Insight - Volume 2, Edition 3 by GxMedia

From The Desk of The Editor-In-Chief

The Health & Wellness Challenge

n this edition of Insight we bring you a rich variety of perspective on health and wellness issues in Guyana and further afield.

Our team is pleased to provide readers with informed pieces explaining the concept of wellness and the challenges to achieving optimum health and wellness today. In examining health, we turn our attention to the nursing profession. Questions are raised about the quality of nursing instruction and the priority accorded the needs of nursing in the public health system. Our local and regional contributors also serve up a spate of views and reviews on matters such as the health benefits of a common vegetable – with a focus on its impact on people affected by cancer – and the growing challenge of obesity in the Caribbean. As usual, though, Insight is examining more than just the theme of our main features. Apart from health and wellness we’ve included pieces from various fields to stimulate discussions on matters of current concern as we give you more Insight with provocative contributions from prominent commentators. We feature an Op-Ed on local government elections in Guyana from outgoing United States Ambassador to Guyana Brent Hardt. There is also the usual analysis of recent regional developments, this time with a special look at elections in the Caribbean and unfolding trends in voter participation and the issues that arise. We thank regular subscribers for their continued support for this unrivalled publication as we hope to continue bringing you the Insight you deserve. Remember, we also maintain a strong online presence and welcome your comments, both off and online, and suggestions for strengthening our credentials as Guyana’s premier news and current affairs magazine.

NAZIMA RAGHUBIR EDITOR-IN-CHIEF

Insight Volume 2 Edition 3

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Volume 2, Edition 3 - 2014

Published by Insight INC

62 Area “Q”, Turkeyen, ECD, Guyana, South America

Insight Team Editor in Chief Nazima Raghubir

Editorial Consultant Wesley Gibbings

Assistant Editor Andrew Kendall

Copy Editor

William J. Carter

Layout and Design

Photography

Mensah Fox

Arian Browne, Aubrey Odle, Neilon Dias, Wesley Gibbings

Contributors

Ambassador Brent Hardt, Edward McSweegan, Melissa Monroe, Meghan Lee-Waterman, Lenandlar Singh, Dr Fred Nunes, Dr Karen Cummings, Earl B. John, Louisa Reynolds, Yvette DeFreitas, Dr Emanuel Cummings, Mark McGowan, Vanda Gomes, Lucy Anderson, Dr Geoffrey Frankson, Alim A Hosein, Dr Joyce Jonas, Charlene Wilkinson, Penelope Harris, Marlon Daniels, Timothy Austin, Andrew Kendall, Camille Roopnarine, Tamara DeHaarte, Wesley Gibbings

LETTERS TO THE EDITOR

Should be emailed to editor@insightgy.com Published letters may be edited for reasons of space and clarity

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Insight - The Health & Wellness Challenge

53 In The Neighbourhood

4 | Elections, Constitutions and Change in the Caribbean

Features Health & Wellness

18 | The Head Teacher’s Lot Life without a Secretary

7 | Local Elections - Connecting People to Government

Talking Language

10 | Biased? Prejudiced? Me? 12 | Why Learn A Second Language? Why, indeed? Then again, why not? 14 | The Case For English ‘B’ 16 | Literacy education and Creole-speaking children

Development Focus

Personality

21| Caribbean Tribute to A.J. Seymour

Insight Volume 2 Edition 3

Tech Bits

54 | Computers and your Health

Facts & Fun

56 | Treating Illnesses – Guyanese Style

Nutrition

53 | From Farm to Table - Thriving on locally produced fruits and vegetables 3

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St George’s, Grenada

Regional Roundup Elections, Constitutions and Change in the Caribbean By Wesley Gibbings

High voter turnouts, wide margins of victory and change marked two of the last Caribbean general elections since January 2013 while the Democratic Labour Party (DLP) of Barbados narrowly escaped defeat at the polls on February 21, 2013.

aint Kitts and Nevis and Dominica are due to hold elections in 2014 while St Vincent and the Grenadines and Trinidad & Tobago will enter the new

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year with election campaigns already in full swing. The year thus far has delivered remarkable regional election results. First there was Grenada on February 19, 2013 and then Antigua 4

and Barbuda on June 12 this year saw voter turnouts of close to 88% in Grenada and over 90% in Antigua and Barbuda. In both instances there were “landslide” victories by parties www.insightgy.com

Gaston Browne, PM Antigua and Barbuda

that had previously held power. In Grenada, following a five year hiatus, the New National Party (NNP), under Dr Keith Mitchell, for the second time won all 15 seats in the country’s House of Assembly. The last time the party achieved this was on January 18, 1999. It was later routed by the National Democratic Congress (NDC) in 2008 by an 11-4 margin. In Antigua and Barbuda, the Antigua and Barbuda Labour Party (ABLP), under new leader Gaston Browne, returned to power following 10 years in parliamentary opposition by a margin of 14-7 in the 21 seat House of Representatives. The ABLP had lost by a relatively close margin of 9-7-1 in 2009 and by a wider margin of 12-4 -1 in 2004. The going was much closer in Barbados on February 21, 2013 when the DLP beat back a strong challenge from the Barbados Labour Party (BLP) to win by 16 seats to 14 in the closest electoral contest in the country’s history. Election surveys, intense traditional media campaigns and strategic social media interventions have been in evidence throughout the period of campaigning in all three countries. These campaign activities have given rise to concerns about sources of election financing by political parties (which was thoroughly examined in the last edition of Insight), media coverage of election surveys and the use of social Insight Volume 2 Edition 3

media as a campaign tool by political supporters and well-coordinated outfits financed by the various political organisations. There has been an ensuing thrust by some elections agencies to themselves make wider use of social media platforms. In fact, the International Institute for Democracy and Electoral Assistance (IDEA) has published a social media guide for electoral management bodies to ensure their information reaches wider audiences and is better understood by electors. Special attention is also being paid to traditional media performance in the coverage of elections and their outcomes in the Caribbean. The model for enhanced media coverage of elections developed by the Guyana Elections Commission (GECOM) is considered by many elections officials to be a worthwhile exercise that can be replicated in other territories. Recent electoral outcomes in the Caribbean have also brought into focus issues of constitutional change. A Constitution Review Advisory Committee has been established in Grenada to address, among other things, the possibility of introducing a system of proportional representation to deal with parliamentary 5

representation at times when a firstpast-the-post vote would have left parliament without an opposition voice. The UPP had placed the issue on the agenda in Antigua and Barbuda following the report of the country’s Constitution Review Commission of 2002 which had proposed that while elections to the House of Representatives should remain subject to first past the post elections, senate appointments should be via a system of proportional representation, based on general elections results. In Trinidad and Tobago, a system of proportional representation was introduced in time for local government elections on October 21, 2013 focusing on the selection of unelected aldermen to Trinidad’s (this does not apply to Tobago) 14 municipalities. Continuing consultations on constitution reform in the country have offered up different versions of similar reforms at the parliamentary level. For the moment, the focus is on winning elections. Current outcomes have placed incumbents under considerable electoral pressure and countries are being well-advised to consider constitutional provisions that assure a greater voice for citizens in the decision-making process. www.insightgy.com

Local Elections

Connecting People to Government By Ambassador Brent Hardt

“This nation is ready. Our young people are ready. We are ready for local government elections. We will continue to speak until you do your duty and see that we can access our democratic right.” - Sara Bharrat: May, 2014

n January 2013, I joined with diplomatic colleagues from Britain, Canada and the European Union in calling on all parties in Guyana to come together to hold Guyana’s first local government elections in almost two decades. “Given the important and pressing need for effective local governance,” we wrote, “we believe that 2013 should be a watershed moment for the people of Guyana -- the year they can once again democratically elect their local government.” Later that year, as the four bills for modernising local government were caught up in political wrangling, we joined with over a dozen civil society groups to urge passage of the legislation. All four bills were passed unanimously by the National Assembly, and the President eventually assented to three of them. With the legislation in place, the way was paved for the restoration of effective, elected local governance for the people of Guyana. Unfortunately, as 2014 rolled around, no elections had yet been Insight Volume 2 Edition 3

Ambassador Brent Hardt

announced and the Government began to signal that it intended to delay even longer. The acting Minister of Local Government suggested that the people of Guyana were not ready for local government elections. In February, the PPP Party Chairman Clement Rohee likewise suggested that local elections would not be called because “it’s a very complex election.” “We get the distinct impression from our [sic] commissioners,” he added, “that they [GECOM] are not ready for local government elections.” Given the prospect of further delay, diplomatic colleagues and I again joined with even more civil society groups -- the private sector, 7

unions, chambers of commerce, bar associations and others -- to urge the President to seize the historic opportunity he has to restore elected local governance to the people of Guyana. We jointly concluded: “So now, the legislative foundation is in place. The election machinery is ready. The political parties have reaffirmed their desire to hold local elections, and are making campaign preparations. It is our hope, as the PPP pledged in its 2011 manifesto, “that local government elections are held, bringing much needed reinvigoration into local government entities.” That is something all stakeholders can agree on in 2014.” Since this appeal, there has been a groundswell of support building behind local government elections. Newspapers have been filled with letters to the editor and columns arguing for early local elections. The Stabroek News has begun running a daily page one column with appeals from an array of stakeholders for local elections. The outgoing Chairman of the Georgetown Chamber of Commerce, Clinton Urling is leading a group of young Guyanese who have made local government elections the top priority of their new organisation, the Blue Caps. This growing grassroots movement for local government elections makes clear that the people www.insightgy.com

British High Commissioner Andrew Ayre, US Ambassador Brent Hardt, Canadian High Commissioner Nicole Giles and Head of the European Delegation Robert Kopecky speak to a local media professional

of Guyana recognise just how vital a restoration of elected local governance is to their future and the future of their country. As a University of Guyana student, Sara Bharrat, wrote in a passionate letter to the editor in May 2014: â&#x20AC;&#x153;This nation is ready. Our young people are ready. We are ready for local government elections. We will continue to speak until you do your duty and see that we can access our democratic right.â&#x20AC;? Since I first began advocating for local government elections back in January 2013, many have asked why I devoted so much diplomatic energy to this issue. The reason is quite simple: While Guyana has made strides in strengthening its democracy, the continued absence of democratically elected and effective local government remains a persistent drag on Guyanaâ&#x20AC;&#x2122;s national development. Only when people know who to seek out to help address the day-to-day issues and challenges that affect their lives, will they once again have confidence in their future and a belief that they can build a better life for their families. The tangible benefits of local democracy go far beyond the act of casting a vote. Throughout the world, countries and international agencies have come to recognise the vital importance of representative local government. Effective and efficient public administration coupled with Insight Volume 2 Edition 3

healthy local governance can drive development efforts. Local government institutions bring government closer to the people, fostering greater inclusion, civic responsibility, empowerment and participation. Local government offers one of the most important avenues for women and other groups typically under-represented to participate in the development of their communities and influence decision-making processes that directly affect their lives. In communities throughout the world, a new generation of democraticallyelected local leaders is creating change and sparking national development. Beyond all of these compelling

reasons for local government elections, the need in Guyana is even more urgent because of the structure of national political representation. Because of the list system in the National Assembly, there is little connectivity between people in specific communities and members of parliament. In other Caribbean countries, the U.S., U.K. and Canada, for example, people live in a district with an elected representative to whom they can turn when they need action from government. If they have a pothole in their road, garbage not being picked up, or drainage blocked, they can appeal directly to their M.P. or congressman or woman to seek action.

Members of Guyana Shines pose with US Ambassador Hardt 8

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In Guyana, by contrast, there is little connectivity between people and their elected representatives. The representatives are responsible to their party, and can be replaced at will by the party’s leadership. They have no specific allegiance or responsibility to represent the interests of people in a town or district. A Guyanese living in a community with potholes, garbage, or drainage is therefore not sure who to turn to for redress or action. Such distance between people in communities and their government can lead to frustration with the political system, and eventually, indifference and apathy. This in turn can frustrate development and undermine the democratic foundations of a country. Only when people know who to turn to help address the day-to-day issues and challenges that affect their lives, will they once again have confidence in their future and a belief that they can build a better life for their families. President Donald Ramotar himself has been among the most vocal in recognising this urgent need and supporting local government elections. In July 2013, he affirmed that local government elections are “badly needed because many of the problems we face are due to the fact that we did not have local government elections.” In a political landscape that

is too often divided, there is in fact a broad political agreement on the need for local elections. In its 2011 manifesto, the People’s Progressive Party called for reinvigorating local government and pledged to “ensure, within one year of the 2011 general elections, that local government elections are held, bringing much needed reinvigoration into local government entities.” A Partnership for National Unity likewise called for “the implementation of agreed Local Government Reforms and the holding of Local Government Elections.” And the Alliance For Change affirmed that in its first year in office it would “implement local government reforms and hold local government elections.” Over the past year, all political parties have repeatedly expressed their eagerness for local government elections, their desire to make their case to the voters, and their interest in competing in localities throughout the country. The PPP, APNU, and the AFC have all begun campaigning in many regions. Despite suggestions to the contrary by the Minister of Local Government, the Guyana Elections Commission made clear publicly that it is fully equipped

and ready to stage local government elections. It has already demarcated the boundaries and constituencies in almost all 71 districts, and each district has been targeted for voter education. By all accounts, GECOM is prepared and poised to ensure free, fair and transparent local elections when called upon to do so. At this point, it is only for the government to put forward a date for elections to be held so GECOM can undertake the statutory steps required by law to hold local government elections. In 2014, it is time for Guyana to seize its potential by affording its citizens strong and effective local governance to build safer, more prosperous, and more democratic communities. Ambassador D. Brent Hardt is the United States Ambassador to Guyana since August 2011 and will end his stint at the end of August this year. Ambassador Hardt also serves as Plenipotentiary Representative of the United States of America to CARICOM.

British High Commissioner Andrew Ayre, US Ambassador Brent Hardt, Former Canadian High Commissioner David Devine and David Singh, Director of Conservation International Insight Volume 2 Edition 3

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Language

Biased? Prejudiced? Me? By Alim A. Hosein

“Our language use suggests that as human beings, we exist in a perpetual state of prejudice.”

discussed language prejudice on a wide scale in my last article, indicating the disadvantage and prejudice that persons face because of their language, or the views others have of their language. Most of us are disgusted at the thought that such attitudes and behaviours exist. However, every day, language prejudice is practiced by all of us – yes, by you and me. Our language use suggests that as human beings, we exist in a perpetual state of prejudice. We do not even realise how divisive and prejudicial are the words we utter to our fellows, how often we articulate words and sentences which reflect or produce bias against others. Some words have caused such deep hurt that they are deeply abhorred. Many of these refer to race or ethnicity. So poisonous are these terms that I will not actually cite them in this article. The most famous is the Insight Volume 2 Edition 3

“N-word”, but there are offensive terms for all races. This matter came to focus earlier this year when a Trinidadian politician was accused of declaring that another politician will not be elected as President because he was too “black”. But even when we use more acceptable terms such as “w’ite man”, “black guy”, “East Indian gyurl” we are using terms that reflect division. Guyanese have an interesting trait: when we talk about people, we include their race, as if racial identity is the important part of the story. We say things like: “Ah meet a man de odda day – a black chap – and he seh dat…” But even innocent-looking words can be loaded with prejudice. “Tall” is desirable, while “short” is undesirable. “Fat” is undesirable while “thin” and “slim” are desirable. In the same way, “old” is a prejudiced term: we would far rather be “young”. But wait - “antique” has high value, even though it means the same thing as 10

“old” (compare “old furniture” vs. “antique furniture”). A recent “Curtis” comic strip in the Stabroek News noted that old things that rich people pass down to their children are called “heirlooms”, but things that poor families pass down are “hand me downs” (in Guyana we might even call them “lef lef”)! Gender differences are buttressed by enormous language prejudice. English seems to use masculinity as the basis of definition in a number of areas of life. So we have “chairman”, “mankind”, “foreman”, “manager”, “workman”, even “woman”, and so on. Other words, such as “engineer”, “labourer”, “author”, “doctor”, professor”, “boss” have become intrinsically associated with males, and it is only relatively lately that feminine versions have been created. Interestingly, some of these – e.g. “conductress”, “managress”, “authress” - have a hard time surviving: people simply slip back to the male versions. In other cases, some awkward terms have been created, such as “lady doctor”, “female cricketer”, “forewoman”, “chairperson”. In cricket, “batter” (referring to both male and female cricketers) seems to be making some progress in entering the language. Feminists have been trying to redress the balance - “history” becomes “ herstory” when it is written by and about women, and “women” itself is another word that they try to reclaim by making it refer exclusively to female anatomy in the coinage “wombmyn”. But some words are difficult to change: how does “workwoman” sound to you? And, “master” has the female counterpart “mistress”, but www.insightgy.com

think of this: you can be “master” of the universe, or “master” of your own destiny, or you can “master” a game or a situation. But can you “mistress” it? Words such as “boss”, “pilot”, “driver” remain stubbornly without a feminine version. And even though we do have female bosses, the word still conjures masculinity. If I say “My boss” or “doctor” or “professor” or “pilot” or “driver” , many Guyanese, would immediately assume a male person. A man goes through life as “Mr.” whether he is married or not. Women, on the other hand, are expected to declare their status: they become “Mrs.” after they get married. I have read that for this reason, the French have banned the word “Mademoiselle” from official documents. Then there are the slang words, many of which refer to women and parts of women’s bodies. Women are called “sweets”, “thing”, “chick”, “babe/baby”, “a food” and so on – all things that you can use, control, consume. If they fight against such discrimination, they are called “whore”, “bitch”, and other derogatory terms. There are tons of slang which refer to their body parts: “boobs”, “bobo”, “bumper”, “bambam”, “fish” being the more acceptable to write here. Do an exercise: draw up a list of such terms. Then do a similar list for male body parts. Compare the lengths of the lists, and do a comparative analysis of what each term means or suggests. A man who controls many women is a “player”, “big Papa”, “dan” while a female who has many men is a “dangles”, “spare wheel”, “sleep around”, “prostitute”, “clothes clip”, “cockle”….. The male terms reflect power and even suggest an enviable state of being, while those for women are tremendously negative. Of course, everyone knows that it is only women who “gossip” or “talk name” but men “discuss” and “analyse”. Men make “observations” while women “nag”. A “bachelor” is a free, handsome, enviable young man, while a “spinster” is an old, miserable, lonely woman. A “husband” is a person of authority, one who earns the money and makes the decisions, while a “wife” obeys and respects her Insight Volume 2 Edition 3

husband. A “housewife” is someone who does no work, and whose contribution to society is negligible. We also use language to exercise prejudice against others by distinguishing our habits from theirs. So, I “spend my money wisely”, but you are a “miser”; I am “openminded”, but you “do not exercise proper judgment”; I “speak the truth fearlessly” but you are “rude and arrogant”. I “consult” others when making a decision, but you “can’t make up your mind”. We use language to include and exclude - selectively. Have you ever noticed that when the West Indies win a match, we say “We win!” and when they lose we say “Dey lose”? This kind of inclusivity and exclusivity pervade the rest of our language. We talk about “dem people” and “you all” as against “we” and “us”. Of course, “dem people” have all the negative and undesirable characteristics. We say “y’all like do stupidness”. Similarly, every Guyanese speaks proper English; only “dem people ova deh” speak the creole language. In politics, one party becomes the government – they have to govern, while the other side is excluded and becomes the opposition – they have to oppose. Can’t we find more progressive language? In the same manner, labelling someone a “terrorist” makes it easy to curtail their liberty, or to judge them

by a different standard. However, persons who use violence to secure an advantage for us are “liberators” and “freedom fighters”. I read that the persons who are targeted by the U.S. drone aircraft are called “bugs”. This is the ultimate discrimination and de-personalisation through language, and it allows people to be treated as “expendable”. Because of such prejudice, some people advocate the use of “neutral” language. This “political correctness” movement seeks to cleanse language of bias. But this is a tough job, since the new terms may themselves reflect some kind of partiality, and human beings being what they are, new terms of prejudice are constantly being created. “Vertically challenged” seems to me to be just as bad a term, while “differently able” seems ambiguous. Whether we can clean up language is not the point, however. The fact is, language is not inherently prejudiced. Language is a human thing, and it is we who load our bias, negativity and discrimination on to it. So, is weh de clean up gat fuh start, an who gon begin? Alim A. Hosein is a Lecturer in Linguistics, Department of Language and Cultural Studies, School of Education and Humanities, University of Guyana

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Why Learn A Second Language?

Why, indeed? Then again, why not? By Tamara DeHaarte

The Guianas, close to each other, have the opportunity to be fluent in at least three other languages. So why limit ourselves? The Guianas, close to each other, have the opportunity to be fluent in at least three other languages. So why limit ourselves?

he Guianas of South American are in quite a unique situation. They are the only English speaking (Guyana, formerly British Guiana), Dutch speaking (Suriname, formerly Dutch Guiana) and French speaking (French Guiana) countries on the continent. All the others speak one dialect of Spanish, or other. The Portuguese spoken by Brazilians, although not Spanish, is understood to some extent by the continent’s Spanish counterparts. The Guianas, close to each other, have the opportunity to be fluent in at least three other languages. So why limit ourselves? The opportunity to be familiar with a language other than our native tongue is an exciting one. The French and the Dutch have already put measures in place to ensure that their citizens learn and become proficient in at least two other languages. The acquisition of a second, or even third, language seems a prominent achievement, there. In Guyana, we have historically studied Latin in the past, and today in schools French, Spanish and, more recently, Portuguese. But to say that the majority of Guyanese understand and recognise the importance of acquiring another language is another issue. For many learning another language seems daunting if not difficult. One is faced with new vocabulary, tense formation, verb conjugation, and syntax. One

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must also be able to demonstrate an ability to communicate competently in the four skills – listening, speaking, reading and writing. With the potential difficulty posed when faced with a new language the question for too many seems to be, “why even bother?” The motivation behind learning a second language is to prepare students/persons for their roles and responsibility as global citizens. With the advent of the computers and the internet, the world is not as remote and distant as it once was. Every day, at any moment, persons encounter others of different cultures, languages and countries. To interact with these persons it is only fitting that some common tongue/form of communication be decided. Think of the impression which would be created when a stranger from a different land recognises the time and effort which was taken to learn about another. Nelson Mandela – a nobleman, a politician, an activist, and a man loved by many – once said “If you speak to a man in a language he understands it goes to his head. But if you speak to a man in his own language it goes to his heart.” 12

Many argue that there is no need to learn a second, much less a third language, especially if you are an English speaker. They use the argument that English, although not spoken by the largest numbers of humans, is considered as the world’s most dominant language. They point out that it is used at various global forums as the language for communications. Besides, they continue, if a foreigner enters your Guyanese domain then they should know and learn your language, right? Wrong. Such a narrow point of view is ridiculous. How about both persons make the attempt to learn each other’s language? Why not evince camaraderie and true exchange of culture and livelihood through the most overt means possible – learning of another’s language? These and other such arguments are put forth in attempts to dissuade students from learning a foreign language in Guyana. Why bother, detractors argue. It’s pointless if www.insightgy.com

you’re already speaking English. They are told that there is little scope, scant situations where they will be compelled to use this “new” language, that it is unimportant for their intended careers. But, I always encourage students not to limit themselves. The world is open to them and language is the means by which they can cross any barrier. When they are open to language learning, they are opening themselves to opportunities, to new experiences that could prove essential to their individual development. I can recall so many instances where students refused to take a foreign language in their fifth form Insight Volume 2 Edition 3

year at schools only to later in life, whether at university or in their careers, be forced unto paths where a foreign language was not just helpful but essential. And, thusly, they begin to regret their childhood decisions. As a parent and an educator I cannot overemphasise enough the importance of learning a second language. You never know where the future will take you. It is a valuable asset which will enhance any curriculum vitae. Moreover, as our global community grower continually smaller a second language may become essential when communicating with others around the word. 13

Imagine yourself in a conference where you are the only English speaker. The others around you speak several languages and are able to switch as easily and quickly as they please whilst you are unable to take part in any conversation where English is not being spoken. Imagine the loneliness and isolation when everyone is speaking to each other but you are unable to partake in any of the conversations. How would you feel? Wouldn’t you prefer to study and learn another language now and save yourself of any embarrassment or difficult encounters. Even if such a situation is one you manage to avoid, second language learning is a valuable asset and is never regretful. Even in situations where you may not use that second language, it can still enhance one’s personality and character. Studying a second language, though it may prove difficult at first, is similar to studying a new concept in mathematics, or economics. When has knowledge of any new concept ever been a detriment to acumen? When it seems as though the world is against you for learning another language and you question the time being invested it is important to remember your neighbours and global friends who you will meet in the future. They will be more comfortable if you speak to them in their own language, and you will be better for that knowledge. Tamara DeHaarte is the Head of Department for Modern Languages at The Bishops’ High School www.insightgy.com

The Case For

English “B” By Dr Joyce Jonas

t’s time to take stock. At least, in the area of our children’s education. Those of us looking on from the vantage point of grey hair and experience are horrified at what we see: the intensely competitive spirit that has taken over in education robs our children of most, if not all, of the joy of learning. Do we really think we are doing the right thing when we send tiny tots to “lessons”? Or when we haul our ten-year-old out of bed in the wee hours of the morning to study for the dreaded Secondary Schools Entrance Examination? Or when we agree for our fifteen-year-olds to carry anything from 10 to 20 subjects for their Caribbean Secondary Education Examinations? Haven’t we allowed things to get out of hand? As one who has taught at both secondary and tertiary level for almost four decades, this writer can attest to the fact that far too many of our bright young minds are being numbed by the tediously repetitive schedule of learning. I’ve seen the glazed look come over their faces as we settle down to the lesson in hand, as if experience has taught them that it’s going to be deadly

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boring, but you just have to endure it for the sake of getting that piece of paper in your hand that, allegedly, will be your passport to a good job. But they’re not fools; they know there will very likely be no good job at the end of it all—unless, of course, Daddy has his own business, or Uncle is Someone Who Knows Someone. Learning should be a delight, not a chore. Watch any tiny tot “discovering” butterflies and lizards, or reaching out podgy hands to experiment with some new tactile experience! We human beings are naturally inquisitive about the world 14

around us—and since it’s such an amazing world, learning about it can and should be a thrilling journey of discovery. Since for most of our children this is not the case, I say it’s time to take stock. Regardless of curriculum changes, the time-honoured goals of education remain unchanged: first, to prepare children to be gainfully employed and to make a useful contribution to society, and secondly, to enable children to maximise their potential and become fulfilled as individual human beings. I would like here to make a www.insightgy.com

case for the study of Literature, arguing essentially that “English B” meets both these requirements—and better than any other subject on the curriculum. The Caribbean Examinations Council has, in its wisdom, made English a double award: Language and Literature. Literature, they felt, was so important that it needed to occupy more than just a small corner of the English programme; it needed to be a subject in its own right. Despite this strong signal being sent from regional educators, we hardly value Literature here in Guyana. Many of our students “drop” English B when they reach Fourth Form (and sadly, some are not even taught it even in lower school). They, and their parents, seem to have the notion that whereas subjects like Maths and Integrated Science and Principles of Business are “useful”, Literature is not. But this thinking is fundamentally unsound. The discipline of studying Literature does, in fact, give the youngster practical skills, but is, in addition, superbly suited to helping the student wrestle with ethical, psychological and philosophical questions. Literature is “useful” as a background for any number of careers. The child who reads literature learns to study human behaviour in the novel or play, and so is being prepared to deal with people sensitively and diplomatically in the real world. What better training could you want for a doctor or personnel officer, for an office manager or teacher? The child who reads literature comes to understand the dynamics of a storyline, of the bias of point of view, of the power of emotive language. What better training could you want for a lawyer or law enforcement officer, a social entrepreneur, or a school principal? The child who reads literature—Third World literature especially—confronts, in the safe space of fiction—conflicts of race, religion and class, and learns to walk for a while in the other guy’s shoes, growing in empathy and understanding for his fellows. In a society that is daily becoming more multi-cultural, aren’t those skills - empathy, sensitivity, Insight Volume 2 Edition 3

diplomacy, shrewd judgment required attributes for many careers? Studying literature can develop skills of logic, comprehension and clear expression; it can awaken an awareness of moral issues and an admiration for the nobler human qualities. Literature, in the hands of a good teacher, can make our young people more sensitive, more imaginative, more empathetic, more ready to hear another’s point of view. But more than this: in leisure moments, familiarity with literature will offer access to a world of imagination, mental stimulation and wonder that cannot be rivalled by any of the latest movies or hi-tech gaming. How, one wonders, will the next generation of creative writers emerge to challenge and delight us, unless we give our youths the skills to appreciate creative writing that is worthy of emulation? Our teenagers live in a world that is far more challenging than the world their grandparents grew up in. Their awakening sexuality is daunted by the spectre of AIDS. Everywhere they are bombarded with consumerist messages that they should “live for now”, and that they “deserve” whatever product is on offer. Technology puts unheard of power at their fingertips in the virtual world, but in reality they languish in a state of powerlessness. Daily they hear news reports of ubiquitous atrocities and conflicts, and the Leaders and Authorities they are told to respect are, too often, discovered to be corrupt. Indeed, the very planet they

are living on appears doomed to destruction. Literature cannot make these problems go away. But being able to lose yourself in a good book is wonderfully healing and strengthening. Students will soon be selecting the subjects they hope to concentrate on in the final two years at secondary school. These young minds are at a crossroads—and so are we. Should we continue to send the message that education is all about accumulating A’s in allegedly “practical”, “useful” subjects, or do we remind ourselves that education is about developing the whole person? Let’s stop the madness. This year, when the kids are selecting their CSEC subjects, let’s limit them to a maximum of ten. Let’s nudge them in the direction of English B - and let’s demand good teaching of the subject too!

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Literacy education and Creole-speaking children By Charlene Wilkinson

The Guyanese Creole voice still does not have true legitimacy in the country which gave it its identity.

t is difficult to pretend that unwritten languages have the same prestige as written languages—which is another way of saying that it is difficult to pretend that people who speak languages that have no written tradition have the same prestige as the people whose languages do. The popular Creole of Guyana, (called Creolese by the general population and Guyanese by linguists) serves as a link between generations and between cultures over this vast landscape of 83,000 square miles as well as across the Guyanese diaspora. Yet, it remains a ‘victim’ of an insidious hidden curriculum within our education system that teaches an attitude to language reflective of a certain power relationship between speakers of English and speakers of Creole. The Guyanese Creole voice still does not have true legitimacy in the country which gave it its identity. This article invites discussion of the implications of the hidden curriculum for our children’s language development. The verbal interaction below took place in one of the primary schools I visited in June of 2011: During break one Tuesday morning, Two Grade One girls approach me. I have visited their school about three times for the term and they are now quite comfortable around me.

Pupil A: Yu miin yu din chek it bifoo yu bai it? Do you mean you didn’t check it before you bought it? [The idea is preposterous] Me: [Taken aback by the straightforward and bold criticism] Wel, ai reeli doohn plee tuu moch geem yu noo. Onli mi daata doz plee an shi gat shi oon kompuuta. Well, I really don’t play too many games you know. Only my daughter plays, and she has her own computer. Pupil A; Yu doz go skuul? Do you go to school? Me: Yes. Pupil A: Yu doohn gat skuul chuuzdee? Don’t you have school on Tuesdays? Me: Yes, bot a get pomishan to kom an si yu. Yes, but I got permission to come to see you. Pupil B: Uu lorn yu to plee dis? Who taught you to play this? Me: A tiich miself. Yuu biliiv? I taught myself. Do you believe? Pupil B: Ye. Yes. By this time a small crowd has gathered around me. The children press themselves to get closer enough to look at the screen. Two other children add to the questions, opinions, observations: Pupil A suddenly gets territorial:

Pupil A: Dis ting gat geem? [referring to my laptop] Does this thing have games? Me: Noo. No Insight Volume 2 Edition 3

Pupil A: Yu-aal stap lukin pon di uman kompuuta! Stop looking at the woman’s computer! 16

Three children complained about the rudeness of their peers and the cruelty towards a frog displayed by some Grade 5 boys: Pupil B: Mis, M..... ga E….. pensil. Di bai len ii fo rait an hi eehn wahn gi bak di bai ii pensil. Miss, M….. has E….. ’s pencil. The boy lent him to write with and he doesn’t want to return the boy’s pencil. Pupil C: Mis, dem chiren singin wail sang. Mis wen yu doon de hee, dem singin “Dem a Wach Mi.” Miss, those children are singing wild songs. Miss, when you are not here they usually sing, “Dem a Wach mi”. (Chutney music is of East Indian origin and indigenous to the Caribbean.) Pupil: D: Dem bai fait outsaid: Dem big bai wa de in greed siks. Ii sok a krapoo finga. Ii wen toch krapoo an wash ii han wid di krapoo wata an dem kikin di krapoo an den L. . . . mash it. Those boys fought outside: The big sixth grade boys. He sucked a frog’s finger. He touched the frog and washed his hands with the frog water and they were kicking the frog and then L….. stepped on it/crushed it with his foot. Pupil C: An e putin ii finga in ii mout. And he is putting his finger in his mouth. After break was Science class. The teacher delivered the lesson mainly in formal English, using questions to elicit responses from the class. One or two girls gave very short responses in English. But the majority of pupils did not participate verbally in the www.insightgy.com

discussion, and those who did spoke in Creolese. The lesson was about caring for pets. Ironically, when one of the children suggested that a frog could be a pet, the teacher seemed puzzled and did not accept the suggestion. Unfortunately, she was not privy to the earlier lively discussion at break time. The culminating activity of the Science lesson was copying from the blackboard a numbered list of English sentences about caring for pets. As the copying ensued, I also noted some of the comments the children were making: Pupil 1: (Speaking to the child sitting next to her) Mi de tuu moo word dan da. I have passed you by two words. Pupil 2: Mi de to laang word. I have reached a long word. Pupil 3: Mi don. I am done. Pupil 1: Ai ga wan moo word. I have one more word to go Pupil: 2

Ai de to chrii. I am at number three.

While the sentences being copied were indeed related to the care of pets, it was the teacher who had created them, not the pupils, and they seemed to view the culminating writing task as a competition in copying, rather than a review of what they had learnt about the care of pets. In other words, the knowledge and ideas of the Science class might have been more effectively developed in lively discussion in Creolese rather than through an English transcription exercise. Needless to say, if it seems to be the hidden policy that children are not to be encouraged to negotiate school knowledge in Creolese, the idea of teaching children to read and write Creolese might be quite preposterous to educational authorities. The end of term composition papers on the themes of self and school of four Grade One pupils from the same class are shown below. Insight Volume 2 Edition 3

Figure 1: Grade One Composition—test papers showing behaviourist type assessment strategies The paper receiving the highest mark does not demonstrate self-expression, but repetition and recall. Thus, positive reinforcement (a high grade of 8/10) is given to the child who best imitates a particular pattern taught during the term. Negative reinforcement (failing grades of 0/10 to 4/10) is used to ‘punish’ the children whose emergent literacy does not reflect a capacity to imitate well. I propose that the questions below are essential to any discussion of literacy education: • Can schools really hold children in high esteem when they delegitimise their spoken language as soon as they enter the school gates, by the practice of negotiating school knowledge in English only, relegating Creolese to the school yard? • If initial literacy involves matching the sounds of the child’s language 17

to the letters, how do Creolespeaking children make this first step successfully of literacy is taught in English only? • Is it possible to develop high levels of literacy competence which involve genuine self expression and critical thinking, if children are not taught to write their feelings (the ‘affective domain’) and thoughts (the ‘cognitive domain’) in their first language before they write in any other language? • Is the educational advancement of Creole speaking children in Guyana of lower priority even of foreign visitors/investors who are given the opportunity of learning English as a second/ foreign language, using their own languages as the basis for language learning? I am interested in hearing from our teachers. www.insightgy.com

The Head Teacher’s Lot

Life without a Secretary

nter the office of any professional and there’s an indelible fixture running through them all. Chances are the first person you’ll meet is a secretary. They may be dutifully manning the phone, or furiously typing some urgent document. They will enquire as to your purpose at said office, direct you to whom (they think) you should speak with. Their duties transcend beyond what is visible to visitor, their duties are many and range from typing correspondence, updating and reporting to their bosses, setting up meetings and in the 21st century they are important assistants to managers, leaders and top officials in nearly every organisation. What would professionals do without secretaries?

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By Andrew Kendall

Well, Head Teachers lead their schools without them. It seems in our taut society where every eye is on the school, a month does not pass where the expediency and effectiveness of the education system isn’t called into question. This is hardly surprising considering it is the sector which gains the most money at the country’s annual budget. Questioning the effectiveness of the money being dispensed seems natural. What can be done to improve the integral sector which every Guyanese is affected by is a fair question. But what is responsible for effectiveness? Considering the time a head teacher spends dealing with administrative duties for example in

an A-Grade primary school , a centre for more than 700 students and 30 teachers, having a secretary to assist a Head Teacher in her numerous duties seems an investment worth making. Schools submit 12 annual typewritten documents, 16 termly ones, eight monthly ones and six others which vary in amounts per year. That doesn’t include any impromptu request the Ministry may contact a school for at random over the school year. Last year at a forum at Cyril Potter’s College of Education, Education Minister Priya Manickchand noted how disheartened she was to see Head Teachers of schools so often not performing their duties. It’s a fair point. If there is ineffectiveness at the top, the whole more often than not could be in jeopardy. It’s why the Teaching

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Service Commission process for hiring Head Teachers is so arduous. But how effective a leader can a Head Teacher be if they’re being forced to stretch themselves between two positions – principal and secretary. Over the course of two weeks, calls were made to 80 Nursery, Primary and Secondary schools in Guyana, 60 of them had no secretaries. In the schools without the secretaries the schools dealt with the situation in various ways. At one school the Information Technology teacher, at another the Deputy Head Mistress, at another the school’s librarian, in many cases the Head Teacher, in some others, whoever was available at the time. A teacher, so excited at the prospect of the piece exclaimed, “I’ve been asking for years. I have over 600 students and over 30 teachers to manage. It’s too much work for me. Every time I ask the Ministry says they’re not employing that level of workers.” A number of other Head Teachers echoed this sentiment. Yes, they had reached out to the Ministry for secretaries, their requests bore no fruit. In all cases, where secretaries were unavailable a teacher – oftentimes the Head Teacher – would be forced to juggle several tasks including their administrative job and Insight Volume 2 Edition 3

the duties of a secretary. On the surface the issue might seem banal. Teachers have been oftentimes forced to be a profession which depends on malleability – they’re ostensibly there to teach children but within that perform duties of parent, counsellor, mediator, judge, doctor, and friend depending on what the child needs. What’s one more ad hoc profession under their hat, like a secretary? But the situation is more insidious than the ostensible. Beneath the unspectacular scenario of teachers being adaptable and taking on a task which the school needs, is revealed a more problematic situation where a legitimate administrative staff on board at a school in the form of a secretary would do so much to prevent teachers from having to stretch themselves thin. It would be one thing if no schools had secretary, or even if the Ministry felt that no schools should have any. At least then plausible deniability would be a legitimate defence. But that seems not to be the case. The Education Ministry’s Public Relations Officer, Suelle Williams explained that a policy for secretaries in schools was being drafted this year and would be released later in 2014. Asked what happens in the interim, 19

Williams directed me to speak with the Ministry’s Human Resource Officer Jacqueline Simon but pointed out that as it stands the Ministry sees the importance of secretaries in schools and ensures that every A-Grade school has one. Having called several schools, Stella Maris Primary – A grade with no secretary; West Ruimveldt Primary – A Grade with no secretary, North Georgetown Primary – A Grade with no secretary; Winfer Gardens Primary – A Grade with no secretary, the Ministry was not fulfilling its own stance. Ms Simon and Permanent Secretary Delma Need have been unavailable to calls, visits and e-mails. Chief Education Officer – Mr Olato Sam was also elusive as was Principal Education Officer – Baydewan Rambarran Even an impromptu to the Minister of Education eventually proved futile – she was not in the office. It seemed as if my digging had reached an impasse, an impasse which proved ironic considering the subject under investigation. For the truly egregious thing in the almost month long quest to get someone – other than the Public Relations Officer – on record to discuss the absence of secretaries in public schools the only ministry officials I happened to make direct contact with were secretaries. It gave a semblance of a ministry where secretaries were playing an integral role. And this is not an unusual thing, for in a 2011 study in corporate offices 60% of workers found secretaries more important than bosses. The public system isn’t quite equitable with the corporate world but the thrust of the study seems sounds – secretaries are important, they perform invaluable duties. The Ministry of Education’s own office seemed to depend on them. Yet, in more cases than not, Head Teachers in schools were being robbed of that assistance. Earlier in this year, whilst discussing issues affecting teachers in Guyana with INSIGHT, Lance Baptiste of the Guyana Teachers’ Union mentioned lack of secretaries in some schools. In decades gone by schools would have floating teachers. When schools have an excess of teachers those with no fixed class would float around from class to class if teachers www.insightgy.com

in a level would be absent. Oftentimes, though, with no secretary at their disposal the Head Teacher could use this teacher as an informal secretary giving her time to focus on her own administrative duties. Floating teachers are a thing of the past, though. It is rare for a school to be allowed more teachers than for teaching. And with no teachers to spare the makeshift secretary is not an option. Instead schools and staff must survive with what is available to them. Nature abhors a vacuum and the fact that schools have not imploded from the lack of secretaries might suggest an issue not worthy of much attention. But the question at hand is not so much can schools function without secretaries as it seems to be should schools be forced to function without them. Based on the fact that so many schools were without them, it was clear the placement of secretaries in schools was not an issue which the Ministry of Education considered exigent. In its way, though, the situation seemed to represent a microcosm of the education system in the country.

The absence of secretaries in schools seemed one where the efficacy allowed of others industry was one which was unavailable for school. The necessity of the secretary for top officials in other fields, seems a luxury provided to only some Head Teachers. For if every Dean at University of

Guyana, every top official in a public ministry, every major businessman in an organisation was entitled to a secretary, why not the head teachers? If secretaries are so essential why are so many schools being forced to function without them?

Caribbean Tribute to

A.J. Seymour

Arthur James (A.J) Seymour

John Agard

Vanda Radzic

Grace Nichols

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By Wesley Gibbings

ribute continues to be paid to iconic Guyanese writer Arthur James (A.J.) Seymour more than 25 years after his death on Christmas Day in 1989. Guyanese home and abroad had remembered his 100th birthday in January and, in April, Trinidad and Tobago’s leading literary festival, Bocas Lit Fest, recognised the prolific poet and publisher whose work in both capacities greatly assisted in lifting the status of Guyanese literature. The April 26 event was attended by writers, journalists and lovers of literature and featured readings by some of Guyana’s accomplished writers. Kyk-Over-Al co-editor, Vanda Radzic, paid high tribute to the founder of the literary journal and suggested that his work as its first editor had done much to promote the literary careers of persons such as Wilson Harris, Martin Carter and Nobel Laureate Derek Walcott. Kyk-Over-Al was founded in 1945 by Seymour. It was known as a prestigious and prolific publisher of known and little-known writers. In 16 years, 50 editions of the journal were produced. Seymour, a graduate of Queen’s College, had over 10 collections of poems to his name. These include his first collection Verse in 1937; More Poems in 1940 and the acclaimed Over Guiana, Clouds in 1944. Suns In My Blood was published in 1945 and Leaves from the Tree in 1951. Selected Poems was published in 1965 and Patterns in 1970. This was followed by My Lovely Native Land the following year in 1971 and Selected Poems in 1983. AJS at 70 was published in 1984 in time for the poet’s birthday and was edited by Ian McDonald. Collected Poems 1937-1989 was published posthumously in 2000 and was edited by McDonald and J. de Weever. It is now out of print. Seymour was lso responsible for the publication of An Anthology of Guianese www.insightgy.com

Poetry in 1954, The Kyk-Over-Al Anthology of West Indian Poetry which was first published in 1952, and the Miniature Poets Series (1951–53) of pamphlets, which included work by Martin Carter, Wilson Harris, and Ivan Van Sertima along with other Caribbean writers. Radzic took to Trinidad prized early copies of Kyk together with reprints published by The Caribbean Press. At the April event, there were readings from some of Seymour’s work by Guyanese writers Grace Nichols, John Agard, Malika Booker and Yaphet Jackman. Overseas’ based journalist/ critic Gaiutra Bahadur and Guyanese diplomat, Dr Riyad Insanally, who heads the Organisation of American States (OAS) office in Port of Spain, also read some of Seymour’s poems. Radzic’s declared that Seymour was a “key figure not just for Guyanese writing, but for the Caribbean as well.” The Seymour flag flew high in Port of Spain at the Bocas Lit Fest.

The Health & Wellness Challenge

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Wellness

A New Paradigm By Geoffrey Frankson MBBS, MA(Oxon)

The challenge for modern health care providers is to influence lifestyle decisions in a positive direction without compromising freedom of choice.

he outstanding challenge to the architects of a modern health care system is the change in patterns of disease and disability that has taken place over the last fifty years or so. In all, except the least developed societies, people are living longer (largely due to a decreased likelihood of premature death from acute, infectious disease, accidents or violence) and modernising their lifestyles to include: 1) a higher energy intake - primarily from animal fats, oils and simple carbohydrates, 2) less physical exertion - especially less walking and less manual work, and 3)

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more stress - rooted in rapid rates of change in the social environment. Modern patterns of morbidity are a direct result of these lifestyle changes, and the medical and social consequences are a high and growing prevalence of obesity, type II diabetes mellitus, certain types of cancer, hypertension, cardiovascular diseases, venereal diseases, substance abuse, domestic violence, accidents and social displacement. Among the elderly, even when they have escaped serious illness, modern lifestyles are leading to a lower quality of well-being, largely due to poor physical strength and a reduced role in the social and economic life of 24

the society. Lifestyle, then, has become the main determinant of the well-being of the people. Social and economic progress has led to greater freedom of choice for communities, families and individuals, and ultimately, it is choices about the physical and social environment, the food supply and opportunities for exercise and relaxation that will determine the standard of health that the population enjoys. Left to their own devices, people are inclined to drift in a negative direction where their personal health habits are concerned. Instinctively - and perhaps genetically - they seek to maximise energy intake and minimise energy output. They strive for advantage in social relationships, and look for short-term rewards in their economic practices. Strong “traditional” value systems counter these tendencies by guiding – and even restricting - personal choice. Freedom from such traditional constraints in modern society leads to poor decision-making and consequently, lower standards of health and well-being compounded by weak social support. The challenge for modern health care providers is to influence lifestyle decisions in a positive direction without compromising freedom of choice. They have to find ways to induce people to strive for higher standards of health at the personal and community level; in other words, to replace “survival” values with “growth” values. Higher standards of health require efforts that incorporate, but go well beyond preventative measures such as hygiene and immunisation, protective measures such as public health and safety regulations, and medical measures such as early detection and better treatment of disease. It requires that individuals, whether or not they are free from disease and disability, seek to be properly nourished, physically leaner and stronger, better balanced socially and emotionally, and personally happier and more productive. The prevailing “health system” is entirely inappropriate for this challenge, based as it is on www.insightgy.com

a paradigm in which people will presumably be healthier if their problems can be solved by experts and bureaucrats; that is, if their diseases are properly treated, their food supply secure, the laws regulating their lives enforced, and their cultural and recreational facilities constructed. It continues to place more responsibility on the system than on the individual, hence the prevailing attempt to improve the system by shifting the emphasis to primary health care while leaving the paradigm intact. An appropriate health system would have an entirely different emphasis. It would be centred on health promotion for all rather than on medical treatment for the sick, social support for the displaced and welfare for the indigent. This is a different paradigm from the foregoing since this system is predicated on personal responsibility and holds â&#x20AC;&#x153;careâ&#x20AC;? of any kind to be a means to an end rather than an end in itself. Success is measured with indices of wellness, and the measurements take place, not in institutions or health care centres but in communities.

In such a system, the economics of health goes beyond a reactive search for funds to treat problems to a proactive investment of funds in healthinducing activities. While the avoidance of suffering has had and will always have the highest priority when it comes to the apportioning of funds in the national budget, it is important to note that, in the modern era, such expenditure is not a means to higher standards of health for a whole population. Indeed, if it leads to reduced expenditure on genuine healthpromoting activities, it will be self-defeating in the long term.

Nursing

More Than a Career By Andrew Kendall

“I’m there to advocate for the patient who comes in and isn’t sure what’s wrong but needs medical attention. And I have to help the doctor get the patient’s trust and make sure everything goes right between the two.”

hen Teona Green was 12, she spent some time with her grandmother who was hypertensive. Her grandmother lived in Spareendaam and demanded regular checkups from a nearby clinic. Insight Volume 2 Edition 3

Each morning Teona would take her grandmother to the health centre located in Plaisance a few villages away. They’d arrive two hours before the doors opened, the wait was often tedious. Teona remembers turning to 26

her grandmother during these tedious minutes and observing the focus she had on maintaining her health despite the challenges faced. In these moments she thought, “When I grow up, I’m going to be a nurse so Granny never has to get up at www.insightgy.com

society where the perception of nurses is vastly incorrect. “People have this view that nurses are just doctors’ handmaids. They fix the bed, change the bed pans and that’s it. But, that’s not it.”’

She recounts her day:

4:00 in the morning for a check-up.” Teona Green became a registered nurse in February 2010 at age 24. Like many persons who decide on their career very young, Teona says her interest in nursing is sincere and unwavering, although her immediate attraction was borne out of fidelity for her grandmother’s plight. For Teona, nursing is essentially a job about making a connection with people. She likened herself to the middleman operating between the doctor and the patient ensuring that both parties are satisfied. “I’m there to advocate for the patient who comes in and isn’t sure what’s wrong but needs medical attention. And I have to help the doctor get the patient’s trust and make sure everything goes right between the two.” Teona admits that oftentimes she must perform these duties in a Insight Volume 2 Edition 3

“I get into the hospital about 7:00.” She works the evening shift at the recently constructed surgical block at the Georgetown Public Hospital. “I’m a Night Nurse, you know.” She croons a bit of the Gregory Isaac’s song of the same name. “For some reason, I just prefer working in the evenings.” When she comes in at night, her job entails ensuring that everything is ready for the doctors’ rounds. This includes ensuring all documents and charts are in place and patients are being monitored. Teona, the nurse manager/ night supervisor, is in charge of overseeing nurses, younger and older than her, sometimes up to twelve nurses per shift. She doesn’t find managing older nurses a problem. “Once you treat your co-workers with respect and understanding they’re willing to cooperate with you, it doesn’t matter if they’re younger or older than you. I observe them, see what their strengths and weaknesses are and make use of that.” Teona admits the greatest challenge in dealing with her fellow nurses is motivating them and keeping them assured that their contributions to the health sector don’t go unnoticed. “It’s not just about remuneration. In a way it’d be impossible to put a number to the amount of patience and work that goes 27

into a nurse’s work every day. But even just a consistent show of appreciation for us to know that our work has not gone unnoticed would be great.” Communicating with relatives of patients who passed away while in the care of the hospital is a challenge. Teona tells us that unless in an emergency case, nurses are given the task of informing relatives about deaths. “It’s the hardest part of the job,” she admits. There’s the issue of ensuring relatives in their grief don’t act out emotionally, and even physically. But sometimes it’s as hard on the nurses when they lose a patient. “Remember we are the first person the patient meets when they come into the hospital and we have a closer relationship with them than doctors.” She recalls in particular losing a particular patient once a couple years ago, a death she found difficult to handle. “It’s difficult not to get attached to patients whom we see often. When they die it’s losing someone you know.” These occasional challenges don’t deter her from her adamant focus. She grins as she speaks of her plans for the future, “I don’t want to leave nursing. I want to get my PhD in Nurse’s Education and I want to get as far as I can in this profession.” Even now she’s doing more than just her nightly shifts at the hospital. She’s a part time Nursing Clinical Instructor at the Georgetown School of Nursing and the Chair on the Guyana Nurse’s Association Education Committee. Her grandmother wasn’t alive in 2013 when Teona graduated from the University of Guyana with her Degree in nursing. She died in 2010, a few months after Teona became a registered nurse. She did get the chance to help her with her illness in her final days after she suffered from Cerebral Vascular Accident (a stroke). And from a desire to make her grandmother’s life easier Teona has become a woman who loves her profession and values the chance to make connections with her patients. She’s a reminder that when we think of hospitals, it’s not the just the doctors helping us get better. www.insightgy.com

Nursing Education Ensuring Fitness for Purpose By Gwendolin Tross

The actual steps in the Nursing Process are Assessment, Analysis, Nursing Diagnosis, Planning, Implementation and Evaluation. It comprises theory, practice and research....

tudents who are admitted to the schools of nursing must successfully pass five [ 5 ] subjects at the CXC [CSEC] General Proficiency Examinations grades 1,11 or 111, or GCE O level grades A B and C at one sitting, which must include English Language, Mathematics and one science subject. It is therefore reasonable to assume that these students will be able to cope satisfactorily with a program of nursing studies. The failure rate of students has been alarming across all schools of nursing since the introduction of a new curriculum. This raises many questions, which need to be addressed as a matter of urgency if nursing is to fulfil its mandate and responsibility to clients and patients at various levels of the health care system. One is cognisant of the many challenges faced by those who are responsible for providing a climate that is conducive to teaching, learning and practice. Nevertheless, there needs to be concerted effort to ensure that our nurses are fit for purpose. We are only effective in the field of Nursing Service if our educational preparation addresses the reality of complex multi-systems of health care. Education is the key to the development of excellence in Nursing Practice. The discipline of Nursing has emerged from the needs of an ever-changing society and is a unique interrelationship of art and science. It is a service oriented profession that finds expression in clinical practice.

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Essential to any practice is the theory which supports it. Theory involves intellectual functions and comprises facts, principles, and concepts that are arranged to show their interrelatedness. Two crucial issues need to be considered when planning Nursing Education 1] An understanding of the nature of nursing which has consequences for the value placed on different subjects in the curriculum, and how they are assessed and 28

2] An understanding of what constitutes Nursing knowledge, whether it comes from the Nursing Process or Nursing Models of which there are many. The Nursing process is used extensively as one of the core concepts in Nursing Education as it provides a method of approaching patient care. The actual steps in the Nursing Process are Assessment, Analysis, Nursing Diagnosis, Planning, Implementation and Evaluation. It comprises theory, practice and research, and is based www.insightgy.com

on the individual needs of the patient rather than on routine care. The use of the Nursing Process in decision making situations contributes to efficiency and accuracy. The question is what presently guides Nursing Practice? There are a number of frequently asked question. For example, what is the role of the nurse? How is the role defined? Very often role is defined in terms of functions such as taking temperature, blood pressure and bathing patients. This is a limited view, however, since it dictates specifics rather than viewing the role from a broader perspective. The nurse is responsible for many aspects of patient care for example, that of advocate, teacher, manager and more. Role elements differ from nursing functions, which can change from setting to setting. Education for a practice based profession such as nursing prepares students to undertake a responsible role that is defined by law, and thus have an obligation to produce a competent practitioner. The curriculum currently in use has been adapted to reflect a Caribbean approach to standards of Nursing Education and Nursing Practice. When fundamental changes are adapted, the programme should be piloted before being implemented fully, or subjected to evaluation at regular intervals. Curriculum planning in Nurse Education is dynamic rather than static. Students should be allowed to evaluate the program in terms of its content delivery, clinical experiences and assessments. If no account is taken of studentsâ&#x20AC;&#x2122; perspectives there can be

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no real change. Assessments should be continuous and test the different levels of knowledge. Assessment strategies should be congruent with the curriculum philosophy, aims, teaching strategies and intended outcomes. Nursing Practice is a key component of any setting, be it in the home, primary health care setting or the hospital. The increase in student numbers despite reduced bed capacity in the Tertiary Institution where students are expected to be exposed to a variety of clinical experiences, create frustration and disillusionment for both students and nurse managers. The lack of basic resources and clinical supervision compounds the problem. There is need for clinical instructors who are experientially and academically prepared in current nursing practice. There should be a skills laboratory where students can become familiar with procedures which they may not have had the opportunity to witness on the clinical areas. There should be evaluation of studentsâ&#x20AC;&#x2122; performance in relation to stated objectives after each clinical placement. Results of which should be shared with the school of nursing so that deficiencies could be identified and remedial steps put in place. It is important for Nurse Educators and Nurse Managers to collaborate if progress in the delivery of health care is to be realised. There is need for Procedure Manuals which should include general and specific care plans to give guidance to clinical staff and students. Ward meetings to prioritise and plan patient care using the Nursing process

should be encouraged. There should be careful documentation of care plans and their execution. Careful documentation becomes necessary in cases of litigation. As health systems reform and change and as Nursing Practice develops, the challenge of nursing Education is to respond to the changes. Nurse Tutors need to seek assistance in developing strategies for coping with large classes. There should be collaboration and coordination, not competition. What is also needed within the school of nursing is an organisational chart to determine lines of communication. In addition we need nurse leaders at all levels of the Health care system, who can articulate the value of Nurse Education and Practice, and are proactive in seeking opportunities for the development of nursing as a profession. Challenges for nursing in Guyana are many. The profession is faced with the ongoing dilemma of trying to provide quality nursing care with scarce resources. Despite these challenges however, nurses providing direct care must continually demonstrate by their actions, compassion, concern, commitment and competence, if they are to convince clients, patients and the general public, that they are fit for purpose. Prepared by Gwendolin Tross, SRN, RM, CERT ADVANCED NURSING EDUCATION, DPA, MCH. Founder, former Coordinator of the Bsc Nursing Program, University of Guyana.

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Converting Nursing Education to Better Practice

ursing Education in the Caribbean has generally followed International trends. Theoretically, the region has been meeting all the international standards. Our locally-trained nurses leave and work all over the world and are commended for their high performance. Nursing is a profession. Why then do we get the kinds of complaints we do about the nurse in the public hospital setting? Some of the most common complaints we get from patients, relatives and administrators are talking in a rough manner to patients and their relatives, not preparing patients adequately before procedures are performed, ignoring patients’ requests and poor communication skills. In theory, nurses are taught to address all of these problems. The question thus arises as to the reasons behind the behaviours exhibited. For one, nurses are members of our societies. They emerge out of the dynamics of local and national communities. But, in Trinidad and Tobago, for instance, we appear to have problems treating our own people with respect. Look at our families. Many treat each other worse than strangers. We kill our own relatives. Nurses who work in the public system, however treat patients in the public setting differently than those in a private setting. Is this because they know they would be either disciplined or fired for ill treating patients in a private setting? Communication skills are a part of the curriculum which seems to disappear in the public setting. The importance of respecting each individual can never be emphasised enough. Some contend that the difference in treatment extended to patients by Caribbean nurses in overseas settings suggests a belief that foreigners are in some way “better”.

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By Vanda Gomes

Are we still fighting with colonial issues? There is also an apparent view that the elderly and poor people don’t know anything and should be treated differently. Isn’t this a reflection of how society should think about and treat the elderly and the poor? Over the years, low nurses’ salaries, a lack of tools to work with and poor working conditions have been identified parts of the problem. These are valid reasons for job dissatisfaction but it should not influence attitudes and the quality of care administered to those who need it. At entrant interviews, most nursing candidates applying say that they want to help people or that they always wanted to be nurses. How do we know if they really want to help or know what it means to help those who cannot do things for themselves? Perhaps, it is that we should look at restructuring the recruitment procedure to identify those with the requisite personalities and attitudes who are better suited to the profession. There has also been the claim in Trinidad and Tobago and other territories that many nurses are recruited only because they knew someone, usually a politician, who provides them with introductory letters. There is a contention that such an introduction has become a principal criterion for entry. Over the years this changed somewhat, but it still has some influence in acceptance process. 30

Academic qualifications (CXC and CAPE) are important for understanding and equipping the student to pass exams. But just as important is the ability to show compassion and to foster relationships with relatives and patients. These issues are contentious and subject to debate. However, it is time the region begin examining ways in which the sound theory extended during periods of nursing education can convert to more professional practice and conduct. As it is, we appear to be training for export. It is clear that more needs to be done to keep our nurses home, so our populations can benefit from what is high quality training, whatever its shortcomings. Better remuneration packages, modern tools to work with and overall better workplace conditions are healthy places to start. The main training needs are all captured under the umbrella of individual behaviour, the integrity of training institutions and the commitment of the political directorate. Only then will we see the high standards of nursing care we desire and deserve. Vanda Gomes is a former nursing educator in Trinidad and Tobago and is a registered nurse and midwife. She is currently pursuing a Masters in Education (Health Promotion) and is the holder of a Diploma in Education and Certificate in Public Administration. www.insightgy.com

The Maternity Challenge By Mark McGowan

The maternal mortality rate refers to the number of female deaths as a result of pregnancy or its management per 10,000 live births per year. It would include deaths that occur during pregnancy, childbirth or within 42 hours of a pregnancy that had been terminated.

n the early morning hours of June 4 2013, 28-year-old Luan Rodney, pregnant with her second child, died at the Georgetown Public Hospital. This was a few hours after she had been administered the labour inducing drug Cytotec. An autopsy

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revealed that her uterus had ruptured, resulting in her bleeding profusely before she died from hemorrhagic shock. Her baby also died. Investigations into the incident revealed that two doctors, in addition to at least two nurses, were culpable since they demonstrated gross negligence and mismanagement. Press reports suggest that Rodney had developed complications because she had not been properly monitored and emergency medical interventions had not been rendered in a timely manner. Sadly the incident above is not an isolated case. Over the past few years, the local media have, with alarming frequency, highlighted cases where mothers, and sometimes even their babies, die during or just after childbirth. These incidents signal a worrying trend within our local healthcare system and recently released reports on the maternal mortality ratio confirm that all is not well in this sector. The maternal mortality rate refers to the number of female deaths as a result of pregnancy or its management per 10,000 live births per year. It would include deaths that occur during pregnancy, childbirth or within 42 hours of a pregnancy that had been terminated. According to a recent report â&#x20AC;&#x153;Trends in Maternal Mortality Estimates 1990 to 2013â&#x20AC;? produced by the World Health Organisation (WHO), UNICEF, UNFPA, The World Bank and the United Nations Population Division, www.insightgy.com

Guyana is among five territories in the Caribbean and Americas with the highest rates of maternal mortality. This is ranking second after Haiti. Guyana, according to the report, records 250 deaths every 100,000 live births. The report also notes that Guyana is one of six territories where the rate increased between 1990 and 2013. The report said too it is unlikely that any country in the region would meet the Millennium Development Goal (MDG) 5A, which calls for the reduction of the maternal mortality ratio by 75 percent between 1990 and 2015. In short, while current Health Minister Dr Bheri Ramsaran is on record as saying he believes Guyana can make the MDG goal the statistics reveal a different story. Chief Medical Officer Dr Shamdeo Persaud, during an interview with Stabroek News in 2012 indicated that for the period 2009-2010, there had been more than 40 accumulated maternal deaths. And according to figures released by the Ministry of Health, the maternal deaths in 2011, 2012 and 2013 were 14, 25 and 18 respectively- figures which indicate the difficulties in reducing or even stabilising the numbers of these unwanted deaths. Following the apparent upsurge in high profile maternity deaths in 2010, which saw eight women dying while giving birth at public hospitals between September and November, Cabinet Secretary Dr. Roger Luncheon had indicated that the then Health Minister Dr Leslie Ramsammy and his junior counterpart Dr Bheri Ramsaran had been severely criticised for their poor record keeping on the various incidents. A Cabinet sub-committee on health was also established to investigate these incidents. However, not much appeared to come out of this

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initiative, for major challenges seem to persist in curbing the incidence of preventable maternal deaths. Yet, the country’s Chief Medical Officer is on record as saying that the experiences gained from the earlier maternal deaths during the 2010-2012 period had been taken on board by the health sector in an attempt to avoid such occurrences. Dr Persaud’s contention was that many of the country’s maternal deaths were caused by hypertension and eclampsia and as such more could and should be done for expectant mothers in the home and in the communities. He did admit, however, that improvements could be made in managing hypertension during delivery. Speaking about the need to educate women about their gestational period, Dr Persaud said that often women who had given birth to children before without complications, feel it will always be the case and ignore the necessary procedures until it is too late. On the other hand, Dr. Persaud, in that 2012 interview with the Stabroek News, said that the attitudes of nurses were a problem noting that

many expectant mothers complain about this. This, he said, was probably due to the lack of supervision of junior nurses. To curb this, he said more than two senior nurses should be on duty at any one time so as to ensure that issues that arise are addressed in a proper manner. This, in itself, speaks to the need for adequate training of personnel- doctors included. The horror stories alleging neglect, carelessness and malpractice amplify the need for such training. Recently Guyana’s current Health Minister Dr Ramsaran insisted that maternal health is a priority and said that new mechanisms are in place to investigate every maternal death even as the health sector strives to minimise these numbers. “Every death is one too [many] and we are working to bring the number of maternal deaths to zero,” he says. Only time will tell how much progress we make as a nation in this area. The challenges are real and the nation needs to see the Ministry of Health successfully overcome them sooner rather than later.

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The Challenge

of Early Childhood Development

he highly specialised structure of our government into separate technical ministries is not always well suited to serving needs that require collaboration from several disciplines. Early childhood development (ECD) is one of these areas. More and more, data show that a child’s prospects in life are considerably limited if not substantially determined in what is loosely called The First 1,000 Days, or roughly the period of pregnancy and the first two years of a child’s life. Some stretch the period for a further six months to the first 30 months. Needless to say, it is the poor who are most affected. Insufficient pre-natal care, insufficient nutrition, inadequate or inappropriate emotional stimuli all result in permanent harm to the child’s physical, mental and emotional growth. And the net result is long term disadvantage of income earning. There are programmes that suggest that intervention costing less than US$1.50 per child can have

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By Dr Fred Nunes

a radical impact in reversing this intergenerational aspect of poverty. The challenge is that to make these interventions work, we have to design programmes or work with NGOs who will function across typically separate domains – health, education, and social welfare even agriculture. Although the problem manifests itself as one of poverty, the real learning has been that mere cash transfers do not have the impact of more integrated programmes. But before trying to design a programme, let us first understand the science on which it is built. Child development starts very early, well before pre-school, indeed, even before birth. The sensory pathways in our brains that determine our capacities in adult life, form and begin to develop in the last trimester. While still low at birth, the pathways for vision and hearing develop exceedingly rapidly in the first month, peak in about the fifth month and then new pathways are added far more slowly and fall to being quite low by month 18. Similarly, the pathways for 33

language in a child’s brain are quickly laid out in the first six months, peak by the 10th month and then additional pathways are added far more slowly. The same is true for our higher cognitive function, same pattern: a steep rise to a peak at about month 14 and then a steep decline of additional pathways to a much lower rate of growth by the 26th month. [See Chart 1] There is no escaping the importance of optimising this incredible period of brain development in early childhood. There will never be another period like this in the child’s life. It is in this period that the economic and cultural differences within our society set our children on very different paths. If we truly want to create a level playing field, this is where public policy has an important role to play. If we take this logic seriously, we would realise our highest returns to human capital by investing most at the beginning and must less later on. [See Chart 2] My hunch is that if we were to plot our investment it would almost www.insightgy.com

be the mirror opposite of this line, being very low in early years (birth to 3 years), still very low in pre-school and then much higher for high school and college. If this is correct, we are investing far too late, long after the opportunity for highest returns has passed. What would such a programme look like? Actually, given the network of health personnel, especially Community Health Workers (CHWs), Guyana is well placed to deliver an appropriate ECD programme. Patrick Premand*, suggests that such a programme would have four components (a) Protection, (b) Nutrition (c) Health and (d) Psychosocial stimulation. Protection would include family planning and pre-natal care, birth and child registration, guidance in child rearing, discipline, punishment and conflict management. Clearly, there would be a real role for Social Welfare and Child Protection officers. Nutrition would involve exclusive breastfeeding, complimentary feeding, recognising malnutrition, Vitamin A supplementation, deworming and iron absorption. Obviously, there would be a real opportunity for Agricultural Extension Officers to advise on what foods are best suited for what nutrition – and how those foods should be prepared. Health involves vaccination, educating parents to act promptly at the first sign of disease, providing guidance on hygiene, sanitation and hand-washing. This would be a central role for CHWs and their link to Health Centres. Psycho-Social Stimulation is undoubtedly the most challenging set. Like the others, this arena involves change in behaviour; but this one is more challenging culturally. Getting parents to speak with their children long before they have language. These are not traditional services in the public sector, yet as we see in Chart 1, they are critical. This involves language stimulation, stimulation through play, getting the child ready for school, psycho-social development of the child (attachment, separation, managing his/her moods – excitement frustration, etc.), helping the parents to understand Insight Volume 2 Edition 3

child development and to manage the child’s sleep. I would imagine that Child Welfare would have all these skills. I am unaware of how instrumentally they are employed in positive service to families. This is not mere theory. Programmes with some of these components have been implemented in Jamaica, Colombia, Nicaragua, Chile, Bangladesh and Niger. Visits of as little as 2.5 hours per week with a trained educator that cost $100 per month have led to claims of income increases of 42% in adulthood. In some instances the programmes are delivered through NGOs. This is pretty persuasive stuff. But it requires a radical shift in how we

make public investment decisions. And the primary beneficiaries will be the poor. So we know full well this won’t happen. We will continue to spend public funds so that they support those who already have power and privilege. In all likelihood, we will ignore the data and continue to use public funds to provide welfare for the middle and upper classes. Patrick Premand, a World Bank staff member in the Global Practice for Social Protection and Labour. He made a presentation, “Linkages between SPL and ECD” to the SPL Learning Event in Istanbul, in April 2014. The two charts attached are from that presentation.

Chart 1 Chart 1

Chart 2

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Latin America declares war

On Junk Food in a Bid to Tackle Obesity By Louisa Reynolds

“This is a pandemic. It’s not a problem that we’re going to face in the future; we’re already in the midst of a public health crisis. - Enrique Jacoby, a Pan-American Health Organisation

(PHO) advisor on obesity.

atin America and the Caribbean face a cruel food paradox. In a region where 47 million people go hungry, 23% of the adult population and 7% of pre-schoolers are overweight or obese, one of the shocking statistics highlighted in a report published last year by the Food and Agriculture Organisation (FAO). As the obesity level grows, though, arguments over whether “fat” necessarily equals to “unhealthy” become louder and louder. The relationship between health and bodyweight has always been hotbutton, but as the weight crisis grows in the Caribbean it has reached cacophonous heights. Our waistline is expanding and four Caribbean nations – St Kitts and Nevis, Belize, the Bahamas and Barbados - are among the top five countries with the highest prevalence of obesity in adults aged over 20. St Kitts and Nevis reports the most worrying figures, with 41% of all adults over 20 suffering from obesity, nearly twice the Latin American average (23%). Mexico ranks fourth on the list, with 33% of its adult population over 20 classified as obese, a total of 60 million people, more than the entire population of Central America. Among the South American countries with above average levels of obesity are Venezuela (31%), Chile and Argentina (29%). Latin America’s alarming

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obesity figures are consistent with those reported by other developing countries, reveals a study published by the UK’s Institute for Overseas Development (ODI). Today, one in three people across the globe are fat and in the developed world alone, a staggering 904 million people are obese, compared to 250 million in 1980. The problem is particularly severe in middle income countries such as Mexico and Egypt, where the population’s purchasing power has risen, and so has its intake of meat and other fatty foods. Coupled

“Natural foods such as vegetables, pulses, cereals, fruits, and chicken are being replaced by snacks and sodas...” with a more sedentary lifestyle as the expanding middle class abandons public transportation in favour of vehicles, the result is an increasingly unhealthy lifestyle that has led to a rise in cancer, diabetes and heart disease, and is already placing a heavy strain on public health services. “This is a pandemic. It’s not a problem that we’re going to face in the future; we’re already in the midst of a public health crisis. Look at Mexico; diabetes has increased exponentially 35

due to the excessive consumption of sugar and in ten years’ time that will drive its public health system to bankruptcy”, says Enrique Jacoby, a Pan-American Health Organisation (PHO) advisor on obesity. Jacoby puts the blame squarely on a growing fast food industry with an aggressive marketing strategy that has targeted a particularly vulnerable group: children. “Natural foods such as vegetables, pulses, cereals, fruits, and chicken are being replaced by snacks and sodas. Opening a packet of Doritos is certainly more convenient than preparing a plate of rice and beans, especially when people lead a busy lifestyle and don’t have time to cook but that convenience is like a Trojan horse that ushers in huge amounts of sugar, fat and salt, the number one cause of the illnesses that we are suffering from today, including obesity”, says Jacoby. The global obesity epidemic has set alarm bells ringing. The good news, though, is that the region’s governments are taking the issue seriously and are not afraid of imposing more stringent regulations on product labeling and fast food advertising. In Chile, new legislation that comes into effect this year will force food producers to place clear warning labels on their products if they contain high levels of sugar, calories or fat, similar to the health warnings that www.insightgy.com

tobacco companies are required to place on cigarette packets. Junk food advertising that targets children will also be outlawed. In November 2013, Ecuador also imposed mandatory food labeling using a traffic light system, where levels of potentially harmful ingredients are marked as red, yellow or green. Peru, Uruguay and Costa Rica have banned junk food from school canteens. “Banning junk food from schools is very good but it’s also important to educate children about healthy eating habits. Brazil, for example, has introduced vegetable patches in schools so that children can learn about how tomatoes and other vegetables are grown and also about their nutritional value”, says nutritionist María José Coloma, one of the authors of the FAO report. Meanwhile, the Mexican authorities have approved a one peso tax (about US$0.08) on each liter of soda, have built cycle paths and have opened free gyms in Mexico City’s slums as part of a plan to help Mexicans to shape up and get fit. Latin American governments have proven to be far more successful in terms of taking on soda manufacturers and fast food companies than developed countries such as the U.S., where the almighty junk food lobby has managed to block many attempts to impose tougher regulations on the industry. In New York, for example, the courts scuppered former mayor Michael Bloomberg’s plans to outlaw super-size sodas last year. Coloma argues that it is Insight Volume 2 Edition 3

also important for Latin America and the Caribbean to return to ancestral cooking and teach the new generations to relish beans and tortillas or a plate of quinoa, rather than burgers and fries. “We need to return to our ancestors’ eating habits. That needs to be taught at school; the advantage of schools is that you can reach out to the parents and get the whole community involved. Local produce is important; parents and children need to start cooking together because that has been lost”, says Coloma. Some researchers, however, believe we have been the victims of scaremongering and argue that being overweight and even obese does not necessarily lead to heart disease, diabetes and other life-threatening diseases. “Lifestyle manners are far more important than weight. A heavy person with a body mass index that falls under the overweight or obese range but who is very physically active and eats a healthy diet is more likely to have a reduced chance of developing diabetes than someone who is not overweight but who is very sedentary and eats a poor diet”, says professor Glenn Gaesser, director of the Healthy Lifestyles Research Center and the Exercise and Wellness Program at Arizona State University. According to Gaesser, a person’s weight is often determined by genetics rather than by diet or exercise patterns and people whose genetic makeup has made them heavy built will rarely lose a significant amount of weight regardless of whether they swap 36

potato chips for salads or how many hours they spend on the treadmill. Gaesser’s book Big Fat Lies argues that the weight loss industry has fuelled an obsession with thinness and has spread the myth that fat equals unhealthy. “The US and most countries in the world seem to worship a thinner body so the weight loss industry stands to benefit from people who are fat and would like to get thinner. There is a financial consideration with regard to the obesity crisis”, says Gaesser. In his opinion, the World Health Organisation (WHO) has failed to “factor in physical fitness” in its reports and recommendations. Jacoby, however, is adamant that although regular exercise is undoubtedly important, sensible eating habits are the main key to wellbeing. “A burger, a coke and a portion of fries can add up to 1500 calories. To burn no more than 300 calories you need to run for about 40 minutes at a fast pace. We would have to become super athletes in order to burn, process and metabolise all the calories that junk food contains. It makes far more sense to understand this epidemic as the result of an excessive intake of certain substances”, he says. And as weight issues grow to a feverish pitch the question of whether lack of physical fitness or overindulgence in the wrong food is most responsible for the expanding waistlines remains unanswered. And as arguments over what factor is unequivocally responsible continue, humans in the Caribbean, Latin America and around the world grow larger and larger.

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the critical signs

y initial understanding of autism was quite naïve and consisted of recognising that there were differences in children with autism but not exactly knowing what these differences included. As an autism education specialist, I think it is adamantly important to first understand as best as possible what autism is and second how it affects those on the spectrum. Autism was first described in the 1940s by Leo Kanner and, as of 2014, is reported to affect 1 in 50 children in the United States according to the Centres for Disease Control (CDC). The term ‘autism’ is used to describe a neurological difference in brain development, which substantially affects how a person develops. It does not necessarily mean that IQ levels are affected but rather the way in which Insight Volume 2 Edition 3

By Meghan Lee-Waterman

information is processed differs from a typically developing person. There are several different areas where individuals with autism may have difficulty understanding and coping. These areas can be considered particularly essential for parents, school staff and professionals to recognise and comprehend so that proper attention can be given to individuals with autism as they will have individual educational needs to be met within these specific areas. As an educator I tend to spend a lot of time focusing on what support pupils need within an educational setting which can usually be duplicated to fit within a home environment too. Many children will need different levels of support in areas such as the understanding of social interactions and emotional expressions of parents, teachers and peers, the interpretation and use of communication and language - both verbal and non-verbal, the differences in how information is processed. I believe that all of these areas are key principles that all persons working with children on the autism spectrum must be aware of to successfully engage and interact. The area of Social Understanding comprises recognition of a situation and deducing the appropriate reaction to address this. The difficulty with social understanding for children with autism lies within what is called Theory of Mind (ToM) (Baron-Cohen, Leslie and Frith, 1985). 37

The proponents of the ToM theory state that the ability to understand one’s own and others’ minds appears to occur spontaneously in childhood. In autism, however this lack of ability leads to many developmental abnormalities, which are characteristics of the neurological condition. Emotional Regulation is another area where children with autism can have difficulty efficiently comprehending. In order to deduce a child’s ability to emotionally regulate his or her self is to identify the child’s understanding of emotion. This can include decoding gestures, facial expression, tone of voice and body language all of which can sometimes be easily misunderstood by children with autism. There is also the comprehension of basic emotions such as happiness, sadness, anger, fear and socially complex emotions such as surprise, guilt, pride and embarrassment to name a few. Individuals who display a better ability to self-monitor their physiological arousal and emotional state are more able to sustain social interaction, to problem solve, and to communicate effectively. There are two types of emotional regulation, self regulation and mutual regulation. There is a developmental progression from behaviour to language to metacognitive which comprises all necessary steps in identifying solutions www.insightgy.com

in an emotionally demanding situation. The importance of teaching coping strategies for emotional regulation to children with autism, in my opinion, is imperative for caregivers to understand and practice. It can provide necessary solutions to dealing with emotions such as anxiety and anger for example, which children with autism may have difficulty coping with on a daily basis. A key focus for caregivers should be to constantly maintain an awareness of attempts at communication both verbal and non-verbal. We must first deduce where the child is at in terms of their level of communication both through understanding and reciprocity and then we can find ways to meet and successfully engage with the child. It is imperative to establish functional communication that will independently support a child with autism throughout his/her life. There have been a number of successful interventions for children with autism, although it is well worth noting that since autism is a spectrum, what may work for a single child will not necessarily work for all. I have learnt much through trial and error and have found, as recommended by many professionals, that the best way to engage with a child is to use pieces from several interventions and be attentive to what works best. One particular, key principle that is imperative is for caregivers to be aware that children on the autism spectrum usually display different reactions when it comes to flexibility of thoughts and behaviour. Most neurotypical children learn from a young age that they cannot always get what they want in terms of objects, situations and events; they learn that when something does not go the way they hope then they need to adapt and move forward. Children with autism, however, learn and adapt differently and many find great comfort in routine and familiarity of thoughts, actions and behaviours. We, as practitioners, need to be able to recognise the importance of these repetitive patterns of behaviour, interests and activities because for many children with autism these Insight Volume 2 Edition 3

formulate a coping mechanism for dealing with the world and its contents. With each area of difference for children with autism there are both positive and negative effects that are produced by their characteristics. Sometimes the repetitive actions of self-stimulatory behaviour also known as stimming can take the form of rocking, flapping or spinning actions which although they may not always be socially appropriate, allow the child to sometimes increase vestibular stimulation and/or provide a self-regulation calming method when his/her anxieties raise too high. In this instance, this type of repetitive pattern of behaviour can provide a positive outlet for a child to express his/herself and to engage in an enjoyable, nonthreatening activity. On the opposite end however, some restricted and repetitive

behaviours can limit a childâ&#x20AC;&#x2122;s opportunities to successfully engage in learning and experiencing activities which could be beneficial to them in the future such as learning life skills. Other times, their behaviours could be self-injurious, have an effect on their moods and temper and sometimes lead to bullying from peers. It can be challenging for caregivers to work with a child who has difficulties with thinking and behaving flexibly, as a child on the autism spectrum can experience high stress levels when they cannot predict what will happen next during an activity or throughout the day. This can also lead to trouble with problem-solving skills such as generating strategies and ideas of how to adequately address a situation effectively. My advice to staff would be to 38

take the noted behaviour patterns and consider the long-term acceptability of it in terms of age appropriateness and developmental appropriateness. As previously mentioned, sometimes children with autism have difficulty problem-solving; the role of caregivers can be to assist by introducing different choices and encouraging the child to make decisions in a safe and structured environment such as their classroom. The provision of additional support for children with autism can most often come in the form of structure: this includes during class time unstructured times such as break or lunch and transitioning between activities. To conclude, the four areas of difference for children on the autism spectrum - social and emotional understanding; the use and understanding of speech and non-verbal language to communicate; flexibility of thinking and behaviour; and sensory perception are all core attributes for existence and coping in society. For most of us, these areas are faced quite easily on a daily basis and generally do not affect us to a great extent; we learn what is expected of us in situations without much given thought or emphasis but to children on the autism spectrum day-to-day life can be challenging and they need constant support and guidance. My knowledge and understanding of these particular areas of difference for children on the autism spectrum has increased greatly and they are the key principles on which I would recommend any staff new to autism focus. Each child on the autism spectrum is unique and what may affect one child may not necessarily affect another and the same goes for suggested interventions. In building awareness and learning to better understand these particular areas I believe that persons working with children on the autism spectrum have a better chance in making a difference. Meghan Lee-Waterman is an Autism Education Specialist in Trinidad. www.insightgy.com

Rescue and Recovery

in the Health Care Sector? By Dr Karen Cummings

ystemic analyses of the health sector in Guyana over the last two decades have indicated and identified a myriad of problems and principal aetiologies ranging from and relating to staff, planning, management and financing, to data and quality of care issues; many of these are still to be addressed. Guyana boasts five levels of health care, namely, Level 1- the Health Post; Level 2 –the Health Centre; Level 3 - the District Hospital; Level 4 -the Regional Hospital and Level 5 - a tertiary level institution with specialists, a referral and a teaching hospital. The highly decentralised health care system is made up of the Ministry of Local Government and Regional Development undertaking responsibility for managing, financing and providing health services at the regional level through the Regional Democratic Councils (RDC) and the Regional

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Health Authorities (RHA); whereas the Regional Health Services of the Ministry of Health provides the health workers in the region. Here are a few Paradoxes. Although there has been a constant increase in the allocation of finances to the health sector over the years, attempts made to engage and match financial information with performance indicators have failed to show better management of the health care system, job creation and environmental protection. These allocations are not based on needs assessment. There has been ad hoc planning and crisis management so much so that priority problems are unable to receive the required allocated resources in a timely manner. The inadequate and inexperienced health managers at the regional levels who continue to perform in ways causing them to be reactive rather than proactive, and to engage in minimal 39

monitoring and evaluation of the quality of health services rendered, let alone offer supportive supervision to the varied health teams. We have some problems. There are shortcomings and major faults in Guyana’s Healthcare system. The World Bank Report 2009 addressing concerns such as Nurse Labour and Education Markets in the English Speaking Caricom Issues and Options for Reform, has stated that low staff morale and high levels of demotivation have resulted in recruitment and retention problems of this category of health care workers: in addition to the inadequate remuneration for health workers especially the health workers in the hinterland. The relative shortage of qualified nurse tutors has been a major constraint to the expansion and strengthening of the nursetraining capacity as evident in the pass rate of the recent Nurses examination finals. A large student to tutor ratio, overcrowding, insufficient training materials, and inadequate infrastructure were posited for this dilemma. The primary care system has failed to respond to the increased importance of health promotion and disease prevention. The lack of adequate and necessary tools for physical and technical infrastructure is noted. Society’s ability to reduce inequities, an essential condition for meeting commitments including the United Nations Millennium Declaration and reaching the millennium developmental goals four (4) and five (5) by 2015 appears to be elusive. There is the erection of buildings which are unused, as well as medical equipment such as the ultrasound machine placed at health care facilities as “white elephants” owing to the lack of skilled persons to utilise same. www.insightgy.com

There is the shortage of essential drugs, the untimely distribution and improper storage of drugs and supplies; plus the nonexistence of a Public Procurement Commission to address accountability, transparency and the perception of value for the tax payers’ money. This proposition comes against the backdrop of billion dollar contracts for the purchase of drugs and other supplies for this sector. The party I represent in the National Assembly, A Partnership for National Unity’s (APNU’s) vision of healthcare holds out corrective promises. In order to save this sector, some immediate measures need to be implemented and should include participatory democracy at the community level while strengthening the political dialogue with the help of overseers or supervisors at the local level. As mentioned in our manifesto, the APNU in Government will improve the socio-economic status of health workers, our valuable health resource, by providing a realistic Health Workers Package to include better salaries and remuneration to encourage motivation and enhance retention in order to guarantee a high level of commitment and efficiency. Through capacity building, health workers will be trained in new areas and re-trained with an emphasis on strengthening supervisory skills. APNU will empower public health nurses and the psychiatric nurses with the necessary skills to roll out programs such as the Integrated Management of Childhood Illness (IMCI) and the Integrated Management of Adolescent and Adult Illness (IMAI). APNU will ensure that there is clinical governance which permits the establishment of treatment guidelines and for health professionals to address and solve problems in a multidisciplinary manner. The establishment of clinical mobility innovation will be stressed to allow health care providers to monitor and communicate with patients thus altering the manner in which health care is delivered. Research has shown that the use of mobile technology can be used to track health information and indicators Insight Volume 2 Edition 3

such as weight and glucose levels. It has been posited that clinical mobility drives collaboration, improves health information delivery, healthcare work flow, integrates Healthcare and Lifestyle as well as unfetters patients and physicians. Studies coming out of the Cleveland Clinic have shown that discharged patients when provided with medication consultation via virtual pharmacists resulted in better medication adherence, discharge planning and discharge care coordination. Clinicians are able to use mobile health networks to supplement health- related information offered at the time of discharge and direct them to in-depth disease specific information in an easy- to -understand way. Efforts will be made to look for cost-effective, user-friendly solutions to reduce readmission and improve healthcare outcomes in a bid to reduce costs. The use of this new form of technology to tele-monitor vital sign of ageing patients by video-conferencing with caregivers and virtual interactions with physicians in the different elderly care homes will be explored. There will be the establishment of maternity homes for high risk mothers in every region of Guyana with the necessary equipment and tools to provide for better quality of care for pregnant mothers and to improve and reduce the maternal and neonatal mortality enhancing Guyana’s chances

of reaching the Millennium Goals 4 and 5. The media through the television programs will see more health advertisements to promote healthy lifestyles and longevity. The long awaited Drug Procurement Commission will be established to ensure that the essential drugs are available and there is transparency and accountability for monies spent on the purchase of such commodity. Lastly, APNU will develop a waste management program and plan and will work with local government bodies and the city council to improve the environmental health and sanitation of the citizens. Certainly the “pick it up” campaign will better read “throw it in”. To allay fears, APNU after differentiating the vital from the expedient, and mapping out a new pathway to a better healthcare system to support excellence in healthcare, consideration will then be made for a specialist hospital to attract medical tourists and provide world class health services to its citizens. It is hoped that these improvements and interventions will transform the health system so that all Guyanese can enjoy a Good Life. Dr Karen Cummings is a medical doctor and a Member of Parliament representing A Partnership for National Unity.

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A Viral Stew in the Caribbean By Edward McSweegan with Melissa Monroe

“There is a gap between what scientists know and what the public knows, and journalists are the critical bridge between those groups.”

n late January 2014, dozens of journalists and other media personnel, students, public health officials, and scientists met at St. George’s University in Grenada to talk about the threat of infectious diseases, and how journalists and scientists should communicate with each other and with the public. Organised by the Windward Islands Research and Education Foundation in Grenada and the Institute of Human Virology and the Global Virus Network (GVN) in the U.S., the workshop provided reporters with new information about viruses and the diseases they cause and gave them a chance to speak with scientists about how complex medical information can be delivered to the public in a timely, accurate fashion. That was an important goal because, as one workshop participant noted, “there is a gap between what scientists know and what the public knows, and journalists are the critical bridge between those groups.”

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Why meet in the Caribbean to discuss viruses? The Caribbean represents a diverse population of peoples and unique ecologies, scattered between South and North America, and visited daily by planes and ships from all over the world. People and cargo travel. So do viruses. The most recent example is the sudden appearance of an obscure African virus called “Chikungunya” on the island of St Martin in late 2013. Now it is hopping from island to island, carried about by infected travellers and mosquitoes. AIDS and HTLV Much of the Caribbean and South America has a long history of dealing with deadly yellow fever virus carried by mosquitoes. A more recent viral menace has been AIDS, caused by the Human Immunodeficiency Virus (HIV). The virus is passed from person-toperson, mother-to-child and through shared syringes and body fluids. HIV attacks the body’s immune system, targeting a class of white blood cells 41

called CD4 cells. As those CD4 cells die, the body can no longer fight off other infections and diseases. At the end of 2011, an estimated 230,000 people were living with HIV in the Caribbean and 10,000 people died from AIDS. There are drugs to treat the symptoms of AIDS and other drugs to directly attack the virus, but they are not a cure-all. Researchers still are looking for both a preventive vaccine and a cure. Earlier this year, GVN’s Dr. Robert Gallo said, “I believe the field is close to a functional cure for AIDS, but not a virological cure, or total elimination of HIV from the body. A functional cure refers to an HIV infected person who could keep the virus suppressed with evidence that the person wouldn’t ever need to take antiretroviral drug therapy anymore.” Another virus somewhat like HIV is the Human T-cell Lymphotropic Virus (HTLV-1), which can cause lymphoma (a cancer) and rare neurological diseases such as tropical spastic paraparesis. There is no vaccine or effective treatment for HTLV-1. HTLV1 is transmitted the same way HIV is, but less effectively. Still, across the Caribbean rates of infection may vary from 0.3-7% in the general population, to 5% in HIV-infected persons. A Flying Syringe While viruses that cause cold and flu readily jump from person to person on their own, other viruses responsible for serious illnesses and death often are delivered by the whining sting of a mosquito. One such mosquito is Aedes aegypti, which can be found in www.insightgy.com

tropical and subtropical urban areas. It is considered a dangerous pest because it can transmit serious viral diseases such as dengue, yellow fever and Chikungunya. Yellow fever, once the scourge of the Western Hemisphere, remains endemic to some South and Central American countries and several Caribbean islands. Foreign travelers and residents in high-risk areas rely on the highly effective D17 vaccine to prevent the disease. A more pressing, but less deadly, problem is dengue fever. Also known as ‘breakbone’ fever, dengue is numerically the most important mosquito-borne virus infecting humans, with an estimated 100 million annual cases worldwide. Dengue is characterised by severe headache, skin rash and debilitating muscle and joint pain. The infection occasionally develops into a severe and potentially fatal form called dengue hemorrhagic fever. There are no specific treatments and dengue vaccines are still experimental but early diagnosis and access to proper medical care help keep fatality rates below 1%. An Old Virus in a New Place Similar to dengue and yellow fever, Chikungunya (CHIK) is a viral disease that causes debilitating joint pain, fever, nausea, fatigue and headache. It is rarely fatal, but in the Insight Volume 2 Edition 3

presence of other illnesses, can contribute to complications and death. As with so many of these mosquitoborne viruses there are no specific treatment options and no vaccines to prevent infection in the first place. Chikungunya was first discovered in Tanzania in 1952 and since then has been found in many other African and Asian countries. Huge epidemics have occurred in India, and cases have been imported into Europe through infected travelers. Now the virus has made the long trek across the Atlantic. On 19 December 2013, two confirmed cases of locally acquired chikungunya virus were reported on the French Caribbean island of Martinique. The World Health Organisation announced this was the first time local transmission of CHIK had been detected in the Americas. Since then the virus has spread to a dozen islands. Experts predict the virus eventually will reach the Americas, perhaps joining Dengue on the edges of Florida and the Mexico-Texas border. Not only is CHIK a new virus and new threat to the region, it can be confused with other infections and delay proper treatment. Andre Merits, an Estonian virus expert and member of GVN, recently said, “Clinicians in the region of the Caribbean must be on high alert as CHIK is often mistaken for dengue fever or even malaria. Once we know the genotype [of the virus], we will know more about the efficiency of mosquito transmission, and public health officials can begin to take prevention measures to contain the outbreak.” Prevention and control largely comes down to reducing the number 42

of natural and artificial water-filled habitats that support mosquito breeding. In addition, people should limit their exposure by wearing protective clothing and mosquito repellent. An Old Story Often Repeated Chikungunya is just the latest example of how diseases emerge in new places among vulnerable populations. “Emerging viruses” is a phenomenon that is frequently repeated as people travel and move deeper into forested and tropical environments. Climate change also will allow virus-carrying mosquitoes to push into once colder regions. Passenger jets and cruise ships will transport infected passengers from island to island and nation to nation. National borders are not barriers to infected wildlife and insects, which often carry new viruses into new places. And viruses mutate; last year’s flu vaccine is seldom effective against next year’s flu virus. So the race goes on—us versus the viruses. If we do not want to fall too far behind we must continue to study these emerging viruses, develop new drugs, test new vaccines, and train the next generation of medical researchers. As the Chikungunya virus spreads across the Caribbean we can imagine that the region is a kind of crossroads between Africa and the Americas, and between tropical jungles and modern urban centers; all connected by the new technologies of fast jets and ships that bring together old viruses, hungry mosquitoes, and new peoples. It is an old story that will be repeated in new places. Edward McSweegan, PhD is a program manager at GVN and Melissa Monroe is an intern. For more information about emerging viruses and GVN’s taskforce on chikungunya visit gvn.org or contact emcsweegan@gvn. org. www.insightgy.com

Health Sector

Reflections

uyana’s health sector has transformed over the years bringing Guyanese closer to the goal of being the healthiest nation within the Caribbean. Recognising that the health of the Nation is its wealth, investments were made within the last decade and access to better services in the remotest of areas of Guyana is testimony of this. Let’s start with the life expectancy of Guyanese. Life expectancy has risen from 40 in the 1950s to 61 by 1970 to 67 in 2010 and 70 by 2012. All of this complements the government’s commitment to improve the health of Guyanese. This is evident in its spending over the last decade as Guyana has maintained a trajectory of the health sector receiving the second highest percentage of funds to carry out its mandate annually. In 1991, the health sector received 2 percent of the total National Budget. This has seen a vast increase to 11 % in 2014 per capita investment has increased from US$7 to US$150. In relation to infrastructure improvements, several regions have been provided with new hospitals to aid in their ability to deliver adequate health services. Hospitals were constructed in regions 1, 2, 3, 4, 5, 6, 9 and 10. Additionally, the primary health care system was boosted with

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By Lucy Anderson

the renovation and upgrading of most of the health centres and posts within all of the regions. The personnel capacity has improved with over US$1.6 million being injected annually into training at the undergraduate and postgraduate levels. More than 400 young people have been trained as general medical officers through the Cuban Scholarship Programme. This complements the national programme which is conducted at the University of Guyana, with an average of about 30 graduates per year. Additional to the several upgraded programmes at the University of Guyana, Post Graduate Programmes in Gynaecology, Orthopaedics, Internal Medicine, Paediatrics, emergency medicine, anaesthesiology and surgery have been established and complement efforts to increase the number of health workers and the skills base needed to improve quality of care. Improvement of infrastructure which has resulted in the expansion of services offered not only on the Coast, but most importantly to the hard to reach hinterland communities has also been a significant part of the health sector. These activities have been part of a crafted path that has been articulated in several health sector 43

strategies, policies and plans with the most recent being the Health Vision 2020 Strategy which is the guiding document for the health sector throughout the current decade. This Strategy moves the sector forward based on the significant achievements that were made during the last decade. The strategy like the two strategies before, aims to integrate the delivery of quality, effective and responsive health services and prevention measures to improve the nation’s physical, mental and social well-being. One major achievement in the health sector is the successes in relation to the Health-related MDG goals. The 2011 MDG progress report for Guyana noted that 2015 targets for nutrition and child health have already been reached and the country is on track to reach targets in education, water and sanitation and HIV/AIDS. For MDG 4 which speaks to reducing child mortality, the report indicated that Guyana has already met its target of reducing under-five child mortality rate by two-thirds by 2015. The under-five child mortality rate has declined from 120 per 1,000 live births in 1991 to 16.9 per 1000 live births in 2010. Infant mortality rate has declined from 45 per 1000 live births in 1999 to 13.5 per 1000 live birth in 2010. Such successes are due www.insightgy.com

to implementation of the several Nutrition, maternal and child care initiatives which also included a comprehensive child immunisation programme that achieved almost 100% coverage for all major vaccination across the entire country. Nutrition levels have improved with the number of children suffering from moderate malnutrition declining from 8.8 percent in 2003 to 5.1 percent in 2010. In addition, less than 1 percent of under-5 children suffer from severe malnutrition. The implementation of the Integrated Management of Childhood Illnesses initiative has aided in the decline in childhood related diseases. Through this programme a more comprehensive approach to child health was taken. This saw not only improvement in childrenâ&#x20AC;&#x2122;s health status but also improvement within the health institutions to provide efficient care for all. One major success is the remarkable reduction in the number of babies with HIV to positive mothers. This number decreased from 38% in 2000 to less than 5% in 2012. Guyana has succeeded in the reduction of maternal deaths through the increase in the availability of skilled personnel as health workers with responsibility for obstetrics procedures and care are continuously receiving training. This is evident in the continuous decline of the maternal mortality ratio over the past years from 320 per 100,000 LB in 1991 to 96.5 in 2011. Additionally Guyana has succeeded in implementing that safe motherhood initiative at all levels. This initiative is based on five pillars addressing pre conception care, antenatal and prenatal care, clean and safe delivery, management of high risk pregnancy and post natal care. The initiative promotes early clinic registrations to enable expecting mothers to receive required information and care. MDG Goal 6 makes Guyana proud with the prevalence of HIV/ AIDS in the population decreasing from more than 5% 1995 to 1.1% in 2011. Access to Anti-retroviral drugs has quadrupled over the last five years increasing from 18.4% in 2004 to Insight Volume 2 Edition 3

more than 90% by 2012. This success has been achieved through a multi-pronged approach which included the establishment of several partnerships nationally and internationally. These efforts included programmes that aimed at improving knowledge and awareness of the disease including the need for testing. Efforts have been made to ensure that persons know the importance of being tested as well as provision of various sites and opportunities for persons to get tested. This saw the birth of national testing week which is an event held annually and aimed at encouraging all Guyanese to get tested. The Malaria programme has seen a similar success with the prevalence decreasing from 59,311 per 100,000 persons in 2005 to 22,840 per 100,000 in 2010. These achievements have been as a result of the many prevention efforts made through the Malaria programme. Which included extensive distribution of insecticide treated bed nets and information materials. Additionally efforts have been made to improve the capacity of health workers to detect the malaria parasites through improved microscopy skills and treatment of persons. The Tuberculosis death rate reduced from 15.7 per 100,000 in 2004 to 10 per 100,000 in 2010, however there has been an increase in the prevalence. This increase may be as a result in transmission but can 44

also be as a result of the improvement of the TB programmeâ&#x20AC;&#x2122;s ability to detect cases. Our achievements as it relates to meeting the health related MDG goals 4, 5 and 6 are much to boast about. These were not achieved without various challenges including maintaining funding for some programmes, loss of human resources and several setbacks due to climate related threats. However lessons learnt over the years and institutional knowledge have been recognized as very important and over time, efforts are being made to document these to aid in future mitigation efforts. Recognising that Guyanaâ&#x20AC;&#x2122;s future depends on the health of its people, the trajectory that has been set will ensure this. Lucy Anderson is Coordinator, Guyana Global Fund Country Coordinating Mechanism Secretariat. www.insightgy.com

Managing our wastewater challenge By Marlon Daniels

The idea of integrated wastewater management in Guyana is currently nonexistent. Massive capital, capacity building and legislative interventions are needed across the entire sector.

he Government of Guyana (GOG) has signalled its commitment to preventing further environmental deterioration of its terrestrial and coastal waters through the signing of the Cartagena Convention and the ratification of its associated protocols. With assistance from the Global Environment Facility (GEF), and in collaboration with the Inter-American Development Bank and the United Nations Environment Programme (UNEP), the GOG has entered into an agreement through the CReW project to tackle its unique wastewater issues. The Global Environment Facility in partnership with the InterAmerican Development Bank (IDB) and the United Nations Environment Programme (UNEP) has set up the Caribbean Regional Fund for Wastewater Management (CReW), a 4-year project dedicated to testing pilot

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financing mechanisms that can be used to provide sustainable financing for environmentally sound and costeffective wastewater management. The Project is also intended to facilitate policy discussions, regional dialogue, and knowledge exchange regarding wastewater management with the key stakeholders in the Wider Caribbean Region. Through the CReW intervention, the Guyana Wastewater Revolving Fund (GWRF) valued at US$3 Million was created, with an additional US$560,000 committed in counterpart funding from the GOG, geared at supporting the efforts of the Government of Guyana in improving wastewater management, with specific focus on public-private partnerships. The idea of integrated wastewater management in Guyana is currently non-existent. Massive capital, capacity building and legislative interventions are needed across the entire sector. However, given the time constraint of this project, the focus on the heavy (high-risk) polluters was 45

determined to be most appropriate. In this way, the impact on reducing the environmental burden through wastewater pollution would be most felt. The private sector is home to the large commercial and industrial wastewater generators. For this reason, a public-private partnership approach was envisaged to achieve the objectives of the CReW Project. Over the long term, the Project aims to honour the commitments of the LBS Protocol. However, the short term objective is to raise the awareness of the issues surrounding wastewater management in Guyana. Eventually, from promoting the first generation projects, and operationalising the revolving fund, it is hoped that the impetus thus created will propel the sector towards an integrated wastewater management approach. An agreement was signed between www.insightgy.com

the Government of Guyana and the IDB for the sum of US$10,000,000 for the improvement of the operational performance of the Georgetown Sewerage System (Georgetown Sanitation Improvement Programme - GSIP). This contract was signed on December 8, 2010 based on an agreement that the GOG and the IDB will cooperate in the execution of the Georgetown Sanitation Improvement Programme. Components of the Programme will include the complete replacement of the 5.5 km sewerage ring main in Georgetown; replacement of all delivery mains; purchase and installation of additional pumps for the 24 pumping stations to ensure adequate pressure, operational reliability and improvement to the electrical connections. It will also include an assessment and emergency rehabilitation of street sewers in selected areas and purchase of maintenance and operating equipment. Further, the implementation

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of the programme will include the strengthening of GWIâ&#x20AC;&#x2122;s Wastewater Management and Energy Efficiency. This component will involve the development of an asset management implementation strategy; staff training programmes on wastewater operation, maintenance practices and energy use. The contract will also include public awareness campaigns that will target schools and business owners. This component is significant in light of the continued abuse of the system by customers who continue to dump solid waste which affects the efficiency of the system and results in overflows. It is imperative that these structural improvements provided by the programme be complemented by the proper use of the system by customers in order to achieve maximum efficiency. Marlon Daniels is the Pilot Coordinator, Guyana Wastewater Revolving Fund and Timothy Austin is the Public Relations Officer, Guyana Water Inc.

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The Impact of Water Quality on Public Health By Camille Roopnarine

â&#x20AC;&#x153;252 (people) Stricken with Gastro as Outbreak Worsensâ&#x20AC;? screams the headlines of a local newspaper in March 2013. This was a direct result of the consumption of unsafe water in one of Guyanaâ&#x20AC;&#x2122;s Hinterland regions, Region One. There the main sources of water included rivers, creeks and rainfall. This seems contradictory given the fact that Guyana has achieved its Millennium Development Goal for Water (see Goal 7). Vast improvements in access to improved drinking water have been made. Table 1 details such improvement. In 2011, 95% of households had access to an improved drinking water source compared to 86% in 2000. Access to safe drinking water is indicated by proper sanitary sources. These improved drinking water sources include household connection, public standpipe, borehole condition, protected dug well, protected spring, and rain water collection.

Unprotected wells and springs, rivers, ponds, vender-provided water, bottled water can all be considered questionable sources. Also Access to sanitary water comes hand in hand with access to improved sanitation facilities for excreta. These facilities include connection to public sewer, connection to septic system, pour-flush latrine, and ventilated improved pit latrine. Unimproved sanitation facilities include public or shared latrine, open pit latrine, or bucket latrine, all of which Insight Volume 2 Edition 3

could find their way into water sources. Guyana was able to achieve these figures by expanding water access in the hinterland regions and in remote areas. However, despite improved access, a number of environmental health hazards such as poor hygiene practices (such as storage), poor business practices and changing weather patterns have all sought to compromise the safety of the water being consumed by Guyanese. In spite of increased availability of drinkingwater, quality service is a large scale is still to be addressed. Water supply to households is often intermittent and this increases contamination risks of water supplied by the water utility. Safe drinking water, as defined by the World Health Organisation, does not represent any significant risk to health over a lifetime of consumption, including different sensitivities that may occur between life stages. Unsafe water increases the risks of water-borne diseases especially to infants and young children. The majority of water related diseases are 47

related to microbial contamination. The greatest microbial risks are from the ingestion of water that has been contaminated with human or animal faeces. Some of these diseases include hepatitis, cholera and diarrhoea. The Pan American Health Organisation (PAHO) has been working in the area of Water Safety Plans in Guyana for a number of years. These water safety plans address water quality issues from source to households. Sources of Water in Guyana. The name Guyana is an Amerindian www.insightgy.com

word meaning “Land of Many Waters”. Indeed Guyana is blessed to have a variety of water sources that can be drawn upon as sources for potable water. Unfortunately, a variety of industrial activities increase pollution to these sources. These activities include mining, river transportation and agricultural run-off. This pollution presents a challenge to the water treatment facilities as it becomes increasingly difficult to treat highly polluted water to bring it to potable drinking water standards. Short, Medium and Long Term Solutions for Improved Water Quality in Guyana Based on the water safety plans developed for Guyana, several

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interventions have been identified. Some short-term interventions are: • Consumer education programme including home water treatment methods • Improved storage facilities at home • Improved hygiene practices at home Longer term solutions include: • Prevention of pollution of water sources (rivers, aquifers, ground water) • Updated water treatment systems • More rigorous public health monitoring system • Improved monitoring of public water supply

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The Anticancer Properties of Bitter Melon By Dr Emanuel F. Cummings

Cancer alone contributes up to 16% of all deaths worldwide. In the United States 1 in every 4 deaths is due to cancer. The World Health Organisation has recently predicted that by the year 2035 the number of cases of cancer worldwide will increase by 75%.

ancer is at staggering epidemic levels. The sheer number of people affected by the disease is as heartbreaking as it is mystifying. The disease is a major public health problem and we are slowly learning more about the causes, as well as preventive measures. It is a major global public health problem currently affecting several million people worldwide. Cancer alone contributes up to 16% of all deaths worldwide. In the United States 1 in every 4 deaths is due to cancer. The World Health Organisation has recently predicted that by the year 2035 the number of cases of cancer worldwide will increase by 75%. The Pan American Health Organisation (PAHO) has reported that 60 % of all deaths in the Caribbean Insight Volume 2 Edition 3

are due to chronic diseases including cancer, diabetes and cardiovascular disorders. It has been reported that the CARICOM Region, which consists mainly of the English-Speaking Caribbean has the highest prevalence of prostate cancer in the world. Figure 1 shows that in 2008 the Caribbean reported cancer deaths of 100 per 100,000 just below the world average of 106. These figures in relation to cancer deaths in the Caribbean were not significantly different from those of developed countries and Asia, except for South Africa, the United Kingdom and the rest of Europe but were significantly higher than the African

and South-Central Asian Regions. These figures are however quite worrying considering the minuteness of the Caribbean population as compared to that of other regions of the world. What is quite interesting is that cancer is considered a genetic disease with environmental influence, hence the figures of the Caribbean Region correlate with Asia as a whole but there is some amount of disparity when we look at the incidence in Central Asia and Africa where these regions reported incidences that are significantly lower than the Caribbean Fig.1 Estimated Cancer Mortality Region. (Cancer Research UK 2008) We are reminded that 49

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a significant majority of the Caribbean Population came from Asia and Africa. In Guyana, death from chronic disease including cancer is on the increase. According to the Ministry of Health Statistical Bulletin (2009), Guyana has reported a steady increase in the prevalence of cancer which is now listed as the third leading causes of death overall. With regard to ethnicity, cancer is listed as the major cause of death in the Amerindian population and second cause of death in persons of African origin while in the East Indian population it is listed as the fourth cause of death. In terms of gender, cancer is listed as the major cause of death in the females in Regions 1, 4 and 9. It is the major cause of death overall in Region 7 and is also listed as the major cause of death in males within the age group 5 to 14 and females 45 to 64. The data from the Ministry of Health suggest that the Amerindians, in addition to Region 4,the largest region, which represents the largest section of the population are the most affected. Among the major forms of cancer that has been reported by the Ministry of Health Statistical Bulletin in 2009 are prostate, breast, cervical, stomach and pancreas among others. Generally, factors that have usually been cited as having contributed to the increase in the morbidity and mortality of cancer are our modern life styles. Exposure to excessive sun light and all forms of radiation, lack of physical activity, environment insults, exposure to industrial chemicals and waste, and, most significantly, dietary changes. These include the increased consumption of processed and fast foods and a reduction in the consumption of fruits and vegetables. This high morbidity and mortality of cancer has impacted negatively on the health care system hence the need to find a form of treatment that is both effective and affordable and which can complement the current use of conventional treatment. Medicinal Plants and Cancer Since ancient times, plants and herbal preparations have been used as medicine. Research carried out Insight Volume 2 Edition 3

for decades has certified several such claims of use of several plants in traditional medicine. In fact most medicines are derived from plants. Prior to the availability of chemotherapy, dietary measures and a multitude of medicinal plants have been identified and used for the treatment of different diseases including cancer. Much research has been focused on the scientific evaluation of traditional drugs from the tropical plant; Momordica charantia (MC). Extracts or preparations from this plant have been used commonly or frequently as an anti-cancer agent and anti-diabetic agent and it is often described as the food of medicine. MC is commonly known as either bitter melon or bitter gourd, corilla, karela in Guyana and cerasee in Jamaica. Bitter gourd grows in all

tropical parts of the world and it is cultivated throughout Caribbean, South America, Asia and Africa The plant is a slender climbing annual vine with long-stalked leaves and yellow, solitary male and female flowers borne in the leaf axils, it is related to squash and cucumber plants. The fruit looks like a warty gourd. The young fruit is emerald green, turning to orange-yellow when ripe. The Latin name “momordica” means “to-bite” referring to the jagged edges of the leaves, which appear as if they have been bitten. All parts of the plant, including the fruit, the stem and seed taste very bitter. In botanical terms, the plant is referred to as Family: Cucurbitaceae, Genus: Momordica, Species: charantia, Synonyms: Momordica chinenus, Momordica elegans, Momordica 50

indica, Momordica operculata. Traditionally various parts of the plant have been used: for example, the leaves have been boiled and served as a tea, the fruit has been cooked or pickled or liquefied and used as a form of prevention and treatment several ailments including diabetes, hypertension , HIV AIDS, and cancer. Several studies have so far confirmed some anti-cancer benefits of MC and indeed there is the need to investigate much more this property. It has been reported that extracts of the MC are rich in the anti-oxidant, flavonoids. It is well established that antioxidants play an important role in the elimination of free radicals from the body since high levels of free radicals are often associated with carcinogenesis and many other chronic ailments. Laboratory based studies have indicated that a crude water extract of the MC can significantly reduce the growth of cancer cells in culture. It has also been reported that extracts of the MC have been used quite successfully to treat cancer of the nasopharynx in China and the Northern African region. Among the phenomena that have been documented, and are subject to further investigation, is the claim that extracts from the MC destroy cancer cells. This is by preventing Deoxyribonucleic acid (DNA) synthesis, hence the reduction of cell proliferation that is quite characteristic of cancer cells. There is other scientific evidence that the bitter melon seed extracts displayed anti-cancer activity in cancer of the colon and the breast and extracts from the fruit of the plant prevented prostate cancer progression. The mechanism by which this occurs is poorly understood, hence the need for more studies. Studies are ongoing with regard to the anti-cancer properties of the MC and it is my hope that extracts from this plant will contribute significantly to chemotherapy in the not too distant future. Dr Emanuel F. Cummings Senior Lecturer in Biochemistry and Molecular Medicine School of Medicine, University of Guyana. www.insightgy.com

Low-Cost Healthy Eating By Yvette DeFreitas

The first rule that should be observed when shopping on a tight budget is “buy foods that are in season”. Buying vegetables and fruits when they are scarce can cost double what it would cost when they are in season.

n recent times, Guyana and the rest of the world have been inundated with a number of new and controversial dietary findings. For example, the culprit associated with heart disease is no longer saturated fat but highly refined carbohydrates, Coconut oil is no longer on the list of dangerous foods, instead, margarine and other semisolid (trans-fats) created from oils are topping the list. These and other new debatable nutrition-related hypotheses deserve some scrutiny but the question we will examine here is an age old one that is relevant to over a third of Guyana’s population. “Can a poor person eat healthy?” Guyana’s poverty assessments (the Household Income and Expenditure Survey published in 1993 and Guyana Living Conditions Survey published in 1999), each show that well over one-third of households in Guyana are living in moderate poverty (on less than US$2 daily). Approximately two thirds of these households, or 29% of the total population, can be further described as extremely poor, with an expenditure level that challenges their ability to purchase the basic foods required for a healthy diet. There are an unknown percentage of families experiencing “dietary poverty” because they have stuck with expensive conventional dietary habits or adopted new lifestyles that harm the family’s food budget. Before we proceed, let us establish what is meant by the term “healthy eating”. Healthy eating refers to the consumption of a variety of

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foods from different food groups, so that our bodies may receive all the nutrients needed for good health. To facilitate healthy eating in the Caribbean, the Caribbean Food and Nutrition Institute (CFNI) grouped foods into six food groups and developed four Meal Plans (Twomix, Three-mix and Four-mix ) to show people how to eat healthy at various cost levels. By following the Two and Three-mix Meal Plans, a family on a low budget can consume foods that provide them with a satisfactory amount of all the nutrients that are needed for good health. Like the Four-Mix the Two Mix (Meat/Peas + Starchy Food) and Three Mix (Meat/Peas + Starch + Vegetable) meals should be accompanied by a fruits in the form of a beverage or snack to boost the vitamin and mineral content. In cases where a Two-mix is used regularly, vegetables should be added to meals whenever they are available so that the family will in reality be consuming a diet that consists of Two and Three mix meals. In addition to their rich vitamin and mineral content, vegetables contain antioxidants and phytochemicals known to stave off and control cancer and other chronic diseases. Having familiarised oneself with the makeup of a healthy meal, families need to understand portion sizes. It has become fashionable to serve large chunks of meat, the most expensive item in the food basket. The tendency towards overweight and obesity even among the “poor” is an 51

indication that starch, sugar and fat are also overused. Cutting back on these items is one way to cut the food bill. Now, for some strategies that can be employed to s-t-r-et-c-c-h those food dollars. Start with a plan. Budgeting helps us see where our money is really going. When we do a budget we can identify any unnecessary spending threats into our food budget. You may say, “I don’t make enough money to budget” but the truth is that you do not have to make a lot of money to benefit from budgeting. In fact, budgeting helps us to prioritise and stretch whatever little income we have so that we get more of what we truly value. It may even help us to see the relationship between high medical bills and low food bills. Other consequences of poor eating are loss of income due to ill health and poor educational performance in children. Having allocated a sum of money to the food budget, a detailed menu plan consisting of meals and snacks should be made for the day, week or month depending when you are paid. . Then a shopping list of relevant ingredients should be developed. To avoid waste due to spoilage, only buy enough fresh produce for the meals on your meal plan. To avoid impulsive buying while on shopping trips, eat before going out and leave the children at home. Less will be spent on snacks you cannot afford. The first rule that should be observed when shopping on a tight budget is “buy foods that are in www.insightgy.com

season”. Buying vegetables and fruits when they are scarce can cost double what it would cost when they are in season. Another helpful strategy when shopping on a low budget is to compare prices. Compare the price of foods with similar nutritional value e.g. carrots and pumpkin, peas and meat. Compare the prices of different brands. Compare the price of packaged and tinned items against fresh produce. Many people think that eating expensive meats and processed foods is tantamount to eating healthy, but that isn’t the case at all. Like meat, peas and eggs are rich in protein. And while tinned and processed items may have added nutrients, the cheapest, most nutrient-dense foods are often fresh produce. Families on a low budget are therefore advised to fill their baskets with fresh greens and fruits, dried peas and beans and basic staples like rice and flour from stalls or groceries that sell quality items at a good price. If a tinned or packaged item is cheaper, opt for a few tins or packages. Loading your basket with convenience items such as coconut milk, tinned meats and juices, and packaged snacks is a big temptation, even for the family on a low budget. But succumbing will often cause the budget and your healthy diet to fail. The price of these items is usually elevated to cover labour costs, and they are often nutritionally lacking or high in sodium, oil and other substances that aggravate or promote conditions such as hypertension, diabetes and obesity. If a family is committed to eating healthy on a budget, learning how to cook, and investing in a basic time and labour saving device such as a pressure cooker, if possible, would be another useful step towards eating healthy. The dishes don’t need to be complicated. Pea soup with chunks of ground provision and greens of your choice is a healthy Three-mix that takes 15-30 minutes to prepare in a pressure cooker. Ground provision is a good source of dietary fibre; peas (and meat if used) provide protein and iron; and greens add vitamins A and B, and other important nutrients and Insight Volume 2 Edition 3

phytonutrients to the meal. To save time and fuel, cook in large batches and freeze leftovers for later in the week. In recent years and in the 1970s “the kitchen garden” was promoted as a means of supplementing the food basket of Guyanese families. All that is required is a small piece of land or a few empty drums that can be filled with soil. Since the majority of persons existing below the poverty line live in rural and interior regions, the kitchen garden should be a strategy that can be readily employed to help shaved a great deal of money off the food bill. Excess items can be preserved or sold. Following the flood of 2005, the late Dr. Hector Muñoz (then IICA Emeritus Professional) introduced Guyana to hydroponics technology. This is a method of farming (in water) that would be quite useful to landless families in urban areas. Now for persons who do not fall below the poverty line but who have, nonetheless, convinced themselves that they are poor and therefore cannot eat healthy. They 52

should make a list of the family’s expenditure and examine it. They may find that if less is spent on fastfood, cable, hair dos, sneakers, weed, clubbing and shows, alcohol, video games, trendy name brand clothes, cigarettes and all kinds of overpriced items that are considered necessary, much more would be available for a healthy diet plan. This does not mean that families are not entitled to some leisure or treats. It just means that spending on treats and leisure activities must be done in moderation and not at the expense of a healthy diet. The main thing to remember when on a low budget is that eating healthy may be a challenge, but it is doable. It is only impossible if we remain undedicated to figuring out how it can be done. So make a plan, shop wisely, take the challenge of planting a vegetable garden and brush up on your cooking skills. Yvette DeFreitas is a Retired Public Health Nutritionist, Ministry of Health, Guyana with a Masters in Education for Primary Health Care from the University of Manchester. www.insightgy.com

From Farm to Table Thriving on locally produced fruits and vegetables By Penelope Harris, Nutritionist

There are so many good reasons for eating locally produced fruits and vegetables, especially those grown in your own back yard.

n Guyana, we are fortunate to have an abundance of fruits and vegetables on our local markets. Added to that, most householders have some amount of land space that we can plant some crop to make ourselves more self-sufficient. Nowadays, there is much talk about super fruits. They are right here and include papaws, watermelons, soursop, mangoes, cherries, sorrel, lemons, guavas, psidiums, Suriname cherries and many others.

Why are they super fruits?

They contain important chemical substances called phytonutrients, which play a vital role in disease prevention. Phytonutrients are not vitamins and minerals, but they are very useful to know about. Apart from fruits, there are many vegetables that are rich in vitamins, minerals and phytonutrients. They provide a great boost to our health. Guyana is blessed with many of these vegetables from which we can achieve health benefits. In this article, I will focus on some of those phtyonutrients that can be readily identified by the colour of the produce. Firstly, there is the group of carotenoids. Two of the better known ones are alpha-carotene and betacarotene. These are found in foods with a yellow and orange coloring pigment. They include papaws, mangoes, mamee apples, awaras, courios, pumpkin and others. Many green vegetables, such as calaloo and

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ochroes also contain carotenoids, but the yellow pigment is masked by the green colouring pigment, chlorophyll. These carotenoids are converted into vitamin A in the body. For this reason , they are sometimes called pro-vitamin A. Then there is lycopene. Lycopene is a red or pink coloring pigment. It is found in tomatoes, sweet peppers, watermelons and pink grapefruit to name a few. Lycopene has been linked to a lower risk of prostate cancer. We can look at the purple and blue colour in fruits and vegetables also. These are anthocyanins. They include red onions, psidiums, jamoons, purple cabbage and boulangers with their purple skins. These substances are known to be powerful anti-oxidants. They help to slow the aging process, protect against heart disease and tumors, prevent blood clots, and fight inflammation and allergies. The yellow colouring found in oranges, lemons and grapefruit are flavonoids. These chemicals lower cholesterol levels, and many have antioxidant properties. Allicin, which is white is found in onions and garlic and is found to have antibacterial, antioxidant and anti-inflamatory properties. Most green leafy vegetables contain lutein, which can inhibit macular degeneration. As mentioned before Guyana has a super-abundance of fruits and vegetables which can promote good

health. We need to make better use of what we have. We also need to learn to plant up every square foot of land available to us as well as assist those who may be weak or vulnerable to have access to land or be able to plant. Hydroponic farming is an option for those who may not have much land space. How do I classify a food as a super food? Usually when it meets all or most the following characteristics: 1. It grows locally is found in abundance in the particular location. If it is found in abundance, it means that it has the ideal ecosystem around it, it is thriving and has the optimum amount of nutrients it should have. 2. It is in season. Buying fruits and vegetables when they are in season, helps you to ensure that you get value for money. Buying fruits in season ensures freshness. Fruits in season have lots of vitamins and minerals. 3. It is rich in nutrients. Usually it contains powerful anti-oxidants such carotene, vitamin C and may also contain fibre and phytonutrients, mentioned earlier. 4. It has a moderate to low glycemic index. The glycemic index tells us to what extent the blood sugar will be raised. 5. It is not loaded with fats and simple sugars. Letâ&#x20AC;&#x2122;s therefore pay keen attention to buying healthy foods and buying foods with a variety of colours every week.

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Computers and your Health

hances are you’re reading this article on a computer or a mobile phone, maybe a tablet device or some other modern gadget, and wondering what is all the fuss about -‘Computers and your Health’. Perhaps you had not thought about it before or may have, but have chosen to overlook any of it simply because you could not be bothered as these gadgets are now part of your everyday work and social life and any of the consequences are acceptable. Or perhaps, you do need to know about this important topic. Just in case you need a refresher or an entire crash course, the rest of this article provides a brief on this important topic. So read on. If you are a computer professional you are likely spend many hours sitting in front of your computer doing real work, reading, playing games, or just wasting time as is often the case. In fact, this pattern is true for many non-professionals, as everyday users spend enormous amounts of time on the computer doing various tasks. The consequences of extensive computer use could be devastating.

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By Lenandlar Singh

Let’s start with a personal story. Approximately ten years ago I woke up one morning and could not get out of bed. I could not move or turn. My back was totally gone. How did I get to this state? The long and short of it: excessive improper use of the computer. For a period of about 1 year leading up to that morning and my back troubles, I spent at least 4 hours every night sitting on a small, uncomfortable chair, slumped in front of my desktop computer which was placed on a small bed (a more comfortable arrangement was beyond my finance at the time). If you could imagine this sitting position, you would envision a bending position, with my back under tremendous pressure. However, at the time I could not be bothered as I had to get work done and of course it was my profession after all. So you are thinking – well isn’t it obvious, that you would risk your health that way? Well yes, the health consequences of improper usage of computers and poor work environments can be predicted but sometimes we are too hooked to be 54

bothered. Sometimes we cannot do better. But should we risk our health at the expense of work or leisure use of computers? Consider the following set of questions as a test of what your current habits. Do you sit or lie on your bed while using your laptop or tablet computer, and with the room lights off? Are you using a makeshift arrangement at home for your desktop computer, perhaps a regular table and chair or are you using a specially designed chair and computer desk? Do you spend many hours reading on your computer, browsing the Internet, and perhaps trying to close off the next hottest argument on social media? Do you sometimes feel like you are overdoing it but do not have the will to take a break? How about your work environment? Is it comfortable? The big word we use for that is Ergonomics – is your workplace specially designed for effective and healthy work? The truth is that severe health issues may arise as a result of extensive and incorrect/improper use of computers; whether desktop or laptop computer, a tablet or even smart www.insightgy.com

phones. Some of these health issues are outlined below, with suggestions for creating better usage habits to minimise their occurrence. 1. Physical/Muscle problems: back pains, chest and shoulder pain, leg cramps and pain at the top of your feet, and general muscle soreness are the most commonly felt physical problems associated with improper computer usage. Repetitive stress injuries such as painful wrists caused by awkward stretching to use the mouse or having your wrist in an awkward position may arise. The most obvious solution to these problems is to set up your computer environment using ergonomically designed tables, chairs and other equipment. Well-designed work spaces allow you to adjust your seating positions, alignment of your monitor and mouse for best use, among other things. Stretches and walks, constant short breaks and periods of relaxation help to prevent extensive periods of stress on your body and are most useful for minimising and preventing these physical problems. Insight Volume 2 Edition 3

2. Vision problems: constant exposure to your computer monitor and focusing extensively without looking away, and poor lighting and flickering monitors, may cause extra strain on your eyes. Computer vision syndrome (CVS) is the most commonly known problem associated with extensive viewing of the computer monitor. This problem can be minimised by using anti-glare screens and glasses, and by aligning your computer monitor to a comfortable viewing position (usually 10-15 degrees below your eye level from the centre of the screen). It is also useful to place the monitor at a comfortable distance away. A constant break from the computer of 15 to 20 minutes for every 2 hours of work is a good guide. 3. Headache: headaches are a common problem associated with extensive computer use because of the extra stress placed on your eyes and your neck. Constant breaks and comfortable alignment of your neck with your monitor is important. 55

4. Other problems: stress disorders and computer addiction, sleep disorders, obesity and other related social problems are commonly attributed to the use of computers. For children, it is important that parents set time-limits for computer use. It is also important for parents to -encourage physical activities. Adults are advised to take breaks from the computer and engage in physical activities. Technology has impacted our lives in many ways. In particular, the extensive use of computers is a known cause of several health-related problems. Enough care must be taken to prevent and minimise these problems. One of the most important things to do is to ensure that your work environment is comfortable. While it is an additional expense, carefully designed tools will help to minimise health problems. In general it helps if you are aware of the potential problems associated with computer use and take deliberate steps to minimise these problems.

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Treating Illnesses

Guyanese Style Western medicine has gained acceptability globally. But someone suffering a minor ailment may still hear a Guyanese style remedy which is not always necessarily in tune with the most recently accepted treatments. Here is a sample

Rub saliva on your neck when you’re suffering stiff neck.

Drink your urine as a cleanser to detoxification.

of some Guyanese remedies.

Use bleach on your toe if it has a fungus

Put a match-stick in a baby’s hair for hiccups.

When a marabunta (wasp) bites you take the leaf of three different plants to rub over the bite to prevent swelling. Drink hot water to help lose weight. If a young child has a protruding navel, have the baby’s uncle visit one day and have him push the protruding navel down with his toe. It should go down. This “remedy” only works if during the visit, the uncle speaks to no Insight Volume 2 Edition 3

Use eggwhite to combat poison indigestion.

Use egg-white and orange juice to tackle anaemia.

one before pushing the navel. If you have a cold boil fever grass, Suriname cherry leaves, lime leaves you boil it and you drink the concoction. For asthma relief boil sourie leaf. (Sourie is the Guyanese name for the fruit from the Averrhoa bilimbi, also called tree sorrel.) 56