Disclaimer: The views and opinions expressed by the author(s) do not represent the official position of Barbados TODAY.

As we move into any New Year, one tradition is to make a New Year’s resolution. Some social marketing research shows that a majority of these resolutions focus on improving personal health, such as losing some weight, doing more exercise, and paying more attention to eating and drinking habits. Gym registrations traditionally spike in January, but quickly taper off. Coming after a long season of gorging on food and drinks, a health resolution is a good idea, but for many it’s too little too late. A better idea would perhaps be to set health resolutions at the start of the festive season; after all, an ounce of prevention is better than a pound of cure.  

In Barbados, the festive season seems to start around the middle of November, as our advertisers seem to merge Black Friday sales shopping, adopted from high-income countries, into Independence Day into Christmas and then New Year’s Day, to be shortly followed by Errol Barrow Day on January 21st. Through sales and other gimmicks, we are encouraged to ‘shop till you (or at least your money, including end-of-year bonuses) drop’ and generally fete, eat, drink and be merry. For too many people, this translates to about six to eight weeks of unbridled activity (while stocks and funds last). 

The food festivities start with Independence, with persons invited to sample as many conkies as possible to determine whose conkies, made with or without raisins, are the best. After ‘conkie season’, the Christmas season officially or unofficially starts: ham, stuffed turkey, jug-jug, black cake (often alcohol-infused) are washed down with sorrel, juices and a wide variety of alcoholic beverages. Mouth-watering desserts, including chocolates, sweets, biscuits and ice-creams, complete the feasts. The volumes of food and drink consumed are designed to keep our obesity figures as high as they are, in the top 20 of the world, and obese persons fuel our chronic non-communicable disease (CNDC) pandemic.

Therefore, we must reset our efforts at prevention and treatment of these CNDCs. Sure, many people behave like ‘one-day Christians’, who do many wrong things for six days a week, and on the seventh day suddenly remember the path to ‘health righteousness’. We have no shortage of speeches on the effect of the CNDCs on deaths, sickness and even the economy, in between a tsunami of advertisements that promote inappropriate health habits.

In the background, COVID-19 lurks. The pandemic may or may not be over, but the virus is still here. At a recent press conference, the Deputy Chief Medical Officer offered statistics to support a rising rate of documented COVID-19 infections on the island, even while admitting that fewer persons were coming forward for testing. Nonetheless, the Chief Medical Officer (CMO) noted that there was a cessation of many of the official (‘mandatory’) COVID-19 protection measures from midnight the same day. This coincided with the day where the media were reporting and showing crowds of persons, mainly without masks, jamming into stores to take advantage of VAT-free
shopping. The media has also been showing crowds of un-masked persons enjoying various events, many of them indoors, apparently dismissive of the threat posed by COVID-19. It must be remembered that some people here remain unvaccinated, or have refused to get the booster shots. Vulnerable individuals, and this group includes the elderly and those harbouring CNDCs, are at increased risk of severe illness and death from COVID-19.

Worldwide, in spite of best efforts, which include mitigation measures, vaccinations, specific medications like antiviral medications and monoclonal antibody treatments [neither of which we could easily afford here], COVID-19 still kills about one in one hundred persons who contract the disease, with a higher rate in vulnerable persons.

The ‘mantra’ of our Ministry of Health (MOH) over the last three decades has been “Your health is your responsibility”. Philosophy: great. Is it working with the CNDC pandemic? There is no statistical evidence to support this (so the CMO has stopped releasing annual statistics). Will it work with the COVID-19 pandemic? The MOH has cut back on releasing the COVID-19 dashboard (daily statistics), which allowed anyone interested to keep track of the pandemic here. Official statistics to follow what is happening here are harder to come by, but a rising COVID-19 rate is likely.

The resumption of Q in the Community, a monthly physical activity event aimed at getting the elderly to become more physically active, is a good thing. It unfortunately had to be stopped at the height of the COVID-19 pandemic. What is not so good now is that a high proportion of our elderly have one or more CNDCs, and are thus vulnerable to a serious health outcome. It is perhaps unfortunate that the crowds of elderly persons coming out to this function have generally declined to wear face masks.

Internationally, we see COVID-19 is on the rise again, with the emergence of new variants of the Omicron strain, specifically the XBB.1.5 which is surging in China, far away, and in the USA, much closer to us. But this virus has shown that geographic distance is no barrier to its spread. Vaccination, the three Ws – not Weekes, Worrell and Walcott but Wash your hands, Wear your mask and Watch your (social) distance – offer some protection. While the CMO has relaxed many restrictions, it should still be the case that ‘your health is your responsibility’. Act now.

At one stage in life, we were fearful that a masked person may cause you harm, and many still do, when our crime situation is being looked at. But now, no thanks to COVID-19, we are also fearful that unmasked persons may cause you harm as well.

So our health focus needs to last longer than the first week of a New Year, as many New Year Resolutions do. The CNDCs have caused, and continue to cause, significant suffering and death, and have overwhelmed our health care services. And that was before the COVID-19 pandemic. As a disease, COVID-19 creates many health problems, but among other issues it makes the CNDCs worse, and actually accelerates the demise of many CNDC patients. And right now, another ‘virus’ has crippled our main hospital, making life and death even harder for anyone who becomes ill.

We must embrace healthy eating, get adequate amounts of both sleep and exercise, and make sure we keep our weight under control. In conjunction with your personal physician, we must ensure that your blood sugar, blood pressure, and blood cholesterol are kept within your target range. “Thou shalt not smoke”, and if you must drink, practice moderation. Ensure that your COVID-19 vaccinations are up to date, and practise all COVID-19 prevention measures. Our resolution is to be healthy all year round.

Dr. Colin V. Alert, MB BS, DM. is a family physician and associate UWI family medicine lecturer.

The post #BTColumn – We need action, not (empty) resolutions! appeared first on Barbados Today.

Ever since he began volunteering two months ago for weekend shifts at a clinic in one of the largest shelters in the border city of Ciudad Juarez, Mexico, Dr. Brian Elmore has treated about 100 migrants for respiratory viruses and a handful of more serious emergencies, the Associated Press reported.

But what worries him most is something else.

Many migrants are traumatized after their long journeys north.

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The "worsening trauma" experienced by the migrants, the AP reported, often involves witnessing murders and suffering from kidnappings and sexual assault.

"Most of our patients have symptoms of PTSD — I want to initiate a screening for every patient," Elmore, an emergency medicine doctor at Clinica Hope, told the AP.

The Catholic nonprofit Hope Border Institute opened the clinic this past fall with the help of Bishop Mark Seitz of El Paso, Texas, which borders Juarez, said the AP. 

"The Hope Border Institute (HOPE) brings the perspective of Catholic social teaching to bear on the realities unique to our U.S.-Mexico border region," the group's website says. 

"Through a robust program of research and policy work, leadership development and action, we work to build justice and deepen solidarity across the borderlands."

Professionals including doctors, social workers, clergy and law enforcement say growing numbers of migrants are suffering violence that amounts to torture — and are arriving at the U.S.-Mexican border in desperate need of trauma-informed medical and mental health treatment, the AP reported.

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But resources for this specialized care are scarce.

And the network of shelters is so overwhelmed by new arrivals and migrants that only the most severe cases can be handled, according to the AP's reporting.

One specific example, as a case manager described: "A pregnant 13-year-old … fled gang rapes, and so [she] needs help with child care and middle school."

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Zury Reyes Borrero, a case manager in Arizona with the Center for Victims of Torture, visited the young girl when she gave birth — and described the circumstances.

"We get people at their most vulnerable. Some don’t even realize they’re in the U.S.," the case manager told the AP.

In the past six months, Reyes Borrero and a colleague have helped about 100 migrants at Catholic Community Services’ Casa Alitas, a shelter in Tucson, Arizona, she said.

Each visit with a migrant can take hours.

Caseworkers try to build a rapport with the individuals — and focus on empowering them, Reyes Borrero told the AP.

This group of people "might not have any memory that’s safe," said Sarah Howell, who runs a clinical practice and a nonprofit treating migrant survivors of torture in Houston, Texas.

When she visits patients in their new Texas communities, said Howell, they routinely introduce relatives or neighbors who also need help with severe trauma; yet they reportedly lack the stability and safety necessary for healing.

Most migrants need "first-aid mental health" as well as long-term care that’s even harder to arrange once they disperse from border-area shelters to communities across the country, noted another professional.

Left untreated, such trauma can escalate to where it necessitates psychiatric care instead of therapy and self-help, Dylan Corbett, Hope Border Institute’s executive director, told the AP.

Service providers and migrants alike are saying the most dangerous spot on journeys filled with peril at every step is "la selva" — the Darien Gap jungle separating Colombia from Panama, crossed by increasing numbers of Venezuelans, Cubans and Haitians who first moved to South America and are now seeking safer lives in the United States, the AP reported.

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Natural perils like deadly snakes and rivers only add to the risks of an area rife with bandits preying on migrants, the same source noted.

Meanwhile, over four million migrants have flocked to the southern border since Vice President Kamala Harris was assigned the task of addressing the "root cause" of the crisis nearly two years ago, Fox News Digital reported this weekend.

U.S. Customs and Border Protection tracked 233,000 border encounters in November.

That's a 35% increase from when Harris was assigned her role on mass migration there in March 2021. 

These encounters are expected to increase after the expiration of Title 42, a pandemic-era policy under President Donald Trump that allows border agents to turn away migrants at the border.

The White House in December could not define exactly what Harris does in her role to address the mass migration.

"I don’t have anything to lay out specifically on what that work looks like," press secretary Karine Jean-Pierre said at a press briefing when asked about the role of the vice president.

The vice president’s office did not respond to a request for comment.

The Associated Press, as well as Fox News Digital's Patrick Hauf, contributed reporting.

President Joe Biden turned 80 on Nov. 20, 2022 — and debate is ongoing, from a health perspective, about his advanced age and the capacity of individuals of that age to serve in the highest office in the land. 

Biden has surpassed former President Reagan as the oldest president to serve in the White House — and the milestone has people wondering: Is there an age that is too old for someone to be president?

"I think it’s a legitimate thing to be concerned about anyone’s age, including mine," Biden himself told MSNBC in October.

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He added, "But I think the best way to make the judgment is to watch me."

When the Founding Fathers, who were mostly in their early 40s, were deciding the age of the president in 1787, they were more concerned with someone appearing "too youthful" than too old, according to History.com.

Article II of the U.S. Constitution specifies a minimum age — 35 — for someone to be president of the United States without setting a maximum age limit, the website added.

"I'm concerned about age-related dementia, which the job can accelerate given the pressure of the office," Gary J. Schmitt, resident scholar in strategic studies at the American Enterprise Institute, told History. 

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"But I'm also concerned about the higher percentage of the chance of death while in office, meaning [the American people] will be voting for one candidate but getting someone else who we have not vetted as seriously."

President Biden has a past medical history significant for non-valvular atrial fibrillation, gastroesophageal reflux, seasonal allergies and mild sensory peripheral neuropathy of his feet, according to his November 2021 health summary.

What is atrial fibrillation, exactly? The heart is composed of two upper chambers, called the atria, that pumps blood into its two lower chambers, known as ventricles, per the American Heart Association. 

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It normally contracts and relaxes to a regular beat. But in atrial fibrillation — or aFib — the atria beat irregularly so that blood does not flow into the ventricles efficiently, the association added. 

This can lead to blood clots.

"If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results," the cardiology association noted on its website.

Depending on their risk factors, including advanced age, some patients are placed on blood thinners to prevent this complication — including Biden, who is on the blood thinner called Eliquis as of November 2021.

The medical report also noted a stiffened gait that was largely attributed to arthritis changes in his spine, although it was noted "to be perceptibly stiffer and less fluid than it has been in the past."

The report attributed his persistent coughing and throat-clearing to his acid reflux.

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A comprehensive neurologic exam did not reveal any neurological disorder, the report noted, but it did confirm mild peripheral neuropathy in his feet.

The doctor attributed his subtle gait changes in part to "limp and compensation" changes after he suffered a fracture in his right midfoot the year before.

"President Biden remains a healthy, vigorous, 78-year-old male, who is fit to successfully execute the duties of the presidency, to include those as chief executive, head of state and commander in chief," wrote Dr. Kevin C. O’Connor, physician to the president.

Former President Ronald Reagan, the nation’s 40th president, was almost 78 years old at the end of his second term in January 1989, according to the History.com website. 

While in office, he survived an assassination attempt as well as surgery to remove a cancerous polyp in the colon — proving resilience is a quality not reserved for only the youth, History added.

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Reagan famously deflected attention from his age with humor during the 1984 debate with Democratic opponent Walter Mondale, joking, "I am not going to exploit, for political purposes, my opponent’s youth and inexperience."

Biden’s predecessor, former President Donald J. Trump, was 74 years and 200 days old when he left office, according to History. 

In an exclusive interview with Fox News medical contributor Dr. Marc Siegel in July 2020, Trump said he could successfully recall a sequence of five words on a cognitive screening test. 

Dwight Eisenhower was 70 years and 98 days old when he left office in January 1961. 

He survived a massive heart attack scare the year before he won reelection, per History's website.

But James Buchanan, our nation’s 15th president, had his health deteriorate while in office because of the stress of the job. He left office after only one term, at 69 years and 315 days old, the same source noted.

A 2011 study on aging of U.S. presidents found that the men in the White House tended to live longer once inaugurated compared to men of the same age — "even if they hypothetically aged at twice the normal rate while in office."

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"All living presidents have either already exceeded the estimated life span of all U.S. men at their age of inauguration or are likely to do so," the study noted in 2011. 

Not all experts, however, agree that the medical report in November 2021 was adequate to assess Biden’s functional and mental status. 

"Most troubling was the report his gait had stiffened significantly over the prior year," Dr. Siegel, professor of medicine at NYU Langone Medical Center, recently wrote in the New York Post.

Biden's health report did not mention an MRI of the brain or a cognitive test, Siegel added.

A "stiffening gait can be associated with multiple conditions (including white matter damage or normal pressure hydrocephalus) that cause cognitive decline."

Siegel reminded readers that Biden had two brain aneurysms surgically clipped in 1988 and had a bleed in the head. 

Both conditions can lead to long-term risks of cognitive decline in certain patients, according to the medical literature, Siegel added.

As another presidential annual physical is due, he advocates for Biden to have a comprehensive cognitive neuropsychiatric test — as Trump did with the Montreal Cognitive Assessment while in office — and to release it publicly, as his predecessor did. 

"Of course, there’s substantial precedent for ill presidents hiding their ailments from the public, from Woodrow Wilson’s severe case of Spanish flu (which arguably affected the Treaty of Versailles) and subsequent stroke to Franklin Roosevelt’s heart failure to the extent of Dwight Eisenhower’s heart disease to John Kennedy’s Addison’s disease, all while still in office," Siegel wrote.

Other experts suggest Biden will continue to function well despite being in his golden years. 

"The older people become the less like each other they become," Dr. John W. Rowe, professor of health policy and aging at Columbia University in New York, told Fox News Digital. 

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"Factors beyond chronological age, such as race, gender, educational attainment, marital status (being alone is risky, especially for men), access to good health care and financial status, in addition, obviously, to general health status, have very important impacts," he added.

"By these criteria, President Biden is in a privileged group and is likely to continue to function very well for several years."

But Siegel requests full transparency because Biden’s "erratic" public behavior has called his mental fitness in question.

"Dr. O’Connor has an obligation based on medical ethics to determine the functionality of the president," Siegel noted. "This ongoing assessment should include a full neurological evaluation."