The National Nutrition Centre (NNC) has expressed concern about the proliferation of overweight Barbadians and pockets of undernourished people.
Acting Assistant Nutrition Officer at the NNC, Brian Payne, told members of the media on Wednesday that while Barbados has always had less fortunate people who do not get enough nutritious food, “we may expect a higher incidence of undernutrition” as a result of the increase in the cost of living.
“The challenges that we are having in Barbados relate to over nutrition in the sense that . . . we are seeing higher levels of overweight and obesity in children and adults. And a large part of it is associated with diet,” he said as he addressed the centre’s Nutrition Conference, which coincides with National Nutrition Month, at the Radisson Aquatica Resort.
“In terms of overweight and obesity, I can’t give you the numbers now, but you can imagine there has been an increase. People point to the numbers in terms of one-third of the general population being obese and overweight.”
Research conducted in 2012 found that 30 per cent of children in Barbados were overweight, but Payne said the NNC plans to conduct research to determine the updated nutrition status of Barbadians.
He said the recently launched Barbados School Nutrition Policy is one of the key initiatives designed to allow the Ministry of Health and Ministry of Education to have some measure of control over what children are eating and drinking in school.
“We are happy with the response thus far. I think there have been some initial challenges and this really relates to trying to sensitise the stakeholders – parents, teachers, students, and the vending community as well,” he said.
“The challenges kind of relate to the fact that it’s hard to get everyone in the same place at the same time. I think we appreciate that we need to meet people where they are so we have been doing more work in the schools to sensitise the students,” Payne added.
The nutrition officer added that the centre has launched its Healthy Eating Guide for Barbados, a public health intervention programme that teaches Barbadians key skills and concepts to help maintain a healthy, balanced diet.
(AH)

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One local consultant internist believes that the last three years of COVID-19 have turned the focus on the need to re-examine the current policies used to address mental health illnesses and the non-communicable diseases (NCDs) affecting citizens.
Dr Petra Crookendale also believes it is time preventive medicine, and “generational health” are seen as practical policies going forward for the country, as a change in healthy lifestyles needed to start from the ground up.
Speaking on the lessons learned by the medical fraternity after the prolonged battle with the pandemic, Dr. Crookendale, said the rise in anxiety and depression among locals seeking help, has been stark.
“One of the things that I have noticed is that we do need to improve our mental health facilities, the ability for people to have counselling and so on. One of the glaring things that came out of COVID-19 was the mental health issues, especially things like anxiety and depression.
“There are people who don’t want to acknowledge that they do have a mental health issue… which by the way, post COVID, I think all of us do, it’s just the degree to which we have it. I think a lot of it existed before COVID but people were coping. Now after COVID they are not coping as well and this is why these symptoms of anxiety are manifesting,” she explained.
Her comments aligned with those of Minister of Health Dr the Most Honourable Jerome Walcott made in the Upper House as the Senate debated the Appropriation Bill 2023. The minister said that over the course of the last three years of the pandemic many patients have been reporting to several institutions with mental health concerns, with cases having increased by 200 per cent since 2019.
Dr Crookendale said though Barbadians may have gotten numb to the NCD numbers affecting the country over the last several years, the cases of chronic illnesses being diagnosed remains uncomfortably high.
(SB)

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DOCTORS OPTIMISTIC ABOUT IMPROVEMENT IN WORK HOURS, CONDITIONS AFTER DISCUSSION WITH QEH ADMIN
By Shamar Blunt

Junior doctors at the Queen Elizabeth Hospital (QEH) are hoping that talks with officials at the state-run institution will bring an end to the excessive workloads that have resulted in some of their colleagues quitting and even seeking mental health intervention.
And as the medical professionals warned that the current state of affairs created room for medical errors, the Barbados Association of Medical Practitioners (BAMP) expressed support for a reduction in their work hours to protect the public from harm.
In a statement sent to Barbados TODAY, the ‘Concerned Junior Doctors’ identified themselves among those who Government Senator Dr Crystal Haynes and consultant physician at the QEH and Deputy Dean of the Faculty of Medical Sciences at the University of West Indies Cave Hill Campus Dr Kenneth Connell said were forced to work 32 hours or more on a stretch.
“While we remain dedicated to providing the best care for the patients under our charge, the vicious cycle of long work days and even longer on-call shifts continues to take a negative toll on our physical and mental
well-being,” they said, noting that burnout and long sick leave are commonplace.
“As of today, several of our colleagues have either migrated to the US, UK or Canada – creating brain drain –, resigned from their posts, taken protracted sick leave periods or even require mental health counselling for physician burnout and the sequelae thereof.”
Senator Haynes, speaking in the Upper House during the debate on the Appropriation Bill, 2023 earlier this week, and Dr Connell in an interview with Barbados TODAY on Wednesday called for an end to the long workdays that were putting strain on the medical professionals and had the potential to also put members of the public at risk.
“We join with Senator Dr Crystal Haynes to make a valiant effort to come to a reasonable, safe and practical approach to regulation of working hours for the medical staff employed at the institution,” the non-consultant doctors said.
They further expressed optimism that discussions with hospital management would bear fruit soon.
“We have been in communication with the administration of the QEH to implement measures that lead to the restructuring of our various departments to ensure both patient and doctor satisfaction as well as safety in the administration of our medical care to our charges,” they disclosed.
“It is, therefore, our hope, in the year 2023, that with the drafting of legislation, the times of 32-hour shifts, severely sleep-deprived physicians – [a situation] affecting our cardiovascular health – and the resultant risk of medical errors from the above is fully abolished and put behind us.”
Highlighting their “arduous plight”, the doctors said while the general public may not be fully aware of their working conditions, some patients could attest to the long hours they were on the job.
“On several occasions, patients remark in awe that the same speciality doctor that attended to them at 8 a.m. while waiting in the Accident & Emergency Department remains on active duty until 4 p.m. the subsequent day, oftentimes without lunch [or] dinner breaks and little to no sleep,” they wrote.
“This equates and corroborates the 32-hour shifts mentioned [by Senator Haynes] that junior doctors in almost all specialities – including Internal Medicine, General Surgery, Obstetrics & Gynecology and Pediatrics – experience once every four days. Added to this, on average, a standard workday can easily go beyond the recommended eight hours due to the persistent issue of increasing patient loads, perpetuated by delays in both investigations and administration of treatment.”
The doctors also noted that in 2019, with the advent of the COVID-19 pandemic, “an already mentally and physically exhausted workforce from critical departments were split in two to attend [to] the dynamic needs of the Harrison Point facility while still meeting their contractual obligations at the Queen Elizabeth Hospital”.
“Thankfully, with the significant reduction in the number of severely ill COVID patients needing specialist care, our efforts no longer need to be strained in providing care to two facilities,” the doctors noted.
However, they said, they remain overworked and have made it a priority to take their physical and mental health more seriously than ever before.
Their call for that to change was supported by BAMP president Dr Lynda Williams who welcomed “an urgent examination of the hours that junior doctors now work”.
“We fully support the need to transition to an ideal number of working hours that will allow them to have safe, productive and fulfilling lives and that will protect the public from harm,” she said in a statement sent at the request of Barbados TODAY.
Noting the dangers posed by doctors working excessive hours, she referred to several studies, saying: “Fatigue causes significant negative physical and psychological effects. For every hour that a doctor works beyond 11 hours of continuous work, there is a measurable decline in cognitive performance, psychomotor skills, clinical acumen and prescribing accuracy. Depression and burnout, risks to physical health and fear of litigation also affect junior doctors disproportionately.”
Dr Williams acknowledged that the costs associated with expanding the allotment of junior doctors at the QEH would be significant, but said allowing the current situation to continue without intervention would be even more costly.
“In order to reduce junior doctors’ working hours, as Senator Dr. Haynes pointed out, a large influx of new staff would be required. This requires careful investigation because increasing junior staff also increases the need for supervision and training.
“BAMP appreciates that in a developing nation such as ours, a large increase in staff at once will have a significant economic cost. However, we also believe that no cost is greater than the safety of our junior doctors and, ultimately, the lives they care for,” the doctor said.
Though noting that the practice of doctors working 30 hours or more per shift was “a longstanding and complex problem which is not unique to Barbados”, Dr Williams pointed out that other jurisdictions had proven the situation could be addressed.
Even so, she acknowledged, reducing doctors’ working hours was only part of the solution.
“Several developed countries have introduced restrictions on the number of hours that junior doctors can work; however, organisational cultures of working long or antisocial hours often exist and doctors in training reported being unofficially expected to work extra hours voluntarily, even when working time restrictions were implemented,” the BAMP president noted.
“Furthermore, lack of resources available for work, lack of nursing staff and ancillary staff, poor workflow, poor shift design, lack of adequate facilities as well as interdepartmental pressures may mean that simply restricting the number of work hours may be insufficient to address issues relating to stress, fatigue and their consequences for the junior doctor. In short, reducing junior doctors’ working hours only partially addresses the problem.”
Dr Williams gave BAMP’s commitment to working with the Ministry of Health and Wellness and the QEH to find “workable solutions to the highlighted problems”.
Up to late Thursday, QEH officials could not be reached for comment.
shamarblunt@barbadostoday.bb

The post Hope for change appeared first on Barbados Today.

The Ministry of Health is committed to tackling the significant increase in people turning up in the island’s healthcare system with mental health illnesses.
Health Minister Dr the Most Honourable Jerome Walcott said over the course of the last three years of the COVID-19 pandemic many of these patients have reported at several institutions with general numbers shooting up by over 200 per cent since 2019.
As he made his contribution to the debate on the Appropriation Bill 2023 in the Senate on Wednesday Dr Walcott noted: “In the Ministry of Health, we recognise that post-COVID mental health illness and disease in Barbados is a real concern. We have been looking at the attendance at the various clinics, and the attendance to the ‘psychi’ clinics in the polyclinic system [since] 2019. We are now over 200 per cent above what it was then, which tells you that there are people seeking care [and] to be evaluated.
“The ministry this year is really going after mental health,” he insisted.
He further revealed that the previously operational Mental Health Commission had been re-established, along with a strategic plan which was first drafted using the 2005 Mental Health Reform Policy.
Dr Walcott stressed that the mental health of citizens and the policies governing this aspect of healthcare needed to be relooked.
“We need to look at the whole issue of governance of mental health illness in this country. We need to look at public education and the stigma associated with mental health illness, [and] we need to look at community mental health.
“We have started but we really need to push it. We need to integrate it totally into the polyclinic system. We are expanding the numbers of psychiatrists and counselling psychologists in the community because we need to move it into the community.”
He added: “There are a number of issues with teenagers in the schools, some of the violence we are hearing about is related to mental health issues.”
He explained that clinics have been introduced in the antenatal and postnatal at the Queen Elizabeth Hospital, recognising that postpartum psychosis is a real factor, and that “people can become suicidal after delivery”.
(SB)

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An Independent Senator who works at the Queen Elizabeth Hospital (QEH) claims there has been little to no improvement in patient care at the Accident & Emergency (A&E) Department since the multi-million-dollar upgrade.
In fact, ENT specialist Dr Christopher Maynard said that far from getting better with the $11 million expansion, the situation appears to be worse for some patients seeking assistance there.
“The A&E was supposed to have been expanded and the project was supposed to be finished and the people of this country were supposed to be treated in a better facility and more efficiently. One can’t question whether it is a better facility, but it’s certainly not more efficient. Some would argue it is worse,” he charged in the Upper Chamber on Wednesday as the debate on the Appropriations Bill, 2023 continued.
Senator Maynard noted that with an additional $5.2 million to be spent to complete the refurbishment, improving how the department functions is important because without that, “you would have created a larger, spacious, more comfortable A&E for people to wait in for longer times and have worse outcomes”.
“The budget given for the A&E department by the then Minister has now been increased by 50 per cent, give or take a couple of hundred thousand. It is amazing that you’ve had to increase the budget for a project by 50 per cent in a tertiary care institution, and you still can’t deliver. Something’s really wrong…. Things are worse than they were before. We need change and we have to fix it,” he contended.
Dr Maynard also questioned whether there had been a “real facts and figures” assessment of outcomes in several departments that had been assigned additional funds.
In that regard, the doctor queried “whether the waiting lists are generally getting shorter and whether productivity is genuinely increasing”.
He took issue with the claim made by Senator Dr Crystal Haynes, during the debate on Tuesday, that the backlog of cataract surgeries had been cleared.
“I challenge that because every week, I get calls from people who dropped off the waiting list. So you can say you have cleared the list of the people who are listed but there are a large number of persons in this country who are almost blind because they have cataracts, and while they may have gone for surgeries during COVID, they have dropped off the map and they haven’t been coming because they are terrified and for various reasons they didn’t come, so don’t be lulled into a sense of security that you have fixed the problem,” Dr Maynard said.
He acknowledged, however, that there was no “easy fix” to the situation at the QEH and stressed that “leadership is important”.
“If you have 2 000-plus people under one roof and do not have the right leadership, you have problems and the people who you treat will have worse problems. So, I call on those in charge to stop the experiment and make a change and fix it. It requires some hard, harsh decisions. It requires that workers of all sorts – lowest paid workers and the highest paid workers – have to improve their productivity, not just turn up to work, and they have to be assessed without fear,” the Independent Senator said.
(JB)

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By Shamar Blunt

A consultant physician at the Queen Elizabeth Hospital (QEH) says the practice of junior doctors working shifts in excess of 30 hours is “dangerous” and needs to stop in the interest of patient and public safety.

“It’s not acceptable,” Dr Kenneth Connell acknowledged in an interview with Barbados TODAY, a day after Government Senator Dr Crystal Haynes called for an end to 30-hour work days for these professionals.

He disclosed that an internal study done in the department of medicine showed that “11 out of 14 junior staff members felt significantly burnt out”. Although he did not indicate when this study was done, Dr Connell said the findings were “significant”.

“These are doctors in internal medicine who have been working long shifts, so 32 hours at least. Internal medicine admits roughly about 70 per cent of the admission burden to the hospital… but yet these doctors are working at their limits, having not slept,” the doctor said.

The Deputy Dean of the Faculty of Medical Sciences at the University of West Indies Cave Hill Campus suggested that just as there are limits on the number of hours pilots are allowed in the air, having caps on the length of doctors’ shifts would be in the best interest of the public.

“Is it possible for pilots to be flying a plane for 30 hours without rest, or working 30 hours? I have been in airports where flights have been [delayed or] cancelled because, during the upcoming flight, the pilot would have crossed his number of hours without sleep. 

“But yet, we have people making critical decisions, life or death situations, that have possibly not slept or we cannot guarantee that they were sleeping for ‘x’ period of hours. To me, in 2023, that is unacceptable,” he said.

During the debate on the Appropriation Bill, 2023 in the Upper House on Tuesday, Senator Haynes said the problem of doctors working extremely long shifts needed to be addressed urgently to safeguard the safety of both patients and healthcare providers.

“[Working excessive hours] is very normal for a lot of doctors, both at the intern level and at consultant level. You work all day on the wards, you spend the night in the ER [emergency room] dealing with emergencies that are coming through all night, and then you continue to work into the next day. That is something that is a threat not just [to] patient safety but [to] the personal safety of our healthcare providers,” the medical practitioner said.

She noted that there were studies which showed that working for more than 17 hours with little rest can lead to fatigue-related impairment in cognitive and physiological functioning, which is comparable to the person having a blood alcohol concentration level of 0.05 per cent – similar to levels seen in alcohol intoxication.

Responding to Senator Haynes’ concerns, Dr Connell acknowledged that junior doctors are often asked to work even longer than 30 hours while on call. 

“I thought it was a conservative estimate of saying 30 hours, to be quite honest. I’ll use my speciality as an example. [They] start work at 8 a.m. – these are junior doctors if they are on call –, they work through until 8 the next morning. That is described as the on-call period and then when they finish that period, their day then starts. So from 8 a.m. until 4 p.m. [the following day], which by my calculation is 32 hours at least,” he explained.

“This doesn’t mean that they will leave at 4 p.m. because they may leave after, but they continue their work day as if it is a new work day.”

Dr Connell said while this is viewed as a “badge of honour” among healthcare providers, the practice is a dangerous one.

“It is almost what I would describe as an unacceptable badge of honour in medicine, that we work long hours and we did it and therefore, our juniors should do it. It’s not acceptable. Mistakes will happen,” he warned.

“In some parts of the hospital, like emergency rooms, there is a shift system so doctors do an eight-hour shift or six hours and then they leave and then another shift comes. Obviously, the ER is high intensity so they need that, but my argument is it is not in the public health interest to have a doctor that has been working continuously – so not just in hospital but sleep deprived – for 30 hours, and is making any clinical decisions. That doctor should not even be getting into their vehicle and driving home. That’s dangerous.”

The medical consultant stressed that for the situation to change, additional funds would have to be made available to hire additional doctors to improve the shift system.

“It is not going to be a cheap transition. The only thing that is preventing doctors from working shorter hours is [that] you will need to hire more doctors. There needs to be 24-hour coverage, so if one group of doctors are going to work [fewer] hours, then someone has to come in and take over from them. 

“So this resistance to change is largely driven by a financial kind of argument where we cannot afford it. But the flip side of it is can you afford the public health risk? If the answer to that is no, then doctors have to be capped on the number of hours that they’re working,” he said.

During her contribution to the debate, Senator Haynes suggested that the University of the West Indies (UWI) “is producing enough doctors every year that we should be able to expand the complement of staff at the junior doctor level to do away with this system and to roll out a proper roster where we can limit the number of hours”.

Dr Connell told Barbados TODAY that even if more graduates were coming out of university, additional posts would have to be created for them to fill.

“They’re only going to get hired if there are posts for them. So, if you don’t have enough paid posts in the hospital then you can’t hire enough doctors to allow for a shift system to begin with,” he said.

shamarblunt@barbadostoday.bb

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Despite the naysayers, interest in Barbados’ medicinal cannabis industry is high and the island’s first therapeutic facility is on course to open in the coming year, the head of the Barbados Medicinal Cannabis Licensing Authority (BMCLA) has disclosed.
The BMCLA’s Acting Chief Executive Officer Senator Shanika Roberts-Odle said on Tuesday that additional training will also be made available to Barbadians who want in on the industry.
She was speaking on the Appropriation Bill, 2023 in the Upper House when she highlighted the progress made in issuing licences in an industry that she said the Government is pursuing as an economic contributor and also to provide medicine that can bring relief to the suffering of Barbadians.
In addition to the initial two licensees representing nine approved and eight issued licences, an additional six licensees and 10 licences have been approved.
“That is progress in this country in an industry where they said no one would be interested; in an industry where they said we would never be able to make inroads. We are making them,” the BMCLA boss said. “2023-2024 will see us having our first therapeutic facility opened in this country. We already have our first working medicinal cannabis farm up and running.”
She said the BMCLA has also made progress in training, research and development, and reported that the agency’s free, three-term cannabis crash course programme, which is now in its second term, has been well received.
“I am happy to say that it has not just been well subscribed, it has been oversubscribed,” she said.
“And term three of that programme, we are working with the University of the West Indies who, in fact, has one of their own training programmes as it relates to training doctors on the use of medicinal cannabis in the treatment of their patients.”
The Government Senator disclosed that the BMCLA has created a training programme “that would give the best opportunity to Barbadians who want to be involved in that industry”.
“I’m happy to say that we have finally reached an agreement with one of the major educational institutions in this country – which will be announced in the coming two months – to carry out that training for Barbadians to allow them to be able to understand where the international requirements lie and to be able to give them a qualification that they can’t just use in Barbados, they can’t just use in the region, that they can go internationally and be able to present themselves as well studied, well learned and qualified,” she added.
In her contribution which focused on the work of the Ministry of Agriculture, Senator Roberts-Odle sought to dispel the notion that licences to get a foot in the industry are not affordable.
The BMCLA issues licences across several categories and types, under which licensees can cultivate, transport, process, sell, import, export, research and develop medicinal cannabis and medicinal cannabis products.
The authority’s CEO pointed out that licences are valid for five years – which she suggested is longer than in other parts of the world – and payment plans were offered.
“I would argue that I have not seen anywhere else that will allow you to pay on a payment plan. We allow our licensees to give us 60 per cent of the cost of their licence upfront and to pay the remainder over the next three years,” she explained.
For example, Senator Roberts-Odle said, for a tier one licence which costs $29 700, a payment of $17 820 is made up front and the remainder is due over three years.
“You can pay that on a yearly basis which is $3 960, or you can pay that on a monthly basis which is $330. That’s a Courts bill,” she asserted.
(DP)

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By Anesta Henry

Pharmacies have recorded an increase in the sale of products to treat upper respiratory issues as Barbadians contend with smoke and ash from cane and grass fires that have been occurring across the country.
President of the Barbados Pharmaceutical Society (BPS) Yolan Pantin told Barbados TODAY on Tuesday that in recent weeks, there has been an increase in the number of people going to pharmacies to purchase over-the-counter medications and have prescriptions filled, as they seek relief from sinus issues and allergic reactions.
“Obviously, because of the situation we have been seeing more people passing through. It depends on what the doctor has written on the prescription and if they are looking for simple things like Histal, antihistamines, and maybe some nasal sprays, depending on how severely they are being affected by the present conditions.
“They are coming with allergies, depending on how long they leave their symptoms, and some persons will receive courses of antibiotics because respiratory tract infection has occurred and that is something that only the doctor deals with,” Pantin said.
She warned Barbadians experiencing respiratory tract infections to treat their symptoms as soon as they show up.
Additionally, Pantin said, individuals should seek medical attention if they do not get relief using over-the-counter medication after three days.
She said the Otrivin nasal spray, in particular, should not be used longer than three days, as doing so could cause “rebound rhinitis where they would actually be hooked on having to use it continuously”.
“If after three days and they find that their symptoms really haven’t dissipated they really should see a physician,” the pharmacist recommended.
Pantin said pharmacies currently have adequate stock to meet the present demand.
While some pharmacies are out of allergy and sinus tablets, people battling with sinusitis can also use the multi-symptom tablets for the time being, since they are basically the same medication, just slightly different strengths.
“Right now, as far as the oral preparations and the nasal sprays that are over-the-counter are concerned, we do have adequate stock on the island,” she said.
Pantin advised those known to suffer from sinusitis, allergies, or asthma who are working in areas affected by the smoke and ash, to resume wearing masks.
“A couple of my customers that have passed through have actually purchased masks because they work in areas close to the smoke and the ash and so on. So, because they do suffer from respiratory problems – some are asthmatics as well – they have chosen to resume wearing masks in order to help with not getting as much smoke inhaled into their lungs and their upper respiratory tract,” she said.
“So, for safety and for your own health, for persons who are compromised with respiratory illnesses of any form, I would advise them until this really dissipates in another two weeks, or unless we get a heavy rainfall, they should resume wearing the masks.”
On Monday, during an interview with Barbados TODAY, Chief Medical Officer Dr The Most Honourable Kenneth George urged asthmatics and people who suffer from allergies and sinus complications to take all precautionary measures to protect themselves amid an increase in cane and grass fires.
While indicating that he had not received reports from polyclinics or the Queen Elizabeth Hospital (QEH) regarding an alarming increase in persons reporting to those facilities complaining of health issues due to the environmental hazard, Dr George supported the Ministry of Education’s decision to closely monitor affected schools to protect students and teachers from potentially harmful effects.
anestahenry@barbadostoday.bb

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The St Stephen’s Nursery School will remain closed for the remainder of the week after the Ministry of Education’s plan to temporarily relocate students to the nearby Anglican Church failed.
Issues including poor lighting and inadequate lunch arrangements at the church were among the challenges identified by parents and by teachers who tried to facilitate classes there.
Arrangements are to be made for students to engage in classwork online and materials will be distributed to parents to keep the children engaged.
On Tuesday following meetings at the St Stephen’s Anglican Church with executive members of the Barbados Union of Teachers (BUT), teachers, president of the Association of Public Primary School Principals Ivan Clarke, staff and parents, Chief Education Officer Dr Ramona Archer-Bradshaw said the ministry did not have adequate time to ensure the church was a conducive learning environment.

Teachers and parents also complained of the fact students had to walk through the church’s graveyard to access the bathrooms, inadequate ventilation and difficulty conducting five classes in a confined area. The situation was further aggravated when workers came to dig a grave in the cemetery using a drilling machine. They were later instructed by the funeral director to complete the job when classes were dismissed.
There are 145 students enrolled at the school in four nursery and five reception classes. Only the reception classes could be accommodated at the church.
Meanwhile, due to the environmental issues that caused the school to officially close twice last week and on Monday, Archer-Bradshaw said a plan of action “was quickly put in place so that children would not lose additional teaching time” and the ministry had instructed the principal to contact the priest to use the church.
“On Monday we were told that the situation had not been rectified as had been expected on Friday so we decided to take quick action with regard to getting the children in the space . . . Sometimes things don’t always work out,” said Archer-Bradshaw.
“If we had three or four days to come and inspect and so on, I could understand that, but we decided that we would come and we would try with the space and I want to thank the teachers and principal for actually coming and trying,” she added.
Last week, the BUT reported that the Ministry of Education was working with environmental health officers to address the problem. A neighbour who raised chickens had promised to have the pens cleaned by last Friday. The environmental problem was first raised last Monday when the school closed early and two days later, parents were given the option to collect their children from the school. However, the school remained open.
(SZB)

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Doctors María Arias Peña, Raymundo Hernández, and Plutarco Arias indicated that difficulties in falling asleep also cause poor work performance, increase the chances of suffering strokes and create greater obesity.

Medical professionals said that most road accidents happen because drivers and conductors fall asleep. They indicated that the sleep disorder causes apathy toward sex and that on several occasions it ends in divorce between couples. They explained that sleep apnea, which manifests itself in snoring at night, is more common in people aged 40 and older.

Doctors highlighted that the ARS provides coverage to people who suffer from this health problem. Dr. Plutarco Arias, president of the National Sleep Apnea Institute (INAPS), stressed that this entity continues to advance in the development of its specialized personnel to treat patients suffering from sleep disorders.