious gum disease called periodontitis. This causes decay of both the gums and bone around the teeth. It can result in the teeth becoming loose and uncomfortable. It is quite common among older people although some people are genetically prone to the disease. Smokers and diabetics are also more prone to the disease. Your dentist can detect early gum problems, treat the gums and stop teeth becoming loose.

SOFT TISSUES This constitutes the rest of the mouth including your tongue and cheek. Although mouth cancer is rare, it is very important to examine the mouth and look for early signs especially among people who smoke, drink excessive alcohol or regularly chew betel nut pan.

Cancer can kill you and is very difficult to treat if found when it has developed into its late stages. Unfortunately, this is also the first time people tend to notice any problem. If your dentist detects mouth cancer in its early stages you have a much better chance of survival.

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Asian Voice - 2007 Gujarat Samachar

Dr Emily Champ BDS MFGDP Qualified 1999 Guys dental hospital General dental practitioner working in SE London

So have I convinced you to visit a dentist? I hope so.

Weâ&#x20AC;&#x2122;re here to help you. So register with a dentist today and maintain a healthy mouth.

HOW TO HELP TO LOOK AFTER YOUR TEETH 1) Register with a dentist today.

2) Brush your teeth twice a day with fluoride toothpaste.

3) Floss between your teeth every day.

4) Reduce sugary foods in your diet especially between meals.

5) Stop smoking and reduce alcohol and betel nut pan

TO FIND A DENTIST British Dental Association. (www.bda-findadentist.org.uk) NHS direct 0845 4647 Contact your Primary Care Trust Ask your family and friends

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HEALTHCARE

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