The life force to Koreans: hiking the fabulous Koreas’ mountains


Korea's mountainsMore spell-binding Korean landscapes are found beyond Seoul in the Seoraksan mountain range.

Mountain culture and customs are hot-wired into the lives of each Korean. What better way to get under their skin than to hike together with them?SOUTH Korea lies along a peninsula that is hugely mountainous, with a spinal ridge running for 735 km from the DMZ boundary in the north to the East China Sea down south.

This mountain range has monumental relevance to the people of Korea as it is believed to provide the life force to the nation: its arterial rivers drain seawards, bearing sustenance for the inhabitants living in the lowlands. Many historical events that occurred on these mountains have been documented whilst just as many myths and folklore have been re-told over generations.

For the tourist, hiking the mountains of the Korean peninsula would seem like a natural activity, to immerse in the culture of this dynamic country.

The terrain is not high, the tallest peak being Cheonhwangbong at 1,915m, in Jirisan National Park, at the southern tip of the range. The next highest peak is Daecheongbong, 1,708m in altitude, squatting on Seoraksan National Park diametrically to the north.

The ranges are inter-linked through a series of hiking trails, following the ridge line closely and crisscrossing valleys and rivers. Temples, villages, farms and shelters dot the hills.

Soothing: The scenic mountain ranges of Korea are rich in bio-diversity. The N Seoul Tower is a popular tourist attraction. Go early to avoid the long queues for the cable car.

Such an eco-system has made mountain hiking a national pastime that is likely to overtake taekwando in popularity as a sport. There’s also a whole line of Korean celebrity fashion wear for hikers. Unfortunately, for the tourist, not much promotional information on hiking is available from official tourism literature.

It would take a lifetime to explore the legendary mountains of Korea and we had limited time to spare before our wedding anniversary celebration back in Seoul.

Day trip to Seoraksan

We took a 3-hour bus ride to Sokcho, a tourist town on the north-eastern coast of the Korean peninsula and an entry point into Seoraksan National Park.

The park showcases the Seorak mountain range, and is loved by the locals for its natural beauty and bio-diversity. Hikers come to marvel at the uncanny ruggedness of the “Dinosaur Ridge” and soak up the fables of the mountains’ origins.

There are many trails up picturesque Seoraksan, numerous short ones requiring half-day’s effort and several longer routes that are more than 10km in distance.

A good option for tourists is to hop on the cable car, not far from the Visitor Information Office, and catch a ride up to Gwongeumseong Fortress at a height of about 900 m. This was the option we selected together with a long queue of like-minded tourists. We reached the counter at 10.30am but all tickets were sold out.

Without wasting any more time, we opened the map, picked out what looked like an easy route and headed out to Biseondae Cliff.

It was only 2.3km one-way and took us through a forested area, tracing a path beside a gushing stream. The fresh air and fine drizzle made the pace invigorating.

 Many eateries are found along the trails of the park.

We skirted a pool of crystalline water at the bottom of a huge rock face, which I took to be Biseondae Cliff, and crossed a short bridge whereupon the trail ended abruptly at a locked gate. Beyond laid wilderness that could be experienced only with a permit from the ranger’s office. We clambered up a rocky slope and joined some hikers on a break.

“Where are you from?” queried the ajeossi (middle-aged man). I told him we were from Malaysia, as I shared a chocolate bar with his 10-year old son. I remarked that the scenery here had a mystical and mysterious air.

He nodded, “Ah, as mysterious as the disappearance of your airplane”. I guess he was referring to MH370. We both nodded and sighed. They wished us a good trip and moved on. We stayed a while to admire the view of the distant peaks framed in by the hillside trees. On our way down we stopped by a tea house. Bibimbap downed with a hot bowl of miso soup tasted a lot better here than in the lowlands.

We dozed on the bus back to Seoul. That chilly night in Seoul, we captured our last “high” at the N Seoul Tower, atop Namsan. Standing 236m tall, the tower accords a night scene of the city.

We were feeling pretty tired, but fulfilled. So, I suggested we take the cable car up instead of climbing the stairs. I didn’t hear any objections.

Hiking near Seoul

THE view from Bugaksan might have been more panoramic if not for the faint haze hanging over the “ancient quarters” of Seoul that April morning.

To the south-west, we could just make out the hillock of Inwangsan and the colourful string of hikers inching up its summit trail, while afar north, the rocky peaks of Bukhansan glared in the sun.

Seoul, the 600-year old capital city of South Korea, is encircled by a fortress wall that links four surrounding hills, Bugaksan, Ingwangsan, Namsan and Naksan. Of these, Bugaksan is the tallest at 342m and is located in the neighbourhood of Samcheong-dong, majestically overlooking Cheongwadae (Blue House), the President’s official residence and office.

We had taken the northern route of the fortress wall, entering through Hyehwamun Gate, muddling through a residential area up a steep incline, and, with some orienteering instinct, located the path that followed the ancient stone wall, leading us up a hill of cherry trees.

Due to its proximity with the Blue House, this section of the trail requires foreigners (who are called “aliens” in official documents here) to sign in at Malbawi Station with their passports (or “Alien Registration Card”) and sign-out at Changuimun Station.

Guards are posted at intervals within eye-shot of hikers. One young cadet approached me to view my camera photos and requested some to be deleted. The pictures were mainly landscape shots, mostly bird’s eye views of the city, which didn’t look pretty anyway, back-lit by the morning sun.

It was a quarter past eleven when we arrived at the top of Bugaksan. The guard, more militia than forest ranger, had been monitoring the growing crowd at the plot, and sternly ushered any lingerers to move on. No picnic here, literally, just pictures.

The Koreans are actually a helpful and friendly lot. On the way up we had approached more than a few ajumma (“aunty”) for directions and they were profuse with their assistance; expressive hand gestures and finger pointing, and a continuous barrage of verbal directions, delivered in Korean.

We nodded our gamsa-hamnida (“thank you”) and they gleefully let us off. Still clueless, we were comforted to know that at least we were in hospitable country.

The descent to Changuimun was unexpectedly steep, and the high steps slowed the pace somewhat. Overall, the hike was enjoyable, requiring just three hours, which left us plenty of time to slip back downtown for another helping of sumptuous Korean spicy soup.

By Lee Meng Lai The Star/Asia News Network

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Living life to the fullest


living-life-to-the-fullest
Chan, an avid mountaineer and myelofibrosis patient, with a photo of himself (in red jacket) and fellow climbers at the summit of Mount Kinabalu. Photo: UU BAN/The Star >>

Despite having a rare blood disorder, Tan Sri Chan Choong Tak not only continued his active lifestyle , but also took up mountain-climbing.

FORMER Dewan Negara president Tan Sri Chan Choong Tak’s motto in life is to live it to the fullest.

Not surprising then that among his many accomplishments are two Malaysian Book of Records titles as the oldest Malaysian to reach the top of Mount Kilimanjaro’s Uhuru Peak (on Aug 31, 2003, at the age of 70) and the oldest Malaysian to reach the top of Mount Kinabalu’s King George Peak (on Aug 29, 2004, at the age of 71).

Uhuru Peak is the highest point on Mount Kilimanjaro, which is the tallest freestanding mountain in the world (from sea level) and the tallest mountain in Africa, while King George Peak is located on the more challenging and lessclimbed Eastern Plateau of Mount Kinabalu, Sabah.

What makes these two records more significant – aside from the impressive fact that Chan only took up mountain-climbing in his sixties – is that he was suffering from a rare bone marrow disorder at the same time.

His condition, primary myelofibrosis, is one of a group of diseases called myeloproliferative neoplasms, which are caused by abnormal production of blood cells in the bone marrow.

In the case of myelofibrosis, the problem lies in the abnormally-increased production of megakaryocytes, which are the cells that directly give rise to platelets. This results in an initial increased number of platelets in the body.

Cytokines – protein growth factors that are produced by megakaryocytes – are also correspondingly increased.

And as these cytokines are what stimulate the bone marrow’s fibroblasts to produce collagen, this results in an excessive amount of collagen being made.

The collagen deposits in the bone marrow as webs of fibre – similar to scar tissue on the skin – resulting in the disease’s characteristic fibrosis of the bone marrow.

With the collagen taking up so much space in the bone marrow, regular blood cell production is disrupted.

Red blood cells (RBCs) are usually decreased in number and abnormally formed, resulting in anaemia, while white blood cells (WBCs) are abnormal and immature, resulting in increased infection rates.

With production of blood cells in the bone marrow disrupted, the spleen, which is the body’s secondary supplier of blood cells, steps up to meet the body’s needs.

This extra work usually causes the spleen to enlarge (splenomegaly), resulting in pain or a feeling of fullness below the left rib.

Occurring commonly in those above 50 years of age, myelofibrosis is caused by a spontaneous genetic mutation (i.e. not inherited) in the affected person’s blood stem cells. This is what causes the uncontrolled production of megakaryocytes.

The cause of the mutation itself in primary myelofibrosis is, as yet, unknown.

Accidental discovery

As the symptoms of myelofibrosis, like fatigue, shortness of breath, pallor, frequent infections and easy bruising, are quite vague, diagnosis can be quite difficult.

In Chan’s case, he did not notice any signs or symptoms of myelofibrosis prior to his diagnosis.

In fact, it was a combination of a road accident and his wife, Puan Sri Cecelia Chia’s sharp eyes that alerted them to the possibility of a problem.

He shares: “My son gave me a racing bike for my 60th birthday – that was 21 years ago. So, I used to cycle around. Then, I met with a road accident.”

Chan was cycling along the narrow, winding roads of his hillside residential area in Seremban, Negeri Sembilan, when he suddenly met an oncoming car.

With no space to avoid the car, he braked hard and was thrown to the ground in a head-first fall.

“My helmet broke and I thought I would be paralysed. My friend, who is a doctor, straightaway rang up the hospital and they sent the ambulance,” he says.

Fortunately, Chan suffered no major injuries from the accident.

However, his cardiologist son insisted that he be checked more thoroughly for brain injuries, which resulted in him seeing a neurologist.

While his brain turned out to be fine, his wife noticed that his platelet count from the blood test were quite high – between 600,000 to 700,000 platelets per cubic millimetre, when the upper limit for normal is 400,000.

His son then sent him to consultant haematologist Dr Ng Soo Chin, who prescribed hydroxyurea to bring down his platelet count.

That seemed to work quite well for Chan, and it was, in fact, shortly after this that he began mountain-climbing with a group of fellow MBA (Masters of Business Administration) alumni from Tenaga Nasional Bhd.

Chan was then a director of the company, and had gone to Ohio University, United States, to study his MBA along with other Tenaga Nasional executives.

“So, as I climbed, I continued to take hydroxyurea and everything was normal.

“But Soo Chin said, hydroxyurea will eventually bring down your red corpuscles (another term for RBCs), and recommended anagrelide,” he says. Anagrelide is a platelet-reducing agent.

Accelerating disease

Chan continued happily with the two medications, until the year 2011, 18 years after his initial diagnosis.

By then, he was seeing consultant haematologist Datuk Dr Chang Kian Meng at Hospital Ampang, Selangor, as Dr Ng had advised him to continue his follow-ups at a public hospital as his medications are quite expensive.

Chan shares that Dr Chang started him on epoetin alfa and pegylated interferon that year as his blood cell levels were fluctuating.

While interferon decreases the production of blood cells in general, epoetin alfa stimulates the production of RBCs to counteract the effects of anaemia.

However, his haemoglobin levels dropped even further, and he started requiring blood transfusions about once every two months.

The transfusions made a big difference as he reports feeling “very energetic” after receiving the first one. (Fatigue is a common symptom of anaemia.)

The following year, it was the WBCs turn to go “completely haywire”, when a blood test revealed that they had dramatically increased to about 56 from the regular range of about 4 to 10.

He also started experiencing profuse night sweats and cramps, along with the occasional itchiness that had started in his seventies – all of which are among the symptoms of myelofibrosis.

“Then, both Dr Chang and Soo Chin agreed that I had entered into myelofibrosis in acceleration,” he says.

The only cure for myelofibrosis is a bone marrow transplant, but aside from the difficulty of finding a suitable donor and the riskiness of the procedure, Chan’s age rendered him unsuitable for such a treatment.

Fortunately for him, a new drug had recently been approved by both the European Commission and the United States Food and Drug Administration for use in myelofibrosis at that time.


A new drug

The drug, ruxolitinib, inhibits certain enzymes in the JAK pathway, which regulates blood cell production. Half of primary myelofibrosis cases are caused by mutations in the JAK genes, which results in the dysfunctional production of blood cells in the bone marrow.

However, the drug was not available in Malaysia then. (It was only launched in the Malaysian market in 2013.)

This is where his political connections as a Gerakan life member and former secretary-general came in useful.

Then Minister in the Prime Minister’s Department and Gerakan president Tan Sri Dr Koh Tsu Koon offered to help pass on the letter Chan had written to the Health Ministry requesting approval to use the drug on compassionate grounds, to the Health secretary-general.

Four days later, Chan received the approval he needed, and received his first dose of ruxolitinib in October 2012.

Since then, after some adjustments in dosage, Chan’s blood cells are back in the normal range and his last transfusion was in December 2013.

He is currently doing well enough for his doctor to lower his dosage of ruxolitinib, while still taking epoetin alfa and interferon.

Life goes on as normal for this active 81-year-old, who still climbs hills, reads newspapers of various languages and blogs daily, works out in the gym and does regular morning calisthenics.

Of his condition, Chan shares that he never felt the need to know about the disease, being only interested in his blood test results.

“I didn’t know what myelofibrosis was all about until I was asked to do this interview. That was the first time I went into Google to see what was myelofibrosis,” he says with a laugh.

“But I knew it was a dangerous disease, but I wasn’t bothered. I continued to carry on with my normal life.”

He adds: “I’m not bothered with what happens because I have full trust in my doctors.

By Tan shiow China The Star/ANN

Related:

101 Ways To Live Your Life To The Fullest personalexcellence.co/blog/101-ways-to-live-your-life-to-the-fullest/  – If your answer to any of the above is a no, maybe or not sure, that means you’re not living your life to the fullest.

Let the sunshine & natural light in for better health, quality life, more sleep at night


Sunshine_windowsA study has concluded that windows in the workplace could mean up to 173% more white light exposure during the day and an average of 46 minutes more sleep at night. – AFP

A STUDY from Northwestern Medicine and the University of Illinois at Urbana-Champaign indicates that all-day exposure to natural light, even by means of a window, leads to longer sleep duration at night, as well as increased physical activity and quality of life.

“There is increasing evidence that exposure to light, during the day, particularly in the morning, is beneficial to your health via its effects on mood, alertness and metabolism,” says senior study author Dr Phyllis Zee, a Northwestern Medicine neurologist and sleep specialist.

The study was conducted on office workers, and windows in the workplace could mean up to 173% more white light exposure during the day and an average of 46 minutes more sleep at night, researchers concluded.

They also noted a trend of workers with more light exposure being more physically active than their counterparts.

In the study, researchers surveyed 49 day-shift office workers, of which 27 worked in windowless offices and 22 had windows in their offices.

Quality of life and everything health-related was self-reported, whereas sleep was assessed by means of the Pittsburgh Sleep Quality Index (PSQI).

A subset of 21 participants was surveyed for light exposure, activity and sleep by means of actigraphy. Ten of these participants worked in windowless environments and 11 hailed from workplaces with windows.

Actigraphy logs ambulatory physiological data, in this case motion and light illuminance, by means of a scientific wearable device.

“Light is the most important synchronizing agent for the brain and body,” says Ivy Cheung, co-lead author and Ph.D. candidate in neuroscience in Zee’s lab at Northwestern. “Proper synchronization of your internal biological rhythms with the earth’s daily rotation has been shown to be essential for health.”

Sunlight is an important source of vitamin D and a CDC report indicates sun exposure is important even for breast-fed babies, despite the high quantities of vitamin D in breast milk.

The study was published in the Journal of Clinical Sleep Medicine. – AFP Relaxnews

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Your name is your fortune


Everyone’s name contains positive or negative vibes, based on the combination of letters in it.

Numerology_Pronology_Name Science_Pronology

AN individual’s character, prosperity, fame and good health depend on how his or her name is pronounced.

According to the sciences of pronology and numerology, we can improve our lives and minimise troubles if we make certain changes to our name as per the rules of this ancient knowledge.

Pronology analyses sound vibrations in a name while numerology deals with numerical values of each letter assigned to the name.

Making modifications to your name can change your fate, stresses renowned numerologist Alaghar Vijaay from Chennai, India.

He says that when a name is given to a newborn child, it is vital for the date of birth to be “added”, based on numerology principles, to give the most auspicious sound to the infant’s name.

I recently met Vijaay, who has authored 21 books on ancient secrets, to get a better understanding on the phonetic impact and hidden secrets of names.

People facing challenges in the areas of health, relationship and prosperity, or obstacles in life, should check on how their name is pronounced.

This is no laughing matter because our name carries a power that can determine our destiny, says Vijaay, an engineer by training.

There are 26 letters in the English language and each has a special wavelength, colour and characteristic.

Take, for example, the letters O and N appearing together in a name. The numerological value of O is 6 and that of N is 5. The sum of the two is 11, whether the letters occur as “ON” or “NO”.

But ON denotes forward movement and positive action, whereas NO has a negative connotation and failure.

Vijaay says pronology offers an understanding of both the forces that may occur in a name and gives people an opportunity to act accordingly to remove the ill effects and increase the beneficial values.

For example, he said, names containing the sounds “dhi”, “dy” or “di” could benefit from some modification because those vowels represent something related to demise.

Our name is like a mantra. When it is repeated like a chant it vibrates a certain sound which exerts an influence on the cells in our body.

This may produce auspicious or inauspicious results.

In his book entitled Pronology, Vijaay explains that when two letters are combined, their separate wavelengths meet and generate a sound that can be positive or negative.

For instance, he says, when the letters A and P are paired it will produce a sound like “APE”, and an individual having such letters in his or her name will have ape-like characteristics.

Where the letters K and L are joined, it sounds like “KILL” and those with this component in their name will face trials and struggles.

When the letters are reversed from KL to LK, the sound “LIKE” is generated and this vibration will boost their energy, allowing them to enjoy peace and happiness.

When the sounds “Han” or “Khan” occur in a name, the person gets an enhanced sense of self-confidence and a strong desire to achieve their goals in life.

Hindi stars Shahrukh Khan, Salman Khan and Aamir Khan are some of the living examples of success and fame owing to such names.

Other favourable names are Kartik, Ayappan, Raman, Mahalingam, Selvan, Aravin, Barath, Praveen, Ashvin, Jayakumar, Uthayakumar, Velu, Murugan, Vishnu, Ganapathy, Ramakrishnan, Ashvin, Rajen and Rajakumar,

Women having vibrant-sounding names can be assured of a happy, peaceful and comfortable life.

Those having names with pleasant sound combinations like Vijaya, Preethi, Anujaya, Jeyashri, Karisma, Rajaletchumi, Abarami, Gyathri, Jeya and Ragavi will generally enjoy peace and comfort and get good-natured husbands. Names like Vimala, Kamala, Mala, Nirmala, and Malathi will be dominating and they will have the skills to earn as much as or more than their husbands.

To attract positive vibrations into a name, an individual should add letter combinations such as UD, ON, RUN, GAIN, VIN, VIND, ARARS, AN, GA, VN, NS and RS.

Avoid letter combinations like SAD, LOSS, SAT, DOWN, NO, LESS, ILL, NA, NE, LO, SK, VK, KK and KL.

Some examples of positive names: Abdul, Rahim, Hassan, Halim, Rashid, Jaffar, Yassin, Zaid, Karim and Azar, Faroz, Arshad; Kuan, Tong, Man, Wong, Liang, Shing, Chin, Fatt, Yee, Sing: Richard, Henry, Clinton, Albert, Robert, Anthony, Winston, Johnson, Angela, Amy, Angeline, Betty, Jacquiline, Rebecca and Rita.

To increase the power of a favourable name, Vijaay suggests that people should write their name in red ink and capital letters 108 times daily on a white sheet of paper.

Another exercise is to enunciate their name as many times as possible in front of a mirror for a minimum of 48 days.

Such acts can also be performed while bathing, driving and combing your hair, and can stimulate the results to take effect immediately.

To further invoke the power of your name, take a rectangular card and write it down 27 times in red ink.

The name card should be read out loud at least nine times and placed under the pillow.

If the above exercises are done consciously for 180 days continuously, an individual can expect to see the desired result in his or her life within this period.

Whether you place a new letter to enhance your name or remove one to correct any ill effects, what is vital here is for the exercise to be done with absolute faith and utmost respect in expectation of the desired results.

Vasthu Sastra Talk

T. Selva will present a talk on how to choose an auspicious property and energise a house using pyramids at The Star Property Fair today at 11.30am at G Hotel, Jalan Gurney, Penang. Admission is free; to register, call 012-329 9713.

T. Selva, senior consulting editor at The Star, is the first disciple of 7th-generation Vasthu Sastra master Yuvaraj Sowma from Chennai, India. This column appears on the last Sunday of every month.

Sources: Ancient Secrets T.Selva

T. Selva is the author of the Vasthu Sastra Guide and the first disciple of 7th generation Vasthu Sastra master Yuvaraj Sowma from Chennai, India.

tselvas@thestar.com.my

Clean hands save lives, wash your hands to combat germs!


Clean HandsPETALING JAYA: The role of hand hygiene in preventing the spread of drug-resistant germs is the focus of the World Health Organisation’s annual “SAVE LIVES: Clean Your Hands” campaign this year.

Launched yesterday, the campaign is in line with WHO’s recently-released report on Antimicrobial Resistance: Global Report on Surveillance.

How bacteria become resistant : Bacteria grow resistant to antibiotics through natural selection. When drugs are used, some organisms may have ways of surviving. As they reproduce or pass DNA to other bacteria, those traits become more common, weakening antibiotics’ power. Antimicrobial Resistance
The report states that there are increasingly more types of bacteria which cannot be killed by antibiotics. The report also stated that no one in the world is safe from this menace.

However, WHO also reported that should compliance with hand hygiene in health facilities increase from under 60% to 90%, there could be up to a 24% reduction in the infection of methicillin-resistant Stap­hylococcus aureus (MRSA).

MRSA, most commonly contracted in hospitals, is rapidly becoming more difficult to treat with current drugs.

“Whether it is the hands of the patient, their visitors or the healthcare team, people must remember to practise good hand hygiene in a healthcare setting, especially in hospitals,” said Patient Safety Council of Malaysia member Dr Milton Lum.

Good hand hygiene means washing the hands thoroughly with soap and water before and after touching a patient.

“Everyone has germs on his or her body so despite our good intentions in visiting our sick relatives or friends, we may actually pass on a bug unintentionally,” said Dr Lum.

Patients for Patients Safety Malaysia chairman J. Manvir said he believed that patients should also wear masks to protect themselves from airborne infections.

“Children under 12 should not be visiting patients, especially in hospitals.

“You may not be able to teach them to practise good hand hygiene but you can keep them at home to prevent them from passing on an infection to the patient as well as preventing them from getting ill,” said Manvir.

Antibiotic resistance has been around since the 1940s when the first antibiotic, penicillin, allowed doctors to kill off the many bacteria that were the source of different infections.

However, subsequent misuse of penicillin accelerated the natural evolution of the bacteria, resulting in the microbes becoming resistant.

Contributed by Tan Shiow Chin The Star/Asia News Network

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The world’s leading health organization is sounding serious alarm bells about the problem of antibiotic resistance.
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WHO’s Alarm Bells: Antibiotic Resistance Now a ‘Major Threat to Public Health’


The world’s leading health organization is sounding serious alarm bells about the problem of antibiotic resistance.

Antibiotic Resistance_bacteria

In its first report on the issue ever, the World Health Organization (WHO) is sounding alarms about the issue of antibiotic resistance and the global public health threats it poses to our increasingly interconnected world.

“The problem is so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—is a very real possibility for the 21st century,” the report states.

Antibiotic resistance occurs when bacteria no longer die when treated with antibiotics. As a result, doctors have to use stronger, more potent antibiotics, and the more those are used, the more resistance bacteria develop to those as well. The WHO is warning that we’re reaching a point in which the strongest antibiotics doctors have in their arsenal, the “treatment of last resort” drugs as they’re called, no longer work.

And in fact, it’s no longer just bacteria that are becoming resistant. The WHO has stopped referring to the problem as “antibiotic resistance” and now calls it “antimicrobial resistance,” to encompass other organisms, such as viruses and parasites, that no longer respond to the drugs of choice. Namely, treating the viruses tuberculosis and HIV, and malaria (a parasite), has become harder as these diseases become resistant to medications. Even H1N1, the so-called “swine flu” that reached pandemic levels in 2009, has begun developing resistance to potent antiviral drugs.

Resistance Is a Worldwide Problem

One of the major points of the report is that diseases that used to be restricted to certain locales are now spreading internationally:

Among their key findings:
• Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumonia—carbapenem antibiotics—has spread to all regions of the world. K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients. In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections.

• Treatment failure to the last resort of treatment for gonorrhea—third generation cephalosporins—has been confirmed in Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom. More than 1 million people are infected with gonorrhoea around the world every day.

• People with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64 percent more likely to die than people with a non-resistant form of the infection. MRSA, which can cause septic bloodstream infections when exposed to broken skin, is one of the most common “community-acquired” resistant infections, meaning you’re likely to pick it up anywhere other people are—your gym, place of worship, a nearby park or even at schools. In the Americas, as many as 90 percent of staph infections are reported to be MRSA.

• There hasn’t been a new class of antibiotics developed since the late 1980s.

We Can’t Track What We Don’t Know

The WHO is calling on countries all over the world to step up their surveillance of these deadly infections, something that happens rarely, if at all. An investigative report, “Hunting the Nightmare Bacteria,” that ran on the PBS program Frontline in October 2013 revealed that public health officials in the U.S. have little to no data on the extent of antimicrobial resistance in this country. Healthcare facilities aren’t required to report outbreaks, the report found, and many don’t because they don’t want to scare people or have to deal with bad PR.

“It is frankly embarrassing that we as a country do not know where resistance is occurring, how bad the problem is for various organisms or who’s using what antibiotics when,” Brad Spellberg, MD, an infectious disease doctor at Harbor-UCLA Medical Center, said in the documentary.

The Centers for Disease Control and Prevention has estimated that antimicrobial resistant infections hit two million people a year and kill at least 23,000. But the WHO notes that in most countries around the world, including the U.S., often only the most severe infections are documented and minor community-acquired infections (which can get passed along repeatedly and wind up as a severe infection) go unreported.

Clean Up the Food Supply!

For quite possibly the first time, the WHO also called out the food industry for its contribution to antimicrobial resistance. ” The use of antibiotics in animal husbandry—including in livestock, poultry and fish farming—are leading to increasing recognition that urgent action is needed to avoid inappropriate use, and to reduce antibiotic usage in animal husbandry and aquaculture, as well as in humans,” the report states. In the U.S., 80 percent of antibiotics sold go into animal feed to prevent infections in healthy animals or to speed growth. And we’re not alone. “In many countries, the total amount of antibiotics used in animals (both food-producing and companion animals), measured as gross weight, exceeds the quantity used in the treatment of disease in humans,” the authors found.

The same classes of antibiotics used on these animals are the same as those given to humans. In particular, fluoroquinolones, antibiotics used widely in the poultry industry, are increasingly ineffective against urinary tract infections caused by drug-resistant E. coli bacteria, which have been detected on all forms of supermarket meat, and against MRSA soft-tissue and skin infections.

Numerous groups in the U.S. have sued the Food and Drug Administration to revoke its approvals in animals for antibiotics that are valuable for humans. The agency’s only response has been to set voluntary guidelines for the industry.

What You Can Do

Despite the damage factory farming has done to antibiotic effectiveness, the WHO and other public health officials insist that the first line of defense in controlling the problem of antimicrobial resistance is the healthcare setting: Stopping doctors from giving patients antibiotics for conditions they aren’t designed to treat, for instance, when you’re given antibiotics for a cold that’s caused by a virus, not bacteria.

• Don’t automatically ask for antibiotics when you feel sick and visit a doctor.

• If your doctor prescribes an antibiotic, ask if there’s an alternative before just accepting the advice. Some doctors feel compelled to offer the drugs to make people feel better, but asking for an alternative can open up a dialogue about other options.

• When you do need an antibiotic, take the full course, even if you’re feeling better.

• Wash your hands frequently to protect yourself from community-acquired infections, and keep your hands away from your nose, eyes and mouth, where infections can enter.

Contributed by  By EMILY MAIN

Where Health Meets Life

Alarm bells over antibiotic resistance 

Antibiotic Resistance_pills

The World Health Organisation’s most comprehensive report to date sounds a warning that we are entering a world where antibiotics have little effect.

THE World Health Organisation (WHO) has sounded a warning that many types of disease-causing bacteria can no longer be treated with the usual antibiotics and the benefits of modern medicine are increasingly being eroded.

The comprehensive 232-page report on anti-microbial resistance with data from 114 countries shows how this threat is happening now in every region of the world and can affect anyone in any country.

Antibiotic resistance – when bacteria evolve so that antibiotics no longer work to treat infections – is described by the report as “a problem so serious that it threatens the achievements of modern medicine”.

“A post-antibiotic era, in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century,” said Dr Keiji Fukuda, WHO assistant director-general who coordinates its work on anti-microbial resistance.

“Without urgent, coordinated action, the world is headed for a post-antibiotic era in which common infections and minor injuries which have been treatable for decades can once again kill.

“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine.

“Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”

The report, “Antimicrobial Resistance: Global Report on Surveillance”, shows that resistance is occurring in many bacteria causing different infections.

It focuses on antibiotic resistance in seven bacteria responsible for common, serious diseases, such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea.

What is especially alarming is that the bacteria’s resistance has also breached “last resort” antibiotics, which are the most powerful medicines that doctors resort to when the usual ones do not work.

When patients do not respond to the usual medicines (known as first-line or first-generation medicines), doctors prescribe newer (second line medicines) which also usually also cost more.

When these also don’t work, newer and often more powerful (but sometimes with also more side effects) antibiotics are used, and they are even more expensive.

If these third-line or “last resort” medicines are not available or too costly for the patient, or if they don’t work on a patient because of antibiotic resistance, the patient remains ill or dies if the infection is a serious one.

New antibiotics have been discovered in the past to treat infections when the old ones became useless due to resistance.

But these discoveries dried up in the past 25 years.

The last completely new classes of anti-bacterial drugs were discovered in the 1980s.

Pathogens that are becoming increasingly resistant including to the more powerful antibiotics include E. coli, K. pneumonia, S. aureus, S. pneumonia, salmonelia, shigella and n. gonorrhoeae.

Key findings from the report include:

> Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, K. pneumonia — carbapenem antibiotics — has spread worldwide.

K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients.

In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections;

> Resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E. coli – fluoroquinolones – is very widespread.

In the 1980s, when these drugs were first introduced, resistance was virtually zero.

In many countries today, this treatment is ineffective in more than half of patients;

> The sexually transmitted disease, gonorrhoea may soon be untreatable unless there are new drugs. Treatment failure to the last resort of treatment for gonorrhoea – third generation cephalosporins – has been confirmed in several countries; and

> Antibiotic resistance causes people to be sick for longer and increases the risk of death.

For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection.

There are many cases of patients being infected by MRSA in hospitals.

The report also gives useful information on the worrisome building up of resistance in four serious diseases — tuberculosis, malaria, HIV and influenza.

A major factor accelerating resistance is in the animal husbandry sector, where there is a liberal use of antibiotics mainly to promote the growth of the animals used for food, for commercial purposes.

This builds up resistance in the bacteria present in the animals.

These resistant germs are passed on to humans who consume the meat.

The report has a small section on the animal-food chain, which has been identified as a major problem.

The European Union has banned the use of antibiotics as growth promoters in animals, but it is still allowed in other countries.

A WHO press release on the report calls for some actions. These include:

> Setting up basic systems in countries to track and monitor the problem;

> Preventing infections from happening in the first place to reduce the need for antibiotics;

> Only prescribing and dispensing antibiotics when they are truly needed, and prescribing and dispensing the right antibiotic(s) to treat the illness;

> Patients using antibiotics only when prescribed by a doctor and completing the full prescription; and

> Developing new diagnostics, antibiotics and other tools to stay ahead of emerging resistance.

Contributed by Global Trends by Martin Khor

Martin Khor is executive director of the South Centre, a research centre of 51 developing countries, based in Geneva. You can e-mail him at director@southcentre.org. The views expressed are entirely his own.

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Doctors have bad days too


AS a doctor I have always been asked questions by enthusiastic parents about the job.

Among the questions are: “How is it being a doctor?”, “What do you think if my children become doctors?” and “How much do you earn per month as a doctor?”

Despite an overflow into this profession, many parents are still willing to invest in their children pursuing medicine. Recently, there was an incident in my clinic that still remains in my mind.

There was a patient complaining of the bad attitude of another medical practitioner. He was unhappy and alleged that the doctor did not explain to him politely and treat him appropriately.

I was not present at that time to comment on it, but tried to resolve the misunderstanding amicably by saying doctors too had bad days.

To my surprise, the patient replied: “To me, doctors should always have good days.”

The doctor–patient relationship is unique. It’s like a weighing scale that needs commitment from both parties to maintain its balance.

Undoubtedly, a patient sees a doctor when he or she is unwell and all patients deserve tender loving­ care from their doctors.

But how many patients have done anything to show their appreciation for what their doctors had done for them?

This is a routine day for a doctor. In government/private hospital settings, a doctor has to do ward rounds every morning at 7am, usual­ly examining 30 to 50 patients, depending on “good or bad days”.

After the rounds, the doctor continues seeing follow-up patients at the Out Patient Department (OPD) and that would easily be around 50 patients and more before late afternoon.

After the OPD service, the doctor has to do ward rounds again to review the patients.

On average, a doctor will see around 80 patients per day (working from 7am–5pm). This is one patient every 7.5 minutes.

That is why it is very common to hear patients saying that they waited two hours in the long queue, only to be treated by the doctor in a few minutes.

There is always a tendency for doctors to divide the time unequally with every patient, on a case-by-case basis. In complicated or life-threatening cases, more time is spent with the patient.

In a general practitioner’s clinic, the conditions are no better. The general practitioner is virtually trapped in the small consultation room for a whole day, seeing patients with various ailments.

Like every human being, doctors also face obstacles in life, besides the challenges from career, family, friends, etc.

Long working hours, patient load, stressful working environment and poor quality of life are issues faced by doctors.

We cannot be smiling happily all the time. Sometimes, doctors may look cold and stern. Yet, we try our best to treat the illness of each patient in every possible way.

We uphold the Hippocratic Oath that we took before joining this sacred profession. The essence of the oath is “Above all, do no harm”.

Yes, you may be right that doctors earn well. To most of the doctors, the money that we earn is merely numbers in a bank account. We might not even have a chance to spend it all.

A word of thanks, a small card from patients will truly enrich our days.

By DR H.B. CHEE Muar

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