Wave: Fall 2009 - Winnipeg Regional Health Authority

Suicide preventionIt’s everybody’s businessNo more secrets No more shame No more suicidesTogether we are strongerJoin the conversation.Go to suicideprevention.ca and make your voice heardCASP/ACPSsuicideprevention.ca4 WAVE

523720Table of contentsFeaturesMaking the gradeA healthy diet can help your kids do better at school 1442Battling the bugGearing up for the H1N1 virus 20Coleen’s storyThe host of Vitality TV talksabout her journey of self-discovery 42Departments & ColumnsA Letter from the Winnipeg Health RegionPreparing for H1N1 7Health BeatAsthma breakthrough; hand hygiene 814ResearchMeet PARO, the robotic harp seal 37Ask a NurseHPV and you 50In MotionActive kids are ready to learn 52Healthy EatingGet more out of your workout 54What Wellness Means To MeTransplant athlete David Wladyka 56Big PictureWhat is in an apple 58Fall 2009 5

Fall 2009 Volume 1 Issue 3Publisher Winnipeg Regional Health AuthorityPresident & CEO Dr. Brian PostlRegional Director, Communications& Public Affairs Michele AugertEditor Brian ColeContributing Writers Joel Schlesinger, Dolores Haggarty,Susie Strachan, Martin ZeiligColumnists Jorie Janzen, Kristine Hayward, Linda CooteMcPhillips Hearing& Audiology Centre Inc.www.audiology-online.comYour Ears Deserve An AudiologistChristine Dino, Au.D.Doctor of AudiologyCall For A ConsultationBefore Buying Hearing AidsCreative Director Krista LawsonPhotographers Marianne Helm, Trevor HagenIllustrator Krista LawsonOn the Cover Coleen Rajotte, photographed by Marianne HelmEditorial Advisory Board Jan Currie, Lynda Tjaden,Dr. Michael Moffatt, Dr. Wayne Hildahl, Réal J. Cloutier,Dr. Cheryl Rockman-GreenbergWinnipeg Free PressPublisher Bob CoxVP Sales & Marketing Laurie FinleyManager, Advertising Tracy MainlandWave is published six times a year by the Winnipeg RegionalHealth Authority in co-operation with the Winnipeg Free Press. Itis available at newsstands, hospitals and clinics throughoutWinnipeg, as well as McNally Robinson Books.Advertising SalesCall your Winnipeg Free Press sales representative orphone 204.697.7389.SubscriptionsWave is available through subscription:One year (six issues) for $12.60 ($12+GST)Payment may be made by cheque, money order,VISA, or MasterCard.To subscribe:Phone: 204.697.7122Fax: 204.697.7370Send an e-mail to: edithbonner@freepress.mb.caOr write to:WaveC/O Winnipeg Free Press1355 Mountain AvenueWinnipeg, MB R2X 3B6Check out for ourpromotional video - type oticon deltaPh. (204) 953-42001399 McPhillips St.Northgate Shopping CentreWinnipeg, MB R2V 3C4YOU DON’TNEED A DIET.YOU NEEDMOMENTUM.Editorial OfficeWinnipeg Regional Health Authority650 Main StreetWinnipeg, MB R3B 1E2Phone: 204.926.8144; e-mail: wave@mts.netA French-language version of this magazine is available atwww.wrha.mb.ca/lacourant. You can request a printed copy bycalling 204.926.7000.The information in this magazine is not meant to be a substitutefor professional medical advice. Always seek advice from yourphysician or another health professional regarding any medicalcondition or treatment. Opinions and views expressed inthis publication do not always represent those of the WinnipegRegional Health Authority. This publication may not be reprintedor reproduced in whole or in part without the consent of theWinnipeg Health Region.For information on pricing, class timesand locations in your area call1-800-651-6000 or 987-75466 WAVE

A Letter from the Winnipeg Health Region Dr. Brian Postl, President & CEOPreparing for the H1N1 virusBased on the evidence, it seems a pretty safe bet that we will seemore people infected with the H1N1 influenza virus this fall andwinter. Just how many is hard to say.Agencies such as the World HealthOrganization say the virus has establisheditself as the dominant influenza strain inmany parts of the Southern Hemisphereand warn that a second wave in NorthAmerica and Europe is on its way. At thesame time, the agency says the strainshows no evidence of mutating into amore lethal form.All the talk surrounding a possibleresurgence of H1N1 this fall and winterhas left a lot of people feeling a bit worriedabout potential risks to them and theirfamily. That’s understandable. No onewants to put themselves or members oftheir family needlessly at risk.The urgency surrounding H1N1emanates from its sudden appearance inMexico last spring and its seeming abilityto spread quickly and kill a large numberof people who were exposed to it. We nowhave more information to help us put thethreat into better perspective. For example,we now know that many people infectedby the virus will show little or no effects,while some others will get sick and be ableto recover at home. That is not to diminishthe seriousness of the H1N1 threat. Peoplewho do get sick can get extremely sick,and a significant number of people havedied from complications related to thevirus. In trying to assess the risk of H1N1,the best advice is: don’t panic, but don’ttake it lightly, either.The logical question, then, is what, ifanything, can we do to reduce our risk ofbecoming sick? Fortunately, the answer isthere are plenty of things we can do.In fact, we here at the WinnipegHealth Region have just put thefinishing touches on an actionplan designed to help preventthe spread of H1N1 andbetter treat those who dobecome sick with the virus.In this, our third issueof Wave, you will find aspecial report on the H1N1virus. In addition to a storythat helps put a humanface on the virus, youwill find information onhow you and membersof your family can help reduce the riskof becoming infected with the virus.You will also find information about ourmass immunization campaigns, for bothseasonal influenza and the H1N1 virus,as well as other measures we are takingto help prevent the spread of H1N1 andtreat those who do become ill. Hundredsof Winnipeg Health Region staff members,often working with outside groups such asthe province, the federal government andthe City of Winnipeg, among others, haveworked hard to pull together this readinessplan, and I am confident that we are wellpositioned to deal with the H1N1 threat.But there is more to influenza preventionthan vaccines and staffing levels. As thevirus spread through our province lastspring, it became clear that specific groupswithin the larger community are more atrisk for illness brought on by disease andafflictions such as the H1N1 virus. It’s fairto say that H1N1 doesn’t discriminate –the virus will attack anyone. But it’s alsofair – indeed, important – to point out thatthe virus seems to have thrived in someof our First Nations communities. Sciencedoes not have an answer for this yet, butI think it’s pretty clear that at least part ofthe reason is that many residents in thesecommunities are living in less than idealconditions. Poor access to healthy foods,crowded living conditions, lack of runningwater – all of these things can underminea person’s health, making them moresusceptible to chronic diseases orinfections, like the H1N1 virus.As a Region, we are committed todoing what we can to treat patients whocome through our doors. But our duty andour responsibility does not end there. Asnoted in a report produced last year byCanada’s medical officers of health, socialand economic conditions can negativelyinfluence the health and well-being ofindividuals, resulting in a health equity gapbetween those who live in poverty and thosewho do not.As a Region, we are trying to do our partto close that gap. Through various outreachprograms, we have taken steps to work withour community partners to provide careand wellness information to those livingin less than ideal conditions. We have anaboriginal health program to support effortsto reach out to First Nations people livingin Winnipeg and in remote communitiesthroughout Manitoba and Nunuvut. In thewake of last spring’s experience, we createda committee to look at ways to enhanceH1N1 prevention and care for First Nationspeople. Meanwhile, Catherine Cook, whoheads our aboriginal health program, hasbeen named by the province as an advisoron H1N1 issues.The Winnipeg Health Region is steppingup in other important ways as well. Forexample, we have contributed $250,000 tothe Winnipeg Poverty Reduction Counciland $600,000 to reduce homelessnessin our community. These efforts will noteliminate the health threat posed by H1N1and other diseases and afflictions. But theycan help reduce the risk. And they also helpunderscore the Winnipeg Health Region’scommitment to caring for all.Some members of the ICU team at St. Boniface General Hospital. From left: Grant Beck, respiratory therapist; JonathanGabor, resident; Jennifer Bergen, registered nurse; Garry Mousseau, health care assistant; Rob Ariano, pharmacist.Fall 2009 7

your healthHandhygienePilot project aims to reduce hospital infectionsA hand hygiene awareness pilotprogram has been launched withinthe Winnipeg Health Region as part ofits effort to improve patient safety inhospitals and nursing homes.The three-month project is intended toraise awareness about the importantrole hand hygiene can play in reducinghealth-care associated infections,says Ryan Sidorchuk, Leader, PatientVoice Facilitation, Patient Safety withthe Winnipeg Health Region.Health-care associated infections arethe most common serious complicationof hospitalization,” says Sidorchuk.One in nine patients admitted to Canadianhospitals acquire an infectionas a consequence of their hospitalstay. By raising awareness about theproblem, the Region hopes morehealth-care workers and hospital andnursing home visitors will take steps towash their hands.“Everyone can make a contribution toimproving patient safety by practisinghand hygiene, says Sidorchuk. “It’s aneasy and effective way to help stopthe spread of illness.”The program is another step in theRegion’s Hand Hygiene Strategy andPromotion, which was implementedin 2005 to reinforce the importance ofhand hygiene for health-care workersas well as patients, residents, clientsand visitors in all settings.Sites and units where this program willtake place include Victoria GeneralHospital, Health Sciences Centre, DeerLodge Centre, Holy Family NursingHome, Extendicare Oakview Place,ACCESS Transcona and three CommunityHealth Agencies; Klinic CommunityHealth Centre, Mount CarmelClinic and Nor’west Co-op CommunityHealth Centre.Various educational tools have beendeveloped to reinforce the need forpractising proper hand hygiene andwill be available at various locations.Throughout the project, there will beevaluations and audits of health-careworker hand hygiene practices. Informationgathered from the project willhelp inform and refine a region-wideawareness campaign.10 WAVE

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When Pain Won’t go AwayFrom the dull, nagging ache of tendonitis to the sharp,stabbing jolts from shoulder and back injuries, pain canbe devastating and rob you of your quality of life. It can go onfor months – even years, while you try to ignore it, take painmedications or have treatments that don’t work. In themeanwhile, you’re losing sleep and missing out on yourfavourite activities. All you want is the pain to go away!“To get rid of the pain, you need to get rid of the injury itself,”said Diana Mason, RMT, of LaserHealth ® Solutions. “Butoften, our cells don’t have enough energy to complete thehealing process. They get stuck in an inflammation cycle.When that’s the case, you need a therapy that gets to the rootof the injury and treats it right at the cellular level.” Whilemost medications just mask the pain and inflammationtemporarily, there is now a treatment available which canstimulate and finish the healing process, resolve inflammationand help the body develop healthy new tissue rather thantroublesome scar tissue.“This treatment is done with a cold laser,” explains Mason.“Not the type of laser that cuts or burns, but one that is gentlyabsorbed by soft tissue. During the absorption process, cellsare stimulated to produce more adenosine triphosphate – orATP. This is the simple fuel that cells use to do what they’resupposed to do – regenerate and repair. Think of it likephotosynthesis, plants absorb sunlight and convert it to energythat’s used to grow and repair.”Cold lasers have been studied for decades in scientific andclinical studies. Studies prove how highly effective it is inrepairing damage to soft tissue. From shoulder injuries tosciatica, tendonitis, plantar fasciitis, and sports injuries,cold lasers are now used to help heal these injuriescompletely. Even arthritis and degenerative disc diseasesufferers can see long term benefits from this treatment –without the negative side effects many experience with longterm use of pharmaceuticals.The cost of treatment is very reasonable and may be claimedon insurance plans which cover Massage Therapy orPhysiotherapy. As an experienced Massage Therapist, Masonoften uses manual techniques and stretching / strengtheningprograms along with the cold laser to help patients improveeven faster. “This combination is a perfect way to get rid ofscar tissue and inflammation - and help keep it away! Soinstead of just temporary relief from pain, you are receiving atreatment that acts in a curative way.”If you’re ready to get rid of your injury – and the pain – forgood, call Diana Mason, RMT, at LaserHealth ® Solutions foryour assessment — 204-255-7779 . Conveniently located inBorowski’s Health Foods at 437 St. Anne’s Road. For moreinformation, you can also visit the comprehensive website atwww.laserhealthsolutions.com . View videos of treatmentsbeing performed, clinical studies, and over 400 testimonialsfrom people who thought they would never get rid of theirpain – until they went to LaserHealth ® Solutions!I had pain in my heelsince mid-March ‘08. Ihad tried everything,exercise, icing, heat, andnothing seemed to work.I went to see Diana atLaserHealth ® Solutions.In a few treatments I wasfeeling less pain. I had atotal of 8 treatments andmy heel is great. ThanksDiana! No more pain. Ican walk again!Mary S.Plantar Fasciitis“Thanks to laser treatment and you,surgery was not required, and Iwas able to have a full summer oftraining and fun. Without lasertreatment, I wouldn’t be in thepeak physical condition I am rightnow, which allows me tocompete at the extremelyhigh level of athleticismthat is requiredof all NHLers.”Thanks again,Brennan TurnerChicago Blackhawks/Rockford Ice HogsAnkle Injury Shoulder Injuries Plantar Fasciitis Tennis Elbow Sprains & Strains®By LaserHealth ® Solutions Back Pain Tendonitis Arthritis SciaticaPain and Soft Tissue Rehabilitationwww.laserhealthsolutions.comCorp.LaserHealth ® Solutions • 204-255-7779 • 437 St. Anne’s Road

Making thegradeHow toeat yourway to asuccessfulschool yearBy Susie StrachanKyra McCubbin is careful aboutwhat she packs for lunch.“I’m in the accelerated program, whichmeans I’m taking university-level coursesthis year,” says the 17-year-old SturgeonHeights High School student. As a result,she tends to favour foods that might giveher brain a bit of a boost. On any givenday, she will choose from a menu thatincludes seafood, eggs, pasta and salads –foods that may help give her an edge in theclassroom.Her brother, Scott, is also conscious ofwhat he eats. A student at Bruce JuniorHigh School, the 13-year-old tries topick foods that may help him excel at hisfavourite sports – badminton, basketballand soccer. Lift the lid of his lunch box,and you’ll find a ham sandwich, an apple,carrots and a juice box. He also likes topack a cereal bar, which he’ll pull out for amid-afternoon snack. “Our coaches talk tous every now and then about what to eat,”he says. “I try to pick foods that will helpme do well in sports.”The healthy food choices don’t stop atMenu MakeoverStudies show that students who eathealthy food regularly come toschool prepared to learn, focus andcope with change, says Lori Tighe,Superintendent of the Inner City Districtwith the Winnipeg School Division.“Adolescent bodies are already outof whack, because of the raginghormones, so what they’re eatingdefinitely has an effect on them,” saysTighe, who stresses the importance ofa healthy breakfast, so children havebetter memory recall and behaviour.For the past 30 years, the WinnipegSchool Division has operated a breakfastprogram for children from nurseryschool through to Grade 12 who arenot getting enough to eat at home.The nutrition program exposes kids tofoods they may not have eaten before,and ensures they are eating a balancedmeal of fruit, vegetables, wholegrain breads and cereals and milk.14 WAVE

lunch. Their mother, Lori McCubbin, makessure that Kyra, Scott and middle child Spencer,15, get off to a good start in the morning.The breakfast menu usually consists ofcereal, milk, eggs, waffles, yogurt and fruit.And then there is dinner – selections caninclude meat, vegetables and pasta.In addition to eating healthy foods, thekids also try to avoid eating less healthyfoods. Junk food is limited, although therehave been some breakdowns in that department,acknowledges Lori – the boys dohave a soft spot for Slurpees. “As they getolder, and start to make a little money, theycan buy anything they want to eat,” shesays with a rueful shake of her head. “I’mtrying to let them know what good food isnow, so they won’t fill up on junk whenthey grow up,” she adds.Bottom line: The McCubbin kids aremaking good food choices that shouldhelp them maintain their overall healthand well-being. But can their diet also helpthem become more successful at school?The answer, according to Lorna Shaw-Hoeppner, a community nutritionist withthe Winnipeg Health Region’s ACCESSRiver East health centre, is yes. An increasingnumber of studies are indicating thatwhat kids eat can have a positive impacton their grades, as well as their physicaland social development – the three mainingredients to a successful school year.Moreover, says Shaw-Hoeppner, studiesalso show that being undernourished cando just the opposite.For example, the Children’s Lifestyleand School-performance Study (CLASS) inNova Scotia looked at the performance of5,000 fifth graders. It found that those withthe best diet quality did better, regardlessof other factors. They used an indexto measure diet quality based on a fewthings, including adequacy, balance, fruitand vegetable intake. “We demonstratedthat above and beyond socioeconomic factors,diet quality is important to academicperformance,” according to Paul Veugelers,one of the study’s authors. With kids of allages now back at school this fall, that researchis providing some food for thought.When it comes to eating their way toa better school year, the McCubbin kidsappear to be nibbling in the right direction,says Shaw-Hoeppner. That’s because they’rechoosing fruits, vegetables, whole grains,seafood and pastas – foods that containprotein and carbohydrates that power thebody and boost the brain. And they’re alsoAs for lunch, schools are increasingly changing menusand improving the nutritional value of food offered in theircafeterias and vending machines. The WSD adopted anutrition policy in 2007 that stopped the selling of pop,chocolate bars and chips in vending machines, and supportseducation about proper nutrition in physical educationand health education classes. WSD cafeterias now sellwater, milk and fruit juices, but not pop or junk food. Highschool cafeterias have guidelines that restrict fast food,such as french fries and hamburgers, so these are servedless frequently.community and the foods that represent the cultures. Forexample, one school may have bannock and wild rice onthe menu, and another may have spicy African or Caribbeanfoods.”Other school districts throughout the province follow a similarjunk food ban, following provincial guidelines to counteractrising rates of obesity and other health problems inchildren.“The food is reasonably priced, and includes items suchas soups, salads and sandwiches,” says Tighe. She citedGordon Bell High School as an example of the division’sfood policy in action, noting the cafeteria offers nutritious,inexpensive meals with a nod to the many ethnicities thatmake up the student population. “Schools look to theirFall 2009 15

Food for thoughtResearch suggests that some foods may enhance energy, mood andbrainpower. Here are some examples:Protein: Proteins build and repair body tissues. They are also essentialto the production of neurotransmitters, which allow brain cells tocommunicate with each other. Lean meats, fish, poultry, dairy, eggsand beans are rich in protein and made of amino acids, which areconverted into neurotransmitters and can promote proper brainfunction.Carbohydrates: The brain consumes more energy than any otherorgan in the body. As a result, it needs a steady flow of nutrients.Slow-burning complex carbohydrates provide the energy the brainneeds to function properly. Sources include brown rice, barley,pastas, vegetables and fruits, whole grain breads and cereals, andlegumes such as beans and lentils.Photo:Marianne HelmFrom right: Kyra, Scott and SpencerMcCubbin survey a bounty of healthy food.avoiding the pitfall oftoo much junk food, such aschips and pop, which is high inempty calories, salt, sugar and badfats, which leads to unhealthy bodies andsluggish brains.Not that there isn’t room for improvement.“The McCubbin kids have three foodgroups in their lunches, but it seems bothScott and Kyra are missing dairy products,”notes Shaw-Hoeppner. That’s importantbecause kids can significantly increasebone mass during the teen years, and dairyproducts provide a good source of calciumand Vitamin D, which build strong bones.“They need to consume more dairy,” shesays.Shaw-Hoeppner also has a suggestionor two for Scott’s lunch menu. “Althoughham is a lean deli meat, it is rather high insodium. It would be best to vary his sandwichesand include un-processed meatssuch as roast chicken, tuna or salmon.Milk would be a healthier choice thanjuice, but if juice is selected, orange andpineapple juices have more nutrients thanapple juice.”Being successful at school is oftendefined in terms of academic performance.B-complex vitamins: These vitamins help our bodies turn the foodwe eat into energy. B vitamins ensure optimal energy productionand are important for healthy blood and tissue repair, and help thebrain function at maximum capacity. Foods that contain more thanone type of B vitamin include sunflower seeds, wheat germ, spinach,broccoli, bananas, whole and enriched grains, and lean chicken,beef, and fish.Omega-3: Omega-3 fatty acids are a type of polyunsaturated fatthat is reported to have all sorts of benefits for mind, body and mood.There are three main types: eicosapentaenoic acid (EPA), docosahexonicacid (DHA) and alpha-linolenic acid (ALA). DHA is thoughtto be beneficial for brain development and brain function, whileDHA, ALA and EPA may play a role in enhancing mood.According to Dietitians of Canada, DHA and EPA are beneficial inbrain, nerve and eye development in infants, can reduce the risk ofheart disease, may improve immune function and may reduce therisk of colon and breast cancer. Further studies are needed to determinethe role in depression/mood. The best sources for DHA and EPAinclude salmon, mackerel, tuna, herring, sardines and rainbow trout.ALA can be found in flaxseed, flaxseed oil, walnuts, canola oil margarineand soybeans. Other foods, including eggs, cheese, yogurt,bread and pasta can be fortified with ALA or DHA.Iron-rich foods: Iron helps our red blood cells deliver oxygen to all thecells in our body. Iron deficiency can cause fatigue and low energy,irritability, and affect concentration and cognition. Iron helps thebody by enhancing energy and endurance levels as it helps to transportoxygen to all your body cells. Foods rich in iron include meat,poultry, oysters, beans, lentils, and fortified cereals and grains.Antioxidant-rich foods: Researchsuggests that antioxidant-rich foodsmay help protect brain power andimmune function, as well as stave offdisease. Brightly coloured vegetablesand fruits are rich in antioxidants.16 WAVE

Photo:Marianne HelmBut physical and social development is alsoimportant. Parents want their kids to get goodgrades, but children and youth also need totake an interest in physical activity that willkeep them healthy throughout life, and theyalso need to be able to get along well withothers, says Shaw-Hoeppner. “When a child iswell-nourished – not just not hungry, but wellnourished– they feel better about themselves,and when they feel better, they do better,”says Shaw-Hoeppner.There are certain foods thatseem to help the brain andthere are certain foods thatprovide energy to keepyou going through theday. And of course,there are some foodsthat affect your mood,which can have animpact on how youinteract with other kids and teachers. The bestway to maximize your potential is to develop ameal plan based on a balanced diet, one that canprovide the nutrients required to power the body,mind and soul. And the best place to start doingthat is Eating Well with Canada’s Food Guide,long considered to be the bible of healthy eating.For example, the guide recommends youngchildren eat five servings of fruit and vegetables,four servings of grain products, two servings ofmilk and alternatives and one of meat or a meatalternate every day. Small children have smalltummies, so smaller, more frequent meals andsnacks can be eaten throughout the day. Teenagers,meanwhile, need between seven and eightservings of fruit and vegetables, six servings ofgrain products, three to four servings of milk andalternatives and two or three servings of meat or ameat alternate, such as beans, lentils or eggs.While there is no magic food that can turn achild or teen into a genius or star athlete over-On the menuHere is an example of a menu that could boost your child’s brainpower.BreakfastA balanced breakfast containing food from atleast three food groups – grain products, dairy andfruit – will provide energy to sustain your child forthe whole morning. Children who eat breakfastalso have better focus, memory and concentrationthan those who skip. Try unsweetened cerealor hot oatmeal, toast with peanut butter, milk anda fruit, or scrambled eggs and whole-wheat toast,yogurt and a small glass of unsweetened juice. Trya whole-grain cereal or porridge, along with a protein,such as milk or yogurt. Fruit can be consumedin the form of an apple or orange juice, a bananaor grapefruit.LunchFor school kids, lunch is a chance to unwind fromthe morning and prepare for the afternoon, alongwith refuelling to take them through to 3:30 dismissal.Lunch selections should be made from atleast four food groups: dairy, grain products, meatand alternatives, and vegetables and fruit. Try achicken sandwich with whole-grain bread and yourchoice of fruit or some carrot sticks. Milk would bea preferred beverage, but if not available stick tounsweetened fruit juice or water.SnackIgnore the temptation to hit up the vending machinefor a chocolate bar or a bag of chips.Instead, try a non-coated granola bar, a piece offruit, or a homemade muffin.DinnerThe family dinner doesn’t have to be complicated.Choosing from the basic food groups, you cancreate a salmon dinner, with simple risotto rice andsteamed vegetables. Or maybe try hot and spicyturkey burgers, with marinated salad. Team it upwith a glass of milk and fruit for dessert.Evening snackResist the temptation to grab a bagof chips when watching TV atnight. Instead, go for a bowlof fruit and yogurt, lowfat popcorn or veggiesand dip.Fall 2009 17

efore a test,” she says.The brain’s processes and neuro pathwaysalso require a steady supply of vitaminsA, C, E and B, and minerals suchas zinc, magnesium and iron. Wateris also important for keeping the brainhydrated.Of course, some foods can drainthe brain. Colas and juices withexcess sugar, refined white bread andprocessed snack foods and luncheonmeats, and food with partially hydrogenatedoils are among the mainculprits. Greenwood cites one studythat found that rats with high intakesof fat experienced loss in learningability and memory.In addition to keeping the brainfunctioning at full capacity, it is alsoimportant for young people to keepup their energy and strength. Theschool years are a time when kids candevelop an interest in sports and otherphysical activities, such as dance. Participatingin these kinds of activities will helpdevelop a life-long interest in being activeand promote social interaction. In order toenjoy physical activities, however, one hasto have the energy to do them, and that canonly be provided through healthy eating,says Shaw-Hoeppner.Slow-burning complex carbohydratessuch as whole-grain oatmeal, calcium-richyogurt, blueberries full of antioxidants andvitamin C, sweet potatoes with vitamin A,lean chicken with protein and iron, plussalmon and its omega-3 fatty acids all promoteoverall health, which is necessary foroptimum performance.Athletes should eat around their sport,starting with a small snack two to threehours before a practice or game kick-off.This should consist of mostly carbohydrates,such as yogurt, a bagel and fruit,cereal, milk and a banana, or cheese andcrackers. About 15 to 30 minutes after exercise,athletes should have a snack that ismostly carbohydrate, with a small amountof protein, like chocolate milk or nuts andjuice to replenish their glycogen stores andhelp speed recovery. Two to four hourslater, depending on the time of day, theyshould follow up with a balanced meal.Fluids are an important part of beingathletic, but sports drinks are generally notneeded unless the activity lasts longer than45 minutes. Instead, the athlete shoulddrink about 500 mL of water two hoursbefore their game, and another 250 mL 15minutes before it starts and have gulps ofwater during the activity. Don’t forget to replenishfluid losses after the activity. Interestingly,Shaw-Hoeppner says that drinkinga glass of water will rehydrate your bodyand refresh your brain as well, so you’llregain alertness and focus without havingto resort to caffeine in pop or coffee.Of course, the importance of a mealcannot always be measured by nutritionalvalues alone.What really garners an A-plus fromschools and dietitians is when families havemeals together. Kids who eat with theirparents do better in school, have fewer behaviourproblems and are less likely to usealcohol, tobacco or drugs. Children learnfamily values, along with learning to communicatebetter with adults. The meals alsonourish security and feelings of belonging.“Studies show that children who eat withtheir family several times a week withoutthe TV on are not only better nourished,they are better-adjusted. This reduces therisk of smoking and drug use, aggressivebehaviour, early sexual behaviour anddepression,” says Shaw-Hoeppner.Shaw-Hoeppner suggests aiming for fouror more family meals a week. But if that’snot possible, try to eat one meal a weektogether and add more as you can. Familymeals don’t just mean dinner; breakfast,lunch and even a midnight snack togethercan count as well. Adults should involvechildren in menu planning, shopping forthe ingredients and preparing the food.“Kids can be involved in meal preparationfrom an early age. When you take themto the grocery store, they will be more inclinedto try new foods if they help choosethem,” she says.Adults should respect their child’s right todecide how much to eat, and not force thechild to eat new foods. It can take a dozenor more exposures to new food before achild tries it. Adults also should set the tonefor the conversations at the table, alongwith what behaviour is OK and what is not.Turn off the TV and telephone, and talk.“Get the family dynamics going. Kidswho eat with their families do better inschool,” says Shaw-Hoeppner. “Keep theconversation lines open. Don’t talk aboutyour kid’s failing math grades at dinner.Save that for a quiet time, and keep mealtime pleasant.”Susie Strachan is a Winnipeg writer.Fall 2009 19

PREPARINGSPECIALREPORTAlso insidethis section:Battling theRecognizingthesymptomsHow toreduceyour riskWhat todo if youare sickImmunizationclinicsAccessingservicesRegion gearsup for H1N1When two-year-old Peter Flettstarted showing signs of beinginfected with H1N1 influenza earlierthis year, the staff at the WinnipegHealth Region’s Children’s Hospitalwere there to helpChristina Flett knew something was wrong.Normally, her two-year-old son likes nothingbetter than to play with his toys, especiallyhis little red car. But on this spring day, Peterwasn’t feeling much like playing.Upon closer inspection, Christina discoveredthat he had a bit of a fever. Soon after, he wasBy Joel Schlesingervomiting. At first, she gave him Tylenol anda sponge bath. But when the fever refused toabate, Christina and her father, Jack Harper,took the boy to a nursing station at GardenHill, a First Nations community in northernManitoba.What you need to know about H1N1 influenzaQ: What is H1N1 influenza?A: H1N1 influenza is a respiratory illnessthat causes symptoms similar tothose of seasonal influenza. Cases ofH1N1 influenza have been reportedin people around the world, includingCanada. Influenza viruses changeover time. The World Health Organization(WHO) sets the pandemicalert level globally and has raised it20 WAVEto phase six. This means the virus hasshown sustained community transmissionin more than one WHO region. Thepandemic level is based on the spreadof the virus, not the severity of illness.Health officials continue to monitorthe situation, and plans for pandemicand emergency responses are readyfor use. The influenza outbreak lastspring was province-wide, and morecases are expected in communitiesacross Manitoba this fall and winter.Although there has been an increasein the number of people with severerespiratory illness, this has been a smallproportion of the people who havehad H1N1 influenza in Manitoba. Themajority of people in Manitoba whohave become ill have not requiredhospitalization.

It would be the first of several visits overthe course of the next week. Each time,staff at the station would give Peter medicationto help bring down the fever, and eachtime the fever returned. As his conditiondeteriorated, the family became more concerned.“There was definitely a change ofattitude,” says Harper. “He was drowsy, notfeeling like doing anything.”Eventually, the boy was airlifted to theWinnipeg Health Region’s Children’sHospital, the primary pediatric treatmentcentre for Manitoba, northwest Ontario andNunavut. Upon arriving at the EmergencyDepartment, it was apparent that the boywas seriously ill. He was admitted to hospitaland quickly diagnosed with pneumonia,brought on by H1N1 influenza.With that, Peter Flett became one ofmore than 800 Manitobans who have beenofficially diagnosed with H1N1 influenzaso far this year in what has become one ofthe biggest public health emergencies inManitoba’s recent history.Initially identified as swine flu, the H1N1virus first started grabbing headlines inMarch when it was linked to the deaths ofmore than 150 people in Mexico. It quicklyspread right across North America, infectingthousands of people. By June, the viruswas circulating through parts of Europe andAsia, prompting the World Health Organizationto declare the outbreak a pandemic.In Manitoba, the first confirmed caseof H1N1 influenza surfaced on May 4 inBrandon, and by early June the virus wascirculating throughout the province. It isestimated that about five to 10 per cent ofManitoba’s population of about 1.2 millionpeople were infected by the virus duringthe outbreak. Manitoba is reporting 886 officiallyconfirmed cases of H1N1 influenzaand seven related deaths so far this year.First Nations people, especially those livingin remote communities, were among thehardest hit by H1N1 – accounting for abouta third of the cases.Most people exposed to the virus eithershowed no signs of being sick or were ableto recover on their own. But some Manitobansdid become extremely ill. Officialsestimate that about 70 people with H1N1virus ended up in one of the Region’s IntensiveCare Units, often on a ventilator, oftenfighting for their lives. Peter was one of31 children, mostly of aboriginal descent,who were treated for H1N1 influenza atChildren’s Hospital. Fortunately, he wasable to fight off the infection after one weekin the Intensive Care Unit. Many were notso lucky. Some children had to spend asmany as four weeks in intensive care, oftenhooked up to a ventilator because theycould not breathe on their own.As the number of H1N1 cases grew,Peter emerged as the human face of the influenzastory in Manitoba. His family spokepublicly about his experience with H1N1,and his photo appeared alongside manystories on the virus and its impact on FirstNations communities. With health officialswarning of a possible return of H1N1 in thecoming fall and winter influenza season,Peter’s story helps illustrate the unforgivingnature of the virus and the toll it can takeon individuals, families and communities.It also underscores the challenges facingpublic health officers and health-care providers,especially those working in ICUs,as they work to prevent the spread of thevirus and treat those who become infectedwith it.RNA in a baggieInfluenza, in one form or another, has alwaysbeen with us. Defined as an infectionof the respiratory tract, the word influenzais derived from influenza del freddo, whichis Italian for influence of the cold. Althoughthe origins of influenza are not well understood,it is believed the first human casesof the viral infection were recorded about2,400 years ago in ancient Greece by noneother than Hippocrates, considered bymany to be the father of medicine.Since then, there have been countlessinfluenza outbreaks in Europe and elsewhere.There have also been a number ofinfluenza pandemics. The first major oneoccurred in 1917-1918, when a strainknown as Spanish Flu spread around theglobe, killing an estimated 40 million to100 million people. There have been otherpandemics since: the Asian Flu Pandemicin 1957, caused by H2N2 strain, killedabout four million people worldwide, andthe Hong Kong flu pandemic in 1968,caused by H3N2, claimed about one millionlives around the world.In Canada, the influenza season is aspredictable as winter. Indeed, one strain ofinfluenza or another usually arrives withthe first snowfalls of winter and continuesto circulate around the country until spring.The vast majority of Canadians who becomeinfected with these “seasonal” strainsof influenza generally manage to sufferthrough with nothing more than a few daysof discomfort. While seasonal influenzacan cause death – about 4,000 people dieeach year – it is typically the elderly andfrail with underlying health conditionswho are most vulnerable. As a result, thegeneral public doesn’t pay much attentionto the risks associated with the virus, saysDr. John Embil, Director of the WinnipegHealth Region’s Infection Prevention andControl Program. In fact, annual influenzaQ: What about protectingchildren?A: Children should take the sameprecautions as adults, includingwashing their hands regularly andcovering their nose and mouthwhen coughing. Young childrenmay need help with hand washing.To avoid the spread of germs,keep surfaces clean in areaswhere children play.Q: When should Iseek medical carefor my child?A: Older children withinfluenza-like symptomsshould stay home fromschool or daycare. Childrenless than five yearsof age with influenza-likesymptoms should seetheir health-careHow long can theH1N1 virus live?According to the Centres for DiseaseControl, the H1N1 virus cansurvive on environmental surfacestwo to eight hours. This means thatsomeone who touches a telephoneor a door knob that has been contaminatedby someone carrying thevirus can become infected.However, it is important to rememberthat the virus is most oftentransmitted to others by coughing.22 WAVE

Wondering whereto get yourinfluenza shotsthis fall?The Winnipeg Health Region will be stagingimmunization clinics this fall for seasonal andH1N1 influenza. For the latest information aboutwho should get immunized, as well as clinic timesand locations, please visit: www.wrha.mb.caor call Health Links - Info Santé at 204-788-8200,or toll free at 1-888-315-9257.Fall 2009 23

immunization rates are still generallylow for the public, hovering at about 34per cent of the population in 2005, accordingto an article following influenzavaccination trends in Canada, published byStatistics Canada in 2007.Of course, the H1N1 virus is a differentkind of influenza. Like seasonal influenza,H1N1 attacks people with underlyinghealth conditions, as well as pregnantwomen. But unlike seasonal influenza, thevirus appears more likely to infect childrenand younger adults as opposed to thoseover the age of 65, and middle-aged adultsseem to be among those who get most seriouslyill. And although the virus can attackanyone, anywhere, people with Aboriginalancestry, particularly those living in remotecommunities, were disproportionately affectedas the first wave of the virus rolledthrough the province last spring.Although most people seem to be ableto handle the virus with little or no effects,health authorities the world over areramping up efforts to guard against thevirus. But, caution, rather than panic, is thewatchword. “Most people have illness similarto typical seasonal influenza,” says Dr.Sande Harlos, Medical Officer of Healthfor the Winnipeg Health Region. “Peopleneedn’t be overly anxious about it. At thesame time, it does hit some groups hard,and when people get sick, they can getreally sick, so it is important for people toknow if they are at particular risk and whatto do about it.”So why is the H1N1 virus so differentfrom its viral cousins? The answer lies inthe biology of the influenza virus itself.As an organism, the influenza virus is amarvel of genetic simplicity, consisting ofribonucleic acid (RNA) and antigen proteinsenveloped in a membrane container.Or, as Embil likes to say: “Essentially,viruses are a piece of RNA in a baggie.”Simple or not, influenza viruses canbe quite resourceful. Some strains can bepassed between birds, animals (usuallypigs) and humans by direct contact. Onceinside an infected organism, they replicateeasily and perpetually mutate. Indeed, it isthe ability to mutate – a process known as“antigen drift” – that shapes the makeup ofthe so-called seasonal influenza virus thatcirculates through the population everyyear.Generally speaking, an individual infectedby a strain of influenza will developantibodies to fight off the virus. In doingso, he or she also creates immunity to thatspecific strain of influenza. The problem isthat as the virus spreads from one personto the next, it continues to mutate or driftto the point that it becomes a slightly differentstrain of influenza. By the time thenext influenza season rolls around, thevirus has changed enough so that peoplewho had influenza the previous year or theyear before may no longer have completeimmunity to the newly mutated strain. Thisis why influenza viruses keep coming backyear after year, and why scientists are forevertinkering with the makeup of vaccinesthat can keep a particular strain of the virusat bay.But occasionally, an influenza viruswill arise that isn’t the product of “antigendrift,” or normal mutation. This rare occurrenceis caused by “antigen shift” and isresponsible for creating pandemic strains,such as H1N1.Antigen shift can occur in a number ofways. For example, a strain of influenzafrom a bird could spread to a pig. The pigcould also pick up a strain of influenzafrom a human. When the viruses meet inthe pig, they co-mingle, producing a newstrain. This new strain can pose a largerthreat to humans than the typical seasonalinfluenza because those who are infectedhave no immunity to it. This is what isbelieved to have happened with the currentstrain of H1N1.While researchers cannot pinpoint forcertain the H1N1 strain’s origins, they theorizeit likely evolved a few years ago, possiblyin Asia, before drawing global attentionin Mexico. The virus likely came intobeing when two or three different influenzaviruses infected the same cell in an animal,most likely a pig, which is considered anideal host for antigen shift because it canbe infected more easily by both bird andhuman strains. “What ends up happeningis you have a virus that is a combination ofpig, human and bird, which is, presumably,what happened here, and it ends up causingproblems,” Embil says.Inside the ICUAs the H1N1 virus circulated throughoutManitoba last spring, it found a welcominghost in Peter Flett. He was young, vulnerableand living in a community where thevirus was known to be circulating.But the tables started to turn once he arrivedin Winnipeg. Upon being admitted toChildren’s Hospital, Peter was assessed andeventually prescribed a dose of Tamiflu,an antiviral that helps fight the infection.Although he did not require a ventilator,Peter was fed intravenously and did requirean oxygen mask from time to time to helphim breathe. Within one week, his bodywas able to fight off the virus and he wassent home.Others were less fortunate. Dr. MurrayKesselman has worked as an intensivecare specialist at Children’s Hospital forprovider within a day,especially children undertwo years of age.If you have questions orare concerned that yourchild may need care,contact your health-careprovider or Health Links-Info Santé at 788-8200or 1-888-315-9257.Q: Should I be tested to find out if I have H1N1influenza?A: Most Manitobans who have been infected by H1N1 influenzawill have mild symptoms or may not even know they’ve beeninfected. The province gives recommendations on who shouldbe tested, which can change throughout the course of an outbreak.Only people who are severely ill need to be tested. Thismay help us to understand who is at greater risk of becomingmore ill, while also keeping the demands on our labs manageable.Health-care providers know how to diagnose and treatrespiratory illnesses like H1N1 and don’t need test results to beginyour care.

25 years. Without getting into the specifics of any particularpatient, Kesselman says that many severe cases follow afamiliar pattern.First, upon arriving at the Emergency Department, theyare assessed by the triage nurse. In cases where a patient ishaving difficulty breathing, a doctor is called in for furtherexamination.The early warning signs that a child may have influenzaare hard to miss, says Kesselman. Any child who exhibitsdifficulty breathing (flaring nostrils, heaving chest), whois not as focused on their surroundings as they might benormally, and who is lacking in energy is a likely candidate.“And when you listen to their chest… and you can hearcrackling sounds, and the monitor shows their oxygen levelis not as high as it should be, and their heart is racing toofast, and their breathing rate is too high. All of those thingstogether give you an indication that something severe isgoing on.”That “severe” thing going on is the virus at work, infectingthe lungs and causing inflamation of the lungs (pneumonia).While the virus infects all cells that line the airway,of most concern are the cells located in the alveoli, tinythin-walled air sacks deep in the lungs that are responsiblefor oxygenating the blood and removing carbon dioxide. Aninfection can damage or destroy these cells, causing tissuefluid to leak into the alveoli and impairing the body’s abilityto oxygenate blood. As a result, the lungs become very stiffand have to work harder to maintain an adequate supplyof oxygen, and the heart has to work harder to pump moreblood to keep all the body’s cells well-supplied with oxygento ensure they function properly.As the infection grows, the body begins trying to repairthe damage. White blood cells called lymphocytes activatebiochemicals called cytokines, which cause inflammationand build-up of fluid in the alveoli and other parts of theairway passage as they try to fight off the infection. This fluidis the phlegm (mucus) that we often cough up when wehave a lung infection.Treatment involves a number of actions. “The mostimportant thing you are doing right away is making sure thechild is able to breathe,” says Kesselman. Normally, a childwill be given a dose of Tamiflu or another type ofantiviral.Be part of the H1N1 influenzaprevention teamWinnipeg Health Region staff are working to preventthe spread of influenza and treat those who becomeinfected with it. Members of the public can play acrucial role in the H1N1 prevention effort. In addition totaking the usual precautions – washing hands, followingcough etiquette, getting immunized – members of thepublic can take other steps. Here are some examples:Stay informedRead up on H1N1 influenza. For up-to-date informationabout H1N1, please visit the following websites:www.wrha.mb.cawww.manitoba.cawww.phac-aspc.gc.caHome flu kitPrepare a home flu kitconsisting of the following:• Thermometer• Facial tissues• Soap and water• Ibuprofen (e.g., Advil) or acetaminophen(e.g., Tylenol or Tempra). Do not give ASA(e.g., Aspirin) to children and teens.Make some flu buddiesPlan for someone to look after you or your children ifyou are ill, and offer to provide them with the samesupport. You should also identify family members, friendsor neighbours who may be living alone and call themregularly to see if they need help dealing with the flu.Facts about transmissioNQ: What should I do if there is aconfirmed case in my child’s school?A: Currently, there is no need to close schoolsor child care centres. Children who are feelingwell do not need to stay home. Childrenwho are ill should stay home until they feelbetter.According to the Public Health Agency of Canada, transmission of theH1N1 influenza virus is thought to occur mostly through coughing orsneezing. The incubation period for the H1N1 virus is thought to be upto four days, with the communicable period lasting seven days from theonset of symptoms, including fever. This period may extend to 10 daysfor individuals with severe illness. As with seasonal influenza, the H1N1virus is thought to be most capable of spreading during the early stagesof infection. The Winnipeg Health Region recommends that peoplewith influenza-like illness stay home from work or school until theyfeel completely better. In most cases where people have a mild case ofH1N1 influenza and do not require medical care, the virus would runits course in a few days to a week.Fall 2009 25

A specimen will be taken from the noseand throat and sent to the lab for furthertesting. If necessary, the child will be sedatedand a breathing tube is inserted intohis or her throat and hooked up to a ventilator.“All of these things happen simultaneously,”says Kesselman. In the most severecases, a ventilator is hooked up quickly; inother cases, the medical team will monitora patient to determine whether such drasticaction is necessary.“At that point, they’ve got a plastic tubein their throat, they have to be sedated andgiven pain medication to tolerate it. Theyhave other tubes and lines inserted intoarteries and veins in their body to monitorall the other vital processes,” says Kesselman.Once a child is stabilized, he or sheis then equipped with a feeding tube tohelp give them the food they need to fightthe infection.These children – the sickest of the sick– are then transferred to the Intensive CareUnit under the care of a team that includesphysicians, respiratory therapists, pharmacists,nurses and health-care assistants.At this point, battling the H1N1 infectionbecomes a game of wait and see. “Youkind of manage these cases hour by hour,hoping that the body’s defences can catchup with the infection while you are tryingto support it,” says Kesselman.Normally, it might take four or five daysfor a child to overcome an influenza infection.But, many of the kids struck by H1N1were in ICU for a minimum of two weeks,with some staying three or four weeks.“Those that did get that sick, got very sick,”says Kesselman. “If they came with otherchallenges, if they were malnourished, ifthey had underlying heart disease or lungdisease, it was that much more of a challengefor them to handle this.”As the days go by, the ICU team monitorsthe patient’s vital signs and keeps onthe lookout for any possible infections. “It’sa continuous process of watching thosethings,” says Kesselman.Eventually, in the best-case scenario, thepatient turns the corner, and the antibodiesstart to get an upper hand on the infection.The first sign that a patient is recoveringfrom infection is improved breathing.“There is less support from the ventilator.The lungs are doing more work. Then thebody chemistry starts to normalize,” saysKesselman.But even as a child recovers from a viralinfection such as H1N1, there is still muchto contend with. “It’s overwhelming to theirbody, and they are left with a lot of injuryand damage to their lungs, and it takes along time to get them well enough so thatthey don’t need a hospital,” Kesselmansays. “It’s a gradual process.”An ounce of preventionAs the rush of H1N1 cases started todrop off in early August, health-care providersand public health officials within theWinnipeg Health Region heaved a collectivesigh of relief.For years, Region staff had been planningfor something like the H1N1 outbreak, butthe real thing put everyone to the test. Thefocal points were the Emergency Departmentsand ICU sites at the city’s hospitals.As busy as the Children’s Hospital was,other city facilities, including St. BonifaceGeneral Hospital and Health SciencesCentre, were also strained by the suddendemand for care. Hundreds of patientsexhibiting symptoms of the virus turned upin hospital Emergency Departments seekingcare. The influx of additional patientsrequiring lengthy admissions to critical careunits strained resources, including availablenurses, doctors and specialists. Former ICUnurses and other related health-care specialists– like respiratory therapists – werereassigned to bedside care to help ease theworkload. Doctors, nurses and support staffwere working 16-hour days, forgoing daysoff to provide round-the-clock care to criticallyill patients.Larissa Nimchonok, Manager of PatientCare, Medical/Surgical Intensive CareUnit at St. Boniface, says the experiencewas intense. “It probably quadrupled theworkload,” she says. “The issue was thatwith the patients we had, there were a lotthat came at once. They were very sick.”Not only did many require ventilators tobreathe and have to be under the watchof at least one ICU nurse 24 hours a day,some of the more ill patients needed additionalhelp, including the use of Extra CorporealMembrane Oxygenation (ECMO),a heart and lung machine usually reservedfor heart bypass surgery patients. “These(H1N1) patients needed it too because wewere having such a hard time oxygenatingthem,” says Nimchonok.Although the surge in the number ofseverely ill patients tested the limits of thehealth-care system’s ability to manage thecase load, health-care providers were ableto cope, in part because of the pandemicpreparation that had taken place earlier.Region staff have ramped up capacity todeal with a possible surge in patients thisfall, but public health officials say there areother ways to attack H1N1.“There is an old saying that an ounceof prevention is worth a pound of cure.That is certainly true when it comes todealing with H1N1,” says Harlos. The bestsource of protection against the virus isvaccine. But given that a vaccine may notQ: How do I know if I have a fever?A: Fever is a sign that the body is fighting an infectionor other illness. You or your child has a fever if bodytemperature is 38°C (100.4°F) or higher. Touching aforehead or neck is not a reliable way to check ifsomeone has a fever. The best way to measure aperson’s temperature is by using a digital thermometerplaced in the mouth (oral), the ear (tympanic) orunder the armpit (axillary). The use of glass mercurythermometers is not recommended. You can buy adigital thermometer at your drug store.For infants and young children, the safest way to takea temperature is in the centre of the armpit. If thechild is over two years of age, an ear thermometercan be used. Taking the temperature in the mouth isunsafe because young children can bite and breakthe thermometer. Also, the reading can be wrongbecause it is hard to keep a thermometer undera child’s tongue. For more information on taking achild’s temperature, please see the fact sheet Caringfor a Child with a Fever available at www.gov.mb.ca/health/documents/childhealth.htm26 WAVE

Accessing Health Services inWinnipeg during a PandemicThe Winnipeg Health Region is planning to provide health services as usual in the months ahead.However, some services, including elective surgery, or other non-critical services in Winnipeghospitals may be postponed, depending on the level of influenza activity in our community.Services normally available at the Winnipeg Health Region’s primary care and ACCESS centresmay also be adjusted if staff members are required elsewhere in the health system to assist withthe care and treatment of people with influenza.The Winnipeg Health Region will advise the public of any service changes on our website, atwww.wrha.mb.ca and through the local media. Individuals can also check with their healthfacility or provider to confirm appointments if you are unsure.Safety Precautions in Health FacilitiesShould a serious outbreak of influenza occur during the next few months, a number of stepswill be taken to protect patients in hospitals and clinics as well as residents in long-term carefacilities. Also in order prevent the spread of seasonal or H1N1 influenza, all visitors tohospitals, clinics and personal care homes will be asked to adhere to certain precautionsand restrictions such as:• Not to visit a patient at a hospital or a resident at a personal care home at any time if you feelunwell with a fever, cough, body aches or fatigue, or have had any of these symptoms in thelast seven days.• Use hand sanitizer or wash their hands at a sink when entering and leaving a patient’s room or unit.• Follow any special precautions posted outside a unit or on a patient’s or resident’s room beforeentering.• If you are unwell and have a pre-arranged appointment that can be postponed, please contactyour health provider or facility to reschedule or receive further direction about your appointment.Also, those with business in health facilities in Winnipeg should not attend if they are ill.• In Intensive Care Units or other patient treatment areas where additional restrictions arenecessary, the number of visitors will be limited. Also, all visitors will be required to put on theappropriate masks, gowns and/or other personal protective equipment before entering apatient’s room. Bringing children to visit into these areas is not encouraged however, shouldthis be necessary, children must be supervised at all times.Going to a Hospital or Health facility for CareIf you are sick with influenza-like symptoms and need to go to a hospital Emergency Department,Urgent Care or medical clinic, you will encounter signs upon entering these facilitiesasking you to “Stop and Cover your Cough.” Instructions on the signs will ask you to use thehand hygiene products provided and put on a mask before continuing to the reception /triagedesk or waiting area. This important step will further reduce the spread of influenza in our healthfacilities.For the latest information on service availability, please visit www.wrha.mb.ca or callHealth Links–Info Santé at 788-8200 or 1-888-315-9257.Q: What can I do at home to treat a fever?• Dress in lightweight clothing and keep theroom temperature around 20ºC (68ºF).• Drink plenty of fluids in order to replace bodyfluids lost in sweat. If the person who is sick hasurine (pee) that is darker than usual, they needto drink more.• Offer small, nutritious meals. Peoplesick with influenza may not be veryhungry.• Take acetaminophen (ex: Tylenol®,Tempra®). Use the dose and schedulerecommended on the package or by yourdoctor or pharmacist. Ibuprofen (ex: Advil®,Motrin®) may be used for children older than sixmonths and for adults.• Do not give acetylsalicylic acid, also known asASA, (ex: Aspirin®) to anyone under 18 years ofage because it can lead to brain and liverdamage (Reye’s Syndrome).Fall 2009 27

e available until November, there areother measures individuals can take toprotect themselves, she says.“There are no guarantees in life, butthere are ways to reduce risk,” saysHarlos. “One of the most importantthings you can do is to wash yourhands regularly. People don’t realizehow often they can come into contactwith surfaces others have just touched,and viruses can be spread this way.”Other tips include covering a coughor sneeze by coughing or sneezing intoyour elbow or sleeve, or using a tissueto cover your nose and mouth; limitingtouching your eyes, nose or mouth;maintaining your health by makinghealthy food choices, being physicallyactive, and getting enough sleep. Andif you smoke, quit. Smoking increasesyour risk for getting seriously ill withinfluenza. You can get help to quit bycalling the Manitoba Smoker’s Helplineat 1-877-513-5333. “It’s also importantto make sure your kids are taking thesame precautions,” she says, addingthat younger children may need helpwith washing their hands. Adults andchildren with influenza-like symptomsshould stay home from work, schoolor daycare until they feel completelybetter.Back homeIt’s a beautiful day in late August andJack Harper is sitting in a cafe at theSt. Boniface General Hospital. Peteris back home in Garden Hill, playingwith his toys. Harper’s daughter,Christina, meanwhile, has just givenbirth to a baby girl. He is pleased withthe treatment his grandson receivedfrom the medical team at Children’sHospital. But, having seen the impactof H1N1 close up, and with a newgranddaughter in the house, he continuesto be concerned about the impactthe virus has had and could continueto have on First Nations communities.“We’re still fighting this thing,” saysHarper. With the influenza seasonaround the corner, He worries that areturn of H1N1 could be devastating.As a result, he would like to see thegovernment do more in remote communitieslike Garden Hill to shore updefences against H1N1. “We need toprepare for this upcoming flu season.”For its part, the provincial governmentannounced in September that ithas and will continue to take steps tosupport First Nations communities. Inaddition to sending medical supplies,including Tamiflu, to nursing stationsaround the province, the government isalso working with First Nations leadersto ensure “ongoing communicationand problem-solving.” For his part,Harper hopes Peter’s story will helpraise awareness about the potentialhealth risks associated with the H1N1virus. “None of us wants to see thishappen to anyone else.”Joel Schlesinger is a Winnipeg writer.Q: How can I treat other symptoms of influenza?• Get plenty of rest.• Gargle with warm salt water if you have a sorethroat.• Use a cool mist humidifier to help with a stuffy nose.• If a baby is having problems breathing becauseof a stuffy nose, use a rubber suction bulb toclear the mucous. These are available at drugstores. You may also use saline nose drops orspray if the mucous is very thick.There are many over-the-counter cough and28 WAVE

Gearing up for H1N1Region planners take steps toready health-care systemBy Joel SchlesingerIt’s a daunting task.Figure out a way to give influenza shotsto as many as 500,000 people. Twice.When it comes to preventing the spreadof the H1N1 influenza virus this fall andwinter, the job of organizing mass immunizationclinics is one of the more challengingones.It’s easy to see why. Not only do youhave to identify venues large enough tovaccinate hundreds or even thousands ofpeople at a time, you also have to makesure they are properly staffed and accessible.What about parking? What aboutsecurity? Is it on a major bus route?Then there is the little issue of havingto explain to people that the vaccine maybe administered in two doses to ensure effectiveness,although recent reports suggestone dose may be enough. And, of course,the H1N1 vaccine should not be confusedwith the vaccine for the seasonal influenza.That is an entirely different vaccine, onethat will be administered weeks before theH1N1 vaccine is available. That means,when all is said and done, health officialsexpect they will have administered morethan one million doses of vaccine this season.And that is unprecedented.The H1N1 immunization program isjust one example of how the WinnipegHealth Region is preparing for a possibleresurgence of H1N1 influenza this fall andwinter. Ever since the virus surfaced inManitoba last spring, hundreds of peopleworking on dozens of committees havebeen tackling issues ranging from how bestto immunize the public to staffing for IntensiveCare Units with two goals in mind: toprevent the spread of the virus and ensurethose who become ill get the best treatmentpossible. Now, with the flu season justaround the corner, all those hours of deliberationand planning are being put intoaction. The plan is about to be tested.Dr. Sande Harlos is the Medical Officerof Health for the Winnipeg Health Regionand one of the key players in the H1N1readiness effort. Although the planningprocess has been in high gear for severalmonths, Harlos says preparations for apossible influenza pandemic began manyyears ago.“One of the reasons we were able torespond as well as we did to the H1N1surge last spring was because we had plansin place,” says Harlos. “But with the workthat has gone on over the last few months, Iam confident that we are in an even betterposition to respond to whatever unfoldsthis fall and winter,” she says. “I can’t sayenough about Region leaders and staffmembers and the work they have done. Butit doesn’t stop there. Our people have beenworking with outside groups – the City ofWinnipeg, the province, physicians, schooldivisions, business leaders, volunteer agenciesand other community groups to try andmake sure all the bases are covered. It’stypical of Winnipeg – everyone just pullstogether to get things done.”Much of the broader thinking aboutpandemic preparedness involves high-levelplanning among governments around theworld, leaving organizations like the WinnipegHealth Region to focus on implementingprevention and treatment issues.As a result, the Region’s team of plannershas put every facet of health care underthe microscope to prepare for a possibleresurgence of H1N1.The H1N1 plan is based on severalscenarios that take into account demandson the system. “The first goal is prevention.We’ve tried to look at all the things we cando as a Region to help stop the spread. Insome cases, that means looking at immunizationclinics or ways to prevent patientswho may have H1N1 symptoms from cominginto contact with others who may not.In other cases, that means ramping up ourcommunications efforts to ensure peopleliving in our community know how to reducetheir risk or where to go if they needcare,” says Harlos. The second goal is treatment.“We have made every effort to shoreup our supplies and bring in additionalstaff, should the need arise. The planninghas been very detailed,” says Harlos.Trish Bergal, Director of Utilization forthe Winnipeg Health Region, is responsiblefor co-ordinating the activities of many ofthe groups that have been working on thecold medicines sold in storesthat do not require a doctor’sprescription. These includedecongestants, cough syrups,nasal drops and antihistamines.Over-the-countercough and cold medicinesshould not be given to childrenunder six years of ageunless prescribed by a doctor.Check with your doctoror pharmacist before takingor giving over-the-countermedicines to anyone. This isespecially important if theperson is under 12 years ofage, is taking other medicinesor has a chronic medicalcondition. Be sure to readlabel instructions carefullyand do not take more thanrecommended.Q: Should I be wearing a face mask?A: Manitoba Health and Healthy Living and the PublicHealth Agency of Canada do not recommendthat healthy people wear masks as they go abouttheir daily routines. There is no evidence that wearinga mask will prevent the spread of infection in thegeneral population. People who are in close contactwith someone who is sick with flu, like doctorsand nurses, may be asked to wear a face mask toprotect them from the virus. If a mask is to be used, itmust cover the mouth and nose, and hands must becleaned after removal of the mask.Fall 2009 29

Ken Jacques uses a forklift to stock supplies at theWinnipeg Health Region’s warehouse as ClaudeMichon, Regional Manager of Supply and DistributionServices, holds a box of N95 masks.paration for a possible surget inventory includes:730,000 examination gloves13,500 litres of hand sanitizer176,000 treatment courses of Tamiflucare beds, or more than doublethe normal number.Given that the Region is notgoing to be able to hire healthcareproviders en masse in themidst of a crisis, a comprehensiveplan for redeploying existing staffto work the additional criticalcare beds is crucial.Kim Smith, a senior projectmanager on the H1N1 readinessteam, says part of the planningprocess entailed looking at whattypes of procedures could bepostponed, and for how long, inthe event of an emergency redeployment.“You know you can’tstop women from having babies,so that is going to continue tohappen,” says Smith. “But thereare areas where you can postponeelective surgery for a shortperiod of time” and redeploy thestaff, if needed.Part of the planning involvedgoing through a process ofidentifying the skill set of all staffworking within the Region. Withmore than 28,000 people workingwithin the Winnipeg HealthRegion, there are cases wheresomeone working in administration,for example, could beredeployed to the front lines inthe event of an emergency. TheRegion may also bring back someretired health-care providers on atemporary basis, should the needarise.Ensuring health-care workersare healthy enough to providecare to those who are sick isanother important element of theplanning process. As a result, theRegion has taken a number ofsteps to ensure staff are properlysupported through access tohealth services, or simply makingsure there are places withinhospitals and clinics where theycan eat and rest.One of the big issues, ofcourse, is how to make vaccinefor H1N1 available to the publiconce it is ready for use. WhileHealth Canada and ManitobaHealth are responsible for ensuringthere are enough doses to goaround, the logistics of immunizingresidents in Winnipeg andEast and West St. Paul falls on theshoulders of the Region.As a result, the Region is rampingup its seasonal influenza immunizationprogram with a viewto applying lessons learned to theH1N1 campaign.Normally, the seasonal vaccineis made available at various clinicsand doctors’ offices throughoutthe city over a period ofabout six weeks. You can still getyour shot at your doctor’s office,but this year instead of the usualclinics, the Region is planning tostage 12 large clinics throughoutthe city to dispense immunizationsover a three-day period,beginning Oct. 14. Each clinicwill be open between 9 a.m.and 9 p.m. and have three shiftsof about 20 health-care workersadministering the vaccine. TheRegion hopes to be able to administerabout 24,000 doses duringthe three-day period. Throughthis effort, the Region will be ableto determine how many peopleQ: What are antivirals?A: Antivirals are drugs used forearly treatment of influenza. Iftaken soon after a person getssick (within 48 hours), they canreduce symptoms, shorten thelength of the illness and potentiallyreduce serious complications.Antivirals work by reducinga virus’s ability to reproduce, butthey do not provide immunityfrom the virus.Q: If I have influenza-like illness, will I begiven antivirals?A: Tamiflu will be provided to those who are at risk ofgetting seriously ill or who have severe illness. People whoare at higher risk for getting seriously ill with H1N1 shouldget medical care within 24 to 48 hours of starting to feelsick, and not wait it out for a few days first. This will allowa health-care provider to determine whether they shouldbe given an antiviral medication like Tamiflu. Tamiflu, iftaken early (the sooner the better, ideally within the first24-48 hours from the start of symptoms), helps to preventneeding hospital care or even a stay in ICU.Fall 2009 31

it can efficiently immunize over a shortperiod of time. The mass vaccination effortwill be helpful as the Region prepares toimplement the H1N1 immunization program,which is expected to begin in lateNovember.An important aspect of the work beingdone for the H1N1 effort involves surveillanceand epidemiology. As Harlosexplains, “We need to investigate andlearn as much as we can about an outbreakso we can invest that informationin even better planning. That takes a castof hundreds whose hard work is usuallypretty invisible to the public.” In the caseof influenza, for example, a sample froman individual may come into a lab for testing.Once staff confirm that it is a case ofinfluenza, a public health nurse will visitthe individual in question and interviewhim or her, as well as other friends orfamily members, to gather more medicalinformation.Through the interview, the nurse canlearn whether the individual may havesome underlying condition, such asasthma or diabetes, or whether the personsmokes or has a higher BMI (overweight)than average – all factors that could helpshed light on why the person became sick.Next, staff enter the informationinto a database created byepidemiologists who use the informationto conduct analysis. By creating these indepthprofiles, public health practitionersget a better understanding of who may bemost at risk should a second wave comeabout.Based in part on the data collected, notjust in Winnipeg, but across the country,health officials have identified a list ofgroups who appear to be at higher riskfor becoming sick. They include peoplewith chronic medical conditions underthe age of 65; pregnant women; childrensix months to under five years of age;people living in remote and isolated settingsor communities; health-care workersinvolved in pandemic responseor who deliver essential healthservices; and householdcontacts and caregiversof individuals who areat high risk, and whocannot be immunized(such asinfants under sixmonths of age orpeople with weakenedimmunesystems).It takes a teamHealth-care providers working in Intensive Care Unitsthroughout the Winnipeg Health Region will play a crucialrole in caring for patients infected with the H1N1virus. Here are some members of the teamat St. Boniface General Hospital.From left: Grant Beck, respiratory therapist;Jonathan Gabor, resident; Jennifer Bergen,registered nurse; Garry Mousseau,health care assistant; Rob Ariano, pharmacist.Q: I’m pregnant – should I be concerned?A: Pregnant women are not more likelyto get pandemic H1N1, but if they docatch the virus, they may be morelikely to have severe illness that mayaffect their pregnancy. While pregnantwomen are considered more likely todevelop severe illness, the vast majorityof pregnant women did not requiremedical or hospital care during the firstwave of the pandemic in Manitoba.Any infectious illness can put a motherand unborn baby’s health at risk. Generally,the risk of complications frompandemic H1N1, like pneumonia andsevere respiratory distress, is greater inthe second and third trimesters of pregnancy.Complications from H1N1 flu inthe mother may lead to harmful effectson the fetus.Source: Manitoba Health/Winnipeg Health Region32 WAVE

For those who develop flu symptoms,the Region has also planned processes andcapacity for treating and caring for largenumbers of people.A committee co-chaired by DanSkwarchuk, Executive Director of HealthServices Integration, and Dr. MichaelRoutledge, Medical Officer of Health,developed a multi-tiered plan for handlingdifferent scenarios of potentially largevolumes of patients developing influenzasymptoms.The plan, developed with participationfrom public health, child health, obstetrics,primary care and family medicine, communityhealth services, acute and ambulatorycare, calls for awareness and educationstrategies for patients to self-assesstheir degree of illness and to determine ifhealth-care provider assessment is required.People who need help with theirself-assessment may also call Health Links– Info Santé for assistance, and, if necessary,visit their health-care provider forexamination.Should the number of H1N1 casesincrease this fall, Region Primary Care Clinicsand ACCESS Centres are also exploringthe possibility of altering hours of operationand reprioritizing services to see morepatients with influenza symptoms. In addition,the Region is working collaborativelywith family physicians throughout Winnipegto help ensure their work is adequatelysupported in the event of an outbreak.Should there be a dramatic increase inH1N1 activity within the city, the finalstage of the plan calls for the establishmentof two special influenza clinics – one atHealth Sciences Centre, and one at SevenFYIFor the latest news and information about H1N1 influenza,please visit the following:Winnipeg Health Regionwww.wrha.mb.caOaks General Hospital. Potential for additionalclinics in other locations is alsobeing explored. These clinics would helpassess and treat flu patients while also offeringaccess to antiviral medicines whereneeded. But those with more serious symptoms(such as shortness of breath or severeweakness) would still need to seek higherlevels of care, such as the kind available athospital Emergency Departments.The Region is reaching out in other ways.First Nations, Métis and Inuit patients comingto the Region from other areas havethe benefit of accessing services such asinterpretation of medical terminology, physicianinstructions and health-care relatedinformation in Swampy Cree, Ojibway/Saulteaux, and Oji-Cree/ Island Lake dialects.Assistance with discharge planningis available in complex situations, as issupport and advocacy during hospitalizationand some clinic visits. These servicesare accessed by referral through AboriginalHealth Programs – Health Services centralintake line at 940-8880.Manitoba Healthwww.gov.mb.ca/flu/index.htmlPublic Health Agency of Canadawww.phac-aspc.gc.ca/alert-alerte/h1n1/index-eng.phpYou can call Health Links – Info Santé anytime at (204) 788-8200 ortoll-free 1-888-315-9257. Aboriginal health services can be accessedby calling 204-940-8880.Harlos says the planning that has beendone should help ensure any surge inH1N1 activity is handled as effectively aspossible. But even if the threat is less thanplanned for, the community-wide measuresput in place today and the mass immunizationclinics in the near future lay thefoundation for better pandemic planningfor the long-term.It’s a threat that will likely never disappear,Harlos says, because influenzais ever-present, perpetually mutating inthe background – as if the hand of fate isconstantly pulling on the slot machine ofnature, waiting for the right conditions toline up and result in a pandemic.“And if influenza viruses mix and matchin a way that results in a virus differentenough that people have no immunity, andif it can spread effectively from one personto another, then it could be the virus thatstarts the next pandemic,” she says. “That’sthe kind of beast influenza is.”Joel Schlesinger is a Winnipeg writer.Photo: Courtesy Winnipeg Free PressPharmacists such as Melissa Dowd are part of the adultIntensive Care Unit team at Health Sciences Centre.

Could it be the flu?What you should know. What you should do.H1N1 and seasonal flu are expected in Manitoba this fall and winter. If you feel ill,use the guidelines below to help you decide what to do.It’s probably not the flu…If you have not had a fever – even if you have one or more of these symptoms:• sore throat • runny nose • stuffy noseWhether or not it is the flu, you should always pay attention to your symptoms in case they get worseand need medical care.It could be the flu…If you have a fever over 38°C (100.4°F) that came on suddenly, a cough and one or more of these symptoms:• sore throat • joint pain • muscle aches • tiredness or fatigueChildren may also feel sick to their stomach, vomit or have diarrhea. Elderly people and people with loweredimmunity may not have a fever.If your symptoms are mild and you don’t have risks for severe illness (see below), stay home, treat your feverand other symptoms, drink fluids and rest until you feel well enough to return to work or school. Most peoplerecover from the flu without any problems.Contact your health care provider…• If you have flu symptoms and risks for severe illness (eg. chronic illness, weakened immune system, obesity,alcoholism, substance abuse, smoking, pregnancy, Aboriginal ancestry). Children under five and adults under65 have been at greater risk for severe H1N1 illness.• If your flu symptoms get worse (even if you don’t have risks for severe illness) or if you are concerned aboutyour health – even if you have already seen your doctor about this illness.• Early treatment (within 24 to 48 hours) may be very important. If you are not able to contact your healthcare provider for advice or care, you can call Health Links-Info Santé at 788-8200 or 1-888-315-9257.Go for emergency medical help…If you or a loved one has any of the following symptoms, go directly to an emergency room, nursing station,or health care provider, or call 911:• shortness of breath or difficulty breathing• severe weakness• dehydration or no urination for 12 hours• drowsiness or confusion• fever in an infant under three months oldFor up-to-date information about H1N1 and the Manitoba government’spandemic plan, visit the flu website at: www.manitoba.ca.For personal health advice call your health care provideror call Health Links-Info Santé at 788-8200 or 1-888-315-9257 (toll-free).

We’re Building a New Women’s HospitalYou’re invited to join us for an update on the Women’s HospitalPublic Redevelopment Project.OpenHouseWe’d like to show you our progress, and how we’ve been working toaddress the input we received from Manitobans about what you’d likethe new hospital to be.The project team – WRHA, HSC, and our architects and engineers – willdisplay work in progress and answer questions about the project.OPEN HOUSEThursday, October 8, 3 p.m. - 8 p.m. Presentation: 7 p.m.Brodie Centre Atrium, University of ManitobaBannatyne Campus, 727 McDermot AvenueVisit www.wrha.mb.ca/womenshospital for more information.Please note: Paid parking is available in the Emily and Tecumseh StreetParkades, or on the street. Limited free street parking is available after5:30 p.m. For bus routes to HSC visit www.winnipegtransit.com.Winnipeg Regional Health AuthorityAnnual General Meeting 2009Join us to hear Dr. John Wade, Chair of the Board of Directors andDr. Brian Postl, President & CEO share highlights of the 2008/09fiscal year in the Winnipeg health region.Special Keynote Presentation by Dr. Catherine CookThe Aboriginal Health Journey:Connecting with Culture for Improved HealthDr. Catherine Cook is the provincialAboriginal health advisor on H1N1flu issues to work with First Nationscommunities, leadership organizationsand the federal government. She is alsothe Executive Director of AboriginalHealth Programs at Winnipeg RegionalHealth Authority, the Director for theCentre for Aboriginal Health Educationand co-Director for the Centre forAboriginal Health Research atUniversity of Manitoba.A look at the three core components of Aboriginal Health Programsin the Winnipeg health region to improve the health of Manitoba’sAboriginal Peoples.Tuesday, October 27, 2009 • 3:30 pmRotunda, Aboriginal Centre of Winnipeg181 Higgins Avenue36 WAVE

PAROTHE ROBOTIC HARP SEAL PUPFall 2009 37

By Martin ZeiligAime Campbell is just gettingcomfortable on a couch in alounge at Deer Lodge Centre whena white, furry little creature namedPARO makes his appearance.Resting on a pillow on Campbell’s lap,the baby harp seal look-alike turns hishead upward, opens his big brown eyesand lets out a joyful little squawk.“Yes, yes, PARO,” murmurs Campbellas he strokes the little critter’s fur, tearsrolling down his cheek. Clearly, these aretears of joy.“I think it is bringing good memoriesback to him,” offers Lisa Franchi, arecreational facilitator at Deer Lodge whospends a lot of time with Campbell.The scene is becoming a common oneat Deer Lodge. The hospital is conductingresearch to determine whether PARO, afurry robot developed in Japan, can helpboost the spirits of elderly patients whoare living with Alzheimer’s disease, a conditionthat attacks the brain and underminesa person’s ability to think clearly orfunction normally.Campbell, a 94-year-old Second WorldWar veteran, has been spending somequality time with PARO, and the sessionshave generated positive results.“PARO is very effective,” Franchi explainswhile watching the interaction betweenCampbell and the robot. “When heholds PARO, he responds to me in wholesentences. If he’s anxious or frustrated, Iget PARO and he’ll usually respond. It hasa calming effect on him,” she says.PARO’s charms are evident to anyonewho comes into contact with the furrycritter. Now in its eighth generation,PARO blinks and coos with pleasureupon being caressed – much like a wildseal pup would do in response to beingnear its mother on an ice floe off thenorthwest coast of Newfoundland. It alsoresponds to being tickled under the chinor to specific voices.Technically, the research project istrying to determine whether PARO canenhance the social and communicationskills of residents with cognitive and sensorylimitations. It is being conductedunder the Interdisciplinary SummerResearch Program (ISRP) at Deer Lodgeunder the auspicies of Dr. Lorna Guse,Associate Professor in the Faculty ofNursing at the University of Manitoba.The three fellow principal researchers inthis program are U of M colleagues Dr.Kerstin Roger, of the Faculty of HumanEcology, Dr. Elaine Mordoch, Facultyof Nursing, and Angela Osterreicher, ofthe U of M Library.The project is being funded by theDeer Lodge Foundation, which provided$15,000 for this summer’s project,which includes the research as well asthe training of two university students asresearch assistants. As part of the study,three residents interact with PARO threedays a week. “The results are preliminary,but videotapes of the interactions clearlydemonstrate that residents take greatenjoyment interacting with PARO, bysmiling, touching and talking to PARO,”says Guse. “Our staff members are expertat speaking to a person with dementia.The disease of dementia creates a barrierthat separates people from their environment.So, PARO is one more tool that canbe used to help residents with dementiaconnect with their surroundings. PAROenhances the quality of life of people withdementia.”Franchi says Campbell responds toPARO ProfileA baby harp seal in the wild.38 WAVE

“PARO enhances the quality of life ofpeople with dementia.”PARO much like he does to music – withtears, emotion and enhanced verbal skills.“I have worked with other residents in ourunit and most have responded positively toPARO,” she adds.Although Campbell is not part of theresearch project, the staff felt that he wouldbenefit from being with PARO, says Guse.The robot was invented by Dr. TakanoriShibata, an engineer/researcher at Japan’sNational Institute of Advanced IndustrialScience and Technology (AIST), who wastrained at MIT and began developing thisrobot in the late 1990s, according to theofficial PARO website.The concept behind PARO draws on theresearch into pet therapy, which shows thatanimals can help relieve mental stress andboost spirits. Shibata’s goal was to create arobot that could emulate the benefits of apet but without the challenges that comewith having or taking care of a live animalin a hospital or extended caresetting.In 2007, Guse saw a videoclip about PARO being usedin a nursing home in Japan ata Manitoba GerontologicalNursing Association meetingin Winnipeg. Then, inOctober 2007, she had an opportunity toattend an International Psycho Geriatric AssociationConference in Japan.“So, I contacted Dr. Shibata beforehandand he connected me with Dr. KazuyoshiWada of the Metropolitan University ofTokyo,” says Guse. “Much of the reportedresearch on the use of PARO in Japanesenursing homes has come from Dr.Wada’s work. So, Dr. Wada took me tothe nursing home, and I said, ‘I’d liketo do something similar in Canada.’”Upon her return, Guse spoke toJo-Ann Lapointe McKenzie, who is theChief Nursing Officer at Deer Lodgeand the Program Director in Rehabilitationand Geriatrics with the WinnipegHealth Region, about the workbeing done with PARO in Japan.Lapointe McKenzie was en-Photo: Marianne HelmFYIFor more information aboutthe Deer Lodge Centre orAlzheimer’s disease, pleasevisit the following websites:www.deerlodge.mb.cawww.alzheimer.mb.caAime Campbell spendssome time with PARO.PARO is an eighth-generation interactive robot developed byAIST, a leading Japanese industrial automation pioneer. The namePARO comes from merging the words personal robot, and because“Pa” is an explosive sound that is easy to remember. PAROdraws on the experience of animal therapy to benefit patients inenvironments such as hospitals and extended care facilities wherelive animals present treatment or logistical difficulties. Here aresome PARO facts:• PARO has been known to reduce patient stress and stimulateinteraction between patients and caregivers. It also has apsychological effect on patients, improving their relaxation andmotivation.• The robot has five kinds of sensors: tactile, light, audition, temperature,and posture sensors, with which it can perceive peopleand its environment. With the light sensor, PARO can recognizelight and dark. He feels being stroked and beaten by tactile sensor,or being held by the posture sensor. PARO can also recognizethe direction of voice and words such as its name, greetings, andpraise with its audio sensor. PARO can learn to behave in a waythat the user prefers, and to respond to its new name. For example,if you stroke it every time you touch it, PARO will rememberyour previous action and try to repeat that action to be stroked. Ifyou hit it, PARO remembers its previous action and tries not to dothat action. By interaction with people, PARO responds as if it isalive, moving its head and legs, making sounds, and showing yourpreferred behaviour. PARO also imitates the voice of a real babyharp seal.• PARO was designed to look like a baby seal because mostpeople have little experience with these animals. A robot thatlooks human or like a cat or dog would naturally conjure upexpectations of how such a robot should act. If the robot fails tolive up to expectations, users can be disappointed. With PARO,there are no pre-conceived expectations.Source: National Institute of Advanced Industrial Science andTechnologyFall 2009 39

thusiastic about the idea, and Deer Lodgesubsequently purchased two of the roboticseals. “They arrived in early 2008 in a boxmarked PARO,” adds Lapointe McKenzie.PARO consists of a hard metal skeleton,covered by a soft layer of material andhypo-allergenic synthetic fur. “This softlayer has a tactile sensor that measures humancontact,” says Guse, noting that eachrobot costs $4,000 (U.S.).PARO has four other primary senses:temperature, visual (light sensor); auditory,and balance. “It can determine thedirection of sound and speech recognition,and balance,” says Guse, noting that20 U.S. nursing homes and hospitals havepurchased PAROs for testing.“PARO has been programmed withseveral poses and movements. It has a longtermmemory. It is programmed to preferstimulation such as stroking. The more youinteract with PARO, the more it interactswith you, and this is retained in its longtermmemory. PARO sits easily in your lapor on a table.”In Japan, evaluation of the outcome ofPARO with older adults has been basedon the use of Face Scales, observationaltools used in analysis of facial expressionand interaction, counting of utterancesor verbalizations, and physiological tests(urine samples to measure stress levels). TheJapanese have been conducting researchon robot-assisted activity in one nursinghome since 2003. “In fact, research onthese robots in Japan has been groundedin concern that as the proportion of olderadults increases, the number of skilled andunskilled caregivers is decreasing,” Gusesays.PARO is so popular in Japan that morethan 1,000 units have been sold to careproviders in nursing homes and hospitals,as well as to consumers who want a roboticcompanion, says an article in the May 2009issue of iEEE Spectrum Inside Technology– an online journal. It notes, “...researchersat the Danish Technological Institute’sCentre for Robot Technology began thefirst long-term study of PARO’s potentialin elderly care. The researchers distributed30 units to residents of nursing homes with“One family member said, ‘My motherjust melted. She just relaxed. She justsmiled…. She was happy.’”various levels of senile dementia,” says thearticle. “PARO not only makes patients feelbetter but can also help them communicatebetter with others, including caregivers.Shibata wants to make a version of PAROthat would stimulate more verbal communicationin patients with dementia who arelosing their language skills. Another versionwould try to elicit more interaction betweenautistic people and their caregivers.”The positive benefits of PARO are alsobeing noticed by family members. “Onefamily member said, ‘My mother justmelted. She just relaxed. She just smiled....She was happy.’”Staff members were also asked abouthow they felt about this technology, andmost indicated a positive perspective on theuse of PARO, adds Guse. “There were alsopositive comments on the research projectitself. One staff member said, ‘Keep upthe good ideas,’ and another said, ‘Greatproject. Thank you for enhancing lives atDeer Lodge.’”While it’s clear that PARO offers residentsmany of the same benefits as a realpet would, Guse and Lapointe McKenziesay they are unsure about why it works soeffectively as a therapeutic tool. “Why doesa summer’s day work or a beautiful piece ofmusic? But at this point when you’re workingwith people with severe dementia andyou want to bring comfort to them, you’lltry anything,” Lapointe McKenzie says.The bottom line for Guse: “Youcan’t help but smile when you arearound PARO.”Martin Zeilig is a Winnipegwriter.How you can helpThe Deer Lodge Foundationwas established in 1990 “tofund research and educationalinitiatives of practical importanceto excellence in longterm care” at the Deer LodgeCentre. To learn more aboutthe foundation and its work,contact the Deer Lodge CentreFoundation by phone at(204) 831-2900 or by e-mail atfoundation@deerlodge.mb.caDr. Lorna Guse is headingup the PARO research projectat Deer Lodge Centre.Photo: Marianne Helm40 WAVE

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Coleen’sstoryTen years after establishing herself as a hard news reporter for CBC Manitoba,Coleen Rajotte has her own production company, two hit health shows on theair and a self-titled documentary in the works. But the journey from girl with adream to woman in charge wasn’t always an easy road to travel.42 WAVEColeen Rajotte at work in her studio.

By Dolores Haggarty • Photo: Marianne HelmIt’s just after 8 a.m. on a Thursday morning when ColeenRajotte rolls into the Cindy Klassen Recreation Centreparking lot in her grey Toyota 4Runner.The sky is overcast, suggesting rainmay be in the offing, but the air is freshand warm – a perfect morning for a quickworkout.Within minutes, Rajotte, stylishly deckedout in black sweatpants and a whitesweatshirt with a stylized “C” on the leftshoulder, is on the track performing a seriesof lunges and side-squats. “Two, three,four,” calls out Diane Kornel, a tiny but fitlookingwoman who is Rajotte’s personaltrainer. Her voice is low, more encouragingthan demanding, as she puts her clientthrough her paces. “Five, six, seven – bellybutton in! Open up that chest.”Over the course of the next hour orso, Rajotte will run a series of 200-metresprints, each one punctuated by a shortwalk. Later, she’ll cap off the workout witha couple of runs up and down the bleachers.It’s a demanding routine, one thatRajotte carries out at least twice a week,sometimes with Kornel, sometimes workingalone.That this 42-year-old woman is determinedto optimize her health and wellbeingshould not come as a surprise. Tenyears after having established herself asa hard news reporter for CBC Manitoba,Rajotte now heads up her own televisionproduction company and is the host of itstwo flagship health and wellness programs– Vitality and Vitality Gardening – whichare broadcast nationally on the AboriginalPeople’s Television Network (APTN). As aCEO and television host, she needs to lookthe part.But this isn’t a tale about the need tokeep fit and trim for the camera. Rather,it is a story of Rajotte’s journey of selfdiscovery,one that enabled her to connectwith her biological parents and tapinto her Cree-Métis roots. Along the way,Rajotte has not only gained new insightinto a world she barely knew, she has alsolearned about the importance of leading abalanced life, one that is rooted in the traditionalaboriginal approaches to physical,mental, emotional and spiritual well-being.These ideas not only shape Rajotte’s dailyroutine, they are also at the core of eachand every episode of Vitality and VitalityGardening that she produces.Rajotte was not always as deeply immersedin aboriginal culture as she is today.Born in 1966, she says, “My life was blankuntil I was eight months old.” That waswhen Nelson and Betty Rajotte – a UnitedChurch minister and his stay-at- home-wifeadopted her.Her early years – from toddler to midadolescence– were, as they say, “withoutincident.” There was no trauma, noconflict. Indeed, she and her siblings (ayounger brother and sister) were raised ina comfortable, secure environment in asprawling manse on Elgin Avenue, whileher father ministered to parishioners atSparling United Church.As for being “different,” Rajotte andher brother (also adopted and aboriginal)hardly stood out from the other childrenin their multi-racial neighbourhood. Infact, as Rajotte recounts – still with strongfeeling – the first time she realized she was“different” was when, at five years old, shewas shopping with her mother at The Baydowntown.“My mother was a few aisles over. Icalled out ‘Mom’ and all of a suddenpeople were staring at me. Then I saw awoman walk over to my mother; she askedif I was really her daughter and demandedan explanation. That was the first time Irealized I was adopted,” she recalls.Rajotte’s darkest moments came whenFall 2009 43

her father was posted to a church inWestwood. The move from inner city toaffluent suburbia was traumatic. “I beganGrade 10 at Westwood Collegiate and asfar as I could tell, I was the only aboriginalin the school,” she says. “It was like beingin a bad movie.” There was no bullying, nofighting; the other kids just wouldn’t talkto her. “I was shunned for the first time inmy life. It was the loneliest experience I’veever had,” she says.Today though, reflecting on those years,Rajotte is convinced “that the experienceforced me to look at the world in a differentway.” She says she coped by developinga tough exterior. And even as difficultas those years were, Rajotte never lost thesense of what she wanted to become. “Inever thought of running because I wasalways focused. I knew I wanted to be aTV journalist and nothing was going tostop me from reaching that goal.”The first indication of Rajotte’s creativeand entrepreneurial flair came early on. Asa little girl, she loved reading and performing.Her parents, mystified at her ideas,remember her writing plays and chargingkids in the neighbourhood a nickel tocome and watch her perform. But the mostmemorable moment in her young life tookplace when she was nine years old andin Grade 3 at Cecil Rhodes School. “Oneday, our librarian – a wonderful woman– encouraged us to write a book of ourown.” The result was The Sour Orange – asmall book, bound in orange and black,neatly printed in grey crayon from titlepage to end credits. It tells the tale of anorange that runs away to discover hopeand friendship.This early effort, now a cherishedkeepsake, not only reflects Rajotte’s earlyattention to detail, but also signifies a“pivotal point” in her life. “Writing thatbook exposed me to possibilities. It meantthat books weren’t just something in thelibrary that others wrote, they were alsosomething I could create,” she says. Thusbegan the desire for storytelling, which– over time – evolved. A few years later,when Rajotte graduated from Grade 7 atSargent Park School, her life’s goal wasquoted clearly under her yearbook picture:“Wants to be a TV journalist.”Soon after she enrolled at the Universityof Manitoba, first studying Englishand then Labour Studies, Rajotte’s family44 WAVEtransferred to British Columbia. The youngstudent chose to stay in Winnipeg where,living in a small basement suite in St.James and waiting tables 30 hours a week,she put herself through university. In 1989she graduated with an advanced Bachelorof Arts (BA).After her dismal high school years,university was a huge relief. “I loved it,”she says. “People were interested in me ina positive way. I can remember sitting inclasses thinking, ‘Wow, I can just be me.’”And still Rajotte didn’t feel any compellingneed to explore where she came fromor who she was. One reason, perhaps, wasthat over the years there had been littlediscussion about her adoption within heradoptive family. “It was a sensitive topicfor my parents. I knew they loved me andI think they felt that if I looked into mybackground, they might lose me,” sherecalls.After graduation, while working at acouple of brief government jobs, Rajotte,who still envisioned herself a TV reporter,decided to put her thoughts into action.One day, while downtown, she impulsivelydetoured into CBC’s Human ResourcesDepartment. She filled out an applicationfor a summer intern position and – asthe cliché goes – the rest is history. Herresume caught the interest of management,which led to a three-week stint asa researcher that stretched, in turn, into anine-year career as a TV journalist.Over the years, while working in television,digging beneath the surfaces ofpeople’s lives, Rajotte began to feel theneed to search for her own roots. It was,however, a gradual awakening. As one ofCBC’s aboriginal reporters, Rajotte wassent out to cover many of the stories thataffected aboriginal people. At first, she wasuncomfortable covering this area – shedidn’t want viewers to think there wouldbe a bias in reporting. But with time, herattitude changed as she realized her verypresence on air was unique.“There was an outpouring of attentionfrom aboriginal communities. I wasinvited to be a guest speaker at schoolsand aboriginal events. I was being invitedas a role model. And I decided that if I’mgoing to be a role model, I have to find outwho I am.”Rajotte strongly believes she has been“nudged” along every step of her journeyof self-discovery by elders who haveentered her life through her work. For“According to the Hwebsite, the rate oamong Aboriginal1.5 times higher thapopulation...”Coleen Rajotte runs up the stairsof the bleachers at the CindyKlassen Recreation Centre withtrainer Diane Kornel.

ealth Canadaf heart diseaseCanadians isn the generalinstance, in late 1998, while working ona story about residential school survivors,she met Mildred and Esther Bunn from theBirdtail Sioux Reserve. As she toured the oldBirtle Residential School with the elderly sisters,Mildred Bunn asked: “Did your parentsgo to residential school?”Rajotte replied: “I don’t know.”Mildred prodded further: “You have to findthem.”By 1999, Rajotte felt it was time to leaveCBC. Although she had made a name forherself as a respected journalist and waswell established within the corporation, shewas feeling somewhat frustrated. Obviously,within any television news show there aretime constraints on each story told. But bythis time, Rajotte, who had witnessed themany issues plaguing aboriginal communities,wanted to dig deeper; she felt the needto work on longer, in-depth documentaries.Subsequently, supported by longtime partnerJohn Bronevitch (a videojournalist for CBC’sThe National), Rajotte left her comfortablesalaried position to strike out on her own.It was actually a fortuitous time for aCanadian aboriginal journalist. APTN was topremiere on television in September 1999,and as Canada’s only aboriginal TV network,it would need material aimed specifically atCanada’s indigenous peoples. It was a matchmade in heaven. Through her productioncompany, Rajotte developed a number ofdocumentaries for APTN, each one a poignantpersonal story about the social issuesthat have torn aboriginal communities apartfor decades: stories about survivors of residentialschools, of teen suicide in an isolatedOntario community, and, more recently, athree-part series on the tragic aftermath ofaboriginal adoptees. These were hard-hittingprograms, and while they certainly touchedon issues of mental, emotional, spiritual andphysical health, they were not “wellness”programs in the classic sense.It was around the time she started herproduction company that Rajotte took MildredBunn’s advice to find her people. Afterleaving the CBC, she applied to Child andFamily Services for her adoption file. At thattime, people who were adopted could get“non-identifying information.”Rajotte’s adoption papers arrived onSeptember 9, 1999. The date is etched in hermind. Not only because of the magnitude ofthe event, but also because she and partnerBronevitch captured the moment on film. Ina brave move, considering the intimacy ofthe process, Rajotte had decided to documenther search for her biological family.(This documentary – now 10 years in themaking – goes under the working title of“Coleen’s Story.”)Through her file, Rajotte discovered thather biological family had been looking forher since her 18th birthday. After a time, Rajottedid travel to Saskatchewan to meet withher large, extended biological family. Butit wasn’t a journey made in haste; it cameafter much thought and soul-searching. Sheemphasizes that reuniting this way is a slowprocess. There is much raw emotion, andfamilies, understandably, find it extremelydifficult to discuss the past openly. Her ownexperience helped greatly as she produceda three-part series on adoption entitled“Confronting the Past.” And it also helpedas recently as four months ago when, as aguest speaker at Thunderbird House, duringa session called “Circle of Courage,” she wasable to share her own experiences with otheradoptees. “There is an assumption that whenyou are in your 40s you have dealt with it,but that isn’t so,” she says.Reconnecting with her biological parentsgave Rajotte a new perspective on herheritage in more ways than one. She was,of course, able to gain a deeper insight intoher own identity. But contact with her familycaused her to contemplate something shehad taken for granted: her health. During hervisit, she learned that some family membershad diabetes, an indication that she may alsobe vulnerable to the disease. She also had anaunt who was disabled because of a strokein her 50s. “It was kind of a wake-up call,”she says.In addition, Rajotte was becoming moreaware of the health issues facing aboriginalpeople generally. According to the HealthCanada website, the rate of heart diseaseamong Aboriginal Canadians is 1.5 timeshigher than the general population, whilediabetes rates are three to five times higher,and tuberculosis infection rates are eight to10 times higher. Rajotte experienced the impactof these statistics first- hand when LouisQuill, a former chief of the Pikangikum FirstNations Community in northwestern Ontarioand a man she admired for raising awarenessabout suicide among young people on thereserve, died at the age of 38 while waitingfor a kidney transplant.It slowly dawned on Rajotte that she wasin a position to do something to raise awarenessabout health issues facing aboriginalFall 2009 45

people, something that was unlike anythingelse on air or in print. The idea seemed tocrystallize one evening during a dream. “Idreamt I was walking along when I came toa crossroads. There was a sign on the sideof the road that said ‘Vital.’ The crossroadsmay have symbolized a time of change inRajotte’s life, and it didn’t take her longto figure out what the word on the signmeant.Vitality went to air on APTN in the fallof 2006. The key to the show, of course,was the exploration of health and wellnessissues within an aboriginal context. Therewere lots of health and wellness televisionshows on the air, but none with an aboriginalflavour. Rajotte was determined to usethe show to highlight personal stories ofpeople dealing with their health challengesin a way that would resonate with thelarger aboriginal community.Season one was ambitious. The showaired five nights a week for six weeks: eachweekday evening focused on a differentindividual facing a particular challenge.Mondays followed a firefighter from theAboriginal Firefighters Association as heconcentrated on losing weight to becomemore fit; Tuesdays focused on a teenagesynchronized swimmer as she attemptedto eliminate junk food from her diet;Wednesday’s theme was diabetes management.This segment, of all others, garneredthe most response as viewers identifiedwith the young mother of five who, overthe weeks, struggled painfully to manageher disease. On Thursdays, the showintroduced viewers to the traditional waysof healing such as participating in a sweatlodge or gathering sage. And on Fridays,the show tackled stress management asviewers followed Rajotte through some ofher professional and personal challenges.Episodes of Vitality are now in rerun onAPTN, and video clips are available atwww.watchvitality.com.Season four of Vitality will air in thespring of 2010, and, staying with theshow’s basic theme, will concentrate onfour individual makeovers over 12 weeks.Each person will be supported by a groupof experts: doctors, nutritionists, fitnesstrainers, fashion stylists, and relationshipcoaches. As always, the shows are designedto connect to their audience. For example,Rajotte plans to introduce the participantsin one episode to an authentic traditionalexperience as they spend a full day haulingwood poles to build a teepee, choppingwood, and cooking country foods over anopen fire, all under the careful guidanceof an elder. One of the ideas behind thisparticular episode is to measure the caloriesthat the average person would burn offthrough these activities.Rajotte’s companion show on APTN,“Vitality went to air on APTN in the fall of2006. The key to the show, of course, wasthe exploration of health and wellnessissues within an aboriginal context.”Vitality Gardening,has alsoproven to be a huge success. Initially, itstarted as a simple program to help peoplegrow their own vegetables – no small thingwhen one considers the challenges of doingso in some northern communities withtricky climates. It didn’t take long, however,for the show to become more than a gardeningprogram.In one of the first episodes, Rajottelearned about traditional ways of plantingin her own backyard that go backthousands of years, such as sowing corn,beans and squash together in mounds. Thissparked a series of programs that highlightedevidence of aboriginal farming alongthe Red River near Lockport prior to thearrival of the Selkirk settlers at Fort Garry,an important sociological point that is onlynow being included in grade school historytextbooks.Vitality Gardening has taken Rajotte andher production crew all over North America,from an innovative gardening projectin Inuvik to exploring how the ancientMayans in Mexico developed and grew themany varieties of corn. Besides travellingto locations in places like Nevada, NewOrleans and Washington, the show hasalso featured a unique historical gardeningsite in North Dakota where the Mandans– in the 1700s – grew massive gardens ofup to 300 acres. The local farming storylinewill be picked up again when the programairs this fall.Vitality and Vitality Gardening are majorprojects that take up a good chunk ofRajotte’s time (planning for these programstakes 10 hour days, seven days a week forseven months). But she has other projectson the go. The documentary of her lifecontinues to be a work in progress. Sherecently cast a young child to play a youngColeen and an older girl to play herself asa teen. She is also the Artistic Director andco-founder of the Winnipeg AboriginalFilm Festival, which celebrates itseighth season in November.In a touch of irony, eventhough Rajotte didn’t searchout her aboriginal rootsuntil she was in her 30s,today her awarenessof indigenous peopleworldwide is deepand expansive. Herknowledge has grownthrough her explorationof traditional waysfor her television shows, andthrough the Winnipeg Aboriginal Film Festival,Rajotte has also had the opportunityto share ideas and stories with indigenouspeople around the world.Rajotte considers the festival an importantgathering place for international filmmakers,but perhaps more importantly, asan educational opportunity for young aboriginalfilmmakers in high school. To thatend, the festival offers an ambitious set ofworkshops over two days, which includessessions on documentary making, newsreporting, editing music videos, writing forTV and movies, and an introduction to acting.Also, there are workshops on the nutsand bolts of a complicated industry: how tocreate the right resume, how to pitch ideas,how to audition.Just as she was introduced to the “possibility”of writing books in Grade 3 by acreative librarian, Rajotte sees the festivalas an opportunity to show young filmmak-46 WAVE

Coleen Rajote films a standup for APTN at Westview Park.ers the possibility of working in video, filmand television.It’s a late Friday afternoon in July andthere’s a certain “buzz” in the studios atRajotte Productions. Although the interiorof this renovated warehouse – with its softwhite walls, gleaming wood floors andexpansive windows – is designed to createa feeling of calm, at this moment the atmosphereis definitely tense.It’s deadline day. In a couple of hours,Rajotte Productions has to present its proposalsfor the 2010 season of Vitality andVitality Gardening to APTN. After checkingthe numbers and then checking themagain, the shows’ templates are printed,tucked into a brown envelope and sent offto be hand-delivered to APTN’s offices.Rajotte visibly relaxes and takes time toreflect. From a small girl with a dream toa TV producer with budgets looming nearhalf a million dollars, Rajotte has accomplisheda great deal in a short period oftime. Through her work, Rajotte is recognizedas a positive role model withinaboriginal communities. It’s a role shehonours, not only because it gives value toher work, but also because it underscoresher sense of identity.But even now the experienced producerremains astonished at her early naiveté. “Ididn’t have a clue what I would need todo,” she says.Certainly she had story ideas – but to getthem to air would require equipment (veryexpensive equipment), a crew (who wouldneed to be paid), a base of operations andpre-commitments from broadcasters to airthe finished product. Her biggest learningcurve, though, was how to manage moneyflow. “I learned early to keep paper movingbecause deadlines and cash flow could bestressful.” Rajotte estimates that about 35per cent of her time is spent meeting withaccountants, lawyers and bankers. Runninga production company is a constantjuggling act between working out fundingformulas and production budget estimatesand applying to funding corporations suchas the Canadian Television Fund, CAVCO,Rogers Documentary Fund and the ManitobaFilm and Music Corporation, to namea few.Obviously, there were many tough momentsin the early years. Too many, really,to count. One memory, however, doesstand out: the time she didn’t have enoughmoney to pay the crew. It was scant daysbefore Christmas, the crew hadn’t beenpaid in weeks, and the bank refused torelease the bridge financing money. Theissue was one missing signature on onepiece of paper – an issue out of Rajotte’scontrol. The fledgling producer scrambledto borrow enough cash privately to sidestepthe crisis, but it was a lesson learned. Thesedays, she has a line of credit to cover immediateshortfalls.But even with all the stress of working ina “crazy business,” Rajotte says the past 10years have offered her more peace of mind.“I am doing what I want to do. I can makea choice,” she says. “My adoption affectedmy whole life. I realize how little peopleknow about aboriginal people, and if oneperson learns a little through my work, Iam successful.”And they are learning. As testimony toRajotte’s work, she has received manyresponses – many of them though e-mail.She keeps two in particular that were sentin response to her documentary on theaftermath of residential schools (Jaynelle:It’s Never Easy to Escape The Past) posted inher home office:“We are three white professionals livingin downtown Toronto and your documentarygot us discussing the problems that manyaboriginal people face. While we havenot arrived at any solutions, we sincerelybelieve that more can be learned about theproblem if documentaries like the one youjust aired were seen by more people.”And: “Just wanted to thank you….Youtouched me deeply. Please keep it up.”Dolores Haggarty is a Winnipeg writer.Fall 2009 47

Spalifestyle& Fashion BoutiqueRelaxation meets fashion on Henderson HighwayStefani Frischbutter is a case inpoint. The 39 year-old woman spendsher days raising two children, managinga busy household and doingbehind-the-scenes work for a familybusiness. It’s no wonder she sometimesfeels frazzled.Her monthly visit to Spalifestyle andFashion Boutique on Henderson Highwayis just what she needs to relaxand recharge.The spa offers a full range ofservices including various massagetherapies, body scrubs and wraps,facials, manicures, and pedicures.All services are done in private roomsallowing the men and women whocome in for treatments an opportunityto completely relax.As a regular customer at the spa,Frischbutter feels her deep tissuemassage treatments are therapeuticand help her cope with her day-todaystresses.“It’s maintenance for my body,”she says. “If I have a few hours whereI can squeeze in some treatments ithelps relieve sore muscles, tensionand stress. I try to do the things mybody needs.”Sisters Kristin and Monica Janzenopened Spa lifestyle and FashionBoutique a year and a half ago,and as the name suggests, both aBy Helena ColeAn afternoon at the spa may seem like a luxury tosome, but for others, it’s an absolute necessity.day spa and a fashion boutique areincorporated under one roof to offera spectrum of services that complementeach other.“We’re filling a need in this area,”Kristin Janzen says. “There’s nothinglike this in the northeast quadrant ofthe city –East St.Paul, West St. Pauland St. Andrews – and we wanted tooffer a variety of services that peoplecan use without having to go all theway downtown, or to other parts ofthe city.”Frischbutter agrees that having aspa and shopping boutique near herhome is convenient. “Having somethinglike this in the area has beengreat,” she says.“I love the quality of the work atthe spa – the massages are excellentand I have really dry skin so thefacials are extremely beneficial; youreally feel like you’ve had somethingwonderful done,” Frischbutter says.She also loves the selection of clothingand gifts available in the boutique,and has certainly done her fairshare of shopping there.Kristin, a certified massage therapist,says that a spa visit isn’t justabout spoiling yourself, it’s abouthealth and wellness too. Massageand other body treatments may feelheavenly, but they also offer a vari-Services available atSpalifestyle & Fashion Boutiqueinclude:FacialsJane Iredale Skin Care MakeupHand and Foot TreatmentsTinting and Hair RemovalMassage TherapyFull Body ExfoliationBody WrapsFor more detailed information,please visitwww.spalifestylefashionboutique.ca48 WAVE

ask a nurseLinda CooteHPV& YouHow to reduce yourrisk of developingcervical cancer50 WAVEWhat is HumanPapillomavirus (HPV)?Human Papillomavirus (HPV) is a virusthat can infect many parts of the bodyin both men and women. There areover 100 different types of HPV. Someare low-risk and some are high-riskbased on their potential risk of cancer.There are 15 known high-risk typesof HPV that can cause pre-cancerouslesions and cervical cancer; they canalso cause oral cancer and anal cancer.Most of these infections are clearedby the body’s immune system withoutthe individual knowing that theyhad an infection. Persistent infectionof a high-risk virus can lead to earlychanges in the cervical cells (dysplasia).If these changes are not detectedby screening and treated, they mayprogress to cancer of the cervix (lowerpart of the woman’s uterus that leadsinto the vagina). Some low-risk typescan cause genital warts and even somedysplasia. These dysplasias usually donot progress to cancer.How does someone getHPV?Some types of HPV can be spreadduring sexual contact with a personwho is already infected. Sexual contactincludes skin-to-skin contact with thevagina, vulva (the outside parts of awoman’s genitals), penis, scrotum, anusand/or the mouth. HPV is estimated tobe one of the most common sexuallytransmitted infections (STI) in Canadaand around the world. Any person whohas sexual contact can get the virus.What are the signs andsymptoms of an HPVinfection?Most HPV infections occur without anysymptoms. It is easy for people who areinfected to pass it on to others withoutknowing it. It is possible to have morethan one type of HPV infection at atime. While most HPV infections goaway with no treatment, some do notand can go on to cause skin and genitalwarts, or more importantly, cancersof the cervix, or, more rarely, cancersof the vagina, vulva, rectum, penis andmouth.How can someoneprevent or reduce the riskof getting HPV?The only way to prevent HPV infectionis to not have sexual contact (skin-toskincontact) with the vagina, vulva,penis, scrotum or anus. You can reduceyour risk by:• Delaying sexual activity.• Limiting your number of sexualpartners.• Using condoms can offer protectionfrom HPV and other sexually transmittedinfections, but skin that is notcovered by the condom can still beexposed and infected.• Considering your partners’ sexualhistory, as they may not know theyare infected with HPV.• Practising good health habits, whichinclude: not smoking, eating ahealthy diet, getting plenty ofexercise and rest.• Getting immunized with the HPVvaccine to reduce the risk of infection,pre-cancerous lesions andcervical cancer. Current HPVvaccines only protect against someHPV types.Once your body matures and if youchoose to become sexually active, it isrecommended that you see your doctorfor regular checks including Pap testsof the cervix. For more information onsexuality education, visit the SexualEducation Resource Centre Manitoba.What is the link betweenHPV infection and cervicalcancer?HPV can cause changes in the cellson the cervix, called cervical dysplasia(abnormal cells). Over time, thesechanges can progress, stay the same orget worse. If these changes are severeand are not treated, cancer of thecervix can develop. HPV is consideredto be a causal factor in virtually allcases of cervical cancer, and about 70per cent of cancers are associated withHPV types 16 and 18, two of the HPVtypes targeted by the HPV vaccine.How many women getcervical cancer?Approximately 1,350 Canadian womenare diagnosed with cervical cancereach year; about 400 women annuallydie from the disease. In Manitoba, approximately45 women are diagnosedwith cervical cancer each year andapproximately 15 deaths are reportedeach year.What is the HPV vaccine?HPV vaccines have been in develop-

ment for many years. At this time, thereis only one HPV vaccine that has beenapproved for use by Health Canada. Whenthis vaccine is given before being exposedto HPV, it is highly effective in preventinginfection from two of the HPV high-risktypes. These high-risk types (Type 16 andType 18) account for about 70 per cent ofcervical cancers. The vaccine also protectsagainst two low-risk types (Type 6 and Type11) of HPV, which cause about 90 per centof all genital warts.The vaccine is given in three separatedoses (needles/shots) in the upper arm overa six-month period. Clinical trials haveshown that the vaccine is effective for atleast five years. It is not known at this timewhether a booster dose will be needed.Why is the HPV vaccine recommendedfor women?By preventing HPV infections that cancause pre-cancerous changes in the cervix,it is expected that the vaccine will reducethe rate of abnormal pap smears and therate of cancer of the cervix. Currently, thevaccine is only approved for use in womenby Health Canada. Therefore, unlike mostother vaccines, the goal of the program isto reduce the risk for women who are vaccinated,rather than to reduce the spreadof HPV in the whole population. Womenwho receive the vaccine should continue tobe screened regularly with a Pap test. Thisis because the vaccine does not protectagainst all types of HPV that can causecancer and because the vaccine has notbeen studied long enough to show howmany cancers will be prevented.For more information on screening,women should talk to their health-careprovider or contact the Manitoba CervicalCancer Screening Program.Who should receive thevaccine?The National Advisory Committee onImmunization (NACI) recommends the vaccinefor females between the age of nineand 26 years. The vaccine is thought to bemost effective before the onset of sexualactivity; however, females between theages of nine and 26 years can still receivethe vaccine even if they have already beensexually active. Women who are alreadysexually active may be infected with anHPV type contained in the vaccine, butthey can still benefit from protectionagainst the other HPV types the vaccineprotects against. Females who have hadprevious Pap test abnormalities, includingcervical cancer, or have had genitalwarts or known HPV infection, could stillbenefit from the vaccine. These womenmay not have had infection with the HPVtypes included in the vaccine and are veryunlikely to have been infected with all fourHPV types contained therein. It is thereforerecommended by NACI that these womenreceive the vaccine. However, they shouldbe advised that there is no data to suggestthat the vaccine will have any therapeuticeffect on existing cervical lesions. The vaccinedoes not treat existing HPV infections,genital warts or cervical abnormalities.Who will be offered the vaccinein Manitoba?Manitoba Health and Healthy Living hasintroduced a voluntary, publicly fundedvaccine program for Grade 6 girls only.The program will be delivered by publichealth nurses. Before any female receivesthe immunization, information about HPVinfections, the vaccine, and a consent formwill be provided to parents and/or legalguardians.Who should not receive thevaccine?Females under the age of nine or over theage of 26. The safety and effectiveness ofthe vaccine has not been evaluated in childrenyounger than nine years. In addition,the vaccine should not be given to:• Pregnant women.• Anyone who is allergic to any of theingredients listed in the vaccinepackage information.• Individuals who develop symptoms ofhypersensitivity after receiving a doseof the vaccine.Is the HPV vaccine safe?Yes, the vaccine is considered safe, butas with all vaccines, adverse events mayoccur, including rare, life-threatening reactions.Health Canada has done a scientificreview of the quality, safety and efficacy ofthe vaccine and has approved it for use.What are the possibleside-effects?The most commonly reported side-effectsof this vaccine are: pain, swelling, itchingand redness at the injection site, fever,nausea, dizziness, headache and vomiting.Fainting has been reported. Fainting canoccur after vaccination, most commonlyamong adolescents and young adults.As with any vaccine or drug, severe,allergic, life-threatening (anaphylactic)reactions may occur, with symptoms suchas: difficulty breathing, wheezing (bronchospasm)and hives or rash. It is a routinepublic health practice to observe individualswho have received a vaccine for at least15 minutes following immunization. Aswith other vaccines, side-effects that havebeen observed after vaccination include:swollen glands (neck, armpit or groin).Guillain-Barré syndrome, a rare form ofparalysis that is usually temporary, hasbeen reported, but a confirmed link to thevaccine has not been established. For additionalinformation on other rarely reportedside-effects, please consult your publichealth nurse or doctor.Linda Coote is a registered nurse and amanager with the Winnipeg Health Region’sHealth Links - Info Santé help line.FYIYou can access healthinformation from aregistered nurse 24 hoursa day, seven days aweek by calling HealthLinks - Info Santé.Call 788-8200 or toll-free1-888-315-9257.For more information on the program, please visit www.cancercare.mb.caThere are many viewpoints and perspectives on the HPV vaccine andHPV-related matters. The following links provide additional information,covering a range of facts and opinions. These links are not exhaustive andthe opinions expressed are not necessarily the opinions of Manitoba Healthand Healthy Living.Public Health Agency of Canada: www.publichealth.gc.ca (Search: HPV)Sexual Education Resource Centre Manitoba: www.serc.mb.ca/ (Search: HPV)Fall 2009 51

in motionKristine HaywardMaking the gradeActive children areready to learnIs your child ready to learn?Did you know that supporting ourchildren to be physically active can helpthem learn and improve their academicperformance?The 2009 Active Healthy Kids Canada(AHKC) Report Card on Physical Activityfor Children and Youth summarizes currentresearch on the activity levels of Canadianchildren and the role physical activity playsin preparing your children to learn andto do well in school. The report card alsopoints out that there are many influencesthat have an impact on the activity level ofCanadian children, including family, peers,schools and the neighbourhood they live in.One of the key findings in the reportcard is that Canadian children and youthare not as physicallyactive as they need tobe to achieve optimalhealth benefits for52 WAVEnormal growth and development. Canadianchildren and youth were given a lettergrade “F” when it comes to the category ofphysical activity levels. There has definitelybeen progress in the last few years – anestimated 13 per cent of children andyouth met the physical activity guidelinesin 2007/08, up from only nine per cent in2005/06. There is still a long way to go tomake sure that all Canadian children aremaximizing the benefits of being physicallyactive!Another important message highlightedin the report is the connection betweenphysical activity and learning. Researchsupports that academic performance is improvedby participating in regular physicalactivity. One key study links physical fitnessand active living to achievement in mathtests and reading, perceptual skills, IQ andacademic readiness. Another study showedthat physical activity helps to enhancememory and learning, promotes brain cellgrowth, and prompts the release of chemicalsinvolved in learning.The report card praises Manitoba formaking physical education mandatoryfor all four years of high school - the onlyprovince to take such a positive step. TheGrade 11 and 12 curriculum requiresstudents to demonstrate they are engagingin at least 30 minutes of moderateto vigorous physical activity at least fivedays a week. Although these are verypromising steps, our children and youthstill have a lot of work to do to meetCanada’s Physical Activity Guidelinesboth inside and outside of school.As part of its 2009 assessment,AHKC created a FamilyPhysical Activity category,which takes into accountparental modeling, effortsparents make to ensure theirchild is active and parents’perceptions about theirchild’s physical activitylevels.The report card praisesparents for trying hard tofacilitate physical activityopportunities for theirkids. It also notes somedisconnect betweenhow active childrenactually are relativeto what their parentsbelieve. One regionalstudy found that 88per cent of parentsthink their childrenare active enough,while objectivemeasures found that 87 per cent of childrenwere not as active as they should be. Asa result of this disconnect, the report cardgives Family Physical Activity a letter gradeof C+.This data is supported by the findingsfrom the 2005 in motion survey conductedin Manitoba, which reported that over 90per cent of parents felt that their childrenwere physically active, yet less than 10 percent were actually meeting the guidelines.The conflicting data obviously raises afew important questions for parents: Howactive is active? What are Canada’s PhysicalActivity Guidelines for Children and Youth?And what can you do as a parent to supportyour children to be active?

Making timeThePublicHealthAgency of Canadahas developed physical activityguidelines for children and youththat can be used as a benchmarkto measure your child’s physicalactivity level. Generally speaking, theguidelines suggest that children and youthincrease their activity and decrease theirtime spent sitting. The guide recommendsthat children work towards a 90-minutegoal: 60 minutes of moderate activity and30 minutes of vigorous physical activityevery day.Achieving these guidelines can be challenging.The guidelines suggest a “go-slow”approach, increasing activity time byfive-to-ten minute intervals every day untilthe guidelines are met. Activities shouldinclude a combination of moderate activities,such as walking or riding a bike, withmore vigorous activities, such as running,swimming or playing hockey.Finding time to increase activity maycome from decreasing the time children arespending in front of computers and televisionscreens. Research shows there is asignificant relationship between increasedmedia exposure and poor academic outcomes.The Canadian Paediatric Societysuggests limiting screen time in front of acomputer or television to a maximum oftwo hours a day.Working with your children to add morephysical activity to their day teaches themthat physical activity is important for theirphysical, mental and emotional healthand to improve their ability tolearn.Kristine Hayward is aco-ordinator with Winnipegin motion, a partnershipof the Winnipeg RegionalHealth Authority, the Cityof Winnipeg and the Universityof Manitoba.Ensuring your child is physically active is as important as makingsure they get their homework done. Talk to them about theimportance of physical activity. Plan for it, identify barriers and becreative in finding ways to make time for it. Here are some tips:Before and after school:Playtime: Ensure your children have opportunities for unstructuredfree play. Children learn motor and social skills, and develop creativityand intellectual capacities through play.Reduce screen time: Replace “screen time” with playtime. Turningoff the television, computers, video games and cell phoneswill free up time to play outdoors.Join a team: Register your child in a sport program offeredthrough your local community centre or other community group.In addition to the physical health benefits, children learn valuablesocial skills and teamwork from participation in sports.To and from school:Active transportation: Although nearly 2/3 of Canadian familiesindicate that they live within a reasonable distance to walk orcycle to school, parents report that just over 1/3 of children reporthaving walked to school and 80 per cent report never havingcycled to school. Short on time? Cycling is faster than walking.Walking school bus: Team up with other parents or older adults inyour neighbourhood to walk kids in your area to school. Walkingschool buses provide safety in numbers. Check out www.resourceconservation.mb.ca for more information.During the school day:Activate recess and lunch breaks: Send a ball, skipping rope orfrisbee with your child to play with. It will increase their chances ofhaving an active break.Physical Education: Pay special attention to your child’s classschedule and be sure they have the proper clothing and footwearfor every Physical education class.FYI:For more information about the Active HealthyKids Canada and its annual report card,please visit www.activehealthykids.caFor more information on the federal activityguidelines for children an youth, please visitwww.phac-aspc.gc.ca/pau-uap/paguide/child_youth/index.htmlFor more information about Winnipeg inmotion, please visit www.winnipeginmotion.caFall 2009 53

healthy eatingJorie JanzenIt’s not uncommon today to find people heading off tothe gym or rink after a long day at the office. After all,getting in a quick workout or game of hockey a few timesduring the week is not only fun, it’s a great way to keep fitand relieve stress.Unfortunately, many of us are missingan opportunity to get the most out of ourworkout, in part because energy levels tendto be a bit low by the end of the day. Indeed,some may forgo a workout altogetherbecause they are simply too tired. But thereare ways to combat this fatigue and getmore out of your workout.Research shows that proper training techniquescan dramatically improve athleticperformance, even for the amateur who issimply trying to keep his or her waistlineunder control and maintain fitness. And akey part of proper training is planning andimplementing a balanced nutrition plan.What, when and how much we eatand drink can have a significant impacton our ability to get the most out of ourworkout. A good rule of thumb formaintaining your energy throughthe day is to try and eat everythree hours.Start with a good breakfast:a fruit smoothie (milk,frozen berries, banana)with a small low-fat muffinis a good example.Follow it up with alunch that is high infibre, moderate in proteinand lower in fat.Some examplesincludea whole-wheat torilla (stuffed with leafygreens, peppers, salsa) and a bowl of minestronesoup, or whole-grain crackers, tunawith salsa/seasoning and a side of mixedveggies. You can also try a stir fry withmixed beans rather than meat and a smallportion of rice or pasta.Your pre-workout meal is also important.It should generally be lower in fat and fibre,low to moderate in protein and higherin carbohydrates.Focus on the first three food groups inEating Well with Canada’s Food Guide –fruits and vegetables, grain products, milkand alternatives. A bowl of cereal withlow-fat milk, or adding berries to a low-fatyogurt would make an ideal pre-workoutmeal. This will ensure you maintain bloodsugar levels and maximize glycogen stores(muscle glycogen is the storage form ofglucose in the muscles and liver, a.k.a. the“quick energy” for muscle activity). Depletionof glycogen can occur with long andintense (marathon running, cross-countryskiing) or strenuous activity (hockey, soccer,dance), leading to early fatigue andexhaustion. Your pre-game or exercisemeal/snack will allow for a quality workoutor performance.What you drink during the day can also54 WAVE

affect how much energy you have for anevening workout. Coffee, for example, maygive you a caffeine kick in the morning,but drinking several cups throughout theday can sap your energy by late afternoon,especially if coffee is taking the place ofhigh-energy, nutrient-dense foods.Your fluid needs during the day cannotbe met by simply quenching your thirst.It’s always important to drink plenty offluids during the day, particularly if you areplanning on working out. Keeping hydratedallows you to feel more energized throughoutthe day, enhances concentration,decreases food cravings, keeps the bodytemperature regulated, and allows yourbody to keep metabolism and other organsworking. A general rule is to consume atleast two litres of fluid (eight cups) daily.Plain water is enough if your workout isan hour or less. A sport drink may be ofbenefit for activities lasting longer than anhour.Exercise causes muscles to generateheat. Heavy sweating can lead to musclecramping, heat exhaustion and heat stroke.That’s why it is important to ensure youare well-hydrated before a workout. Try toconsume 1½ to 2½ cups of fluid two tothree hours before you begin exercising.During your workout, you should drinkenough to maintain a fluid balance: aim forabout two to three gulps of water every 15to 20 minutes.Remember that tolerance is also key, andfluid needs can be quite individual dependingon climate/room temperature/ humidity,sweat loss and hydration status prior toworking out. If you want to recover after ahard workout, you need to re-hydrate.Proper nutrition and hydration followingthe workout is also important. Thepost-exercise meal plan should includefluids, carbohydrates and protein. Withinthe first 15 to 30 minutes post-exercise,a high carbohydrate drink/food shouldbe consumed. A balanced meal or snackshould be consumed within two to fourhours – depending on when your next mealwill be or when you are working out. Someprotein with the post-workout snack hasbeen thought to help with recovery. Try asmoothie, beans and rice, one to two slicesof turkey on a bagel or a whole wheattortilla, peanut butter and banana, or a cupof chocolate milk.Jorie Janzen is a registered dietitian withthe Winnipeg Regional Health Authorityand sports nutritionist with the Sport Medicineand Science Council Manitoba andCanadian Sport Centre Manitoba.Tips to help enhance your workout performance,body composition and overall health:Eat every three hours, and consumebetween five to eight mealsa day.Include three of the four foodgroups at main meals (fruits andvegetables, grain products, milkand alternatives, meat and alternatives).Consume lean, complete protein(chicken, fish, beef, pork, soy orcombine beans and rice/pasta)every time you eat (at least atyour main meals).Limit fat consumption to about 20to 30 per cent of energy intake.Incorporate vegetables into everymeal. Aim for four to five servingsof vegetables a day and three tofive servings of fruit.Eat fibre by consuming vegetables,fruit and whole grains. It willfill you up and promote regularity.Eat foods high in antioxidants andphytonutrients, such as deep blue,purple, red and orange fruits, red,yellow, and leafy dark- greenvegetables. They help prevent celldamage and promote optimalhealth.Always remember to hydrate before,during and after exercise.Limit calorie-containing drinks.Calories in any form, includingfluids, can add up. Drinking plainwater instead will help lubricatethe joints, help muscle tone, andenhance concentration andphysical performance. Limit your“indulgence” foods to about 20per cent of your total diet.Increase your level of motivationby getting adequate rest… everyday.Fall 2009 55

Photo: Marianne Helm

What WellnessMeans to MeName: David WladykaAge: 22Occupation: Social WorkerThe routine: You can often findDavid riding his bike at Birds HillPark. He recently participated inthe 17th World Transplant Gamesheld in Australia, competing incycling, volleyball, and the 100metre sprint and 4X100 metre relay.For David, wellness means beingable to live life to the fullest. Anallergic reaction to a viral infectionleft him with kidney disease whenhe was six years old. He receiveda kidney transplant from his fatherwhen he was 15 years old. Anavid cyclist, David says he washonoured to represent Canadaat the World Transplant Games.Although he did not win anymedals, David says he had a greattime competing. “Now that I knowwhat the competition is like, I knowexactly how hard I have to train fornext time.” Going forward, he sayshe would like to do more to raiseawareness about organ donationand do what he can to showpeople that transplant recipientscan lead active lives.Fall 2009 57

ig pictureApplesAs the cool weather arrives and the daysget shorter, we can no longer deny that fallis upon us. One of the best parts of fall is thecrisp, juicy apples.This crunchy fruit is not only tasty and refreshing,it’s also packed with vitamin C andsoluble fibre, the kind that helps to reducebad cholesterol. In fact, a single apple canprovide up to 10 per cent of the Vitamin Cyou need daily and 12 per cent of your dailyfibre requirement. The apple’s firm, white flesheven helps to clean your teeth.Apples also contain phytonutrients, naturallyoccurring plant chemicals that have beenlinked to a reduction in chronic diseases suchas heart disease, type 2 diabetes and cancer.Be sure to eat the peel along with theapple to get the most nutritional benefits.Red Delicious, Gala, Fuji, Honeycrisp, McIntosh– try one of the 100 varieties of applesgrown in North America today!58 WAVE