With the peak of flu season behind us, as swine flu cases drop and, as a result, European countries cancel millions of swine-flu vaccine orders, the World Health Organization (WHO) is facing tough allegations of "faking" a pandemic for the benefit of the pharmaceutical industry, according to a Jan. 26 ABC News report.

The allegations have prompted an internal review at the WHO and the Council of Europe hearings, stated a Jan. 26 BBC article. And WHO released an official statement Jan. 22 denying any improper conduct or conflict of interest.

What I am wondering is why WHO is being criticized for obtaining the very outcome it is supposed to: preventing a pandemic? Isn't it possible WHO's "hype" over the swine flu being a pandemic is the very reason it didn't turn into one?

A pandemic, after all, is not something a flu is or isn't; it is something a flu becomes - or doesn't. As death rates rise, a pandemic is assigned a higher category (from 1 to 5) on the CDC's Pandemic Severity Index.

As of today, swine flu is listed as category 1 - the lowest, with a death rate of less than 0.1 percent and on the same level as seasonal flu. It killed about 14,000 people worldwide. In comparison, "A category 5 pandemic would compare to the 1918 flu pandemic, which had an estimated death rate of 2 percent or more, and would kill tens of millions of people," a Reuter's article noted.

What stopped swine flu from spreading to 1918 proportions and killing tens of millions of people? I believe it could have been the preventative measures people around the world were taking sparked by WHO's "hype":

• Could it have been with all the media attention on H1N1, people who experienced flu symptoms were more likely to seek help? (And the estimated 55 million people who became ill from the swine flu were lucky enough to be just that, and not part of the death toll?) Various reports, such as this one - "Emergency rooms crowded because of swine flu scare" - confirmed more people were seeking treatment for even the smallest flu symptom.
• Could it have been the 1 in 5 Americans the CDC estimated who got the swine flu vaccination - thereby stopping the spread of the flu pandemic in its tracks? The greatest proportion of those vaccinated (28 percent of the 160 million) were deemed most "vulnerable" to the influenza, such as pregnant women, children and people with underlying health conditions. I wonder what the death toll would have been had the push for this target group to get vaccinated not happened.
• Could it have been that because of the hype people were more cautious? In May of last year, schools across the country closed - in Boston, Houston and 26 schools in New York - as worldwide swine flu numbers exceeded 10,000 to "prevent its spread among students," according to the ABC News report. Here is a microcosm of the bigger picture: WHO's hype over swine flu causes schools to close to prevent its spread, fewer people get swine flu, and people complain WHO hyped it up too much. Wasn't WHO at the start of this positive chain reaction?

In response to the accusation WHO built up swine flu too much, WHO's Dr. Keiji Fukuda, special adviser on pandemic influenza, responded in the BBC's Jan. 26 article, "But we do not wait until [these global virus outbreaks] have developed and we see that lots of people are dying. What we try and do is take preventive actions. If we are successful no one will die, no one will notice anything."

And what a difficult job that is to prove. WHO is successful when swine flu passes through a globe and no one really notices. When so few people die, the hype they talked about never really happens - WHO did its job. Which is why I believe WHO can't win: If swine flu did become a pandemic, the organization would have been criticized for not preventing it. It didn't, and so now the view is WHO over-hyped it.

WHO never could have known exactly what type of virus swine flu would have turned into, so if the only "pandemic" swine flu caused was in the form of fear and caution, better that than the alternative.

In talking to some of the selfless nurses in the Midwest who lent a hand, or plan to, in the wake of the earthquake in Haiti, I'm struck by a single common theme. The nurses are raring to return to service.

Take Mary Wolff, NP, who has gone on two 10-day mission trips with the Haiti Medical Mission of Wisconsin and plans to return in February. On an average day, she treats 45 patients in the town of Thiotte, Haiti. The very first patient she ever encountered on one of these trips had a machete sticking out of his head and performed surgeries in the open air.

"In Haiti, you go back to basics. There are no X-rays, ultrasounds, cardiac testing. You have to use assessment skills like in Assessment 101. What does the patient say, what is his history? It's wonderful but also very scary to work through interpreters to decide if a headache is a brain tumor or dehydration and worms. For the most part, you keep it simple, realize most frequent symptoms are malnutrition, dehydration and worms, and treat that. It takes you back to the fundamentals of nursing," she noted.

Naomi Fenske, BSN, RN, was part of a group of Madison, WI, healthcare workers that returned from Haiti Jan.11. She said when she heard about the earthquake she wanted to get on the next flight back to the island.

"It's hard enough coming home from a Third World country and seeing what we take for granted. I saw 5 pound one-year-olds and things we just don't see here. I want to go back," she said.

Ditto for Pam Charles, RN, who was actually in Port-au-Prince when the earthquake struck.

Charles assisted with the relief after 9/11 and Hurricane Katrina, yet said the annihilation was so much worse in Haiti because everyone was affected.

"I love nursing and feel so privileged to have been there. When you're a nurse, you see something on TV and want to go," she said. There is a reason our house stayed standing. Without us, many people in that town would've had nowhere to go for care."

News reports are rife with the overwhelming tragedy Haiti faces in the wake of a 7.0 magnitude earthquake that crumbled Port au Prince Jan. 12. Yet amid the despair and death, resilience and hope linger.

Here’s the story of Michele Fils-Aime, BS, RN, TNCC, a trauma nurse at Memorial Regional Hospital, Hollywood, FL — who counts herself among the “lucky ones.” Fils-Aime’s husband, Louis Eusebe, and her brother, Jean — both in Port au Prince when the earthquake struck — are safe and unharmed.

Eusebe landed in Port au Prince around 10:25 a.m. and last spoke to his wife at 3 p.m., less than 2 hours before the earthquake hit. In town on business, he was accompanied by his sister, a nurse from Switzerland.

Meanwhile, Fils-Aime was in the middle of her shift in the emergency department. Suddenly, one of her co-workers told her something had gone terribly wrong in Haiti.

When she heard about the earthquake, her knees buckled. “I didn’t hear from my husband for 3 terrifying days. I couldn’t eat or sleep. I had given up hope, thought I would never see him again,” she told ADVANCE.

Then the phone call came. “Someone called me from work and said Louis was on the line and he was OK,” Fils-Aime said. “We were all crying tears of joy and relief.” (Eusebe couldn’t reach his wife on their home line.)

During the conversation with Fils-Aime, Eusebe shared his experiences in Port au Prince. “He said he felt a jolt and heard a noise so terrible, he thought a plane had crashed. A few seconds later, the earth started to shake.”

When the quake stopped, Eusebe and his sister were still in their car, so they immediately headed north to Cap-Haitien, Eusebe’s hometown. The journey — normally 8 hours — took 2 days as they maneuvered around “a lot of blockage along the way.”

Along the route, Fils-Aime’s husband told her he saw piles of bodies along the roadways, and people bleeding and begging for help. He and his sister did “what little they could” and transported two injured people to Cap-Haitien.

Fearful of aftershocks, Fils-Aime’s brother — her only relative who lives in Haiti — has been sleeping in parks and on the streets. “Part of his house is still standing; Jean just can’t get in there,” she said. “He called this morning [Monday] and said the air has started to smell of dead bodies.”

Fils-Aime said she has heard reports indicating healthcare facilities in Cap-Haitien were expecting 350 earthquake survivors.

“I know my family is safe — I’ll never want anything else,” she said. Her husband is due home Jan. 26.
    
Editor’s note: Michele Fils-Aime’s husband, Louis, was scheduled to meet with the Haitian minister of health and a director of the Red Cross the day the earthquake hit. The Hollywood, FL, nurse has started a foundation, “A Dollar for Haiti,” to raise funds to build a 500-bed acute care hospital in Cap-Haitien, including clinics for women and children and an ED. Her husband had traveled to Haiti to secure approval from the Haitian government.

In the existing hospital, medical supplies are often lacking and men, women and children are crowded into the same rooms. Fils-Aime’s foundation would ensure the new hospital had properly trained medical staff and adequate supplies. Donations for the project can be sent to A Dollar for Haiti, PO Box 81-3427, Hollywood, FL, 33081.

9:53 am

Hello all, FSIL is fulfilling its mission. Thank you to everyone.  We are continuing with the medical clinic on the grounds of FSIL.

1. Relief team (27 persons) from Japan are working from the school: 4 docs and 7 nurses. They will perform surgeries. They have brought with them radiology, sonography and labs. They are sleeping in one of the dormitories

2. Doctors Without Borders did a lot of work yesterday -- debridement, splinting

3. Students continue with dressing changes, assessments, etc...

4. MINUSTAH has fixed the generator.  Now we have power.  They promised to fix the water pump today

5. Michele Sare, RN, [whose earlier letter was printed in this blog] just left to Port-au-Prince.  She is supposed to leave Haiti today.

-- Hilda Alcindor

To all who have taken a personal interest in the Haitian nursing students at FSIL School of Nursing, the first BSN nursing program on the island of Haiti: I thought you might like to take a look for yourselves. Yesterday Haiti Nursing Foundation Director Marcia Lane alerted me to broadcast reports coming right from the school, now being used as a clinic, in Leogane. Go right inside the school's makeshift clinic by clicking here for footage which aired on CNN. Please note there are several male nursing students shown in the report. This is particularly meaningful in an environment where just a year ago one male nursing student there reported repeatedly being called "miss" because the profession was considered of such feminine origin. Perceptions do, indeed, change.

Dean Hilda Alcindor, RN, of FSIL School Nursing, the first BSN nursing program on the island of Haiti created under the guidance of Haiti Nursing Foundation (HNF), has found her voice amidst tragedy. Following is a portion of correspondence from her to Marcia Lane, HNF director. It reveals the succinct and poignant message of reality.

On Jan 16, 2010, Hilda Alcindor wrote:

"Thank God I am alive. The students are doing well. The building is standing. The house that I leased collapsed with everything in it. Thanks for the dean's house on campus, it serves as the headquarters. Our students are doing a wonderful job. FSIL is about the only healthcare facility in Leogane. We need all kind of medical supplies. The students have delivered so far four babies: 3 boys and one girl. All of them are healthy.

"We lost three students (1 senior, 1 junior, 1 sophomore). The sophomore perished with her little girl.
It is overwhelming but I am holding. 

"The school has a lot of cracks (walls and ground). I am afraid if another earthquake comes the school might collapse. ... FSIL ground serves as a tent city. There are about 5,000 people living on the grounds right now. Thank you to all. Continue to pray for us and the people of Haiti"

"Life is either a daring adventure or nothing at all. Security is mostly a superstition. It does not exist in nature." --  Helen Keller

That apt quote is provided by Marcia Lane, director of Haiti Nursing Foundation, as she faithfully passes along an eyewitness account of the immense struggle for survival in Haiti.

Marcia writes, "I'd like to share excerpts from an email that came in from Suzi Parker of Austin, Texas.  She and her husband John have been working in Leogane to help get the hospital reopened.  Her eloquent account has been edited; she apologized for her mistakes as the computer she was using didn't have a well-lit screen."

Here are some of Suzy's own words from Haiti:

"At night we sleep in the yard behind the hospital where the bandstand was. It has fallen, as has the Episcopal school. There are 200-300 people who sleep in that field at night. They sing hymns until almost midnight, and we wake up to a church service, with hymns, a morning prayer, and the apostle's creed. The evening sky is glorious.  In the field there is a real sense of community.  Of course, we are the only blancs [whites] there...

"The injuries we have seen at the hospital are enormous, skulls exposed; one woman died in the yard.  Another woman's leg was cut vertically to the bone, with muscles showing.  Doctors worked and saw over 300 people with cuts, fractures, etc.

 "Of course, we have seen looting.  The end wall of the guesthouse by the shared drugs fell and it was open to the outside. My friends can imagine how I shouted down about 20 looters in the guesthouse. Righteous indignation works wonders, as does a tiny bit of pushing people to get out. 

 "The priority today has been finding a way to get supplies to Leogane.  We keep hearing how FSIL School of Nursing has become a central location of care for the people of the city. But we just heard from Hilda [Alcindor, dean at FSIL] that the generator and water pump are broken. 

"There are so many nurses and doctors here, standing by and ready to help, but it's still not possible to fly into Haiti unless you're with certain relief efforts. One of our board members, along with 300 other Haitian American doctors and nurses, is trying to get clearance for their plane to land tomorrow. They can do so much good if allowed to enter Haiti.

"From someone at the Gates House next to FSIL comes this list of most urgent needs: Medical supplies are number one. (Antibiotics, analgesic;  some people are already having diarrhea because of the poor sanitation situation.) The most important thing for now is cask because a lot of people have broken legs and arms.  Some need to be operated ASAP. There is no anesthesia.... there is a lot of need...  Gloves, face masks, infection control kits, hands care products, sterilizing solutions, IV fluids, Adhesive medical tape, Antiseptic and wounds cleaners, PAIN RELIEVERS, ANTIBIOTICS, Anxiolitcs and sedatives.

"We can start here at the nursing school and maybe setup another station at the stadium where there are a lot of people as well... I should not forget that there is a big need of TENTS because it will take a while before anyone has someplace  to live...."

Suzy also remarked: "I have never understood joy in the midst of suffering, but now I do. The caring I have seen, the help we have received from the Haitians, the evening songs and prayers are wonderful. The people will survive, though many will die. Please pray for us." 

Within a half hour of the earthquake Dean Alcindor was working with nursing students and recent program graduates to care for people injured during the earthquake.

"This is how we are imagining them, and it is a wonderful image indeed," reported Marcia Lane, director of Haiti Nursing Foundation.

HNF board member Donna Martsolf, PhD, RN, and fellow American Michelle Sare, RN, a potential visiting faculty member who traveled to Haiti just a day before the quake, are reported safe at FSIL. "Not only safe, she [Sare] is running the emergency ‘clinic' taking place at FSIL, along with some of the graduates. Donna said the students ‘stepped up big time and they're champs,'" said Lane. Hôpital Sainte Croix (Holy Cross Hospital) in Leogane, a mile from FSIL, was reported yesterday as collapsed. However, Martsolf reported to Lane that it is "cracked, but standing."

What Can You Do?

Lane said she has received many e-mails from people who want to help. She answered: We are encouraging private citizens to focus their efforts on supporting established aid organizations that are deploying resources to Haiti, and to hold off on travelling there themselves. .. There are many excellent organizations working in Haiti, and it's easy to find the most effective, reputable ones. We consider Haiti Nursing Foundation to be one. Contributions will reach FSIL as soon as possible, to cover student and faculty needs, medical supplies, hygiene kits, and other support for the school's relief efforts."

Lane also noted, "It's wonderful how many nurses have asked if they can help in Haiti. At this point, however, only the most experienced relief organizations can deal with the challenges posed by a lack of water, food, lodging and transportation. Most roads that are not strewn with rubble have been impassible at night because of people sleeping or lying wounded there."

  Those looking to donate time, supplies or funds should contact the Center for International Disaster Information (CIDI) at 703-276-1914, or visit them online at http://www.cidi.org/incident/haiti-10a/

Other Support for FSIL

Lane has always been clear about the help needed to support nursing education in Haiti. The need has grown this week. She suggests, "If you have nursing students or others who would like to give specific help to FSIL, funds can be raised for both needed items (medical equipment and supplies, textbooks) and student support. Student Nurses' Associations have conducted fundraising events to benefit FSIL. The University of Michigan SNA is holding its third annual charity ball 'Hope for Haiti' in February. Students from two schools have traveled to FSIL for a week, to work with their peers at FSIL - conducting community health fairs, offering coaching in English, and attending classes together. These have been rich experiences for all involved." For those wishing to discuss any such involvement, contact Lane at mlane@haitinursing.org .

The tragedy that was Haiti a week ago has worsened this week. It has deepened to unfathomable proportions, unimaginable suffering. Innocent people beset by abject poverty, scant healthcare, few medical supplies, unsafe drinking water, raucous streets (there's really no workable police system there) are now also stripped of lean-to homes, meager stores of food, spotty energy supplies and hope itself.

Hospitals have collapsed as the recent earthquake did its best to shake the human spirit from these island survivors. Want to talk nursing shortage? There are only 11 nurses for every 100,000 residents on the island of Haiti. And how many of them are now trapped under rubble? It's anyone's guess.

I've blogged extensively about the pre-earthquake needs in Haiti, nursing volunteerism on the island and the Haiti Nursing Foundation's recently-established - and first - BSN nursing program on the island, FSIL School of Nursing. It was an attempt to share the call for help as well as the pride in their accomplishment. This week the call grew stronger, and the admiration that I feel from a distance in these young, would-be nurses is palpable.

According to Marcia Lane, director of Haiti Nursing Foundation, the nursing students are applying their new skill sets to help earthquake victims. They are pulling together as a team in unthinkable circumstances to realize the power and importance of their chosen profession.

"We know from their response to the fall 2008 hurricanes that FSIL students have the capacity to organize and respond with significant relief efforts," said Lane. "We know that if they are unharmed, they are providing care to people at this moment."

Lane later updated, "We've just received an unconfirmed report that the school [in Leogane, 20 miles west of  Port au Prince] is basically okay and the students are treating many people who've come to the grounds for care."

The school's resistance to the quake may be due to the fact that it was built on reinforced concrete as specified by the U.S. Agency of International Development. A hospital just a mile away was not as lucky - it was flattened.

The nursing school's dean, Hilda Alcindor, RN, a driving force in the creation of the BSN program, has not yet been located and her safety is unknown.

How can enough praise be offered to Haiti Nursing Foundation and the ardent work of people like Alcindor who formed a nursing groundwork on the island? Thanks to their efforts there are now a few more caring hearts and healing hands to help in the face of this natural holocaust.

There will be incalculable needs in Haiti in the coming months. If you care to help from a nursing slant, suggestions are available at Haiti Nursing Foundation's Web site.

Nursing’s ranking as the most trusted profession in America the past 8 years in Gallup’s annual Honesty & Ethics poll is testament to the reverence with which the public holds the caring profession.

It’s a sentiment nurses return each day when they go to work. In fact, for some that sense of commitment to caring about and for others combined with a belief in holistic nursing practice focused on the body, mind and spirit, i.e., “the whole patient,” is the driving force behind choosing a career in faith community nursing. 

ADVANCE contributor Joan Fox Rose, MA, RN, explains in a top story feature running Jan. 13-26 on the ADVANCE for Nurses Web site how faith community nurses become qualified to establish health ministries and typically provide community education rather than hands-on nursing care. And while many are mature nurses, Rose reports, younger nurses are increasingly choosing the specialty.

In 2005, the American Nurses Association, which as early as 1977 recognized faith community nursing as a specialty, teamed with the Health Ministries Association on Faith Community Nursing: Scope & Standards of Practice. Those volumes “articulate the professional expectations of faith community nursing for all care levels and settings,” according to ANA and HMA.

On Jan. 6 this year, ANA released Faith Community Nursing: Developing a Quality Practice, written by Carol J. Smucker, PhD, RN, and Linda Weinberg, DNSC, CRNP, RN. Rooted in the 2005 publication, this new book “is organized as a quick reference for the busy faith community nurse” and includes information for developing a health ministry program.

Both books are available at http://www.nursesbooks.org/ the publishing arm of ANA.

In the newer book, the authors describe their personal experiences working daily in both Christian and Jewish congregational settings to emphasize the variety of faith community settings, the types of positions available and diverse educational backgrounds of faith community nurses.

In her article, Rose profiles health ministries in Jewish and Christian settings in Texas and Florida, but easily could have included any of the thousands of health ministries and faith community nurses serving myriad denominations around the country and enjoying what apparently can be a very satisfying career.

"… Job satisfaction for our nurses is off the scales,” confirms Roy Phillips, MSN, RN, director of a faith community nursing program in Texas serving an area the size of Kansas. “And [our] retention rates are phenomenal!"

In the movies, 2010 has been portrayed as a year of odyssey, finding answers to difficult questions and then finding a way to work together with others toward a common goal.

That view sums up my entire list of New Year's resolutions this year, and if I do it right, my journey will take me to new personal and professional goals.

For the umpteenth time, dieting tops my list, but this year I don't plan to lose 5 pounds every week so I can get to my goal quicker. I plan to use the whole year to gradually take off the extra pounds I gradually put on so when I get to my goal, I'm more likely to stay there. This means a shift in the way I cook, but, frankly, every one in my house will benefit. I just need to find out why I immediately got hungry just thinking about dieting!

To complement that, I have vowed to exercise, but you won't see me joining the gym right away. I know myself too well - we once had a gym membership for a year and I went twice. This time, I will start off small, with 15 minutes of walking every day. I'll build up to longer stretches, then find other exercise to add in, like hikes in a local park or using the Wii Fit that is now just taking up space by the TV.

I have to admit I'm a typical 60s girl - little makeup and not much hair styling. Since I work from home, I only got "fancied up" when I went on a site visit or to a conference. That was OK when my hair was long enough to sit on and I could just braid it or put it in a pony tail. Now that it's short, daughter delights in telling me how horrible it looks when I just wash it and let it go. I will either have to go a lot shorter (not likely, given my ears!) or take the 5 minutes every morning it would take to look polished. Ditto with a touch of makeup, even just at home. Daughter swears it will make me feel better and more professional, so it's worth a try.

These are small parts of the big journey ahead of me this year. The biggest step, and the one most likely to challenge my resolve, is also the hardest: I am a procrastinator. As a newspaper editor for many years, I worked under daily deadlines. Now, as public relations and editorial liaison for ADVANCE, my deadlines are scattered across the calendar. I tend to underestimate how much time I need and overestimate how much work I can get done in any given week. This year, I will (WILL) pull those two disparate ideas closer together, to clean my professional house in a way that helps my team work toward its common goal.

Four resolutions don't sound like a lot, but I plan to reinvent myself from the inside out this year. I'd love to hear from you all on ways that worked for you to achieve your New Year's goals. Resolutions always have been daunting to me, and these all go against my couch potato grain... Five days down, 360 to go...

I beg to differ. There's more to taking responsibility than admitting guilt. Taking responsibility does not mean gloating over a mere chance to incinerate hundreds of innocent people. It does not mean admitting wrong-doing, then swearing to do it again.

Taking responsibility carries more heft. It means owning up to a deed, then doing everything in creation to correct the results of that action. Taking responsibility means intellectualizing the tragic aftermath of a murderous misstep and making retributions to those who might have been killed. It means forging bridges of peace and understanding.

Had the explosives detonated as intended in Detroit, the only "responsible" people likely would have been the first responders -- the EMTs, the police officers, the firefighters, the paramedics, the nurses, the doctors -- on the scene to patch up survivors and attempt to minimize a holiday horror. They would have been holding themselves unnecessarily "responsible" for the ones they couldn't save.

Taking responsibility has become a terrorist's way to say, "I did it, and so what? I'll do it again."  It's become an easy way of snatching a little notoriety in a world gone sick with hatred and ill-will.

The first time a terror group truly takes responsibility  -- defined by Webster's as moral, legal or mental accountability -- it will be cause to celebrate.

There has never been a heart attack in my family, at least not within the boundaries of my memory. Family members have succumbed to cancers of various types; for counter balance, a fortunate handful have made it well into old age.

But a couple days before Christmas I learned that my brother-in-law, still "young" (meaning not yet eligible for senior rates at the movies), vital, and in the rush of middle life, had a heart attack.

He had been out shoveling snow - the first of the Northeast winter - the day before. His son Jamie - a rock band drummer on Christmas hiatus  - had come home for the holidays, and noticed his father was having unusual "heartburn" - a kind that wouldn't quit, and wouldn't allow his father to relax in comfort.

Maybe it was a musician's sensitivity to the proper rhythm of life that allowed Jamie to recognize an interruption to the usual cadence and tempo of his father's daily pace. He knew there was a serious discord. He urged his dad to get to a hospital. And without skipping a beat, he did.

That may have meant the difference between life and death. Jamie's father had suffered a mild heart attack, but a serious blockage remained. It was cleared, a stent was put in place, and he was home in time for Christmas dinner.

We all know better, but we all do risky things - like shoveling snow as we maintain some sort of mid-life disbelief that such activities can kill us. We live in denial that arterial blockages could actually have our names on them. We are human, but we sometimes overlook the reality that our own lives are finite.

And we don't always listen to our kids, because we forget that our children are one step farther along the evolutionary trail than we are. But, my brother-in-law broke that pattern. He had the good sense to heed his personal drummer boy. And now he has every reason to expect to be one of that handful living well into the golden years. A very special gift, indeed.

I was at the gym, doing the obligatory 40 minutes on an elliptical. I was willing to read anything I could get my hands on to help pass time and minimize the drudgery of pumping toward nowhere. To my great joy, wedged among the body-building magazines was an outdated issue of Marie Claire magazine. So with legs straining and heart thumping, I settled in for a light read.

   Then I got to "Forced to Be Fat," an article that stopped me and my elliptical in our conjoined tracks. Writer Abigail Haworth pulled me into a fascinating but completely troublesome description of leblouh, a practice of unrelenting force feeding (we're talking 16,000 calories a day of oily gruel, pure animal fat and more) of adolescent girls in the West African nation of Mauritania. The purpose? To coax young forms into the copious, undulant, multi-chinned, fat-rippled figures of women considered the ideal of femininity and eroticism by men descended from the Moors, nomadic Muslims who traversed the rural western Sahara Desert region of the country.

Hardly able to believe what I was reading, I was jolted further by the magazine's image of a young woman, heralded for her beauty - "largely" because of her ample supply of adipose tissue and the status-building stretch marks all over her 20-something cocoa skin.

Eating or Beating

It seems premarital young "women" (mere children by U.S. definition, at 12 or 13 years of age) are sent to "fat farms" where they are forced (by threat of beatings) to eat. And eat. And eat. Haworth noted that the experience is so harsh that these girls are sometimes forced to eat their own vomit if they have the unfortunate necessity to get sick.

They are restricted from moving - no burning of precious calories at this fat factory. They must languish on the ground until the next gruesome, gruel-some meal begins. The girls, often sent to the farms without realizing the eventual outcome, have been known to cry and scream at feeding times, according to BBC News.

Once the deed is done and the portly figures are in place, these women are highly prized as brides. In time, some women turn to hunger-inducing drugs to help them continue to ingest massive quantities of food - all to maintain their ample girth. The intentional fat retention stands as a sad salute to their men who have been known to threaten divorce if their wives fall "prey" to healthful, svelte bodies.

How did this passion for obesity begin? According to a report on msnbc.com, the preference for excessive fat evolved from a Nomadic past, in which people fought to eat and simply survive against harsh conditions. Fat meant wealth, success and status. And in time, fat meant beauty and sensuality.

Women Face Health Consequences

Too bad for the corpulent desert women of rural Mauritania. Marie Claire reports that diabetes, hypertension, heart disease and depression are becoming the reality of Mauritania's roly-poly beauties. One doctor quoted in the article told of a 14-year-old girl whose heart was so huge it nearly "collapsed under the strain."

The Mauritanian government had tried to effect change, producing get-thin campaigns along with television ads poking fun at fat females. And many Mauritanians in less rural areas prefer Westernized ideals of slender women, and are vocal about it.  However, in August 2008, a military coup removed the country's Democratic government and installed a junta (later maintained in a questionable election) extolling "tradition."  And that tradition includes fat women.

The voices of anti-force feeding activists are starting to be heard in Mauritania, largely in cities where the "old ways" are less attractive. Most heartening is the fact that gyms have begun opening their doors to women who are determined to shed the weight that has become their own human bondage. They are reclaiming their bodies by trading mulafa robes for sweatsuits. While change is slow to infiltrate the Sahara region, it's coming as sure as a shift in the sands.

As I finished the article, I rethought the drudgery of that elliptical machine. Somehow the last 10 minutes didn't seem such a chore. To make a free choice to do what is best for mind and body is a blessing, on any continent.

On another note: Join me and fellow ADVANCE staffer  Kay Bensing, MA, RN, as we launch a new blog in the new year all about fitness, weight loss and universal struggles along the wellness trail.

A big part of looking at evidence is numbers. Nurses need to question whether something can be considered evidence based on the sample size or if predicted outcomes are small or inconsistent.  As well they must scrutinize where the study came from - do the authors or their supporters stand to gain or lose based on conclusions drawn from the studies.

Makes sense. But when it comes to cancer, especially breast cancer, it is difficult to consider evidence that goes against "what's always been done."

Logic vs. Emotion

I believe our healthcare system needs to change (I don't want to use the "R" word). I think we are too quick to do expensive tests, invasive procedures and prescribe pills. I believe in prevention and personal responsibility. I also believe in science and that decisions that impact the masses should be made based on good science and evidence.

When I heard the new recommendations for PSA testing this summer and mammography this week, I was, and still am, hesitant to accept.

Every Mother's Day and Father's Day I do road races that raise money to support breast and prostate cancer awareness. I have a personal connection to both cancers. I know breast cancer survivors who were diagnosed well before age 50. I don't know that I want to forego my annual mammogram - even if evidence tells me the exam is unnecessary.

It would be easy for me to listen to the hospitals, radiologists, labs and other groups who are speaking out against the new recommendation because they seem to have our best interests in mind. But I can't forget these entities also stand to lose a significant amount of money - just like the insurance companies stand gain - with the change.  

Hype & Health

The most difficult part of assessing information like this is the hype put forth by the media and those with political interests. It's difficult to look logically at any study when being barraged with personal stories of mothers, sisters and daughters being diagnosed with breast cancer at a young age. Do the recommendations really say women younger than 50 aren't worth the cost of a mammogram? Using the same logic, then, what about the 30 year olds and 20 year olds? If we don't test everybody for everything are we saying they are not worth it?

The only conclusion I've come to based on what's happened since the announcement is that I don't trust any source to give me pure logic and science. This announcement has only served to confuse and to fuel the current political strife. I wonder if anybody has our best interests in mind.

For more on this topic, read these additional blogs: Mammography Screening Changing? and Mammagrphy and the Right to Choose