Some thoughts on work retreats...

I spent a couple of days this week at a work retreat in Gex, France, hashing out a paper that will be submitted for publication hopefully before my internship at the WHO ends. Perhaps the idea of spending 48 hours with colleagues working on one single project can sound exhausting or intimidating, but I found it refreshing to be out of the office in a beautiful French village and working with young colleagues like myself. The four of us worked well together, and I found the mix of being focused and productive, with being silly and relaxed, made for a very successful retreat. I’m new to the whole work retreat thing, so I have little to compare it to, but I must say that two things stood out for me which made it an enjoyable and productive experience:

1. We spent a considerable amount of time making and enjoying each meal. The combination of cooking the meals together and then enjoying lingering conversation when meals were done was a very nice way to break up the day and focus our energy on work when we needed to.

2. We went for a late walk through the village on the Monday night, and this time physically away from the house we were working at, as well as the peacefulness of exploring a new place in the calm of the night, was an incredibly successful way to unwind after a long day of working.

I feel quite lucky to have had the opportunity to have had such a positive work experience. Now it’s down to the grind to finish off the paper and submit it for first review by this afternoon, eep!

The view from the balcony, in Gex, France

66th World Health Assembly: Self discovery, long days, and free food

I had the incredible opportunity while interning at the WHO to attend the World Health Assembly. The World Health Assembly takes place every year at the Palais des Nations (United Nations Headquarters), where all the UN member states convene to discuss the health agenda for the next year. In addition to the main meetings, there are many side sessions that happen during lunch and in the evenings, which are usually organized by specific country’s delegations, by NGOs or UN or WHO departments.

My duty during the week of the WHA was to man my department’s booth (The Alliance for Health Policy and Systems Research). Although this may sound rather boring, it was actually quite the opposite as I had the chance to speak with individuals in the field of health policy, from around the world, about their work and the challenges their countries face. From Ministers of Health to researchers to students, I learned from each individual I conversed with.

Photo-op at the Alliance's booth, with co-workers

The side sessions were the other highlight of the WHA for me (and not just because of the free food, although interns are notorious scavengers of free food during the WHA, probably because of our non-existent pay cheque). As a future medical student (!!!!) already thinking about the path towards becoming a physician, and the responsibility and challenges that lie therein, I think I approached the WHA differently than I would have otherwise. One particular side session that stood out for me was organized by the International Federation of Medical Students’ Association on the topic of ‘Health of the World’s Girls- The missing link in the global development agenda?’. The topic was incredibly interesting, as the panelists discussed how child health and maternal health are common demographic targets for health initiative, but youth are often forgotten. The event was the first youth-led side session ever held at the WHA, which in itself was exciting, and I was further energized by the possibility of becoming involved with the IFMSA and their many global health initiatives. But more importantly, it made me realize the need to fight for not just women’s rights, but girl’s rights as well. For many girls, particularly those living in LMIC, the time between being a child and being a mother is vulnerable but crucial, when education and empowerment can make an incredible difference. As someone living in a society where education and empowerment has been slowly pushing the age of motherhood back, I find myself in a very liberating time of my life, when I am obviously no longer a child (or teen!) but will not be experiencing motherhood anytime soon, and so have the power to chase my own dreams and experiences. I wish for all girls the opportunity to experience that freedom.

The second side session that really stood out for me was organized by the Costa Rican government and the United Nations Sport for Development and Peace department, and was called ‘Physical activity, sport and noncommunicable diseases’. Well here was an event that had, right in the title, three things that I am incredibly interested in, and it did not disappoint. The event was not run as smoothly as some of the other events I had attended, and some of the speakers were subpar, but despite the quality of the event, it was by far my absolute favourite of the week. I felt so at home in a room full of athletic individuals who are very passionate about using sport and physical activity to tackle pressing problems associated with noncommunicable disease. And simply being present at the event, surrounded by these people, I realized that perhaps my initial interest in sports medicine, that first motivated me to pursue medicine, still exists in a very real way. Throughout university, while taking many biology courses, I always felt that if I went to med school and learned more about all the amazing ways in which the human body works, I might find sports medicine to be less interesting than other fields of medicine. But the side session made me realize that it is important to look beyond the textbook, and consider what in my life is powerful enough to ignite passion and a familiarity that makes me feel at home in a place that I have never been, and to pursue that passion with curiosity and zest.

There were so many exciting and interesting moments from the WHA (such as when Director General, Margaret Chan, crashed the event and sat beside me for about two minutes before making a quick speech and dashing off to another meeting, leaving me rather embarrassingly star struck), but I chose to share two specific moments because I have a feeling they will stick with me long past when my days at the World Health Organization are done.

My co-worker and I checking out some of the other booths at the WHA

A Dream Come True

The week after my adventures with Big Hair, Big Science, I received life changing news. It is with so much excitement, anticipation and passion that I am proud to say that I was accepted to medical school in Canada. The program I was accepted to is a three year program, that runs for 12 months of the year (with only about 9 weeks of vacation in total across all three years!), so in three years time I will be an M.D. I still cannot grasp the reality of this incredible life change.

My path towards medicine began at a fairly young age, when I was diagnosed with type 1 diabetes. I was very ill when I was diagnosed and spent a few days in the hospital, and throughout my stay I always felt rather comfortable at a hospital, perhaps a strange thing for an eleven year old to feel. It’s not that I loved being there or loved being a newly diagnosed diabetic, but I never felt frightened by the hospital, only curious of the noises and sights and sounds. I did not make a big fuss when administering my first needles, or pricking my finger to test my blood sugars. However it was only after my release from the hospital, when the true sorrows and triumphs of living with a chronic illness began, that I discovered my passion for physiology. When my blood sugars were high or low, I had an immediate physical reaction, and I was always curious to find out exactly what was happening inside my body. On the outside I might be shaking, or sweating or feeling grumpy, but I always wondered what was happening at the cellular level?

It took me awhile to place this interest and curiosity in my diabetes into the context of a possible future profession.  But one morning when I was in grade 11, I had a revelation. I would be a sports medicine doctor. It seemed the perfect profession for me, as it combined by passion for athletics with my interest in physiology and my desire to help others.

When I arrived at university, my determination to pursue medicine wavered. Surrounded by intelligent, wonderful, high-achieving individuals in my program, I questioned my own ability to get in to medical school. Something I grappled with continuously over the four years of my undergraduate degree was the notion of what makes a good physician? Each medical school has a slightly different preference in who is accepted, and it always left me wondering, which was the right preference? And who has the right to decide what qualities make a good physician? I still have yet to answer these questions, but I think perhaps, in the broad and varied field of medicine, there is no single set of qualities that are needed to be a good physician, because the field calls for a variety of people with different ambitions, skills, emotions and backgrounds. Yet my own questions about the medical field left me wondering if it was the right field for me. In my senior years in university, I worked at a health policy hub and received an undergraduate fellowship (which is what landed me in Geneva, interning at the WHO for the summer), and I toyed with the idea of pursuing a career in the field of health policy over medicine. But I realized that the long hours of reading and researching, and the lack of individual, one-on-one human contact with others did not satisfy me. I have not completely abandoned the idea of continuing in the field of health policy in some capacity, but I know that for the time being, studying medicine is exactly what I want to be doing.

It has been exactly a month since I found out I was accepted to medical school, and I am not sure I have really grasped the reality of it. Having a dream come true that I have been wanting and grappling with for years is a surreal experience. I am sure once I am back in Canada and settling into my new place, buying my textbooks and preparing for a challenging and rewarding three years of intense schooling, it’ll feel more real, but for now it is an overwhelming little thought in my head that can elicit happiness, excitement, nervousness, relief and determination, all at once.

Have you ever had a dream come true?

Doctor Syntax: The Doctor's Dream By Artist Thomas Rowlandson, English 1756 - 1827

My Diabetes Success Story

This post is written as a response to the International Diabetes Federation's tweet: “We have the power to change. What is YOUR #diabetes success story? Let us know how you intend to carry on the success into 2012”.

My diabetes success story does not begin with success. It takes place 3 years ago, during my first semester of my first year of university, when I was struggling to balance the newness of university academic, extracurricular and social activities with all the usual inconveniences of life with type 1 diabetes. This story may not begin with success, but it does end with it.

Exam season of first year university is a stressful time. Personally, I found myself very stressed about my chemistry exam, as it was the course I found the most difficult, and my mark was consequently not as high as I would have liked, so I really had to ace the exam to get the mark I wanted. After long days of studying, I finally felt prepared for this beast of an exam, and the morning of the exam I ate a big bowl of Mini Wheats cereal (for comic relief, click the link), something I don’t usually have for breakfast because I do not find it very filling.  As a result of this highly sugary breakfast, my blood sugar an hour before the exam was sky high, and I felt terrible and thirsty. In my agitated state, nervous about the exam and feeling groggy from hyperglycemia, I over-bolused.

Flash forward to mid-exam, and the mixture of the sugary cereal carbs, that flashed through my system far faster than they should have, combined with my over-bolusing for a post-meal hyperglycemia, meant my blood sugars were low and dropping fast.  But because this was one of my first university exams ever, and because my mind was unclear due to hypoglycaemia, I didn’t immediately call on one of the invigilators to ask to go to my bag and test my blood sugars.  Instead I sat in my seat, attempting questions that seemed impossible to my sugar-deprived mind, and I believe at some point I must have momentarily blacked out (Note: I have never passed out from hypoglycaemia, although twice in my life, this being one of those times, I have blacked out, while still moving and functioning as normal to those around me, though I simply don’t remember time passing), because next thing I knew there was only an hour left in the three hour exam and I was barely half done.

I finally beckoned the invigilator and got some juice into my system, but by the time my blood sugar was up enough to function properly, I didn’t have enough time to do all the questions on the exam properly and I rushed through quite a few multiple choice questions in the end.

I did poorly on the exam, which was extremely upsetting given the amount of preparation I had done, and the potential I had going in to that exam to succeed, which was all wasted because of my low blood sugar.  I was furious. Furious at myself for allowing my blood sugar control to be so poor, furious at Mini Wheats for being such a terrible breakfast choice, and furious at diabetes for interfering with my life.

But I channelled that anger. I decided that from that day forward, I would not allow poor blood sugars affect an exam.  I strategized. I experimented with different breakfasts (peanut butter toast, oatmeal, eggs, etc.) to see which offered the most stable blood sugar control and minimized the effects of the Dawn Phenomenon (in case you’re wondering, oatmeal was the winning breakfast choice in the end).  I planned.  I made sure I always had juice and crackers in my bag before exams, and made a plan to test multiple times before exams (3 hours before, 2 hours before, 1 hour before, 30min before and 5 mins before) to track my blood sugar pattern.  I prepared for the worst by ingraining in my head that the moment I felt low during an exam, I would immediately summon the invigilator and test my blood sugars, to maximize the time that my blood sugars were normal.    

Now, 23 exams later, I can honestly say that my diabetes has not affected my success on any of my exams since that fateful chemistry exam.  Though this story does not begin with success, I can certainly say it ends with success.  Success that will continue throughout 2012 and that will see me through the rest of my undergrad career, and throughout whichever post-grad opportunities I pursue.    

“Our greatest glory is not in never falling, but in rising every time we fall.” -Confucius

New Year's Resolutions

“All changes, even the most longed for, have their melancholy; for what we leave behind us is a part of ourselves, we must die to one life before we can enter another.” –Anatole France

‘Tis the season for resolutions and new beginnings. I love beginnings. I love the excitement of starting fresh, of new ideas, daydreams, hopes and wishes. I have a lot of expectations for 2012, all of which I hope will come to fruition, but only a few of which I would like to list as my official New Year’s Resolutions.

As a diabetic, of course the first resolution I would like to make is regarding my blood sugar control. My HAICs have been consistently around 7 mmol/g in recent years, and my goal this year is to have an A1C of 5.8mmol/g before the end of 2012. But as any good diabetic knows, blood sugar control cannot be measured simply with an average, as an average can never truly tell the full story.  If I achieve that average through a rollercoaster of blood sugars that’s as crazy as this:

than it is not a fair representation of my blood sugar control. I’d like my blood sugar control to be quite a bit more boring and a lot flatter, probably something like this:

My second resolution is to prevent myself from taking on too many committments (work, volunteering, schooling), and by doing so, allowing myself the opportunity to truly give myself 100% to the commitments that I do make. I have the tendency to take on more than is healthy- in terms of levels of stress- (ahem the 4 jobs I was working plus full time school last semester) and I’ve found this to be not only unhealthy, but unsatisfying too.  I wouldn’t call myself a perfectionist, but I do take a lot of pride in what I do, and I get very frustrated whenever I’m time crunched and forced to do a mediocre job. So this resolution is designed to hopefully allow me the opportunity to excel at and enjoy everything I do this year.

A third resolution I would like to make for myself, and one which is quite easily measurable by the public at large, is to truly keep up with blogging once a week. There are so many benefits of weekly blogs, from developing a stronger online community to expressing myself in times of excitement and frustration, and I do believe that the act of blogging itself helps me maintain better blood sugar control, simply by being a constant reminder of my diabetes. 

My fourth resolution is simple yet difficult all in one, and it is to smile more. Cheesy? Yes. Difficult to measure? Certainly. Important? Immeasurably.  Many people describe me as a very upbeat, smiley person, but I want every smile to be from the inside out. I remember a quote I once read in a running magazine, “Wellness is the key to a long and healthy life. Many people have the wrong perception of it. Wellness is from the neck up, and fitness from the neck down. Too many people work out every day, but go around with the worst attitudes, which just wastes all their physical efforts.” I think that statement captures the importance of attitude and happiness, and I would like to be a more smiley, positive person this year.

My final resolution fits in nicely with these ideas of wellness and fitness. I’d like to run in more races this year. So far I’ve signed up for the Warrior Dash in July, which I’m extremely excited about, and as the warmer months near I’d like to sign up for some more 5 and 10ks, possibly even a half marathon.

Here’s to hoping the new year brings all sorts of good, and fewer sorts of bad.

Inconvenient Health

Accepting responsibility for one’s personal health is a theme that I’ve noticed frequently popping up in my life recently.  I’ve noticed that on a general basis, tending to one’s health in a short term context is much more widely practiced in society than tending to one’s health in a long term context.  Most people seem willing to take small, short term precautions (such as getting more sleep, drinking tea or taking vitamins) to prevent a cold or flu, but taking precautions (such as regular exercise, a healthy diet or wearing sunscreen) to prevent long term health problems such as heart disease or cancer, is much less practiced.  Maybe this is a result of societies need for instant gratification, a tendency to ignore long term pain if the short term gain is rewarding enough, maybe it’s rooted in the naive belief that “it’ll never happen to me”, or maybe my theories about society are completely wrong.  Whatever the cause of this attitude, I can’t help but feel that this blasé approach to our health is extremely ignorant and dangerous.     

I’m an employee of Leave the Pack Behind, a tobacco awareness organization present on campus’ across the nation, and I was recently talking with a friend about his smoking habits (we’ll call him John).  Having been bombarded since youth with “smoking is bad for you” messages, John is pretty tired of the same old reprimand, and he made a comment that really stuck with me:

“Smokers aren’t stupid. We know smoking’s bad for us, but repeatedly telling us that it is won't make us want to stop.”

But why do we knowingly do things that harm our health?  Why is knowing something is bad for us not a good enough reason to make us want to stop? I don’t mean to only target smokers, this question pertains to nearly everyone: anyone who eats fast food on a regular basis, or who rarely exercises, or who eats junk food, drinks pop or energy drinks, goes tanning or simply foregoes sunscreen.  We know all these things (plus many more) are bad for our health, yet I have never met a person who isn’t guilty of doing at least one thing on that list.  Sometimes our reason for doing these things is indulgence (we love the taste of good ol' fast food fries), other times it is mere laziness (going to the gym can be so inconvenient).  I know from a diabetic perspective that my blood sugars are not perfect 100% of the time, not even 90% of the time.  Why do I sometimes decide to eat 30 grams of carbs worth of dried mango when my blood sugar is 11.0 mmol/g, even though I know that my insulin won’t work fast enough to bring my blood sugars down and combat the carbs? Why do I fail to pay enough attention to my blood sugars on days when I’m really busy? Why is my health not my number one priority all the time, including on those busy days? 

It is ignorant and irresponsible to ignore our health in the present.  Our futures quite literally depend on it.  Aside from the obvious selfish reasons for wanting a long, healthy life, the burden of our poor health in the future will not fall on us but instead on our children and our grandchildren.  Ontario’s new Ministry of Health Promotion, which focuses on increasing health awareness, is, I believe, a baby step towards improving the health of the nation, but health begins on an individual level.  I think my friend’s comment about smokers exemplifies that statement.  Just because someone has educated us about the risks or health concerns of a particular habit doesn’t mean we’re going to stop doing that habit. Nobody can force us to take our health seriously, it is a personal responsibility we bear on a 24/7 basis.   Only caring about it 50% of the time or 75% of the time is not enough.  I know I will try harder to take control of my own health, to consciously think about it and make it a number one priority.  Will you? 

"To keep the body in good health is a duty... otherwise we shall not be able to keep our mind strong and clear."

- Buddha

Responsibility

The funny thing about responsibility is that it always seems to gain more importance and notice when other people are affected.   We are responsible for our self, our own health, our own life, but this important responsibility too often comes second to the responsibilities we have to our family, friends and coworkers.     

An example that comes to mind took place two years ago when I spent the last week of summer with my three best friends at a cottage.  It was the perfect trip. No arguing, lots of laughing, a nice amount of relaxing mixed with adventure and only one rainy day!  The cottage was in the beautiful Canadian wilderness, so a lot of time was spent hiking, kayaking, fishing, swimming and ATV-ing.  ATV-ing might seem out of place in a list filled with peaceful, natural activities, but the ATVs were used to quickly get to the minnow pond to gather fishing bait.  Since there were four of us and only two ATVs, each ATV would have a driver and a passenger.

On one trip back from the minnow pond, I was driving with my best friend Scarlett riding passenger.  We were travelling along a paved road and my friend had told me to keep one set of wheels on the gravel shoulder since ATVs were not meant for pavement. The left side of the road was cottages and the right side was a steep, forested drop into the lake.  We were travelling on the right side, as proper driving protocol requires, and the shoulder on this side was rather slim.  I was trying to keep one set of wheels on this thin shoulder, and a large rock is why I think I failed at doing so.  The accident happened so fast that I’m not too sure of the details, but I think the rock shifted the wheels quickly so that they were no longer pointing straight along the road, they were now pointed to the right- over the steep incline towards the lake and into trees. I remember flying into the forested area, holding on to the ATV as it flipped in the air, realizing I was below it and that I should let go and then laying flat beside Scarlett on a bed of pine needles while the ATV flipped down the incline until it hit a tree and stopped.  My initial instinct was not to check if I was injured, but to turn to Scarlett and start with a steady stream of “Are you ok? Is anything broken? Does anything hurt?”.  I wouldn’t let her stand until I had felt her legs and arms for any protruding bones, for fear she had broken something (I’m not a doctor and I’m not really sure what I would have done if I had found any, but I felt it was important to check before she put weight on any injuries).

By the minnow pond pre-ATV accident

I suppose my worry makes me sound like a good, selfless friend, but what was also at play was that feeling of responsibility (and a lot of adrenaline, nothing like almost dying to get the blood pumping).  I had been driving the ATV, I had launched us into the trees, I had put us in danger, I had almost killed us.  If I was injured, so be it, it was MY fault, but if Scarlett was injured, the fact that it was my fault and not hers would have caused me a lot of grief.  Somehow the stars were shining on us that day, and neither of us were severely injured- Scarlett’s head had been bumped around inside her helmet, the ATV handle had given me a pretty nasty bruise when it dug into my thigh, and we were both covered in scratches, but nothing was broken or even fractured, and we were in good enough shape to go for a 4 hour long hike the same day.

It’s amazing how responsibility for others trumps responsibility for oneself. I’m not saying that I should have first checked to make sure I wasn’t injured before asking Scarlett if she was, but I do think that the strong feeling of responsibility I felt for Scarlett in that instance escapes me when it comes to feeling responsible for myself.  My diabetes affects me more than it affects anyone else and the pressure of taking care of it lies solely on me.  I should experience those strong feelings of responsibility for my diabetes, and they should prevent me from neglecting my diabetes, but somehow it doesn’t seem to work like that.  It doesn’t mean I should be ridden with guilt every time I neglect my diabetes, but I should be conscious that it is my responsibility and my health.  And if it isn’t enough to be responsible to myself, I can always think of all my friends and family who expect me to live a long, happy, healthy life in spite of my diabetes, and employ their support with this complicated disease.