Education for New Mothers

This past quarter, I took a Public Health Nutrition and Biology class, in which we focused on various subjects related to nutrition and its association with public health, as well as how it could affect our biology over the course of a lifetime. One of the lectures dealt with pregnancy, breastfeeding, and nutrition. We spent three hours talking about mother and baby issues. Many new mothers (and not-so-new mothers) are not in the loop about information pertinent to the health of their newborns. What a mother does (and doesn’t do) can have an effect on multiple generations. For this reason, it is important to provide education to mothers. For example, many assume that breastfeeding is instinctive, but the reality is that mothers need training on properly feeding their babies.

This particular lecture reminded me of some of the traditional practices that my mother was taught about how a newborn should be treated during the first few months. I want to mention each oral tradition and talk about its relevance to modern science.

1) When you are pregnant, eat a variety of foods.

In this particular class, we learned that there should be an increase in body weight during a normal pregnancy. Pregnancy is not the time to go on a diet. Even before getting pregnant, folic acid from dark, green leafy vegetables (think: spinach) are a must. While you are pregnant, you should be eating nutrient-dense foods and getting your nutrients from a mixed source of vegetables, fruits, and grains.

Interesting fact: Did you know that the habits, behaviors, and health of the mom during pregnancy has the potential to influence health for generations to come? Children born to a mother while she was pregnant during a period of starvation will have a higher chance of becoming obese in their adult years. Similarly, mothers that are either overweight or obese when they are pregnant increase the chance that their baby will be overweight in his/her life as well.

2) Keep your bundle of joy bundled up.

I think my grandmother aggressively emphasized the importance of keeping the baby warm and it is definitely something to keep in mind. However, make sure that you are not overheating the baby. I read somewhere recently that the baby’s temperature should be between 16 and 20 degrees Celsius. You should buy a thermometer and diligently check if your baby might be overheated. Apart from warm clothes, it might be good to invest in cute baby hats.

3) Breast milk is the best milk.

I think we might have spent close to an hour or so talking about the benefits of breastfeeding. Our professor pointed out that breast milk is the cheapest, eco-friendliest, and most nutritious milk for babies. It provides the necessary nutrients as well as antibodies. I had a friend that decided to go the baby formula route because she said that her baby looked too thin. She was only 19 at the time so she did not have much education on baby basics. Breast milk provides the right amount of nutrients and energy for the baby. There is no need to use formula milk and it could in fact hurt the baby in the long-term.

It can be a daunting task to be a new mother, but a rewarding experience as well. Make sure you consult with your doctor or nurse about practices that are safe as well as healthy for your baby. If you have friends that are pregnant or new mothers, share well-researched information with them and encourage them to visit their primary care practitioner.

 

Technorati Tags: health,pregnancy,mothers,education

Is Torture Ever Acceptable?

This quarter, I am taking a class called Public Health Ethics, in which we discuss the moral and ethical justifications of actions taken by public health professionals, governments, or any other entity in the name of protecting society as a whole. During our first class, the professor posed an interesting question. He handed us the Universal Declaration of Human Rights (compiled by the United Nations) and asked us this: Which one of these rights would you be willing to put boots on the ground and fight for? Which one of these would you think are ideal to have, but maybe not worth fighting for? He proceeded by reading some of these ‘rights’ outlined in the handout. All was well until we got to the part about torture. The comments made by a woman in class have been forever embedded in my memory.

Article 5 of the Universal Declaration of Human Rights reads:

No one shall be subjugated to torture or to cruel, inhumane or degrading treatment or punishment.

He asked again: Is this something that you would advocate for? No one should be tortured no matter what? What about prisoners of war?

At this point, a woman in her 40s, dressed in a nurse’s uniform, raised her hand. She said that she had a son who was fighting in the United States Army and that the topic of torture by the American soldiers has been on the news quite often. She was referring to the torture of prisoners at Abu Ghraib. The justification she used for the torture of the prisoners was what bothered me. Her conclusion was that the American soldiers were justified because if they had been the ones captured, the “others” would have inflicted a more cruel form of torture on them.

I know where she is coming from in her thinking. She has a son that has been through a lot with the military service and obviously she will be more sympathetic to the soldiers. However, I think this notion of “they” is problematic. When we start differentiating in this way, it is easy to justify inhumane actions on others, whether it’s killing, torture, or something else. Her answer prompted me to think about this subject more and I decided to do my presentation on “War and Public Health”. My partner is talking about the needs of those that are stuck in the middle of a war (and after the war) in terms of food, water, shelter, mental health, and the like. I will be focusing more on the subject of torture and if this is something that we can justify as public health professionals.

Unfortunately, the U.S. Department of Justice sanctions torture to an extent that it deems appropriate. The Bybee Memo redefined torture and concluded (among other things) that there needs to be a ‘ specific intent’ for torture to be considered as such (1).  It is easy to justify these actions when they are being done to terror suspects, but the reality is that many of these suspects are actually innocent. Over 80% of the prisoners at Abu Ghraib were innocent (2). Furthermore, the confessions taken from these prisoners (even from those that were rightly detained) have been incorrect or fabricated, which has led to even more drastic and unnecessary measures by the U.S. government (1).

The next issue that arises is the role of the public health professionals, including nurses and medical doctors. Do they have a moral responsibility to protest against this? Unfortunately, a loyalty conflict arises where a physician is torn between providing care for the patient and working for the military (3). In this case, should the physician ensure that the prisoner’s medical needs are being met, or be a silent observer? It’s known that clinicians have been complacent in these activities and they have reached to the point that they are aiding in the exact science of the torture techniques. For example, physicians might fabricate reports that state that the detainee is healthy enough to go through the ‘interrogation’ process or not treat the appropriate medical conditions of the detainees(3).

I feel that it is an obligation for public health professionals to advocate that governments provide a torture-free environment for the detainees. Torture is plain bad policy, with few (if any) positive outcomes. It would send a strong message to governments if public health workers united against the atrocity of torture, wherever it may happen.

References:

1.    Iacopino V, Allen SA, Keller AS. Bad Science Used to Support Torture and Human Experimentation. Science. 2011;331(6013):34-5.

2.    Lenzer J. Oath Betrayed: Torture, Medical Complicity, and the War on Terror. BMJ: British Medical Journal (International Edition). [Book Review]. 2006;333(7564):401-.

3.    Singh JA. Treating War Detainees and Terror Suspects: Legal and Ethical Responsibilities of Military Physicians. Military Medicine. [Article]. 2007;172:15-21.

Side Note: Here’s a video that I found, but I haven’t watched all of it. It goes into the details of how medical complicity is present in many cases of torture:

Technorati Tags: public health,torture,ethics,graduate school,health

Eating Better (from Sisterswhoblog)

I wrote this post for Sisterswhoblog and wanted to share it here as well because I think a lot of us can relate to this (on a side note: please join this network. If you’re not a sister, then you should follow the blog).

I recently took a class titled ‘Neurobiology of Learning and Memory’ and one of the topics of the lectures was the connection between eating disorders and the brain. In earlier lectures, we had talked about Depression and Alzheimer’s. Both of the latter two are causes of either a decrease in activity of the brain, or death of neurons in the hippocampus (part of the brain involved in memory and learning), respectively. However, with eating disorders, it’s very different. The attitudes, emotions, and feelings that arise during an eating disorder are actually caused by the starvation, not by an underlying neuronal problem.

I do not want to bore the readers with any biological mumbo jumbo (even though I kind of already have), but the real purpose of this post is this next idea: Most anorexics and bulimics have a high recovery, as well as a high remissive rate when they follow the correct way of eating.

Basically, the idea behind a new treatment plan for patients with eating disorders is teaching them the difference between hunger and satiety. It’s like learning to eat like a kid again! Children will eat when they are hungry, and will let you know when they are done. As adults, we become ‘deaf’ to our bodies natural eating pattern. We eat when we’re hungry and continue to eat long after our body has reached it’s satiety level.
This new system was developed in Sweden and it uses a device called a Mandometer. This device is plugged in a computer and you place your plate of food on top of it. You eat while the plate is still on the scale. The mandometer will tell you your speed of eating and ask you of your satiety levels. Eventually, the patient’s goal is to adjust his/her curve to the ‘normal curve’ for eating. More information can be found here.

The reason I found this to be interesting is because of two reasons: 1) it resembles the way our Prophet (SAW) ate and 2) it works with other eating problems like obesity, as well. So, if any of you are ever in need of a diet plan, just read the Sunnah of the Prophet (and follow it too). This goes first and foremost for myself.

"No human ever filled a vessel worse than the stomach. Sufficient for any son of Adam are some morsels to keep his back straight. But if it must be, then one third for his food, one third for his drink and one third for his breath." – Prophet (SAW); narrated by Ahmad, At-Tirmidhi, An-Nasaa’I, Ibn Majah

“It’s not what you eat, it’s how you eat it.”- Professor M

Gladiator

A month ago, I had chest pain on two different days within the same week. The chest pain was in the lateral left chest region. The pain wasn’t too bad. It was minor pain that felt a little tingly. However, a couple days later, as I made my way into the Microbiology final, two of my fingers went numb on my left hand: thumb and index finger. That scared the heavens out of me! I kept thinking, “I hope it’s not a pre-heart attack .”

I called in the next day to make an appointment and when I told the operator my symptoms, I was promptly connected to a nurse, who asked me some questions:

“Where was this pain?”

“Are you feeling it right now?”

“When was this?”

“Do you have difficulty breathing?”

“Do you have trouble standing?”

“Do you think you will pass out?”

“Are you in any pain right now?”

(Note: If I was really having some kind of emergency, I would have been dead and gone by now)

After the nurse made sure I was okay, I was connected to a receptionist. He asked me some of the same questions and then made an appointment with a doctor for the same day (in fact, just two hours later!). Usually, I have to wait a month for an appointment with a doctor, but I guess I said some keywords that prompted Kaiser to handle the case a little differently.

As it turns out, according to the doctor, it was not heart-related. Instead, he asked me some questions about my computer/typing habits and he speculates that it is probably related to a pressure on a nerve that runs the length of the hand.

Here are some tips he gave me on using the keyboard safely:

-Make sure your wrists are lying flat

-Make sure your fingers are not awkwardly curved like this:

-Sit at a comfortable distance from the computer. Don’t sit too close.

-Your fingers should be flat and slightly curved:

He then gave me a hand brace that I am supposed to wear at night to keep my hand in a neutral position. I loved the brace so much that as soon as I got home that day, I wore it around the house for the next couple of days. It made me look like an amateur gladiator, who could either not afford to make a hand armor out of metal, or ran out of metal because his body armor took too much material; hence the title of this post.

Technorati Tags: random,gladiator,kaiser,doctor,keywords

An optometrist might be the first doctor a person sees in 10 years!

I got to shadow a rather interesting optometrist today. He owns two clinics: one in Westminster/Huntington Beach and the other in Costa Mesa/Newport. The reason I call him "interesting" is because he is not the type of optometrist I get to see at my eye examination appointments.

I go to Kaiser every six months or less often, but I do not get to talk to the optometrist much, except when I need to tell him/her if lens 1 or 2 is better and then if 3 or 4 is more crisper,etc. It's probably because Kaiser is a big corporation and they deal with so many patients in a day. 
I like the way this guy dealt with his patients. He was very friendly and talkative. And the patients enjoyed that. At my last Kaiser appointment, I tried to engage the optometrist in conversation. I started with, "If someone was diagnosed with glaucoma, would you be the one who treats it?" The doctor just looked at me and said, "You do not have glaucoma." I already knew that, but since I was interested in pursuing a career in optometry, I wanted to know more about what they did or did not do, and what they could and could not do. I told her this. She smiled. Then she told me that they (optometrists) provided the pre- and post-operative care for glaucoma, but an ophthalmologist did the actual surgical stuff.

Ever since my interest in optometry grew, I wanted to know more about what they did and what made them different than ophthalmologists. I knew the basic difference: optometrists go to Optometry School and ophthalmologists go to Medical School. But this information is not sufficient. It provides no insight about the capabilities of an optometrist. Instead, it actually hurts the image of the profession. What this deviation from the original topic has to do with meeting the "interesting" optometrist, I will get to that in a minute. But let's just say that meeting with him gave me a new perspective on the profession of optometry.

But the doctor that I saw for my own eye exam was not at all interested in discussing anything other than "You have a new prescription" and " Let me take you to the eyeglass area, where you can pick a frame and order the lenses." And as you can see, that was not an invitation to discuss much. All I could say was, "Alright, thanks doc!" But I did get a tiny bit out of her: she applied to both SCCO (Southern California College of Optometry) and UCBCO(University of California Berkeley, College of Optometry). I could not, however, find out which school she attended to become an optometrist.

Meeting with this "interesting" optometrist today made a huge difference on my impression of optometry. Dr. R.G. went to SCCO and has been practicing for 22 years. I got to sit with him through three patients and between the second and third patient, we got to talk a little about his view on optometry, both present and future. He said that the difference between optometry and ophthalmology is surgery. Optometry is a specialty that provides primary vision care, just short of surgery. Optometrists deal with the functioning of the eye while an ophthalmologist deals with the anatomical fixings. Ophthalmologists come in when all else does not work. When ophthalmologists provide primary vision eye care, they are actually practicing optometry.
He also talked about how an optometrist might be the first doctor a person sees in 10 years. Someone can notice a decrease in vision and get their eyes checked, but other problems might not be as apparent. He gave an example of a patient who visited him after he noticed his visual acuity drop. When Dr. R.G. checked him, he had a swelling in his optic nerve behind his eye. "Only two things can cause this: either a tumor in the brain, in which case he has no chance to survive because it has gotten too far, or malignant hypertension (severely high blood pressure)." So, the doc checked the patient's blood pressure. It turned out that his systolic over diastolic reading was 300/125! This was a cause of alarm. Hence, Dr. R.G. sent this patient to see a family doctor and was immediately admitted to an emergency room. If Dr. R.G. had not sent him, he would have been dead in 24 hours!

The point from his story was that optometrists play an important role in the health care industry and they will continue to do so. His prediction was that in a decade or less, optometry will be merged within the medical field, but he did not sound too optimistic about that.