Aspire!HEALTH AND WELLNESS NEWS FOR YOU AND YOUR FAMILY

WINTER 2003/2004

Aspire!OVERCOMING GRIEF,DEALING WITH THELOSS OF A SPOUSE.

DIABETES EDUCATIONIN POINT DOUGLAS

WINNIPEG WINTERSAFETY

HEALTHYVEGETARIAN DIETSFOR CHILDREN

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Caring for Health À l’écoute de notre santé

lifestyle

“Canadians experience more stress today as a result of thedaily demands of life, work and family” says RandyGoossen, Medial Director of the WRHA CommunityMental Health Program. Goossen cites a January 2003Health Canada national study on balancing work, family

and lifestyle, which shows that working Canadians feel increased conflict asa result of the demands of work and home.

Everyone experiences stress; it is a normal part of life. Relationshipdemands, chronic health problems, pressure at work places, traffic jams,meeting deadlines, financial worries and/or parenting challenges can all besources of stress in our busy lives. Coping with the usual stresses ofeveryday life can already be difficult at times. With increased demands,coping with stress can seem unmanageable and leave us feelingoverextended, overwhelmed and exhausted.

The Effects of Stress...Stress affects each of us in unique ways. Defined as “a demand on

physical or mental energy”, stress can weaken our immune systems, makingus more vulnerable to colds or the flu; it can lead to muscle tension andheadaches; and it can cause tension in relationships. Stress can also triggerfeelings of depression, anxiety and anger.

Your body will often send signals to tell you it is stressed. These signalscould include headaches or gastrointestinal upset. You may even experiencedisruptions in your sleep or a pounding heart.

Here are some Helpful Tips for dealing with stress...1. Recognize your signs of stress and slow down. Listen to your body when

it tells you to take a break. 2. Evaluate your lifestyle – your work situation, your family situation or

your schedule and make small changes to lessen the stress.3. Time management – Do essential tasks and prioritize the others.

Consider those who may be affected by your decisions, such as familyand friends. Use a checklist; you will receive satisfaction as you checkoff completed jobs,

4. Share the responsibilities – don’t do it all alone. 5. Refuel on good stuff – eating well and avoiding overindulgence will help

to maintain a healthy balance in your life. Even mild overindulgencecan give you a next day low, adding to the feeling of overextension.

6. Be active – physical activity is one of the most effective stress remediesaround.

7. Get enough rest and sleep.8. Talk with others – Talking with friends, relatives, a professional

counsellor or support group about those things that bother you cancontribute to your emotional wellbeing.

9. Take wellness breaks and pamper yourself – scheduling time alone ortime to do nothing can be a great stress buster and contribute to youroverall mental health.

10. Have fun!! Laugh and be with the people you enjoy.

Tips adapted from the Canadian Mental Health Association website:www.cmha.ca

These days, it seems like there are no shortage of parties.Birthdays, wedding showers,feasts, anniversaries, holidaycelebrations...the list goes on and on. And at every gathering,food and drink are everywhere, an endless variety of tasty,tantalizing treats.

“With so much temptation, it’s easy to overindulge,” says Judy Barg,community nutritionist, Winnipeg Regional Health Authority. “The result,over time, can be considerable weight gain and health consequences.”

“But,” says Barg, “with smart choices and a bit of resolve, we can enjoythese special occasions and maintain good health.”

Here are some tips to help you enjoy your year-round celebrations:

DON’T SKIP MEALSYou know you’re going to a social gathering later, with lots of food and

drink, so you skip breakfast and lunch. Great idea, right? Wrong! Having alight breakfast and lunch, and perhaps a small meal before you get to theparty, will leave you feeling full and less likely to overindulge.

PRACTICE MODERATIONKeep an eye on how much you are eating, and always start with small

portions. You can always go back for more if you are feeling hungry.

WATCH THOSE APPETIZERSStay away from high energy (calorie) snack foods like potato chips and

foods wrapped in pastry. Choose low fat alternatives like vegetables andpretzels.

AVOID WHITE FOODSAvoid white foods. Most are loaded with fat and calories. This includes

cream-based dips and drinks, whipped cream, white appetizers, custard andanything in a cream sauce (e.g. Alfredo sauce).

HOIST A GLASS OF H2OWater, served in a fancy glass with a wedge of lemon, is a healthy

alternative to alcohol. It’s calorie-free and will help to fill you up.

STAY ACTIVE OR START BEING ACTIVEMake physical activity a priority year round. You will feel better, you will

burn calories and your waistline will thank you. Aim for 30 minutes a day,every day.

FEELING STRESSED?Marion Cooper, WRHA Program Specialist, Mental Health Promotion

Tips for dealing with stressYou’re not alone.

At a dinner party one should eat wisely but not toowell, and talk well but not too wisely.

~ W. Somerset Maugham (1874 - 1965)

HEALTHY HABITS,

healthy weightCheryl Ogaranko, Community Nutritionist, WRHA

feature articles

As the Winnipeg winter sets in, planning a vacation to a sunnydestination may seem like a great escape. However, how do youknow if your destination choice is a prime area to contract yellowfever, malaria or tuberculosis? By taking the proper travelprecautions, you can help ensure that the only things you bring

back from your trip are souvenirs. The WRHA offers bilingual travel health services through the Travel

Health & Tropical Medicine Services Clinic located at 490 Hargrave Street.“We provide a range of services like counselling, vaccinations, healthdocumentation and travel related prescriptions. Travel health accessoriessuch as mosquito nets and insect repellent are also for sale” says JacquieShackel, travel health coordinator. “The Clinic can also provide post-travelmedical assessments and treatment for travellers returning with medicalproblems. Of course, we prefer to educate and prepare travellers before theyleave about the possible dangers and illnesses they could encounter.”

Services at the Clinic are provided by a team of public health nurses anddoctors who specialize in travel health counselling and services for bothshort and long term travel. Shackel was one of the four public health nursesfrom the Clinic who recently were awarded with a Certificate in TravelHealth from the International Society of Travel Medicine. This May,Alexandra Henteleff, Dana Male, Judi Piasecki and Shackel wrote the first-ever Certificate of Knowledge in Travel Medicine International Examinationin New York City, along with over 400 other travel health providers fromaround the world. By passing this exam, the nurses have demonstrated their

expertise and solid knowledge of travel medicine. “[To work in this field]you need a good grasp of public health, communicable diseases,epidemiology - there is a lot to learn and it is fascinating,” says Shackel.

Travellers are encouraged to book appointments with the Clinic at leastfour to six weeks before they leave for their trip. “You need to have enoughtime to get all the information and necessary vaccines before yourdeparture,” says Shackel. “People tend to take more risks and use lesscaution when they travel. It is important that they are armed with theinformation that can help them stay healthy.”

In addition to one-on-one counselling, the Clinic can provide travellerswith further information on food and water safety, travel insurance, sun andswimming safety, disease prevention and much more. Shackel says that herclients also share information with her. “I get to live vicariously through myclients, learn about exotic places through their experiences. I have alsoimproved upon my geography as well.”

The Clinic operates on a cost-recovery basis as Manitoba Health does notinsure pre-travel health advice and immunization services. This means thatindividuals are responsible for full payment of services.

For more information, please refer to the Web site at www.wrha.mb.caand look for: WRHA Travel Health & Tropical Medicine Services under“Finding Care”. To book an appointment, please call: 940-TRIP(8747).

BON VOYAGE!WRHA Travel Health & Tropical Medicine ServicesShawna Zeilstra, WRHA Communications

senior’s health

GRIEFBy Nancy Boomer

Loss and Found: Overcoming

Psychologists tell us there is no greater single stressor in life thanenduring the death of one’s spouse. Working through the flood of emotions that accompany loss canfeel like a daunting task, one that can take a toll on mental andphysical health.

The Winnipeg Regional Health Authority (WRHA) is working withcommunity groups in providing programs and services that can helpbereaved seniors along the way to healing their emotional pain and enjoyingtheir lives once again.

“Some of our clients are trying to cope with the death of a spouse after 40or 50 years of marriage,” says Sonja Lundstrom, a registered nurse who,along with occupational therapist Eleanor Stelmack, staffs the WRHA’s RiverEast Seniors Health Resource Team. “When youlose someone after so many years of a closerelationship, it can feel like losing a part ofyourself.”

Lundstrom says the trauma of loss tends to becompounded by the many changes the bereavedwill experience afterward. Life quickly becomescompletely different, not only in missing abeloved life partner, but in the day-to-day realityof now living single. Some people depended on their spouses to handlespecific chores such as driving, banking, cooking, laundry or arrangingsocial outings. Now, they must adapt by either learning to do these thingsthemselves or finding another way to get them done. All of this comes at atime when the bereaved may be having a hard time finding the energy justto get out of bed every day.

“A lot of people don’t realize that grieving consumes an amazing amountof energy,” says Carol Macpherson, program co-ordinator with Hospice andPalliative Care Manitoba (HPCM). “Some people have trouble sleeping,while others find they have difficulty remembering things. Some of myclients say they feel like they are so consumed by the loss that they are goingcrazy but it’s important to remember that grieving is really the evidence ofhaving loved deeply.”

Macpherson says bereaved individuals should never feel pressured to ‘getover it’ because there are no absolute timelines for the grieving process.Though every person’s grief is as individual as they are, certain feelings tendto be common to many people experiencing loss.

Stacey Miller, a social worker with Age & Opportunity Inc.’s counsellingservice, says many clients report feeling some combination of sadness,depression, anger, guilt, denial, fear, irritability and even lowered self-esteem in trying to adapt to their new identity and responsibilities.

“A big concern is loneliness because many seniors have never had to livealone before,” says Miller. “That can be a huge adjustment for somepeople.”

Miller says one of the goals of grief support counselling is to assureclients that what they are going through is normal and that it’s all right totake whatever time is necessary to heal - not the amount dictated by well-meaning friends who think you should “be over it by now.” Miller sayssupport groups, such as those offered through Age & Opportunity, HPCMand the WRHA, can be very helpful to people working through grief.

“I went to bereavement classes at The Wellness Institute after my husbanddied,” says a West Kildonan widow. “It gave me the opportunity to share myviews about my grief and listen to others’ feelings and experiences. It was

good to hear that others were going through thesame thing as me. Before I went there, I thoughtsomething was wrong with me.”

Venting feelings to a trusted friend or advisor,such as a minister, rabbi or counsellor, is animportant step along the road to grief recovery.Some people find comfort in groups, others inone-to-one mentorship or friendly visitorprograms, walking-and-talking groups, or visits to

the local seniors centre where they are likely to befriend others who arewidowed and relate to their situation.

According to Sonja Lundstrom, reconnecting with others in thecommunity helps give a renewed sense of purpose to daily life and,combined with active self-care such as sufficient nutrition, rest and exercise,can be very beneficial to finding one’s way out of the emotional darkness.

“The importance of social support can’t be stressed enough,” saysLundstrom. “People who have been through our programs tend to becomeour greatest champions because they realize that working through their griefhas helped them find a sense of meaning in life again. You can’t go aroundgrief — you have to go through it. We can help make that happen.”

For more information about grief support programs in yourcommunity, please call Seniors Health Resource Team (River East) at940-2114, (St. James) 940-3261, (Downtown) 957-7216, Hospice &Palliative Care Manitoba at 889-8525 or Age & Opportunity Inc. at956-6440.

Nancy Boomer is a Winnipeg-based freelance writer.

“A lot of people don’t realize thatgrieving consumes an amazingamount of energy.”

your health

Frostbite and hypothermia are physical conditions that result fromprolonged exposure to cold weather. Both conditions are seriousand require immediate attention. Frostbite occurs when our skin tissue freezes, and its symptomscan include tingling and stinging sensations as well as aching and

numbness. Frostbite most often occurs in our extremities, such as ourhands and feet, and on exposed parts of our bodies, including ears, fingers,cheeks and noses.

“If you suspect frostbite, it should be seen by a medical professional fortreatment,” says Dr. Wes Palatnick, emergency medical director with theWinnipeg Regional Health Authority. “The affected area will need to bewarmed with warm, but not hot water (approximately 40 C). Frostbite canbe quite painful and a painkiller may be required. Subsequent treatmentwill depend on the severity of the injury. For very minor frostbite,protection from cold and further injury, a medicated dressing and apainkiller may be all that is required. More serious injuries may require allof the above and

admission to a hospital for further care. In any case, it is best to seek theadvice of a medical professional.”

A person whose body temperature falls to about 35 C and whosemuscular and cerebral functions are impaired is suffering from mildhypothermia. Usually, at 35 C there are few symptoms except for shivering.

A more serious temperature is below 32 C. At this lower temperature, aperson may experience severe hypothermia. Symptoms can range fromlethargy, dazed or irritable behavior and slurred speech to incoherence,muscle stiffness and an inability to move, and loss of consciousness.

Palatnick says the exact management of hypothermia depends on thepatient’s condition. “If you suspect hypothermia, seek warmth by goingindoors, changing into dry clothing, putting on a head covering, andwrapping the body with blankets or an electric blanket if available.”

“Severe hypothermia can be life-threatening,” adds Palatnick. “If thesymptoms of severe hypothermia are present, seek immediate emergencymedical care.”

Jack Marquardson, WRHA Communications

It’s exciting. It’s fun. But is it safe?

Snowmobiling has become one of our most popular winter recreationactivities in Manitoba. In most cases, it is also a safe form of recreation.However, if not used properly, snowmobiles can be extremely dangerous.During one winter season, 11 Manitobans died as a result of snowmobilecrashes and another 157 were injured.

Mike Waite, executive director of the Manitoba Safety Council, says,“most of these deaths and injuries are preventable, and result fromexcessive speed, use of alcohol, night driving and inexperience.” Waiteencourages all riders to learn the right way to operate a snowmobile, andoffers these tips to help ensure that your snowmobile outing is a safe one:

• Don’t drink and drive. It’s unsafe and it’s against the law.• Avoid waterways. Ice conditions are extremely difficult to judge and can

change rapidly. Drowning is a major cause of snowmobile-related death. • Use extreme caution if driving at night. Unseen obstacles can be fatal.• Always travel at speeds that are reasonable for the conditions. Just

because your machine will do 100 kilometres an hour, doesn’t mean thatit’s a good idea.

• Always ride with a buddy, so someone is there to assist in the event of acollision or breakdown.

• Be sure to wear your safety helmet. You only have one head-protect it. • Learn to ride the right way by participating in the Manitoba Safety

Council’s one-day Snowmobile Operators Training Program.

For more information about snowmobile safety,contact the Manitoba Safety Council at 949-1085.

Jack Marquardson, WRHA Communications

FROSTBITE and

HYPOTHERMIA

SNOWSHOVELINGJack Marquardson, WRHA Communications

If you have lived through a Winnipeg winter, chances are that youare well acquainted with your snow shovel. Winnipeg receives anaverage of 115 centimetres of snow each winter, so we have plenty ofopportunity to exercise our shoveling muscles. On the plus side, thisis an excellent way to stay active during the winter. Health expertsrecommend at least 30 minutes of moderate physical activity everyday, and shoveling definitely counts towards that total.

However, research shows that, after heavy snowfalls, there is anincrease in the number of heart attacks and fatal heart attacks amongsnow shovelers. So, is shoveling snow bad for you?

“Not necessarily,” says Jan Schmalenberg, Life Long Wellnessprogram specialist with the Winnipeg Regional Health Authority. “Ifyou take appropriate precautions and keep safety in mind, shovelingsnow can be an invigorating activity and help keep you physically fit.”

Schmalenberg offers the following shoveling safety tips:

• If you are not very active, don’t do heavy work regularly, or have ahistory of heart trouble, speak with your doctor before shovelingsnow.

• Begin shoveling slowly to avoid placing a sudden demand on yourheart. Also, pace yourself and take regular rest breaks.

• Use a shovel that is suited to your needs and capabilities. A smallershovel will lift less snow and put less strain on your body.

• If you have concerns about your ability to shovel snow, considerdelegating the task to a friend, neighbour or family member.

Schmalenberg adds, “if you are shoveling, be alert to the signals ofheart attack, which can include pain, shortness of breath, nausea, andsweating (cool, clammy skin). If you are experiencing the warningsignals of a heart attack, stop all activity and call 911, or havesomeone call for you.”

the safe way

Preventing

SAFE, SMARTSLEDDINGSnowmobile Safety Tips

your lungs

Shawna Zeilstra, WRHA Communications Coordinator withinformation from the Canadian Lung Association, theManitoba Lung Association and John Minski, R.R.T., clinicalspecialist, neonatal care, respiratory therapy.

Few things in life are as scary as the feeling of not being able tocatch your breath. You may have had a dream where you cannotbreathe, or have been in a small space and felt you cannot breathe.You may have even had an experience where you have not beenable to catch your breath and felt panicky and anxious until you

were able to breathe normally again. Breathing is something that we take for granted because it is an

automatic function of our bodies. The respiratory system is responsible forour breathing. Gas exchange through breathing is the most important job ofthe respiratory system. This happens as the oxygen in the air we breathethrough our nose and mouth travels from the lungs through thebloodstream to all the parts of our body. Cells in our body collect and usethe oxygen as fuel, and then give off carbon dioxide as waste gas, whichtravels back to the lungs through the bloodstream to be exhaled.

The lungs and respiratory system are also in charge of other importantjobs related to breathing. They make sure that all air is brought to theproper body temperature; they moisturize inhaled air for necessaryhumidity; and finally, they protect the body from harmful substances bycoughing, sneezing, filtering or swallowing them.

Despite how hard your lungs work to ensure your ability to breath, thereare several things that can stop your lungs from working to their fullpotential. Breathing in materials like cigarette smoke can seriously damageyour lungs. According to the Canadian Lung Association, cigarette smokingis the number one cause of lung cancer and chronic obstructive pulmonarydisease (COPD).

Your lungs do have several built-in defense systems that work to preventdamage to the lungs. These include: Cilia, which are microscopic hairs thatlie along the air passages; Phlegm, Mucus or Sputum, which collects dirt andgerms that are inhaled into the lungs and moves them out to be coughed upor swallowed; and Macrophages, which are cells that live in your lungs andeat up dirt and germs that come into the lungs.

Asthma is a chronic lung condition that affects the way you breathe.Symptoms of asthma include; wheezing, coughing, chest tightness andshortness of breath. These symptoms are a result of a narrowing of theairways due to irritation. Triggers such as cold air, dust, fumes, smoke andother inhaled irritants can provoke asthma. It can also be provoked by suchcauses as allergens (pollen, molds, dust mites) and respiratory viralinfections. Asthma can develop at any age, although according to theCanadian Lung Association, it is most common in childhood.

Influenza, or the flu, is another serious lung condition that occurs whenthe influenza virus infects the airways. The easiest way to prevent influenzais through an annual flu shot. Symptoms of the flu are headache, fever,aches and pains. For some individuals (sick, elderly and immunecompromised) the flu can make them susceptible to developing pneumonia- a serious and sometimes life threatening illness.

The best way to keep your lungs healthy is to not smoke and avoidsecond-hand smoke as much as possible. Pay attention to potentialoccupational hazards - some of the air your breathe in at work may containhazardous substances like chemical vapors. Make sure you wear the properprotective gear or masks while you are working in contact with these typesof irritants. And get your annual flu shot to prevent getting influenza.

For more information about your lungs please visit the CanadianLung Association Web site at: www.lung.ca

When you inhale a smoke, thegases and particles in thecigarette cause the Cilia toslow down. This weakens thelungs’ ability to defendthemselves against infections.Cigarette smoke can alsocause air passages to close upand make breathing moredifficult. It causes chronicinflammation or swelling inthe lungs, leading to chronicbronchitis. And it alsochanges the enzyme balanceof the lungs, which leads tothe destruction of lung tissuethat occurs in emphysema.

LUNGSGetting to know your

WHAT ONECIGARETTE CAN DO:

“I’m not eating meat anymore.” Your first reaction as a parentmay be panic and you may wonder, “What will I feed mychild?”. “How will he or she get enough protein?” If your childmakes the decision to become vegetarian, making sure they getthe nutrition they need does not have to be too difficult. All it

takes is a little planning to ensure that your child’s diet stays healthy.A healthy vegetarian diet is one where the child makes different food

choices rather than just cutting out foods that provided important nutrients.Encourage your child to eat a variety of foods and help him or her byproviding some vegetarian meals for the whole family such as bean burritos,veggie burgers or a stir-fry with tofu.

Getting enough protein is a common first concern for parents, but oftenis quite easy to provide. Some children who are vegetarian choose to belacto-vegetarian, meaning that they avoid meat and meat products, but willstill drink milk or eat milk products such as cheese. Milk and milk productsare an excellent source of protein. Other meat alternates such as peanutbutter, beans, nuts, seeds and tofu will also meet their protein needs.

Iron is also important for all children. Good sources of iron forvegetarians are breakfast cereals enriched with iron, dried fruit (e.g.apricots, raisins), fortified breads and pastas, dark green vegetables,chickpeas and tofu. Including a source of vitamin C such as orange juice ora tomato sauce at the same meal will help increase iron absorption.

To ensure adequate zinc in a vegetarian diet, encourage your child to eatwhole grains, wheat germ, nuts, beans and tofu.

A vegan diet avoids all animal products. In addition to ensuring enoughprotein, iron and zinc, you will also need to help your child get enoughcalcium and vitamin B 12.

People aged 9-18 years have high calcium needs to achieve good bonegrowth. Lacto-vegetarians should aim for 3-4 servings of milk or milkproducts per day; vegans will need calcium-fortified beverages (i.e.calcium-fortified orange juice or a fortified soy beverage). Other calcium-rich foods are almonds, tofu set with calcium and legumes. Vitamin D is ofmore concern. Due to our winter climate, Manitobans cannot rely on thesun to meet our vitamin D needs throughout the whole year. Vegans shoulduse a fortified soy or fortified rice beverage to ensure they get enoughVitamin D in their diet.

Vitamin B 12 can only be found in animal foods. Vegans will needfortified foods (i.e. fortified soy or fortified rice beverage) or nutritionalyeast (not the same as baking yeast). If these are not used, a B 12supplement will be needed.

Use this checklist with your child to look at the quality of his or hervegetarian diet: Does he or she drink milk or a fortified soy beverage withmeals? Does he or she include a meat alternative at least twice per day?Does he or she use iron-fortified cereals and other iron-rich foods regularly?Does he or she make healthy snack choices such as dried fruit, nuts, drycereal, or yogurt?

Help your child to focus on making different choices instead of cuttingout foods and you will be well on your way to a healthy vegetarian diet. Ifyou have further questions about your child’s vegetarian diet, see yourpediatrician or family physician. He or she may refer you to a registereddietitian for assessment and counselling.

Another excellent resource for parents is “Becoming Vegetarian”, 2003 byVesanto Melina, M. Sc., R.D. and Brenda Davis, R.D. For a vegetarian foodguide, visit the Dietitians of Canada website at www.dietitians.ca and clickon “Vegetarian Diets: Vegetarian Food Guide for North America (2003)”.

Dayna Weiten, RD, is a clinical dietitian at Children’s Hospital.Weiten works with the Metabolic Clinic and other Ambulatory CareClinics and assists children and their families with various healthconcerns, including specialized nutritional needs.

children’s health

Aslobbery puppy or fluffy kitten may seem like the ideal friend fora child. However, parents considering giving their child a furrycompanion not only have to understand the responsibility thatcomes along with pet ownership, but also the dangers.

According to Debbie Nowicki, communicable disease program specialistwith the Winnipeg Regional Health Authority (WRHA) roughly one animalbite per day is referred to the WRHA public health program. Many of theseinjuries occur from stray or unknown animals, but there are also numerouscases where the victim knew the animal.

Safe Kids Canada estimates that nearly half of dog bites seen in anemergency room happened with the family pet at home. Vicki Burns,executive director of the Winnipeg Humane Society suggests parents canhelp prevent bites by educating their children when to leave the animalalone, like when they are eating, and how to properly play with a pet.

Jackie Habing, injury prevention program specialist suggests parentsmake sure their children also know not to approach or touch an unknownanimal. Children may need special supervision when visiting the home offriends or relatives who have a pet.

In 2002, there were 12 reported cases of rabies in domestic dogs/cats inManitoba, due to the prevalence of rabies within the provinces’ skunkpopulation. Burns says parents can help keep their pets safe by not lettingthem roam free and by getting regular rabies vaccinations.

If an animal bites your child, call Health Links to ensure that the risk ofrabies can be assessed.

Health Links can provide parents with additional pet safety tips at788-8200 or toll free at 1-888-315-9257. Information can also beobtained through the Winnipeg Humane Society’s educationaldepartment at 982-2046.

Dayna Weiten, RD, Children’s Hospital

HEALTHY VEGETARIAN

DIETSfor Children

ANIMALSMARTS

Prevent pet related injuries through education

By Carly Peters

An award-winning, locally producedtheatre project about Diabeteseducation is continuing to attract agrowing audience almost two yearsafter it was originally performed.

The “Make the Right Choice” play andworkshop, originally staged in the spring of 2002,encourages children in the Point Douglas area tomake healthy eating choices.

“The Aboriginal community is more affectedby Type 2 Diabetes,” says Rosemary Szabadka,the show’s producer and former communitynutritionist for the WRHA in the Point Douglasarea. “In Point Douglas we have the largestAboriginal population in all of Winnipeg, and wealso have the highest rate of Type 2 Diabetes.”

Szabadka felt she had to emphasize theseriousness of the disease through an interactivelearning experience for children.

She originally approached Manitoba Theatrefor Young People with the idea of a play to teachchildren about Type 2 Diabetes. When she saidshe would like Aboriginal actors to be part of theproduction, RB Russell School’s CommunityAction Program was brought on board.

“We wrote up a proposal and got full funding,”she says.

The program at RB Russell, involving 16students under the direction of teacher JayWillman, was handed the task of writing andproducing the play and interactive workshop.Willman says the work done by his students inthe presentation was phenomenal.

“My involvement was mainly to write the playwith the students and direct them through thebest representation of their ideas,” he says. “Thiswas an intense experience for my students. Webecame a family.”

“It turned into this sensational thing that thestudents themselves, with Jay, developed,”Szabadka adds. “It came from their hearts, andthey made it work.”

Willman says the reaction from theperformances and workshops is overwhelminglypositive.

“Our audience loves us,” he says. “After everyshow they asked my students for their autograph.In subsequent communications they told us howthey were trying to make healthier choices.”

Since presenting the project to various classesin Point Douglas last spring, the producers havewon a bevy of awards for their work. Willmansays his students were thrilled to win the

Manitoba Aboriginal Youth Achievement Awardearlier this year. “It’s the highest honour anAboriginal youth can achieve in this province,”he says.

Szabadka also received a Dietitians of Canadanutrition award for her part in ensuring theeducation was getting to the community. InOctober of this year, she presented a chequefrom the prize money she had received to RBRussell’s program and MTYP. “This is a wholesubject that I’d never tackled. It was justsomething that came up in the community asbeing a real issue,” she says in reaction to thewin.

Willman says there has been a positiveresponse from other communities for theperformances, including some in NorthwesternOntario. He adds they have plans to take theirshow on the road to Kenora in the near future.

Szabadka says it took the joint effort ofeveryone involved for the project to be assuccessful as it is today.

“To take health and combine it with the arts isa great idea,” she says. “When differentorganizations get together they’ve got differentcultures and there’s lots of challenges. It was alot of work, but everyone can say that a reallygreat thing happened.”

For more information on Diabetes visit theHealth Canada Website at http://www.hc-sc.gc.ca/ or call the Manitoba/SaskatchewanRegional office at 983-2508.

Tyler Walsh is a Winnipeg-based freelancewriter and video producer.

MAKE THE RIGHT CHOICE!

DIABETESPREVENTION

What can you and your children do to reduce therisk of Type 2 Diabetes?Health Canada suggests three things:Eat Well. Be Active. Have Fun.

Healthy Eating: - enjoy a variety of foods - choose whole-grain cereals, breads, other

grainsproducts - reduce the amount of refined, processed, high-

fat, salty or sugary foods, such as donuts andpotato chips

- drink more water and reduce drinking liquidcandy (soda pop)

- choose colourful vegetables and fruit more often- leaner meats and increase vegetarian options

such as chickpeas, legumes, lentils and tofu- choose lower fat dairy products

Physical Activity: - build physical activity into your daily life – at

home, at school, at work, at play

Having fun:- make physical activity and healthy eating part of

an enjoyable lifestyle- live actively and play with friends and family- try new healthy recipe ideas with your family- look for opportunities to be active and enjoy being

a kid again with your child – build a snowman,walk to school, play hide and seek, dance to theradio or Pow Wow music

diabetes education in Point DouglasBy Tyler Walsh

feature articles

from the inside

human resources

Shauna Allan, WRHA Communications with informationfrom The Upset Workbook, Patient Representative Edition,Meyers and Nance and Dealing with Angry Employees,article posted on www.work911.com

Conflict can happen in every workplace. It may be as simple as aco-worker taking their bad day out on you, or it could be moreserious such as a team’s refusal to cooperate and work together,resulting in missed deadlines and unfinished projects. Conflict inthe workplace is a disruptive force. It affects an organization’s

ability to fulfill its purpose and goals on an everyday level, which is why it isimportant to deal with conflict when it happens.

The way individuals deal with conflict within the workplace determineshow easily the problem can be resolved. When disagreements occur, oneshould keep in mind two basic principles:

Conflicting or angry situations will become negative and destructive ifthey are not dealt with promptly and effectively. Stronger and better teamsexist when situations are dealt with properly.

People want to be heard. Anger can surface unexpectedly throughactivities such as rumor spreading, un-cooperativeness and poorperformance. These activities ultimately obstruct and diminish the level ofharmony, respect and productivity in a workplace. A means for allemployees to express their feelings and thoughts is important; otherwisethey may find other ways to be heard, which might not contribute to aproductive and healthy workplace.

The best way for individuals to address conflict within the workplace is tofocus on problems before they have the opportunity to evolve. Here are anumber of different tips and techniques for dealing with conflictingbehavior. Each of these methods demonstrates that you are genuinely

concerned with and truly want to listen to the feedback that your staff orcoworkers have to offer. 1. Deal with the issue as soon as possible. When an individual expresses his

or her anger, its imperative to deal with the anger as soon as possible, asperformance and productivity levels tend to suffer as a result of delay indealing with anger.

2. Always allow the individual to talk. Don’t interrupt. If a co-worker ishesitant to talk, encourage them by using a kind and considerate tone.Ask whether they would be more comfortable discussing the situationnow, or perhaps they would prefer to talk about it privately at a latertime. Let them decide.

3. Respond to your co-workers feelings first, not the issue underlying thefeelings. Using empathy initially will create a sense of comfort andencourage the individual to be completely honest about his or heropinion and feelings.

4. Use active listening and aim for a mutual definition of the problem. It isimpossible to solve the problem to someone else’s satisfaction unless youare both talking about the same problem. Before expressing ‘your side’ or‘your perception’ of the situation, make sure you have listened to andunderstand what the individual is trying to tell you. Please rememberthat it is not your job or responsibility to prove that the other person iswrong, as it will likely increase their anger level.

WRHA employees and their families who would like furtherinformation on how to deal with conflict in the workplace can call theEmployee Assistance Plan (EAP), offered by Manitoba Blue Cross at786-8880 or toll-free 1-800-590-5553. EAP offers counselling services,seminars and support services and resources on a range of health andwellness issues.

Some staff wellness programs focus oncreating programs to provide antidotesto problems – exercise for inactivity,relaxation for stress, and communicationcourses for conflicts in the workplace.

While these types of programs are important tothe health of workers and a satisfying work life, itis an organization’s culture that impacts levels ofstress

An organizational development approach tostaff wellness looks at things from the perspectiveof prevention, reduction of risk and the creationof internal support systems. In other words, if weaddress the roots of stress and increase the senseof support and collaboration on teams, there willbe a different relationship to wellness programs.Organizations will provide such programs toincrease or maintain retention, physical wellness,and the staff’s sense of being valued; programswon’t be used as band-aid solutions to chronicproblems.

Research in organizational development showsthat all teams have four basic areas of need thatare developmentally interrelated. These are: theneed for clearly defined ends; the need forappropriate means; the need for effectivecoordination of resources; and the need for

effective team relationships. At present theWRHA Organizational Development and Wellnessinitiative addresses these four areas in a teamsystem and educational sessions from anAccountability-Based organizational developmentmodel (see www.impaqcorp.com). Teams at alllevels of our healthcare institutions are beginningto use these sustainable systems of effectivenessimprovement, on-going development andperformance management. Through thisapproach it is our goal for communication andcoordination to improve, and moral andefficiency to increase in a measurable way. Whenwe review the progress teams are making with thissystem, we aim to see an increase in satisfaction,hope and sense of purpose and direction at work.This is a meaningful form of staff wellness.

Changes are never easy and even when we seeteams and individuals improve, there are stillthose people that need more time to be

convinced of what they are seeing or that thechange will last. This takes us to the startingpoint of much of our work: personalaccountability. Wellness is not a final destinationor a static state to be grasped and preserved.Wellness is an attitude and a balancing act. It isabout how we manage the things that impact theway we think and feel everyday. The way werespond to daily factors and moments is a matterof choice. Wellness is a personal choice.Throughout history, human beings have survivedand thrived in the most inhumane circumstancesand found the strength to learn and grow fromthe most horrible events. The power of personalaccountability is that no matter what goes on inthe workplace around us, we always have theability to learn from our experiences, to besupportive of others and to realize that each oneof use play a roll in creating a work environmentthat is a pleasure or a pain. The choice is yours!

Rev. Jonathan H. Ellerby is the Director ofOrganizational Development and Wellness forthe Winnipeg Regional Health Authority, andpreviously served as the Director of SpiritualCare at the Health Sciences Centre.

What Creates Staff Wellness?

Rev. Jonathan H. Ellerby

Wellness is an attitude and a balancing act. It is about how wemanage the things that impact theway we think and feel everyday

DEALING WITH CONFLICT IN THE WORKPLACEthe Proactive Way

human resources

Human Resource Profile:

John MinskiR.R.T.John MinskiR.R.T.

Ablack belt in karate, who has studied themartial art since the late 1970’s, John Minskispends his days caring for preemie babies andsick children at the Health Sciences Centre.“Working with children and babies makes me

feel very positive – it is the optimal job for me,” saysMinski. “The hard part is seeing the children sick, butthe good part is seeing them get better. If parents forgetabout us after they leave here - that is good to me - itmeans their child is healthy.”

Minski first became interested in respiratory therapyas a pre-med sciences student at the University ofWinnipeg. “I saw a pamphlet in the career counsellingarea. [Respiratory therapy] seemed like a dynamic,exciting career – something I would like to be involvedwith. And at that time, you didn’t hear that much aboutthe different opportunities in health care other thannursing or being a doctor,”says Minski. “I enrolled in thetwo year program at theHealth Sciences Centre inRespiratory Therapy and aftergraduation worked as a dutytherapist at Children’sHospital.” Minski worked atChildren’s for seven years, andthen moved to the School ofRespiratory Therapy/Women’sHospital in 1995 where heworked as a clinical specialistuntil 1999, when he moved onto work in Neonatal IntensiveCare within the HealthSciences Centre.

“My present position is a dual role,” says Minski. “Iattend rounds daily to maintain the continuity ofrespiratory care for patients, assist staff and provideresource support for the respiratory therapy staff,respiratory students, neonatal fellows, residents andnurses.

“I am also an educator with the Department ofRespiratory Therapy, School of Medical Rehabilitation, inthe Faculty of Medicine at the University of Manitoba. Ieducate all levels of the three year program and teachboth classroom theory and clinical practice.”

Trying to stay current with the latest clinical practicesand ensuring that this experience is translated todelivering the highest level of neonatal care at the HealthSciences Centre is the greatest challenge in Minski’s job.To ensure that he is able to keep current, Minskiparticipates in several annual conferences on pediatricrespiratory care, and has completed several additionalcertification programs beyond his initial training andeducation. “I am very fortunate to work with a teamwhose drive and open-minded team approach makes usbetter. They promote continual learning and withoutthat [support] we could not excel in the field of neonatal

respiratory care,” says Minski.Presently working on aresearch project about theinterrelation betweenventilator induced lung injuryand surfactant therapy, Minskisays he is also proud of thestaff he works with. “Thepediatric respiratorytherapists, the medical staff,perinatalogists, neonatologist,pediatric intensivists, nurses,pharmacists and the entiremultidisciplinary team in theChild and Women’s Healthprogram are all very special. Iam very proud of the staff I

work with.” In addition to the devotion Minski has for his career,

he is a self-professed “family man” and enjoys spendinghis time away from work with his wife and two daughterscross-country skiing, biking and rollerblading.

VOLUNTEERProfile:

Joe Doran,Manager, Chad’s Bar,Deer Lodge CentreYears before Joe Doran began tovolunteer at Deer Lodge Centre, his father,who was a WW1 veteran, was a patient atthe facility. “I was so pleased with thecare provided to my dad that I decided togive something back by volunteeringwhen I retired,” says Doran.In early 1989, Doran began to visit someof the veterans, chatting or playing agame of cards. He was one of the firstbartenders at Chad’s Place when it firstopened and worked two or three days perweek.Today, Doran continues to work in Chad’sPlace, but in a different capacity. Hemakes sure the bar is functioningefficiently by coordinating volunteerschedules and training, as well asordering and stocking products. “I alsokeep the Volunteer Manager on her toes,”Doran jokingly comments. “I volunteertwo or three days per week at the Centreor from home and also assist with manyspecial events including being involved incoordinating the New Year’s Eve party formany years now.”Doran has also been an active volunteerin the community for many years prior tohis involvement at the Centre. He beganto volunteer at the ManitobaDevelopmental Centre in Portage la Prairiein 1968 as the Fundraising Coordinator oftheir Auxiliary and was instrumental incoordinating a raffle in 1972 that raised$10,000. His efforts have not goneunnoticed. Recently he received anaward from Heather Stefanson, MLA forthe constituency of Tuxedo and acertificate from the Government ofCanada recognizing his many years ofdedication and involvement in thecommunity.

Clinical Specialist, NeonatalIntensive Care, RespiratoryTherapy

Never continue in a job youdon’t enjoy. If you’re happy in whatyou’re doing, you’ll like yourself,you’ll have inner peace. And if youhave that, along with physicalhealth, you will have had moresuccess than you could possiblyhave imagined. ~ Johnny Carson

regional

REGION ATA GLANCE In October, the WRHA launched their new Web site:

www.wrha.mb.ca. The new site was created with the intention

of making health information easier for the public to find. The

2002/03 Annual Report can be viewed on the site, or a printed

copy can be ordered by calling (204) 926-7000. Also located

on the new Web site is the Encompass database - an on-line

health services directory. People without access to the Internet

can also call Health Links at 788-8200 for health services

information.

November 21st, 2003 marked the Grand Opening of the

Winnipeg Centre for Gamma Knife Surgery, at the Health

Sciences Centre. The Gamma Knife is a tool used to treat

people with certain benign and malignant brain tumors and

functional or movement disorders. It requires no incision, so

patients can expect to be in the hospital for a few hours and be

discharged later the same day, with virtually no risk of

infection, brain injury or bleeding. Although, Gamma Knife

centres exist across the world, this is the first centre of its kind

in Canada.

The process of assessing a Personal Care Home resident’s level

of care is about to change through the use of the Minimum

Data Set or MDS. According to Netha Dyck, director of the

Personal Care Home Program of the WRHA, MDS will address

two primary goals for resident care needs. “MDS helps the

WRHA and Personal Care Homes assess the care needs of

residents and develop a care plan that best meets their needs.

Second, the information will help identify the most appropriate

placement for an individual.” Richard Syal, manager of

Corporate and Community Application Development says, “this

is an exciting initiative for Personal Care Homes.” MDS is

currently being pilot tested in four Personal Care Homes;

Riverview Health Centre, Golden West Centennial Lodge, Luther

Home and Bethania Mennonite Personal Care Home. A number

of components are being tested, including wireless technology,

the connectivity of a wide area network, the education and

training process for this type of initiative and the functionality of

MDS. The pilot test is expected to be completed by the end of

January 2004, with the rollout to the remaining Personal Care

Homes and Long Term Care Access Centre to take place from

February to June 2004.

The WRHA has begun a reorganization of its community-based

mental health crisis services. According to Rèal Cloutier, WRHA

vice president, the Salvation Army provided this invaluable

service over the past few years and established a solid

foundation upon which the WRHA can build, and that

reorganization will result in enhanced services for WRHA

clients. Cloutier also indicated that the process should be in

place by spring and that the availability and accessibility of

services would not be affected during the process.

In September, Health Minister Dave Chomiak announced plans

for the tendering of a new prostate centre. The centre will be

built at CancerCare Manitoba, and according to Chomiak is a

significant investment in the battle against prostate cancer.

The new centre will feature a range of educational services,

technological innovations and support services to men afflicted

with prostate cancer.

The WRHA has begun animplementation and evaluationprocess to assess the possibility ofusing tools for waiting listprioritization in the region. Tools have

been introduced into two WRHA programs – theChild and Adolescent Mental Health Programand the General Surgery Program at St. BonifaceGeneral Hospital (SBGH). The prioritizationtools were developed by specialty panelsorganized by the Western Canada Waiting ListProject (WCWL), a consortium of 20 medicalassociations, health authorities, ministries ofhealth, and research centers in Western Canada.These tools have undergone extensive validityand reliability testing, over the past four years.

A Waitlist Steering Committee has beenformed to oversee the implementation andevaluation process. Jan Currie, vice-president

and chief nursing officer, chairs the committee.The Surgery Program, Child and AdolescentMental Health Program, Orthopedics, WRHAPopulation Health and Health System Analysis,Manitoba Health, and Manitoba Centre forHealth Policy also have representation on thecommittee.

The purpose of the WCWL tools are to provideclear measures that can be used to prioritizecases on waiting lists for scheduled services. Inboth the Child and Adolescent Mental Healthand General Surgery Programs, the tools arebeing introduced in a staged manner and theimplementation process is being monitored andevaluated. Initially, priority scores are not beingused to prioritize waiting lists. If supported bythe initial feasibility work, the region willconsider using priority scoring as part of awaitlist management process.

IMPLEMENTATIONOF PRIORITIZATIONTOOLS IN THE WRHA

regional

ADVANCE CARE PLANNING

Talking about progressive illness and dying can be difficult. Asdifficult as it is for patients and families, it can also be difficult forhealth care providers. As a health care provider, you may avoidtalking about death and end-of-life care with your patients forvarious reasons. Perhaps you feel as though you do not have

enough experience dealing with the issue, or are not comfortable bringingup the topic. Whatever the reason, avoiding the issue can result inconfusion and uncertainty about patient’s personal preferences. Mostpatients do want to have a say in their care and value the opportunity to doso.

Through advance care planning between the patient and health careprofessionals, individuals have the opportunity to express their desired typeof care. As well, health care professionals will have a better understandingof their patients’ wishes and will be able to quickly decide the right type ofcare.

Advance care planning is a process to help health care providersunderstand and be aware of their patients wishes regarding end-of-life care.It has begun in hospitals and personal care homes for all new patientadmissions. Patients should ask their doctor, nurse or other members of thehealth care team about this important part of your care. Aboriginal elders or spiritual advisors may also assist Aboriginal patients in dealing with their

end-of-life care decisions. According to Dr. Garey Mazowita, there are problems that can arise when

end-of-life discussions are avoided. “For the patients, families and thehealth care team, it becomes difficult to prepare for a worsening of amedical condition and the treatment priorities, when open and honestdialogue has not taken place,” says Mazowita. “End-of-life decisions involvebalancing treatments against control of pain and suffering. Each individualwill have his or her own set of wishes and priorities, all of which should beunderstood and respected.”

Mazowita says it is important for care providers to know about the wishesof the individual so that they can give them the appropriate medicalinformation.

Communication about personal care decisions also becomes especiallyimportant when patients are being transferred from one facility to another,and when transport services such as Winnipeg Ambulance are involved.Unless communication is clear at each point of transfer or transport, thepossibility exists that the desired end-of-life care would not occur. This caninclude receiving aggressive and potentially invasive treatment in situationswhere only comfort measures were desired, or less commonly, receivingcomfort care when more aggressive treatment was desired and indicated.

is a newspaper created by theWinnipeg Regional HealthAuthority to inform public andstaff about healthcare, healthand wellness within theWinnipeg Regional HealthAuthority.

Reproduction of materials inwhole or in part is encouraged,however, confirmation with theeditor is requested.

We can be reached at:Winnipeg Regional HealthAuthority1800-155 Carlton StreetWinnipeg, MBR3C 4Y1www.wrha.mb.ca

Director of Communications:Sherril Matthes

Editor: Shawna Zeilstra

Kevin Scott, WRHA Communications with information from Dr. GareyMazowita, former medical director, Community and Long Term Care.

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log onto our website: www.wrha.mb.ca. You’ll find information about how we care,where you can find care, opportunities to work in health care, how we’re improving andinnovating in the field of health care, as well as the latest health care news.

Looking for a specific site or service? Click on the Encompass database under“Finding Care” on the WRHA Web site to search the on-line health services directory.

helping with difficult end of life decisions

TO FIND OUT MORE ABOUT THE WINNIPEG REGIONAL HEALTH AUTHORITY,

Communications Department19th floor - 155 CarltonWinnipeg, MB R3C 4Y1

Service des communications155, rue Carlton 19e étageWinnipeg (Manitoba) R3C 4Y1