healthcare – Page 2 – Jewish Independent

Children are also stressed out

The most important thing as a parent is to be able to identify when your child is stressed. (photo from Psychology Foundation of Manitoba)

Despite the numerous technological advances we have achieved to make our lives easier, we are more stressed than ever. Even children are affected.

American psychologist Dr. Robin Alter moved to Toronto in 1980 to work at the city’s mental health centres. Her focus is on children’s health and, over her 36-year career, she has helped treat more than 10,000 families.

“If you’re just in private practice, you don’t get to do that…. You can’t see that many people,” Alter told the Independent. “So, I started thinking that I really need to start writing down what I’ve learned from this incredible experience and try to give it back.

“A lot of the things I was learning on the ground, in those face-to-face meetings, were things I couldn’t read about. It was not written in the studies I was reading. My experience, and what works for people or doesn’t, is different than what was written in books or journals.”

In addition to numerous articles, many of which can be found on her website (docrobin.com), Alter is the author of the book Anxiety and the Gift of Imagination and The Anxiety Workbook for Kids.

When she was in university, Alter’s teacher, Judy Levy, helped steer her toward working with children.

“I loved talking with them and finding ways they could express themselves so we could understand what they were feeling and why they were behaving the way they were,” said Alter. “Then, I came to Canada. I walked into these children’s mental health centres and looked around and I found all these people who shared the same mission as me…. I was ecstatic, realizing that I’m not doing this by myself. I’m doing this with an army of people who are passionate, who are inspired to dedicate their lives and energy to helping children and families.”

When the system switched to providing such care in a hospital setting, Alter opted to work from the outside, to educate people about how changes in society are affecting kids.

According to Alter, the effects of stress start at infancy for many kids, as they are thrust into a daycare environment for eight to 10 hours a day.

“That’s very hard for kids if you think about it,” she said. “When you’re with your family, you can let your hair down, right? You can be yourself, be relaxed. You’re protected, cared for, special. When you’re in a large group of other kids – even if it’s a good place – they have a number of kids to look after … there is always stress involved, some kids who want the toy you want to play with.

“You don’t have the skills yet to figure out a compromise, so you’re just fighting over the toy or feeling left out. Everybody seems to be playing with somebody and you don’t have anybody to play with. And, you know, there’s not always going to be an adult who notices that you’re under stress.

“The children leave their home early in the morning, spend all day in a competitive environment, and [are] picked up at the end of the day just to have dinner, a bath and go to bed…. Going to bed, too, is stress-inducing for all of us, but especially for kids. And we wonder why they are having trouble keeping up.

“I think there’s an epidemic of sleep deprivation,” she added. “Kids really don’t know how to unwind at night, how to take their worries and put them aside. I know most parents have a fairly good bedtime routine, where they read to their kids and turn out the lights, but I think it can be improved. Kids need to learn how to turn off their minds and put the day to rest.”

Alter has conducted nearly 6,000 psychological assessments and continues to do more. For this, there is a form that parents fill out – in 90% of these assessments, parents identify problems with sleep.

According to Alter, Vancouver’s Dr. Gabor Maté, an expert on child development, believes that many kids who are identified as ADHD (attention deficit hyperactivity disorder) are really just sleep deprived and misdiagnosed. And, if they get diagnosed as having ADHD, they will likely get medication – medication that causes sleep deprivation, further intensifying the problem.

The most important thing as a parent, said Alter, is to be able to identify when your child is stressed. The key to doing this is paying attention mainly to what is not being said. “Look for the cues,” she said. “Kids have a different response, but, usually, it’s a change in behaviour. They stop and, sometimes, their eyes get wider. We can do things to alleviate that stress, explain things to them. For example, the other night, at dinner, I drank a little bit of water, and then I was talking to Lewis [her 2-year-old grandson] and he turned to me and said, ‘Baba, you just spit at me!’

“He looked horrified at that. Why would his grandmother spit at him? Something he’s learned in daycare is that you don’t spit. He looked like I had just done this horrible thing. We explained to him that I didn’t spit at him, that it was water that came off my lips and that I’d never spit at him. Then he became unstressed.

“So, sometimes, just explaining what’s going on; giving the kid a good explanation can alleviate the stress. Those are minimal stresses. But, sometimes, there are big stressors going on.”

While stress can be overwhelming, it is important to remember that we don’t want to completely eliminate it. “Stress is our passport, or what we need to have an interesting life,” said Alter.

We have to learn that stress is a part of life and that we need to learn ways to de-stress. This is a main focus of the Psychology Foundation of Canada program Kids Have Stress Too, for kids 3 to 5 years old.

One of the strengths of the program is that it relays that stress is normal, everybody gets stressed. “And, you know, you can identify it in other kids,” said Alter. “When other kids are stressed, you can identify it in yourself and you can help yourself to feel better…. You can learn how to come back, bounce back from stress.

“I was at a session, my own personal professional session with a mother. She was very stressed by her daughter, who was 5 years old and had been diagnosed with epilepsy. The mother was very stressed by the diagnosis and the symptoms. The kids were in the room.

“The 5-year-old heard her mother talking about how stressed she was – and the kid had actually been through the Psychology Foundation program Kids Have Stress Too. Her ears perked up at the word ‘stress’ and she said, ‘Mom, I know what to do when you get stressed.’ The mother said, ‘You do?’ And the kid said, ‘You sing a song.’ She had a song she learned in the program and she sang it to her mother, and it was very cute and helpful, and the mother laughed. Laughter is a good way to alleviate stress.

“Another good way of helping kids alleviate stress is to encourage them to be helpful to others. When we are kind to others, when we reach out and give people food, and share – all those things alleviate our stress.”

The Kids Have Stress Too program teaches children to be aware of when they are stressed. Some kids feel nausea or a rush, as if an alarm system is going off in their body. Some kids feel it in their tummies. Others feel it in their heads. Once they learn what these feelings mean, it normalizes it and then it is not so scary. So, they are able to take care of themselves and sometimes take care of others.

“If you see other kids going through the program, someone stressed, they sometimes put their arm around them and say, ‘It’s OK. Everything’s alright, so let’s go play, let’s go do something fun,’” said Alter. “And that’s what it’s all about.

“There are wonderful little techniques,” she said. “The one I like most is the cloud push. You stand up and put your hands up and push the clouds away, like you’re pushing all the stress away. You’re getting rid of all the things you don’t want. Push them into the sky. Let them fly away.”

Alter shared a story about visiting a junior kindergarten class, where she read the kids a book about animals having a bad day and getting stressed. She was taken aback by the responses she got from the 4-year-olds when she asked them if they had ever had a bad day.

“I turned to them and said, ‘Well, the orangutan is having a bad day. Have you ever felt that way?’ And, I look up to see this whole sea of faces, all shaking their heads as hard as they can, saying, ‘No. No. Never!’ And, I was shocked. I realized that, even at this age, the peer pressure of how we’re not supposed to feel that way, not supposed to admit to others that we feel bad, was already instilled so early.

“Then, they went to little tables independently. We gave them crayons and paper, and each one of them drew these amazing pictures of things in their life that stress them out. One kid drew a picture of his mom having cancer and going to the hospital. Another kid drew a picture of his father leaving the family. And, I realized that they got the message, what I was reading about. They were not going to admit it in the group, but they were very eager to talk about it individually.

“We need to help kids realize that they are not alone with these problems or feelings,” said Alter. “That’s one of the biggest strengths of the program – an adult can help kids, too, by talking about their stresses.”

Parents need to be sharing their feelings with their kids, and then showing them how we move past them, she said.

“Kids don’t so much listen to what we say as much as what we do,” said Alter. “Kids are more doers. And so, for example, getting them out to the yard and doing exercise – throwing a ball around or something – is a good way to alleviate stress.

“Many kids stop talking because we use words they don’t understand, and they just don’t understand what we’re talking about. But, they understand action and behaviour. So, doing things with them and encouraging them to do things is a lot more helpful. Also, laughing is a way to alleviate stress. So, telling a joke, being silly, or just letting … stress out that way is great.

“Kids need to know that when they are out there in the ‘jungle’ of school that their parents are behind them and that they are not alone in whatever is going on,” she said. “Our daughter had a lot of trouble in grades 4 to 6 – bullying, mistreating stuff. Every night, we’d strategize what she could do, have long conversations. None of them worked. She’d say, ‘I tried that. It didn’t work.’ She knew that we were behind her, that she wasn’t alone. She had a team who understood how difficult the situation was. I think all those things help.”

For more information on the Kids Have Stress Too program and more, visit psychologyfoundation.org.

Rebeca Kuropatwa is a Winnipeg freelance writer.

Organ donation awareness

Left to right are panelists at a recent National Council of Jewish Women panel on organ transplants: Dr. Aviva Goldberg, Rabbi Yossi Benarroch, Marshall Miller and Na’ama Miller. (photo from NCJW)

On Dec. 11, the Winnipeg section of National Council of Jewish Women (NCJW) held an organ donation awareness event, featuring community members Rabbi Yossi Benarroch, Dr. Aviva Goldberg, and husband (organ recipient) and wife (organ donor) Marshall and Na’ama Miller.

Benarroch spoke first, after a welcome from organizers and a video about organ donation (youtube.com/watch?v=5cfaAWTH5zM).

“The short of it is, basically, that Jewish law permits organ donations,” he said. “There’s no question about that. Of course, when we talk about law, law is complicated and there are lots of opinions. There’s an ideal in Judaism, which is one of those foundations, and it’s called ‘pikuach nefesh doche hakol’ … which basically means that, in Judaism, there’s nothing more important than saving a life.

“I’m a very observant Jew and I keep kosher,” he said, “but if I had to eat something that wasn’t kosher – pork or whatever – in order to save my life, then Jewish law says you’re obligated to do that.”

Benarroch said it is written that, if someone saves a life, it is as if they have saved the entire world. Furthermore, he said, we are called to not stand idly by if another person is suffering. “We are obligated to intervene and actually obligated to help that individual,” he said.

Marshall Miller, who was diagnosed with progressive kidney disease more than 25 years ago, eventually required replacement therapy.

“Slowly, over time, my kidney failure began to get worse and worse,” he shared. “The disease progressed to the point where, a few years back, my GP at the time said, ‘Marshall, you’re now at the point where you have to go see a specialist because I can’t do anything more for you here … you need an expert to deal with your situation.’

“Everybody who suffers from kidney disease understands that, what kidneys do, among many things, is purify your blood. When your blood isn’t being purified properly, you can start to feel kind of lousy. I think my family can attest to the fact that I was starting to feel lousy. I think my whole family suffered along as I did, as I got sicker and sicker.”

When his kidney function was down to less than 10%, the specialist started talking seriously about replacement therapy. This involved dialysis three times a week until a matching donor could be found.

During the search for a donor, Na’ama Miller decided to find out if she might be able to help other people in her husband’s situation. As it turned out, she was a match for her husband.

“We were told it was a one hundred million shot,” she said. “And so, we were next faced with a bit of a dilemma … because it was scary for the kids. But Samantha and Maya were very much in favour of it, because they didn’t want me to be miserable anymore.”

She said, “People ask me, how I could do this … if it was hard. I give everyone the same answer. It was a no-brainer, a very easy decision for me. As Marshall said … we were all suffering along with him.”

“It’s worth it. You saved a life,” her husband added. “We hope this event here – even if only one more person signs up … hopefully, more and more people will choose to do it among the Jewish community after hearing the story.”

After the Millers spoke, a second video was screened, about a former Winnipegger who donated a kidney to save the life of a woman in California, who he has never met.

“Right now, in Canada, there are over 4,500 people waiting for an organ transplant – 4,500 Marshalls,” said Goldberg, who is the director of the Canadian Society of Transplantation and chair of the Transplant Manitoba kidney allocation review committee. “We don’t have 4,500 Na’amas. That’s why we need donors – both living and also deceased donors.

“That’s what we want to talk about today,” she said, “even if you don’t go forward to become a living donor, which is a really big deal. It’s not something that every person in this room is going to be able to do and that’s totally fair. But, there’s something that everyone in this room can do and that’s to sign up for organ donation after you’ve died – say that this is something I’d like to do, that you’d like to leave a legacy … you can save lives after you’ve died, either with organ or tissue donation. You can save lives by donating organs – heart, liver, lungs, pancreas, kidneys and even small bowel – but, also tissue donation.”

In some cases, people can donate their corneas to help improve the life of others. According to Goldberg, Manitoba, last year, was the fourth on the world list of most donors.

While Goldberg implored people to sign up as donors online, she further reminded them that talking to family about your willingness to be a donor is also very important – and not just immediate family, as they might be in the same car with you when you have a horrific accident, for example.

“The way that organ donation works in Canada, here, in Manitoba, is that after someone has died and they are potentially going to be an organ donor, their family is approached,” said Goldberg. “If you sign up for the registry, it’s a way of saying to your family, on the very worst day of their lives, that this is something your loved one wanted – wanted so much that they went to the registry, signed up, made that choice. It’s a hard discussion to have … [but] it’s so important to do.”

During the question-and-answer period, one attendee asked if there was an age limit for someone to donate an organ. The answer? “No.”

Another question was about the possibility of rejection and, to that, Marshall Miller shared his experience. “I suffered from a mild early rejection,” he said. “But, the ability to detect the rejection and be able to remedy it is incredible. They were able to treat me with medication instantaneously and, really, it was a non-issue for me. Even though there is a risk of rejection, it can easily be found if you attend your appointments and take your medication.”

For information on organ donation in British Columbia and to register, visit transplant.bc.ca.

Rebeca Kuropatwa is a Winnipeg freelance writer.

Limiting screen time is vital

Video Interaction Project coach Jenny Arevalo in action. (photo by Andy Reichsman/Ames Hill Productions)

With the ever-increasing number and variety of screens and gadgets grabbing our attention, pediatricians are asking us to take a step back. Some are even leading a counter-movement, warning parents and caregivers of the harm these technologies are inflicting on children.

Dr. Alan Mendelsohn, a general and developmental behavioural pediatrician, is an associate professor of pediatrics and population health at New York University’s School of Medicine and Bellevue Hospital Centre.

“The American Academy of Pediatrics published a statement designed to help pediatricians and parents think about toys for their children, in an era where toys have really evolved,” Mendelsohn told the Independent. “A very significant concern is that toys with bells and whistles, so to speak – with electronic gadgetry on the one hand or apps designed to engage children on the other – are likely to have very limited, if any, benefit to very young children.”

Mendelsohn has been working to use the pediatric primary care centre to support parenting activities most likely to help children’s development and school readiness. This has led to other programs, like Reach and Read and the Video Interaction Project, both of which teach parents the importance of reading and playing with their kids.

“We still have the same kinds of toys we’ve had in the past – simple, pretend kinds of toys,” said Mendelsohn. “But, at the same time, digital toys have become a high level of focus and priorities for many families. And, that’s in part as a result of the extensive messaging taking place about how electronics can be so important for children, and how apps and computers are going to help children learn.”

photo - Dr. Alan Mendelsohn — Dr. Alan Mendelsohn *(photo courtesy Alan Mendelsohn)*

According to Mendelsohn, there is limited or possibly even no good scientific evidence that screens can be beneficial for children under the age of 2 – with the possible exception of video chats in which the screen is functioning as an opportunity for interaction with family members that otherwise would not take place.

At the same time, he said, there is extensive data documenting that electronic add-ons, and screens more broadly, have a great deal of potential for harm.

“This is true for children of all ages, but it’s especially true for very young infants, toddlers and children who have not entered school yet … for whom that screen time … not only can lead to developmental challenges … but it can actually interfere with play and with parents being able to engage together with their children in the kind of rich, language-based interaction that advances children’s development,” said Mendelsohn.

The American Academy of Pediatrics recommends that children under 2 have no screen time, other than the aforementioned video chats. For children 2 and older, they recommend limiting screen time to one hour or less, and having that screen time be high-quality, i.e. educational, programming.

“This limited screen time should be used as an opportunity for interacting, rather than viewing it as an opportunity for babysitting, which is how it’s often used and viewed by parents,” said Mendelsohn.

“Parents using screen time as a distracter is not necessarily a bad thing…. The academy recognizes, and I think the pediatric community recognizes, just how hard it is to be a parent, especially of a young child. Parents spend the day working and come home to chores, housework and all kinds of things. Obviously, screen time can be very helpful to parents in that way. But, it’s important that parents realize the potential for harm to their children – recognize that screen time is unlikely to be beneficial for their children.”

Mendelsohn recommends that parents find opportunities to play with their kids and read books with them, as these activities are likely to improve their child’s development and help create a positive parent-child bond.

“The important thing here is that excessive screen time, regardless of age, has the potential to lead to problems and challenges for children by interfering with their capacity to pay attention once they start school, as well as by causing challenges with their capacity to regulate their own behaviour and learn in school,” said Mendelsohn.

Schools are using more and more screens and technology, and Mendelsohn doesn’t condemn the use of screens and technology in an educational, monitored setting. Rather, monitored use should extend into the home.

“Parents face a great deal of challenges as they seek to do that,” he said. “The important thing is for parents to be aware and to work, particularly as their children get older, to monitor their children’s screen time and to interact with their children when screen time is taking place, especially higher quality kinds of programming.

“Equally important is for parents look for opportunities to turn the screen off … to have those opportunities every day, whether through reading books together or playing together – always aiming to have quality time.”

Electronic games are not all created equal and those that are engaging and interactive, that foster playing with others – qualities many board games possess – are likely not harmful and might even be good.

“There are not clear answers,” said Mendelsohn. “But, what is clear is that screen time can be overwhelming in time, and that parents have difficulty limiting it. Limiting and monitoring it is the key to having screen time be one of many components of a child’s life as she or he grows into school age versus becoming the most prominent part of the child’s life.”

Mendelsohn suggested that parents ask their pediatricians for advice.

“Pediatricians are there as a resource for parents,” he said. “Parents should raise these issues with their pediatricians, and they’ll enjoy the conversations and guidance they receive.”

Rebeca Kuropatwais a Winnipeg freelance writer.

Wilderness helps youth heal

BaMidbar students hike in all weather conditions, learning to live and care for themselves in outdoor environments. (photo from BaMidbar)

When she was 15 years old, now-camp director Jory Hanselman had some family members who were struggling with mental illness and addiction. At the same time, a couple of close friends passed away in pretty quick succession. Hanselman was struggling to cope, until her parents sent her to a wilderness therapy program.

“It was an extremely transformative experience for me,” Hanselman told the Independent. “I was there over Passover and so, while the program I was at was not in the least bit Jewish, my identity as a Jew was really central to what I experienced and got from it.

“I really connected it to the narrative, and thinking about finding my freedom from narrow places and overcoming obstacles I’ve faced in life. So, I looked into how I could become more involved in wilderness programs.”

In college, Hanselman spent summers at Ramah in the Rockies and saw firsthand the beautiful integration of Jewish learning via meaningful, outdoor-based experiences. And, when Ramah in the Rockies started exploring the idea of opening a Jewish wilderness therapy program, their director reached out to Hanselman, knowing that she had been working in the field. Hanselman was asked to provide input on how to build a therapy program.

“They decided they would move forward and officially create BaMidbar and so I came on board at that time, in September 2016, to help move the program from a space of ideas to implementation and actuality,” she said.

One great thing about its location – literally, in the wilderness – is that it’s only an hour-and-a-half drive from Denver, Colo. However, said Hanselman, “To give you a perspective, we are an hour drive from cell service in any direction.”

The therapy retreat is for Jews from 18 to 28 years old who are struggling with mild to moderate social and behavioural challenges, including depression, general anxiety, social anxiety and more. The young adults in the program have reached the tipping point where the issues are getting in the way of their being able to fully engage with the people and things around them in life.

“We also see lots of folks who have co-occurring substance abuse disorders, who are also using substances in addition to working through challenges associated with other mental health challenges,” said Hanselman.

photo - Staff member Cliff Stockton teaches primitive fire building skills to students at BaMidbar — Staff member Cliff Stockton teaches primitive fire building skills to students at BaMidbar. *(photo from BaMidbar)*

“The idea of wilderness therapy (WT) is using wilderness- and adventure-based experiences as the vehicle for therapy, to grow. So, we joke a lot in the WT industry that it’s not about doing therapy in the wilderness, it’s about doing wilderness-based therapy. It’s not just going out and meeting with a clinician in a wilderness-based setting; it’s really using that experiential environment as a vehicle for working through different therapeutic concepts.”

The BaMidbar program involves the whole family. While students work with an individual therapist, their family is having weekly phone meetings with the therapist who, in turn, also works with the field staff to implement a treatment plan.

“So, our students are learning how to, for example, build a fire with friction, and they use this opportunity to build primitive skills to challenge themselves,” said Hanselman. “They learn what tools they need to work through and understand what they’re capable of.

“Wilderness-based experiences are used as metaphors and storytelling to support our students in connecting what is happening in the wilderness environment to life outside the program.”

The small-group environment at the camp is used as a way to help campers learn and rebuild communication skills and other tools.

“We provide feedback and strong support for them, as they determine how to have healthy emotional responses to different stressful situations, or anger management strategies, and things like that,” said Hanselman.

While there are many WT camps, BaMidbar is possibly the only one that uses a Jewish lens and framework in everything they do, including using the Jewish calendar as an opportunity to look at topics that are thematically relevant to campers.

“To give an example, for Passover last year, every day we had a theme we focused on that tied to the Passover narrative, as well as our student therapeutic journey,” said Hanselman. “Day One, we focused on our narrow place. Day Two, we talked about the story of Nachshon Ben Aminadav … jumping into the unknown and what it might look like to take a leap of faith and know that you need to change your situation, even if you don’t know what the future holds. Day Three, we looked at manna in the desert and talked about what sustains you physically, metaphorically, spiritually. Day Four, we talked about receiving the Torah on Mount Sinai and did a summit hike, talking about our personal value systems, what we live by, things like that.”

With BaMidbar being a kosher camp, Shabbat is a break from the routine, which, in this case, is wilderness. On Shabbat, they spend time in a cabin, while still studying texts through the lens of how they are relevant to one’s life. This is the perfect time, said Hanselman, to talk about family. For instance, “because, throughout Genesis, that revolves around challenging family dynamics…. I always joke that Abraham was the first wilderness therapy participant. He leaves everything he’s familiar with and goes off into the wilderness on this journey of self-discovery. So, we do a lot of programming around Shabbat.”

photo - BaMidbar’s program is rooted in Jewish ritual. Here the BaMidbar community celebrates Havdalah — BaMidbar’s program is rooted in Jewish ritual. Here the BaMidbar community celebrates Havdalah. *(photo from BaMidbar)*

BaMidbar (which means “in the desert” in Hebrew) is non-denominational and the organizers are dedicated to meeting every student where they are in their unique journey, recognizing and honouring that it can be very different for each individual.

“We are very dedicated to making sure that students understand that our goal is to explore meaning, values and purpose through a Jewish lens – not to tell them how to live Jewishly or what that ideal Jewish life might look like,” said Hanselman. “That’s not our goal. Our goal is to look at the wisdom Jewish tradition provides and to support students for whole health wellness.”

Participants can expect 10 to 12 weeks in the wilderness (Shabbat in a two-room cabin). Groups are small, with a current maximum of eight individuals, and the program runs year-round.

In winter, said Hanselman, “We fully outfit our students, so they receive all their gear from us. We make sure they have what they need to be safe and warm in a wilderness environment. We have a lot of staff practices around safety and support in that winter environment, and then we have tents that have wood stoves in them when it gets below a certain temperature.”

The camp fee is around $3,500 US per week. A nonprofit, the BaMidbar program offers scholarships and works with every family, regardless of their financial situation. Currently, about 75% of students receive scholarships provided mainly by private donors and foundations.

While BaMidbar has received many inquiries from Canadian families, they have not had any Canadian participants. “But, we can work with them – from Canada, or Israel, or other countries,” said Hanselman. “We just haven’t yet.”

For more information, visit bamidbartherapy.org.

Rebeca Kuropatwa is a Winnipeg freelance writer.

Operation Warmth wraps up

Left to right: Caryl Kochen, Darcy Billinkoff and Caron Bernstein were three of the many Operation Warmth volunteers over the years. (photo from JWI-BC)

More than 40 years ago, Sylvia Handlesman, one of our B’nai B’rith Women (now Jewish Women International-B.C.) members, brought us a wonderful service project she remembered from her earlier years in England – providing home-baked refreshments, tea, coffee and juices to visitors and staff at hospitals on Christmas Eve and Day.

On checking with the B.C. Children’s Hospital, Sylvia learned that the only cafeteria serving visitors and staff was closed over Christmas to allow staff to celebrate the holiday with their families. The hospital assigned us a small room with a fridge, long table and a number of carts to be loaded with home-baked goodies and beverages that added to the festivities of the season. Even Mr. and Mrs. Santa Claus and their helpful elves enjoyed the repast.

The heart-warming project – Operation Warmth – was both a service and a social gathering for members and family members who volunteered for three-hour shifts, while enjoying coffee, a snack and greeting and visiting with other volunteers as they came during shift changes. Some, who could not walk the halls, stayed in the room filling trays, loading carts and making coffee.

Originally, our members only served refreshments to the visitors and personnel in the children’s wards – due to dietary restrictions, patients were always excluded.

Because of the success of Operation Warmth, the hospital soon requested that our members also cover the B.C. Women’s maternity section.

Since then, on Christmas Eve and Day, JWI-BC family members and community volunteers have traveled through the halls of these wards with loaded carts. A table on the main floor in the area close to the elevator was also kept supplied with goodies for visitors and staff. With time, the original coffee and home-made baking was supplemented with fruit juices, mandarin oranges and other treats donated by local stores and bakeries.

It is impossible to express the appreciation the volunteers received from the hospital personnel, visitors whose children were unable to go home and expectant or newly delivered mothers who were also hospital bound for the holidays. The only years when Operation Warmth was not provided took place when Christmas fell on Shabbat or a snowstorm made travel too dangerous.

With time, most of our original volunteers were no longer with us and, with them, has gone much of the fantastic home-baked cookies and squares that once filled the plates on the carts.

For a number of years, Operation Warmth was organized by Zmirah Rosenthal, with the invaluable assistance of her longtime friend, Ena Salamon. Although Ena was not a JWI-BC member, she was responsible for a major share of the planning that made this project so successful. One year, she even organized the two-day program completely on her own.

Last October, the new Teck Acute Care Centre opened at B.C. Children’s Hospital. As well, hospital staff make every effort to get patients and families home, if only for the day or two, over the holidays. And patients on the maternity wards also have a much shorter hospital stay. As a result of all of these changes, the Operation Warmth program is wrapping up after four decades.

“It has been a privilege and honour to work with the B’nai B’rith Women, now Jewish Women International, in the planning and delivery of this annual event,” said Pat Gillis, manager, volunteer resources, B.C. Children’s and B.C. Women’s Hospital. “My sincere thanks to Zmirah and Ena, who have been the driving force for an event that brightened the days of families from all across British Columbia for so many years. As our facility changes, we want to take this time to thank the many community volunteers who have been a part of our history on Oak Street.”

JWI-BC is also appreciative, and thanks the staff and volunteers of the hospitals and the many individuals and their families who helped make Operation Warmth a success for so many years.

Dealing with addiction

Dr. Jenny Melamed (photo from Jenny Melamed)

“I’ve been in addiction medicine for at least 15 to 20 years now. I spend my time with people in addiction and recovery; that is all the work that I do. I believe in recovery and I believe in remission for the disease of addiction,” Dr. Jenny Melamed told the Independent.

Melamed, who now lives in Vancouver, was born and raised in Johannesburg, South Africa. She moved to Canada with her husband in 1987 – first to rural Saskatchewan, then to Vancouver. Her work with addiction began with a friend’s suggestion to try some work at a methadone clinic. She immediately was drawn to help people in this way and became certified in addiction medicine in the United States, then in Canada and internationally.

“I’ve got lots of initials behind my name,” said Melamed. “I’ve spent most of my time in addiction talking, doing person-to-person counseling. I don’t wear a stethoscope.”

According to Melamed, physicians were among the first abusers of prescription drugs. “It was thought that treating pain with opioids would not be addictive,” she said.

“Opioids are narcotics that act on opioid receptors to produce morphine-like effects, so we were prescribing it and, now, there are so many opioids out there. And we’re having these pill parties, where kids are taking pills from their parents’ cupboards – going to these parties where they’re putting them into these big bowls and they don’t even know what they are taking out. We’re looking at 13- or 14-year-olds that are trying these drugs. They’re finding it young.

“There’s not that much OxyContin available anymore,” she added, “as people are now scared of it.”

Melamed said there is no way to know for sure if a person will become addicted or not. Kids often take more than one possible addictive drug at these kinds of parties, she said, so they will likely not even know which one(s) affected them and what the specific effects were.

“For some people who take their first drink or take their first opioid, they will say that ‘the minute I used X, I felt calm for the first time,’” she said. “For some, it starts immediately. For others, it starts as weekend use at parties. Then, they start to use a little more during the week, and then they start realizing that, when they try to stop, they can’t. They’re actually dependent on this drug and are going through withdrawal. They can’t move away from it.”

Melamed said, “Addiction is a disease of escape. They’re using it to help them cope. I said to a young girl yesterday, ‘Why do you use?’ She said, ‘Sometimes, I just don’t want to feel.’ And that’s what it is. They learn from an early age, and the addiction part of the brain takes over and says, ‘I will help you through this.’

“We all live in a society where there’s a lot of stress and many of us, especially young people that have not developed coping mechanisms, turn to different modes of escape, as they are the easiest thing to do.

“The important thing to remember is that, when you come down from whatever high you used, you still have the stress, if not even worse, as now you’ve got to pay for your drugs. You may have blacked out or overdosed … but, in the spur of the moment, addiction is such an instant gratification that you don’t even think of it. You just think about self-medicating.”

Recovering addicts learn that there is no such thing as a cure from addiction. Addiction may go into remission in the same way that type 2 diabetes can go into remission, said Melamed. If one changes their diet and loses weight, etc., they may not have to use insulin anymore, but, if they gain weight back, change their diet or lifestyle, the diabetes will flare up again.

“So, you get the person who is out with buddies and somebody says, ‘You want to try this heroin?’ not knowing there’s fentanyl in there,” she said. “And they die, because the brain tells them that they can try it just once. And they actually believe that they can go back to being a social user, or a social drinker.

“They don’t understand that this is a chronic disease that is with them for the rest of their life. And, you know, when you say to a 15-year-old, ‘you’re not going to be able to use or drink for the rest of your life,’ it’s a very difficult concept and very scary … and that’s why the AA [Alcoholics Anonymous] concept of one day at a time is really important.”

While only about eight to 11% of people who use a substance become addicted to it, no one knows which substance will entrap them. But, one thing is for certain – it can affect any of us and the problem affects us all.

“I think the first thing we have to understand is that it doesn’t matter what religion we are, what our economic status is – everybody has a risk of addiction,” said Melamed. “We have some very wealthy families in the city who have lost kids to addiction. We have to move it out of the stigma.

“You have the concept of, ‘Oh, he’s a functional alcoholic, just drinks at lunchtime.’ And, we accept that. But, we shouldn’t accept that in any form. And, we also shouldn’t stigmatize it in any form. We need to talk to our children about it and be on top of it.

“In some ways, as a Jewish population, we feel like we’re a little different and protected,” she continued. “We’re not. The conversation has to happen at home. When I gave a talk here, at the Schara Tzedek, about addiction, the room was empty. We believe our kids would never do it.”

There are things you can do at home, in addition to talking with your kids about addiction. Any prescription drugs that are not being used should be returned to a pharmacy for proper disposal, and any medications that are being used on a regular basis should be locked up.

“You also should take a look at why you are using these medications,” she said. “Even as adults, our drug use is inappropriate.”

Melamed said one of the best ways to keep an eye on your kids is by making your home a welcoming space where they and their friends are happy to hang out. That way, they are comfortable being around you and you see what is going on.

“You need to know where your children are, who their friends are and what they are doing,” she said. “And, you cannot assume that, just because they are from the same socioeconomic status, that everybody’s good. It’s really important to know parents, their friends and to know what’s going on.”

Melamed is open to hearing from educators, schools, community groups and others who would like her to come and speak on addiction and its treatment.

Rebeca Kuropatwa is a Winnipeg freelance writer.

Training local doctors

Prof. Mark Eidelman, director of the pediatric orthopedics unit at Rambam’s Ruth Rappaport Children’s Hospital, second from the left, with African colleagues at the Black Lion Hospital in Addis Ababa. (photo from Rambam Medical Centre)

Dozens of doctors from Ethiopia and neighbouring countries recently participated in a practical course, the first of its kind, which trained them to fix pediatric orthopedic deformities. The course, held for the first time in Africa, was led by Prof. Mark Eidelman, director of the pediatric orthopedics unit at Rambam’s Ruth Rappaport Children’s Hospital.

Fifty doctors participated in the four-day course. Some of them had already completed their internships, while others were still interns. They attended lectures about different treatment types, attended workshops and participated in surgeries. The Black Lion Hospital in Addis Ababa, Ethiopia, hosted the course, which was sponsored by CURE International. CURE is a nonprofit organization that assists children in developing countries suffering from medical issues, in cooperation with POSNA, the Pediatric Orthopedics Society of North America.

The Ethiopian hospital’s pediatric orthopedic services are directed by two doctors from England who relocated to Ethiopia several years ago. The doctors created the course in order to give treatment tools to local medical teams dealing with one of the most common problems in the country.

“Against the backdrop of genetic diseases and problems, and especially since there is a great lack of knowledge, infrastructure and treatment capabilities with regard to pediatric orthopedic deformities, there are many people in Ethiopia with problems that are taken care of in other countries at much earlier stages,” said Eidelman. “In Israel, like in many other Western countries, they know how to diagnose problems … and treat them in a timely manner. This helps these patients to enjoy a higher quality of life and prevent their conditions from deteriorating. Now, for dozens of local doctors, there are tools and knowledge to help their patients.”

Joining Eidelman on this recent mission were two doctors from the United States: one who was Eidelman’s teacher, Prof. John Herzenberg, a senior doctor in the field from Baltimore; and Prof. Christof Radler, who is also renowned in his field.

According to Eidelman, the main problem in training African doctors is the difficulty of traveling to the United States to receive training there. “The institutions in Baltimore are considered the best in the field in terms of training and teaching, and the city hosts the leading conferences and courses,” he said. “Unfortunately, most of these doctors don’t manage to secure entry visas for the U.S. and, as such, are denied access to this information. This is the reason why we decided to bring the training to them. At the end of a successful course, we decided to continue with this initiative and, in the near future, I’m supposed to return to Ethiopia in order to train additional doctors.”

Teaching about death

Dr. Jessica Zitter has both written a book and a movie about death and dying. (photo by Rikki Ward Photography)

Dr. Jessica Zitter, who works as an attending physician at a public hospital in Oakland, Calif., struggled with her job’s protocols for years. Until the day a nurse opened her eyes to the possibility that there was a better way, one that involved more compassion in the treatment of patients.

Zitter comes from a long line of doctors.

“They were into the art of medicine,” she said of the mentors she had when she first began her studies. “By that, I mean the art of surgery and intervening, and of doing things in a very precise way. There was something about that that I found heroic, and I wanted to be part of that world.

“So, I went to medical school – pulmonary and critical medicine – which I thought of as the most heroic of the specialties. I went on to start to focus on the machines, technologies, protocols and things that were part of the trade of being a pulmonary critical care physician. I tried to really perfect them … [thinking that,] if I use these perfectly, I’ll be able to help a lot of people.”

But, as she went along, she started to think differently. At first, she suppressed the feeling. “It was truly uncomfortable,” she said. “It caused me a lot of suffering.”

Zitter was using techniques and protocols on people who were not going to benefit from them, knowing full well that they would not benefit from them. Not only was she following her training, but she also wanted to please her patients – give them mainly good news and information about various procedures, instead of telling them the whole truth about their condition.

“I didn’t want to tell them, ‘Hey, I don’t think you’ll survive,’” said Zitter. “I didn’t want to say that because it’s too sad. I would communicate about things that were more practical like, if this happens, we will try this.”

A pivotal moment

Zitter’s approach changed after an encounter in the intensive care unit with a nurse from the family support team, called Power to Care.

“One day, I was about to put in a line [catheter] into someone who was really, really sick and likely dying, and the woman who headed that family support team was standing in the doorway watching…. I was about to put the needle in and she put her hand up to her face and she said, ‘Call the police,’ on a pretend telephone…. She said, ‘Call the police. They’re torturing a patient in the ICU,’” said Zitter. “And that was my epiphany moment. All these moments, I had this doubt. This was like a relief – you’re right, I am torturing the patient. What the heck? There was a clarity there that was really powerful.

“But, the sad truth is that I still put that needle in. I still put that catheter in that woman. The force of what I call the end-of-life conveyor belt is so powerful … not only the conveyor belt itself, but the drive to ‘protocolize,’ heaping on treatments … the culture in the hospital. It’s hard to break out. It’s hard to stop and take a pause, and say, ‘Wait a minute. What the heck?’”

The intervening nurse, Pat Murphy, in some ways became Zitter’s mentor on what it meant to be a doctor.

“I came to it late and from a place of profound dissatisfaction and moral distress, and I was just extremely lucky that I happened to be in one of four hospitals where this movement was starting to take hold,” Zitter told the Independent.

“And, I happened to have been open to it,” she added. She was able to get over her “human defence of not wanting to look stupid or like I didn’t understand … and to be able to say, ‘OK. Teach me.’

“I feel lucky that those two things were in check at that time,” said Zitter. “Not to say that I wasn’t filled with shame and embarrassment about what I’d been doing all that time, but the psychology…. Once you admit there’s a problem, then find a way to fix it.”

After years of immersing herself in this new paradigm, Zitter felt ready to share what she had learned. She published a book about it, called Extreme Measures: Finding a Better Path to the End of Life, in 2017.

As she was writing it, Zitter realized that, if a picture can impart a thousand words, maybe a movie would be able to convey even more. So, she put together a 24-minute documentary, Extremis.

Of the award-winning film, Zitter said, “It really shows the issues that come up in an ICU…. There is also a discussion guide that goes with it, so people can watch it and then come away from it with some lessons learned.

“This movie reaches a wide audience about really advanced care planning,” she said. “A lot of synagogues are using it, medical schools and nursing schools.”

Death education

Zitter was asked to teach sex education at both of her daughters’ schools.

“I want them to be able to make the best decisions they can make about their bodies and their health, and to be empowered to live the best they can,” she said.

But what about death education?

Extremis came out in late 2016. “It was nominated for the Oscars and a lot of my kids’ friends were watching it. And all these kids were really blown away by the movie and they were having a positive response to it,” said Zitter. “It made me think, ‘Why the heck aren’t we teaching kids about death? Why aren’t we having a conversation in high school, just like with sex ed?’ So, a friend of mine designed ‘death ed.’ We did it in her kids’ and my kids’ schools. It was really impactful.”

Zitter would love to see such a class in every school in the United States and Canada, along with other heath education classes, so everyone can have the opportunity to learn about a range of issues and discuss them.

Both the teachers and the students appreciated the lesson on death education, said Zitter. “There were no negative responses. Although some kids cried, and it was terrifying at first, they would then say, ‘That was sad, but I’m OK.’

“I was like, ‘It is sad that we are all going to die.’ But, you know what? It’s really good for these kids too, [because] it’s part of life. If we pretend no one’s going to die and don’t let our kids go to funerals, etc., we aren’t doing anyone a service.”

So far, Extremis has been translated into 90 languages and has been shown in 160 countries.

“We’ve got to tell people what’s actually happening and try to understand,” said Zitter. “I use myself as a prime example…. Why was I putting that catheter into a woman I knew was dying? What are these factors that are propelling me to do things that don’t make sense to me? The idea is to be more conscious of it, aware of it, and change it.”

For more information about the movie and the book, visit jessicazitter.com. The film trailer can be found on YouTube.

Rebeca Kuropatwa is a Winnipeg freelance writer.

BGU finds key protein

Ben-Gurion University’s Dr. Deborah Toiber will be part of a panel in Vancouver called Alzheimer’s, Dementia and You: Research, Risk Reduction and Resources. (photo from CABGU)

Alzheimer’s affects about six percent of people over the age 65 worldwide. For years, scientists have been searching for ways to treat it and to discover its roots, but without much success, until recently.

A group of Ben-Gurion University researchers, under the leadership of Dr. Deborah Toiber, is among those who have made breakthroughs. They have discovered that a certain protein, SIRT6, necessary for DNA repair, is largely missing from the brains of people with Alzheimeir’s. The absence of this protein and the gradual decline in its production by the human body as we age might be what triggers the disease.

On June 5, Toiber will be the keynote speaker at Alzheimer’s, Dementia and You: Research, Risk Reduction and Resources. She will be joined in a panel discussion by Laura Feldman from the Alzheimer Society of British Columbia and Joanne Haramia of Jewish Family Services; Simon Fraser University professor emeritus Dr. Gloria Gutman, one of the founders of SFU’s Gerontology Research Centre, will be the moderator. The event, which will be held at the Rothstein Theatre, is being presented by the Canadian Associates of Ben-Gurion University (CABGU) in partnership with the Jewish Independent, the Jewish Community Centre of Greater Vancouver’s Adults 55+ program, the Alzheimer Society of B.C., Louis Brier Home and Hospital, Jewish Family Services, Jewish Seniors Alliance, and L’Chaim Adult Day Care.

According to David Berson, executive director of CABGU, British Columbia and Alberta Region, “the purpose of the panel is to increase the awareness and understanding of Alzheimer’s disease, dementia and neurodegenerative diseases.”

“Deborah was coming to Canada to visit the community in Winnipeg for a similar event,” Berson told the Independent. “We had a wonderful opportunity to bring the young and dynamic researcher to Vancouver and we jumped at it…. Toiber’s research, as I understand it, is part of a race to discover, isolate and understand the characteristics, components and mechanisms of DNA that will allow us to identify and treat neurodegenerative diseases prior to onset.”

In her email interview with the Independent, Toiber talked about her work and her group’s discovery. She said that DNA deteriorate with age. “It is not something genetic or environmental,” she said. “We repair our DNA and continue going on, but the repairs are not perfect. Some DNA remain unrepaired. As we get older, unrepaired DNA accumulate, and their ability to produce proteins diminishes.”

She further explained: “If the DNA is damaged, and a cell feels it is too dangerous to continue with this damaged DNA, the cell may activate a self-destruct mechanism. If too many cells do this, the tissue with the dying cells will deteriorate, such as the brain.” Essentially, the deterioration of the DNA and the reduced production of SIRT6 protein mark “the beginning of the chain that ends in neurodegenerative diseases in seniors. In Alzheimer’s patients, SIRT6 is almost completely gone.”

Toiber said scientists should be focusing on how to maintain the production of SIRT6 and how to improve the repair capacity of the damaged DNA, because that is what causes Alzheimer’s and similar diseases. Unfortunately, it is impossible to introduce the needed protein directly into the brain. “There is a blood barrier that prevents things from passing into the brain,” she said. “But we are trying to find a way to increase the expression of the protein into the brain.”

Toiber has always been fascinated by the molecular biology of the human brain. “I chose this field because I wanted to understand in-depth how the brain works, to investigate what happens when things stop working,” she said. “I think that molecular biology is the answer to all those questions. It’s like being a detective on the molecular level.”

She realizes that a detective’s work is never easy or fast. “Results take years to build, as they are based on previous findings, ours and other scientists’. My current group, where I am the principal researcher, is about three years old. It is a new lab.”

The research is multifaceted and multidirectional. “We do basic science,” she said. “We use animal models and cells to understand what is happening as we age, what is the cause of disease and what can we learn from this to develop treatments or preventive actions. We also collaborate with medical professionals and other scientists to get a fuller picture of various aspects of aging and neurodegeneration, particularly Alzheimer’s disease.”

Toiber’s group doesn’t work on the pharmaceutical angle of how to introduce the protein into patients’ bodies. Instead, she explained, “We are interested in the molecular causes of aging, such as DNA damage accumulation, and how this leads to disease. We work in experimental biology. These experiments are expensive and difficult. It can take a long time to see and understand the results, but it is also rewarding. Molecular processes help us understand how our organisms work and what happens when things go wrong. We have to be optimistic and keep trying.”

Many scientists in related fields of study are interested in Toiber’s work. “I have talked about our research at the international neurochemistry meeting in Paris and at conferences in Crete and Israel,” she said.

To hear her speak in Vancouver, register at eventbrite.ca. There is no cost to attend.

Olga Livshin is a Vancouver freelance writer. She can be reached at [email protected].

Music helps body and mind

Perla Barabak gave a music workshop on April 17 as part of Jewish Seniors Alliance’s Snider Foundation Empowerment Series. (photo from JSA)

The fourth session of this season’s Jewish Seniors Alliance Snider Foundation Empowerment Series was held with the co-sponsorship of Congregation Beth Israel on April 17. The theme of “Laughter and Music: Feeding the Soul” continued with a program entitled Perla’s Music Workshop.

About 65 seniors were present to enjoy the afternoon event, which began with the regular Tuesday seniors lunch provided by Jewish Family Services. Queenie Hamovich of JFS welcomed everyone and introduced Ken Levitt, president of JSA.

Levitt reviewed some of the JSA programs, including the peer support services. He asked audience members to consider joining JSA and encouraged them to think of volunteering for some of the peer support initiaves. He then introduced the speaker for the afternoon, Perla Barabak.

Barabak believes that music helps the body and mind to relax. It also touches the heart and soul, she said, making it easier for feelings to surface. Thus, music can provide multiple benefits.

Barabak began with some exercises, asking the audience to sound out their names musically. She began with her own name and many people joined in. She talked about active and passive listening; for example, listening at a concert as opposed to hearing background music in an elevator.

Throughout history, she noted, music has been used in communication, movement and at social events (weddings, b’nai mitzvah, banquets).

Songs represent a culture, she said. In this way, music is the song the heart sings. Songs remain with us into our senior years, when other memories may fade. Songs and singing can create pleasure and empowerment.

Barabak then did a guided meditation, getting everyone to close their eyes, listen to the music and imagine a colour. Barabak – who has used music in her work as a psychologist – pointed out how relaxing this is and how music balances our thoughts and feelings. She said she feels that, where there is life, there is music.

As the event ended, many in the audience got up and danced to the music being played.

The next Empowerment Series event – Music for Our Hearts and Songs We Love – will take place on June 25 at Beth Tikvah Synagogue. Caviar and Lace, with Michelle Carlisle and Saul Berson, will perform a mix of classic, jazz and folk songs.

Shanie Levin, MSW, worked for many years in the field of child welfare. During that time, she was active in the union. As well, she participated in amateur dramatics. She has served on the board of the Jewish Federation of Greater Vancouver and is presently on the executive of Jewish Seniors Alliance and a member of the editorial committee.