Saturday, November 28, 2009

Bridging the Generations

“One diamond”
“One heart”
“One no-trump”
“Four hearts”
“Pass, pass, pass.”

And so the bidding goes. My parents taught us to play Bridge at our cottage when we were kids. In those days we didn’t have TV or video games or even a radio with decent reception up there. So when the weather was bad we’d play Bridge or attempt to play, given the game’s complexity. My parents taught us the basic conventions, which helped in later years when my sister and I picked the game up again. More recently I’ve taken lessons, read Bridge books, and begun playing in a women’s group.

Family Bridge is the most casual. We chat, we laugh, we argue, and we constantly change our bids and take cards back when we realize we’ve goofed. Playing with my women friends is still quite casual and there is usually good food and wine involved. It’s social and it’s fun. And we are quite forgiving when it comes to mistakes. We keep score but don’t care who wins. There has been talk about playing for toonies to make us a little more competitive.

A while back, my very keen Bridge-playing friend, Nancy, thought it was time for our social kitchen Bridge group to start playing with the “big boys.” Having found a Duplicate Bridge organization in our community, she put us on the waiting list and after a year or so, we got the call. We were in. Duplicate is serious business. There is no talking, no dawdling, no moaning when you don’t like your cards, and no wine! A card laid is a card played. One time I changed my mind after pulling a card, and even though I had not yet played it and no one had seen it, I was told that it was too late. Seems like a card touched is also a card played.

The average age of my women's group is about fifty. The average age of the duplicate players is about eighty. The men like us; they call us the young chicks, which is probably the last time in our lives that we’ll ever be called that. There are a couple of women in their nineties who play like pros and keep us on our toes.

At Duplicate, all tables play the same hands. After two or three hands you move on to the next table and in one session you play about twelve tables. The only time you can talk is between rounds. During this short interval we slowly get to know one another. We’ve learned about grown children scattered across the country, about great-grandchildren, and retirement residences. There are widows and widowers and people who have been predeceased by their own children. Some of the folks are grumpy and some are gracious and fun. Most are excellent bridge players.

We’ve had our hands slapped when we don’t follow protocol (we’re still learning), and we’ve been congratulated for good playing. One time I made a mistake and didn’t follow suit (which is called reneging) and was put in my place in short order. Our opponent yelled, “DIRECTOR!” to get the organizer’s attention across the room. All heads turned towards us and the accuser continued in a loud voice, “She reneged!”

“I’m sorry,” I said with my face turning crimson. “It was a mistake.” I felt like I had committed some terrible crime. The director said, “It’s a two trick deduction. Don’t worry about it.” The accuser looked smugly at her partner, as if she had achieved a great triumph by having justice served and the criminal adequately punished. This is when I realized how competitive and serious the card game can be. It’s dog-eat-dog in the duplicate world, and we’re not even playing for money. You’ve got to have thick skin to swim with some of these seniors.

Some people collect master points, which is a way of determining one’s ranking. The more master points you have, the more prestige and respect you garner amongst your peers. High master points to Bridge players is like a low handicap to golfers. It sets you apart from the riff raff. I’m not in the game for master points nor do I care about my golf handicap. What I do care about is improving my game, keeping my mind sharp, enjoying the camaraderie, and learning something new.

One of my favourite things about playing Duplicate Bridge is when the gents greet us with their big grins and friendly banter. They can be sly old foxes who cream us at cards, but they have yet to slap our hands if we break protocol. They inform us of the correct rules, but with a whisper and a smile.

Playing Duplicate with seniors is like a microcosm of daily community living. You’re exposed to all kinds of people—friendly, nasty, uptight, easy-going, smart and slow. And there’s always someone in the crowd who warms your heart and makes you feel glad to be there.

Sunday, November 22, 2009

Tips from the Old World

Malcolm Gladwell, author of the popular book Outliers (which investigates what makes people successful), tells a story about a group of Italians who immigrated to Pennsylvania at the end of the nineteenth century. They were simple farming people from a little village called Roseto, looking for a better life in a more prosperous land. From scratch, they built a viable community where they could enjoy freedom and a self-sustaining existence. Many immigrants were doing exactly the same thing at the time, flocking to America to establish a life filled with opportunity and hope.

But something differentiated this particular group from all the others. In the 1950s, when heart disease was the number one killer of men under the age of sixty-five, the Rosetans seemed to be immune. For them, the most common cause of death was old age. When this fact became known, a physician named Stewart Wolf set out to explore the phenomenon. Was it their genes? Their diet? The environment? Their lifestyle? The doctor conducted a study, inviting the entire community to participate. The findings showed that along with a much lower death rate, this group had no suicide, no alcoholism, no drug addiction, and very little crime.

After months of investigation and comparative research, Wolf concluded that genes, diet, environment, and lifestyle were not factors. Did these people live in a bubble? In a way they did. By examining the societal factors, Wolf came to realize that the population’s longevity was a result of their social interaction. They looked out for one another in a way that he had never seen before.

Generations shared homes and helped each other, extended family clans provided support for each other, people shared their wealth and success rather than flaunt it, and they helped and encouraged those who struggled. They had created a powerful, protective social structure that insulated them from the pressures and stresses experienced by most individuals and communities. In other words, they sheltered themselves from the “dog eat dog mentality” that pervades western society.

Gladwell uses this story to demonstrate how success in life, just like success in health, is not always determined by what seems most obvious. This story also demonstrates the importance of community engagement.

It is well known that people who live in isolation are more likely to pass away sooner than those who have vibrant connections with others. Loneliness and isolation can cause more than depression, and physical ailments such as heart disease are high on the list. People need people. We are pack animals who constantly require contact, even if we have an introverted nature.

Social networking is ablaze with millions participating and jumping onto any new form of electronic communication vehicle that comes our way. I know a sixty-year-old woman who moved here from the US a couple of years ago and to overcome her frustrations, homesickness, and challenges of finding work, she jumped right on the social-networking bandwagon. I’m amazed at her knowledge and participation in everything from Facebook to on-line chat rooms to Blogging to Tweeting. She has it all covered, and it’s probably what keeps her going.

Kids are texting someone every five seconds (my own speculative statistics) and when they’re not texting, they’re on MSN. I heard a man on CBC radio say that when when he saw that his daughter had sent something like 13,000 text messages one month, he had to intervene.

We can live in the suburbs or even a city like New York and still feel terribly isolated; just because we are surrounded by people does not make us part of a community. Years ago, when I lived in a big apartment building, I was surprised at how few people I actually bumped into in the elevator. Even when there were several people sharing the elevator, no one looked at each other or said hello. It’s interesting how we crave connections yet avoid them at the same time.

According to the Canadian Institute for Advanced Research, the happiest Canadians are likely to be found in the eastern part of the country. Saint John, NB leads the group, followed by Quebec City, Charlottetown, Moncton (tied with Kitchener, Ont.) and St. John's. Each of these places has a strong sense of community. Knowing neighbours and trusting those around them are the key reasons that these cities found themselves on the top of the happiness scale.

When I re-read Gladwell’s story about the thriving Roseto community, it reminded me of how important it is to reach out to help others, to say something nice (even to strangers), to smile at people in passing, and to be a joiner even if it’s not always our thing. I look to my mother, who is the queen of friendly conversation, as an example. (Although, my sister and I sometimes find it frustrating to go out with her as she befriends just about every soul she encounters.)

Reaching out can pay big dividends in happiness. For those who don’t consider themselves social animals, why not give it a try? You may find yourself a little happier, and a lot less susceptible to heart disease. And if you find it too tough to make connections in the bigger cities, you can always move to Saint John!

Saturday, November 14, 2009

Are you Listening?

Much has been written about the “Art of Listening.” We know how important it is to pay attention to others when they speak. No matter what your profession, you will be apt to achieve much greater success if you know how to listen with intention. For example, a doctor must listen carefully to the patient in order to properly diagnose the ailment; a salesperson must be attentive to clients in order to meet their needs; a manager must listen to the staff in order to optimize productivity; a parent must listen to a child to develop a bond; and a prospective romantic partner had better listen to their love interest if they’re hoping for...a relationship. Why then, are we such bad listeners?

Many years ago, when I was studying in Geneva, Switzerland, I met another Canadian on the bus. He was a businessman working for an international company, and fairly new to the city. I was twenty years old; he was about twenty-seven. When he invited me out for dinner, I accepted. Why not? He seemed nice enough. A few days later, we met at a quaint little bistro in town. Very much a gentleman, he opened the door for me, took my coat, and pulled out my chair at the table—a good start.

When I asked him about his family, the floodgates opened. For three hours, over cheese fondue and a bottle of wine, I learned a great deal about the man: his childhood, his college days, his parents and siblings, his job, his career aspirations, and his travels. By the end of the evening, I felt like I had known this guy forever. And he thought the same thing about me. “I can’t believe how much we have in common,” he said. “I think there’s a destiny thing happening here.” Given the fact that I hadn’t said one word about myself the entire evening, I wanted to laugh. Needless to say, we did not start dating.

Why do people need to talk so much? Perhaps for attention, for self-affirmation, to share knowledge, to show-off, or out of nervousness. Or, to be cynical, because of a sincere lack of interest in others. In Dale Carnegie’s classic book How to Win Friends and Influence People he tells us, “Remember that the people you are talking to are a hundred times more interested in themselves and their wants and problems than they are in you and your problems. A person’s toothache means more to that person than a famine in China which kills a million people.”

When my husband and I moved to a new neighbourhood with our young children, a local minister came to visit. “A getting to know you visit” he called it. He came for coffee after dinner and was most congenial. He told us about his early ministry, his family, about interesting people he knew, and then shared a few entertaining stories. As he was leaving, he shook our hands and said, “It was a pleasure getting to know you.” When we closed the door, my husband and I looked at each other and smiled. What did this minister learn about us? Not a thing. He hadn’t asked one question, or indicated the least bit of interest in us. But his task was done and he could check off the visit on his list of obligations.

I hope I’m a good listener. I do have a genuine interest in what others have to say and I’m generally a curious person, but I know that I can be guilty of talking too much myself, especially about a topic that I’m passionate about. The other day I was so immersed in a discussion with someone that a third person had to call a time-out to get a word in edgewise—a good reminder of how one must always be mindful of others in a group.

Being a good listener does not necessitate sitting in silence while everybody else speaks, but knowing when to pipe in and when to keep mum. Monopolizing the conversation, interrupting others, or tuning people out (as we think of our next statement) are absolute no-no’s and definitely not the way to “win friends and influence people.” The challenge is to be self-aware, socially conscious, and intentional about our listening skills.

Recently, my brother chastised me for interrupting him. At first I was defensive. “But you interrupt me all the time!” I said. Then I realized he was right; I did interrupt him, and it was rude. Part of being a good listener means not cutting people off, which really boils down to courtesy. But even the most well-intentioned listeners can slip-up sometimes, and as with anything, there’s always room for improvement.

Dale Carnegie’s advice: “If you aspire to be a good conversationalist, be an attentive listener. To be interesting, be interested. Ask questions that other persons will enjoy answering. Encourage them to talk about themselves and their accomplishments.”

...and then everybody can be friends!

Sunday, November 8, 2009

Habitat for Humanity, Global Village – Destination Mozambique!

Chelsie McKnight, a young Toronto business woman, has recently returned from a life-changing mission in Africa. In this powerful letter, she shares her experiences with the hope of "inspiring people to take action, giving perspective, serving as a reminder of how lucky we are, or introducing an important dinner conversation with the kids."

Habitat for Humanity, Global Village – Destination Mozambique!
By Chelsie McKnight

“Overcoming poverty is not a gesture of charity. It is an act of justice. It is a protection of a fundamental human right, the right to dignity and a decent life” – Nelson Mandela

Back in one piece! Here’s the summary of one of the best adventures of my life: I mixed cement, sawed reeds and trees, pushed wheelbarrows full of sand and rocks, thatched roofs, tamped floors, and put grout between cement blocks. I made 16 new friends. I ate delicious meals, drank cold South African cider, and took cold showers after sweaty 9 hour work days. I danced with children to Michael Jackson. I danced with villagers on my birthday, and I danced with children who followed me around Massaca.

An incredible success!
  •  7 days
  • 16 volunteers
  • 19 houses
  • 19 guardians & approximately 60 children with a place to call home
I saw orphanages, AIDS ribbons painted on walls, children without shoes or toys, medical clinics, and a first hand look at what disparity really is. I was immersed in culture. I learned about hard work and community. I witnessed gratitude. I fell in love with Mozambique the country and the people. I was able to get “back to the basics” and enjoy the company of others, good conversation, homemade meals, working with my hands, and gazing at the stars like I’ve never seen them before. I did not miss my blackberry, my bed, my TV, my fridge or my shower. I did    not want to come home.

Troubling Statistics
  • 1.5M orphans
  • 1.5M people infected with AIDS
  • Average age: 18 yrs
  • Life expectance: 48 yrs
  • 50% live below the poverty line
  • Income per capita: US$340

Let me assure you that your donations were well utilized and will make a difference in the lives of 19 families. I honestly cannot think of a more worthy cause – decent, safe shelter, and a place to call home; seems so simple. These homes will empower the families that live in them and give them a sense of belonging and hope. When one grandmother was asked what she looked forward to the most; she replied; “The concrete foundation. My grand-daughter Juliette will never sleep in the water again”.

I worked along side the mothers, grandmothers and children that will be living in these homes. Despite the language barrier we laughed at the same things, we sang songs, danced together, cried together, shared meals, and helped each other out. It was so evident to me that we are the same. We all belong to the same “Global Village”. It is unjust that I got to leave the village to return to the comforts I take for granted here in Canada. I am no more deserving of the surroundings and life I have here then the people I met.

Habitat Homes
  • Traditional homes the villagers would build could they afford to
  • Concrete foundation will protect from termites and rain
  • Sturdy walls and thatch roof does not allow rain or sunlight in
  • Come with mosquito nets to protect against malaria
  • Latrine built separately

It is so clear to me now that I must share what I have for the rest of my life. I will continue to share my time with those who need a helping hand. I will share my health and able body with those who struggle with theirs. I will share my wealth and belongings with those who were born without the chance to acquire the same things. I will share my knowledge and stories in hopes of inspiring others to do the same.

If you are interested in hearing more please connect with me and I would be happy to share more pictures and stories. You can also check out the Global Village websites to see if there is a country you would like to visit!


Chelsie McKnight

“People are unreasonable, illogical, and self-centered. Love them anyway. If you do good, people may accuse you of selfish motives. Do good anyway. If you are successful, you may win false friends and true enemies. Succeed anyway. The good you do today may be forgotten tomorrow. Do good anyway. Honesty and transparency make you vulnerable. Be honest and transparent anyway. What you spend years building may be destroyed overnight. Build anyway. People who really want help may attack you if you help them. Help them anyway. Give the world the best you have and you may get hurt. Give the world your best anyway.” – Mother Teresa

Wednesday, November 4, 2009

Should I get the H1N1 Vaccine? A Doctor's Report

Thanks to Barb Power for passing this infomation along. (From a slideshow presentation given by Dr. Mike Evans on October 27, 2009)

Dr. Mike Evans is:
Associate Professor, Family & Community Medicine, University of Toronto,
Staff Physician, St. Michael’s Hospital
Director, Health Design Lab
Director, Family Practice of the Future,
Scientist, Li Ka Shing Knowledge Institute

Getting the vaccine is a choice

• Sometimes we want people to tell us what to do and other times we want all the information before we decide... but I think most of us balk at a missive from “above”.

• It’s hard to argue against vaccines at a population level (if we give it to everybody the clinics and E.R.’s will  be much less busy, less missed work, less people getting sick or even dying) but things get trickier at the individual level.

This presentation takes you through some of the issues so you can decide for yourself.

Values and Change

• When making a decision we usually combine the information with our values.
• Faced with the same information, people will make different decisions. Your values are a factor in this decision. You may have different values than me or another- so feel free to disagree.
• Things will change. We have lots of experience with vaccines but the H1N1 vaccine is new and so this is a story we will have to follow. H1N1 may become more or less prevalent. Side-effects may become more or less of a factor. This “changing game” will also effect how you feel about your decisions.

How sick will I get?

Most of us get a cold seasonally. Definitely unpleasant but it is something we can cope with. Influenza is definitely more than the common cold.

•Bottom Line: For most people H1N1 flu is very unpleasant but they cope. Some people do get sick enough to be hospitalized.
•Reviewing US H1N1 data 1 about 11/1000 got sick enough from H1N1 to be hospitalized and 7/10,000 died from H1N1.
• About 70% of people who have been hospitalized with H1N1 flu have had one or more medical conditions that placed them in the “high risk” category for serious seasonal flu-related complications. These include pregnancy, diabetes, heart disease, asthma and kidney disease.
•84 people have died from H1N1 (as of oct 20,2009) so far in Canada and this number will increase.

Will the H1N1 vaccine actually protect me?

• Influenza vaccine is not perfect. The effectiveness depends on how the “dead virus” (that is injected into you to make you immune) matches with the virus that is circulating in the community and on your own immune system. Older people tend to have less of a response. Usually the effectiveness rates for seasonal flu vaccines is 70-90%.
• It is still early but it looks like the match with what is in the community is very accurate and so hopefully the H1N1 vaccine will be on the upper end of effectiveness.
• Typically we say that it takes 14 days for the vaccine to be effective. With H1N1 it looks like it works in about 10 days.

How do vaccines work?

Your body’s immune system is very smart. If you get invaded by a “bad virus”, your body makes a “photocopy” and sends it around so that if the virus shows up again it neutralizes it and you don’t get sick. Instead of allowing you to get sick, vaccines give you a dead or even a very small live part of the virus so that your immune system is prepared to fight off the real virus.The H1N1 vaccine gives you a dead virus for your immune system to “photocopy”.

Do vaccines weaken my immune system?

No. It makes it stronger. I often get asked if it isn’t better to get the immunity naturally? Yes and no. If you get it “naturally” then you are immune but the problem is that you also get sick! So, for example, if you have had documented H1N1 then you don’t need the vaccine (if H1N1 was suspected but not tested for (which is common) then you still need the shot). The vaccine is just an attempt to make it so you don’t have to get sick in the first place.

What’s an adjuvant?

The H1N1 vaccine in Canada has an adjuvant so it is important to discuss. An adjuvant is an additive that is sometimes put in vaccines to boost the effect. It “primes” the immune system so that a smaller amount of the vaccine has more effect. The advantage of this is that for many of my busy patients this means you only have to come in for one shot instead of two. The downside is that there isn’t as much trial experience with pregnant moms and very young kids. Shots like the tetanus and hepatitis have adjuvants.

What are the side-effects of the shot? and what about these scary things I read on the internet about mercury?

• Perception vs reality: About 20% of people will have symptoms after a flu shot- whether they get a fake/placebo or real flu shot. People often blame illness on the vaccine but they would have become sick anyways. Also the vaccines generally take 2 weeks to work so people can get sick with flu if exposed in that time. Note the only major difference is in arm pain (which wasn’t activity limiting).

•People who should not get the flu shot are those with allergies to egg (the vaccine is grown on eggs)or those with a previous true allergic reaction to the flu shot. This is rare.

•Woman who are pregnant (any trimester) or breast feeding are fine to get the shot and in fact are encouraged as it is protective for both mom and baby.

•About 1 in a million will have a severe reaction (anaphylaxis or possibly Guillain-Barré Syndrome (GBS))1:

•Data is conflicting as to whether a causal relationship exists between modern influenza vaccines and GBS. If one exists, the risk is estimated to be very low (no more than 1 to 2 cases per million doses). Since the introduction of universal influenza immunization in Ontario, there has been no detectableincrease in the number of new cases of GBS requiring hospitalization at the population level. 23 GBS typically happens to about 1-2 in 100,000 people. Just to be safe I would not give the vaccine to somebody where this condition was evolving.

Concerns about Thimerosal:

•Thimerosal is a preservative for vaccines that if we didnt have in there we would have other safety concerns. Most influenza vaccines available in Canada contain minute amounts of thimerosal. Thimerosal has some mercury in it so it is rational to be concerned. Because of this there has been large reviews of the safety of thimerosal. No studies have demonstrated an association between thimerosal-containing vaccines and adverse neuro-developmental outcomes. H1N1 has an adjuvant which means we need about 1/10 of the usual amount of thimerosal.

To keep things in perspective, there is less mercury in the shot than in a tuna sandwich.

Does my decision affect others?

• We’ve talked alot about your chances of getting sick but what we haven’t talked about is the effect of your health on others.
• It’s interesting, and I am biased because I see many older and/or sick people, but my main reason to get the flu shot is to protect these people. If you get the shot you reduce the risk for people in your life who may struggle with dealing with H1N1 swine flu (eg.,people with other diseases and asthma) and conversely, if you get the kids the shot, your chances of getting sick go down quite a bit.

Can you summarize the Risks + Benefits?
It will protect me from getting sick vs. it will make me sick

•Your risk in general of getting pretty sick with normal influenza is about 9-12/100. This can go up to 42/100 if you have kids. This attack rate will likely be higher with H1N1. Early data from the US is pointing this way.

•So far it looks like about 11/1000 with H1N1 get extremely sick and admitted to the hospital. You are more at risk if you have a respiratory condition like asthma. Having said that, most people feel unwell, often miss work, but cope fine.

•84 people have died from H1N1 so far in Canada (as of oct 20,2009) and this number will increase.

•Having the vaccine will be be very protective as there is a good match with circulating H1N1 thus far.

•Approximately 70% will have some arm pain. The pain doesn’t limit activity and is gone typically in 2 days.

•A severe reaction or anaphylaxis is estimated to happen in less than 1/500,000 doses.1 There is no risk or a minute (1 in a million) risk of Guillain-Barré Syndrome (GBS)2

1. When you get the vaccine you protect those around you. Especially those at risk eg., Seniors, kids, people with underlying diseases, pregnant moms, etc..

2. The H1N1 vaccine is like a new version of the flu shot. We have lots of experience with flu shots and vaccines but we don’t have years of experience with this exact version. As well, the adjuvant has been less tested on pregnant moms and children under 6 months. Early trials have not signaled any problems but, having said that, it is a new variation and we won’t know the full picture until it has been used for a while. There is now enhanced reporting systems in North America to gather this data.

What are the recommendations for the H1N1?
Recommendations from the Canadian Public Health Agency:

Q1. What are the recommended doses for the use of H1N1 flu vaccine?


■ The recommended doses for H1N1 flu vaccine are as follows:

■ All Canadians 10 years of age and older should receive one dose of adjuvanted vaccine; and,

■ Children from six months to nine years of age should receive the adjuvanted vaccine in two half-doses, administered at least 21 days apart;


■ Pregnant women should receive one dose of the unadjuvanted vaccine. In cases where the unadjuvanted vaccine is unavailable and H1N1 flu rates are high or increasing, women more than 20 weeks pregnant should be offered one dose of the adjuvanted vaccine. All data to date indicates that adjuvanted vaccine is as safe as unadjuvated vaccine.

Q2. Who should not receive the vaccine?

The following groups of people should NOT receive the H1N1 flu vaccine:

■ People who have had a previous anaphylactic (severe allergic reaction) to any element of the vaccine, OR

■ People with a hypersensitivity to eggs ( e.g. hives, swelling of mouth and/or throat, breathing difficulty); OR

■ People experiencing a high fever, OR

■ People who have previously experienced Guillan-Barré Syndrome within 8 weeks of receiving a seasonal flu vaccine.

The H1N1 flu vaccine is not approved for children under six months.

Q3. How long will it take after I receive the vaccine to have immunity against the virus?

After receiving the H1N1 flu vaccine, most people will start to develop immunity within 10 days with just one dose.

Q4. Can the H1N1 flu vaccine be administered at the same time as the seasonal flu shot and/or other vaccines?

The H1N1 flu vaccine can be administered along with seasonal influenza immunization and other vaccines. Seasonal and H1N1 flu shots should be given in opposite arms. If an individual receives seasonal flu, H1N1 flu and pneumococcal vaccine in the same day, the seasonal flu shot and the pneumococcal vaccine should be given in one arm, and H1N1 flu vaccine in the other.

For more information please see the following website: Centers for Disease Control and Prevention: 2009 H1N1 Flu: Situation Update