On Poverty and Health: The Obesity-Conundrum

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rich man poor man slimmer man fatEver since I started running (and enjoying it), I have been intrigued by the sociology and economics of health and fitness. It coincided with my “coming of age” in medicine, so to speak, so it has been in interesting and ongoing thought-experiment.

I want to address some pertinent falsehoods about health and fitness, and why the disenfranchised have such a hard time of it. Right now I intend to write a two-part series, but who knows.

Quick disclaimer: I would never suggest that being a student-on-a-budget is comparable in hardship to living in poverty. All the same, being a student on a partial scholarship and a heavy student loan certainly did teach me a little about struggling financially and its effects on health.

“Well if they’re so poor, why are they SO FAT?!”

this is a statement I’ve heard too often for comfort. It is not only unkind, but also really short-sighted.

I’ll carry on below, but you really should read this very articulate article, published about South Africa’s obesity crisis last year on Mosaic Science by Ian Birrell, who writes:

“Forget those tired old clichés beloved by the aid industry: today, more people in poorer countries go to bed each night having consumed too many calories than go to bed hungry, a revelation that underlines the breakneck pace of change on our planet.”

As a student, I learned that anything was edible. I had loans that barely covered my basic needs, poor cooking skills, and no transport. I lived in an area close to the university hospital that made it unsafe to walk to the shops, making me somewhat reliant on the campus cafeteria with its exorbitant prices (they did not buy wholesale, and their markups were often 50-100% above commercial).

During my first year of university I became a connoisseur of instant noodles, at times even eating them uncooked.

How much worse for mothers without loans, with other hungry mouths to feed, for whom even two-minute noodles are over-priced?

When my workload picked up, even my poor cooking skills flew out of the window and I started purchasing meals cooked by the campus cafeteria. Although more affordable than their other items, these were overcooked meats and veggies, with copious amounts of salts and sauces, often re-fried.

But I still had the privilege of being a student. I went home for holidays. My parents helped where they could. I was never at a real risk of starvation. I was not a mother coming home from a ten-hour shift in a different suburb, taking two or three buses to get home to her hungry children and (also tired) husband who expected food when there are so few ingredients and little motivation with which to conjure up a meal.

Even so, it took its toll on my health. My weight and my body distribution, but notably also my mental health. My mood took a nose dive, as did my motivation and academic performance.

And that is what I see in my patients every day.

I counsel them about “healthy fats”, but I know that healthy fats are expensive. Avocados? I can hardly afford avocados!

I urge them to cut down on their simple carbohydrates. And when I list these simple carbs, their eyes widen, because these are their staples. These are things they can actually afford, and things that can fill the tummies of their children.

why is a big mac cheaper than a salad

I tell them about eating fruits and veggies, while I know that the country is suffering a drought; that vegetables are not only scarce but expensive; that subsistence farming is a noble idea but one that often falls flat in our socioeconomic environment.

And then I tell them about leading an active lifestyle, and I can hardly take myself seriously. Because my patients don’t live in safe, walled-in suburbs. They live in places where simply being outside can get you a knife in your chest; and where the female body is often synonymous with violation. If I am afraid when I go for a run, why wouldn’t they be?

Am I being a naysayer? I am trying to be realistic. I don’t think it’s impossible for poor(er) people to lead healthy lifestyles. But if it is hard for the affluent, then I know it’s damned harder for those who suffer, and I want other healthcare workers to understand that too.

The Nicest Interns: Part 1

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It’s so easy to complain about my daily work. Annoying patients, a system that is falling apart a little more every day, and inconsiderate or lazy doctors and nurses  <– you see?

And then there are some of my colleagues who just really make me want to be a better person – and a better doctor.

One of our intern-colleagues is well-loved for being a bundle of fun and kindness. Whatever event our hospital’s social committee organises: he’s there, and he is their biggest promoter. He introduces people to each other, and he encourages them to get out of their shell.

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Then there was that one time he walked around casualty on Easter Weekend dressed as the Easter Bunny, handing out goodies to all the interns on-call.

How nice is that?!?!?!

When he has a calm call-duty, he walks around and helps the services that are having a rougher time of it.

Written down, it may seem like he is the biggest gunner or kiss-ass. But he is just so genuine that it does not seem to get on anybody’s nerves (not even my very flammable ones).

I’m by far not a lazy or a mean intern, but when I see people like this guy, I just think: wow. I want to be like that when I grow up.

Ten Books Every Lifelong Learner Should Read

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Linking up with The Broke and The Bookish for Top Ten Tuesday. Today’s topic is “Ten books every (X) Should read.”

fa06114a227c0d6d401a3473ca949b4fI have a million-bajillion lists about books every medical student or health-professional should read; so I decided to pretend I know something and suggest books for, well, almost everyone. On Semester at Sea, we had “Lifelong Learners”. These were slightly older voyagers who had already worked and gained life experience, and who sailed with us and audited classes.

I like the concept of lifelong learning. I love the idea that you are not stuck with learning only about whatever you studied in college/university; I love the idea that you can gain knowledge about almost anything if you are inspired to do so (thank you, Google). I believe I am a life-long learner; and I believe that books are at least partially responsible for that.

The list, in no particular order: Continue reading

Product Review: Subz Reusable Sanitary Pads

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*Disclaimer: this is NOT a sponsored review. My sister and I decided to review Subz because we think it’s a cool product that could use some marketing and some constructive feedback.

About a year ago, I first heard of a product called Subz Pads. These are reusable sanitary pads, produced in South Africa. They are for sale to the general public, but also have a plan for free distribution to financially needy girls.

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Unless you’ve been living under a rock, you’ve probably noticed that sanitary products for women have received a lot of publicity recently, worldwide. In South Africa, the cheapest sanitary pads work out to about ZAR1.40 per pad, and can reach as high as ZAR4.00. In March this year, New York revealed that the city would launch a pilot product to provide free sanitary products to girls. Continue reading

Unrealistic YA Fiction Is Not Such A Big Problem

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Young Adult fiction treads a fine line. On the one hand, it needs to be in touch with its audience. YA readers want to see protagonists who speak realistically, eat realistically, and act realistically.

On the other hand, reading offers us the opportunity to live different lives; to travel to places and settings and adventures that we may never have, and very few people want to read about a normal, boring setting. (Although I am told that Patrick Ness’ The Rest of Us Just Live Here addresses this very well, I’ve not yet read it.)

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Not the topic for this discussion, but I do want to read this book.

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Two Oceans Ultra Part 2: Race Review

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It’s a week since running the Two Oceans Ultra and it still feels like a life-defining moment. I’m already looking forward to next year’s marathon, although my foot is still protesting. I figured I’d offer a few concise lines about particular aspects of the race:

Signing up:

For me, the process went so smoothly. I thought the interface was user-friendly and easy; but I do know that some people had big problems with signing up. The entries do fly, so for future reference, waiting is probably not the best idea. Especially if you’d rather enter for the half-marathon – those entries fly like hot-cakes!

Marketing:

The marketing team did such a great job of hyping everyone up and keeping one up to date. The OMTOM Magazine was superb and the social media pages well-maintained. The biggest flaw was a lack of interaction on social media with people who had complaints.

12924415_10153946065180661_3973261936145693581_n Continue reading