Monthly Archives: September 2019

Immigration and Pharmacy – Success Stories

Pharmacy practice is filled with amazing individuals.  We all know Pharmacists that stand out for various reasons. Lately there has been a climate of intolerance towards those that come to Canada or the U.S. from another country. This confuses me given the history of successful immigration not only in Canada but other countries as well. Pharmacy practice is no stranger to this and I have found it necessary to share the brief stories of just a few of the many immigrants to Canada that have and continue to contribute to the profession of Pharmacy.  My regrets are that I couldn’t include more people here and that their stories are so abbreviated in the interest of space.  These are the stories of just 3 such individuals to spotlight their paths of immigration and contribution to Pharmacy and to Canada.

KYRO

My first call was with Kyro Maseh, a Pharmacist from the Toronto area.  He came to Canada in August 1996 with his family from Egypt.  The main reason for their move was the growing religious discrimination they were seeing and decided it was time to leave.  He was 8 years old when they arrived.  His mom was a Pharmacist, which helped their acceptance into Canada.  At the time Canada was looking for Pharmacists from Egypt and his parents read that it was a good place to raise a family. His dad was a well-known and respected vetrinarian of livestock in their area but gave up that profession when they came here.  Kyro had very little English language and no alphabet skills when he came here but you would never know that now.  He now speaks French, English and Arabic.  His early days in Canada were modest by his standards today and back in Egypt.  Their furniture came from what they could scrounge up from the garbage and housing was not luxurious to say the least.  To add to the family’s stress, his mother was diagnosed with cancer after their arrival.

Kyro eventually returned to Cairo for his Pharmacy education.  At a metropolitan centre he wouldn’t experience the same discrimination as his family did in Asyute where he was born.  One day a mother came into the pharmacy and told Kyro that her son didn’t wake up that morning, he had overdosed.  She said to him that she wished someone had warned him. It was in The Beaches area of Toronto where there is a small community feel.  He began to feel at this moment that it was his calling to help educate others, particularly young people about addiction and prevention of addiction.  Mental health and addiction became an area of focus for Kyro from then on.  He feels that as pharmacists we are good at talking to people and we are knowledgeable in science.  Teaching then becomes an important and natural part of our job. His #EndTheCrisis campaign tries to focus on kids on awareness of addiction.  His warning in hesitancy of immigration points to the case of Raymond Schinazi, who was forced from Egypt, only to become instrumental in the development of antiviral medications we use in pharmacy today.  He says there is strength in diversity, something he is living proof of.

Christina

Tina Privado Azzopardi (Christina) grew up in a relatively poor setting with both of her parents, 3 brothers and 1 sister on the beautiful island of Cuyo in the Philippines.  It’s an area that is quite isolated transportation-wise from the urban areas of the Philippines and very much more laid back.  To see this tiny spit of land on a map verifies the isolation they lived in. She moved to the more metropolitan centre of Manila to pursue a degree in Pharmacy and graduated in 1997.   This would not have been possible without the scholarships she received and monetary help from an Aunt she moved in with during that time in Manila.  Her Aunt was a business owner and fairly well to do.  In return, Christina would help out with the bookstore business as was needed. Upon graduation, she was employed as a lab instructor at the private University she had attended and worked there for 5 years.  The pay was not high in this position.  

Pharmacy practice and overall healthcare in the Philippines is quite different than here in Canada.  She recalls the system as very sad and medications can be difficult to obtain with little structure to any healthcare system, little private insurance, and expensive prescriptions.  The Physician is rarely challenged on a prescription when it comes to switching to a generic or dealing with an interaction.  Physicians are held in high regard like they are here, but it is more of an authoritative role.  Collaborative care with a Pharmacist’s input is not common.  Brand name reps often visit the physicians and leave samples. This leads the physician to often write for the brand name of medications and there is no switching to generics unless it is written for.  Christina tells me it is still this way today back home.  It is not uncommon for antibiotic prescriptions to be filled for part of the total days supply due to the cost.  Being on a chronic medication can financially ruin a family that tries to pay for them.  

Christina eventually saw a benefit in working in Canada.  With the help of a broker that spearheaded the move for Zellers who was looking for pharmacists, she prepared herself for the transition, which included 3 qualifying exams.  She recalls this as an unsure time as scams were often present with such brokers.  At the time, the internet wasn’t as widely used as today and verification of such scams was more difficult.  Eventually, through friends of hers that knew the friends of the broker she was fairly satisfied this was above board and made the move with a group of 5 others; all academia and non-retail in background.  This particular group came from Centor Escolar University and from the University of the Philippines.  Unfortunately for Christina and her family her father passed away of cancer before her time to leave came.

She recalls her arrival in the GTA after 24 hours of travel when the 3 girls in the group opened the door to their new apartment and realized it was completely devoid of furniture.  It was a feeling of emptiness she recalls.  She recounted having the bed sheets she travelled with that night and they eventually got some furniture that was donated by other Philippino families living in the building.  It was in a building that had many other immigrants from the Philippines.  She lived in Barrie for three years where she worked and paid off her commitment to Zellers.  Making the switch from academia to retail in a corporate environment was tough but she was mentored during that time and felt comfortable becoming a store-owner after that.  She embraced the chance to become involved in the independent Pharmacy world.  She now owns a store on her own and partly owns three others.  She purchased a home, got married and has a 6 year old son in Tottenham, Ontario, about 70 km from Toronto.  Her mom stays with her for ¾ of the year and goes back to the Philippines for the remainder. Her commitment to the pharmacy profession is obvious but her 6-day weeks with 4 stores will hopefully become 4 day weeks to give her more family time eventually.

Johnny

Johnny Marya has no direct recollection of his birth country of Greece.  His parents were Christians living in Syria, a minority group in that country.  His father started work when he was 13 with Johnny’s grandfather in the jewelry business in Syria.  It was a family of 6 children and a life of productive work looked more favorable than school.  Early on they knew that North America offered more potential than they saw in Syria, including education for Johnny.  Before Johnny was born they moved to Greece where they lived for a short time around his birth.  His Father became a jeweler – making a fairly good living there.  They decided to begin the work to start the path to Canada and his father moved his wife and Johnny back to Syria while he went to the U.S. to begin the paperwork to have the family moved over here.  The year was 1989.   This is a process that lasted nearly three years.  During this time he didn’t see his father, who supported the family from the U.S., undoubtedly a long period for Johnny.  Finally, in 1992, when he was 2 ½ he moved to Montreal with his mom to be reunited with his dad.

Growing up in Canada offered Johnny and his family (which also now includes a sister) opportunities and education they would not have had back in Syria.  Johnny saw the value of education.  As an immigrant it was instilled in him to get an education first in order to be successful and to work hard to get what you need.  He went to work at small jobs at the same age his father did as a young boy.  His first job was at a grocery store, receiving orders and preparing fruits and vegetables for sale.  His next jobs included a Subway, a Theatre, a paper route, a duty free shop at the airport, snow removal, a forklift driver at a warehouse, a truck driver for a delivery company, and a clothing salesman for H&M. With his family they also started a tourist agency and a popcorn company, both of which they ended up selling.

As Johnny started his 4 year Bachelor’s degree in finance, he approached his father to rekindle the jewelry business that he had started to wind down.  Johnny developed a business plan and incorporated a proposal that included updated technology and smaller batch custom-made jewelry production with little to no overhead in inventory.  This was a busy time for him, working 40 hours per week while in university.  During this time he interned for a live broadcasting company that expanded and offered him a great job that he couldn’t refuse so he took that job and still offered to help his dad with the jewelry business.  He was 22 years old at this point.  He worked there for a year and turned to a recruiting agency to find a job in finance.  He was immediately offered a job with the recruiting company and within 2 years he was one of the top producers, mainly with pharmaceutical companies.  This is how he started to learn about drug companies, including McKesson.  His sister also became a Pharmacist.  After some extra legwork he convinced his future employers at McKesson that the recipe to a successful hire of a salesman isn’t in the salesman’s background in what they sold in the past (like automation), it’s in the ability of the individual to sell.  After all, Johnny spent a long time with the recruiting company coaching others in how to nail an interview.  Johnny has become Regional Sales Manager for Atlantic Canada and been doing that job for 3 years.  

Johnny’s extended family has also immigrated.  An uncle who was a physiotherapist back home, now works in Canada as a masseuse, another uncle is a successful physician in New York, and a cousin is with the Canadian Army.   Johnny’s story underscores the belief that immigrants often have a strong work ethic, come to Canada because they recognize the simple formula of education and hard work leading to success, and can be hired by companies that recognize this value and potential in this country.  While he not a Pharmacist, Johnny represents one of the many immigrants that have come to this country and contribute immensely to healthcare through their special expertise, not to mention the contribution of his family that also came to North America.  He has contributed to the success of many Pharmacies in this country.

The stories from immigrants were all equally interesting for differing reasons as I interviewed them for this blog.  I soon realized it was going to be difficult to tell their stories fully to and keep the blog’s length appropriate.  Immigration has proven to contribute to the success of Pharmacy in Canada.  Its benefits are seen both directly through immigrants who began here with a Pharmacy career and flourished, but also through the children of descendants that have come here from abroad.  Something I have learned through this exercise is how Pharmacy operates in other parts of the world.  From the examples I have heard, Canada is actually an excellent country to practice this profession, given the complaints we may have here in this country.  The respect given to Pharmacists and the value of pharmacy as a profession is strikingly higher here comparatively.  Thanks to all for their contributions in helping to promote the value of immigration through our profession.

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The Mental Health Effects of Weight Stigma & Why We Have To Stop Pushing Diet and Exercise As a “Solution”

I have been working lately with Roni Davis in helping patients understand the concept of “Healthy Weight” and how weight loss. Roni has been through the cycle of regular person, regular person who became concerned with weight gain, regular person who went through diet weight loss and weight gain, regular person who struggled with their mental stability due to dieting, figure athlete, personal trainer, and then to a regular person who talks people down from how they feel about their weight to how they should feel about their weight. Roni’s experience reflects not only what people feel after years of struggling with maintaining or losing weight, but also shows the results of a growing food environment that sets up the general population for failure from the time they wake up until they go to bed – even if they don’t leave the house. We also need to be aware of comments that are derived from privileged individuals who supply advice based on personal feelings of overweight individuals. While I’m a big fan of “not one eating pattern can claim to be the single plan for everyone”, her words of comfort are based on one woman’s experience from a high altitude level that helps to ground everyone.

Last week apparently Bill Maher went on a rant about fat shaming. His argument? We need more of it.

James Corden replied with this:

“If making fun of fat ppl made them lose weight, there would be no fat kids in schools, and I’d have a six pack by now.”

“I’ve been off & on diets since as long as I can remember & this is how it’s going.”

James Corden

It was brilliant. But even he’s still missing the point a little and so I wanted to really dive into the topic. 

That is, fat shaming, weight stigma, and weight loss because like Bill Maher I was someone who also used to fear the fat acceptance movement – but as they say, when we know better, we do better. 

So, what will follow is decades of personal experience, as well as, almost a decade of professional experience.

You see, like tens of millions of other people, I also bought the lie. You know the one I mean, the one that says if I was only thinner, if only I was smaller, if only the scale displayed a lower number, if only I could stick to “diet and exercise” then I’d be worth something – then I’d be happy and healthy and life would be perfect. The lie that says only people who are lazy and no self-control gain weight – the lie that says if only I’d get off my ass and diet and exercise – then I’d be skinny and worthy of love, belonging, goodness, and respect.

THEN, I’d be happy – I’d be worth something. 

But it almost killed me.

And it’s all lies. Right down to the “diet and exercise solution” we’ve been sold – and I say that as a former award-winning personal trainer/nutrition & wellness coach.

Have you noticed this?

You’re sitting around chatting with friends, the subject of weight, or your bodies comes up and everyone is expected to add something derogatory about their body.

“I’m so fat. I’m so gross. This shirt makes me look like a whale.”

“Yeah, me too… I can’t take it anymore and am starting that keto thing on Monday – so gotta enjoy myself this weekend cuz I’m not gonna be allowed to eat this anymore after that” 

And if in that discussion you piped up and said, ‘I actually feel OK about the way I look,’everyone there is going to judge you, scrunch up their noses and think “well doesn’t she just think she’s special”…and they probably wouldn’t call you to hang out anymore. 

That’s how pervasive and expected body hate has become.

We’re supposedto be ashamed of our bodies. 

It’s become not only more acceptable to insult your body than it is to praise it, it’s expected.. it’s even become how we bond… in this weight stigma fueled, collective dysfunction of disordered eating that is serial dieting and body hate.

And it is so toxic. 

My mother has always told me about this one time I was with my grandmother in K-mart when I was 2 – sitting in the shopping cart, I pointed across the aisle and asked loudly… Grammy, why is that lady so fat?!

I was 2. I wasn’t born knowing what fat meant but by the time I was 2 years old, I had already been taught to judge it, to question it and not want to be it.

I was taught that “letting myself go” by gaining weight was a fate worse than death.

So, in my mid-teens, when I put 2 or 3lbs, I was horrified and desperate to take it off.

That first attempt at weight loss, would have ended in a very different way had I known then what I know now. 

But those were the Atkins days.

His low-carb miracle cure said carbs were the problem and my weight loss dreams would be answered if I just quit those. But the more I tried to eliminate carbs, the more I thought about and craved them.. and the more weight I’d gain.

Each time I tried and failed, I was ashamed and felt like a miserable failure. I spent decades scared of my own growing body!

Since “we are what we eat“, I felt like I was bad because I couldn’t stop myself from eating bad stuff. Thoughts like, “you’re a failure, you’re so stupid, weak, pathetic, disgusting!” ran through my head a million times a day. 

His low carb diet rules destroyed my relationship with food, started a 2 decades long battle with my weight and my already low self-worth ended up even lower. By the time I was in my early 30’s I was borderline morbidly obese and haaaated myself and my body.

In 2007, “clean eating” entered my life and within 4 days of trying to follow “clean eating” rules, I had my first binge. The following day, my first compensatory behaviors emerged – I starved myself and exercised for about 3 hours to “make up for it”. Overnight, by doing what I was supposedly “supposed to do” to “solve my weight problem”, my mental health was trashed, just like that. 

Within 8 months I was sitting in a therapists office, hearing the word bulimic come out of his mouth while bawling my eyes out & begging him to tell me why I couldn’t control myself with food. 

We’re taught that perfect bodies are the only bodies worthy of love and goodness and the rest… well, the rest must be shamed and blamed into conforming.

We’re taught that gaining weight makes us bad and losing weight makes us good.

That’s a message we all promote loud and clear every single time someone loses weight and we celebrate them like they just won a Nobel. (but what happens & how do they feel when they regain it – like 95-98% of people who lose weight always do?)

So we punish ourselves with decades of dieting, severe calorie restriction, binge eating (the result of feelings of shame and dietary restriction), over (or under) exercising, and a horribly abusive inner dialogue – without even realizing those things and that world, all just making it worse.

Personally, at my heaviest, I was borderline morbidly obese for my height – and while I WAS dieting and trying to “stick to” exercise – I just kept getting heavier.

Like many people, I started dieting at a healthy weight and “dieted” my way to obesity.

And then, also like many people, dieted my way to an eating disorder. Sure, eventually I did manage to lose the weight and become a “success” story. But that’s ridiculous rare (only about 2-5% who lose weight ever actually manage to keep it off). 

We have GOT to change our definition of success around this whole weight conversation.

Weight gain is not failure and weight loss is not success. Especially when so few actually keep it off and so many end up with eating disorders that almost kill us. 

The sickest thing of all is that in our culture, that’s okay – because it’s better than still being fat, right?

No.

I carried shame with me every where I went like a 100lb weight wrapped around my neck. I felt like I was the only one who hated myself and couldn’t control myself with food, or “stick to” anything.

I thought I was the only who treated my body like a garbage dumpster, the only one punishing myself in that desperate attempt to make my body conform into something considered acceptable.

I thought I was the only one using food to so desperate try to fill a hole that I couldn’t quite identify.

I thought I was the only one who spent decades in the disordered eating world of serial dieting, and getting up every morning vowing that “today I’m going to be good!”only to hate myself for caving and eating a cookie or something by mid-day.

I thought I was the only one who stood in the mirror using words like disgusting, fat slob, gross, and worse when I’d see my reflection.

But I wasn’t. 

There are millions.

Trust me when I tell you this – people who struggle with their weight ARE TRYING TO DIET AND EXERCISE THE “PROBLEM” AWAY. 

It isn’t working. We have to stop telling everyone that’s what they need.(I wrote an ebook that talks more about why it’s not working. If you want a completely free copy, email me: roni@ronidavis.com)

75-97% of women report having unhealthy thoughts, feelings or behaviours towards their bodies at least once a day. 

That is a whopping majority of women who already believe there is something wrong with their bodies. They don’t need you, or Bill Maher or their doctor, or ANYONE else reinforcing it.

How, as a society, did we ever come to believe that the answer to physical or mental health is walking around living with shame, unhealthy thoughts, feelings or behaviours and hating ourselves for not being good enough because of our body size?

It’s ridiculous.

And we just keep passing it on to each new generation.

80% of 10 year old girls report having been on a diet and more than half of girls as young as six report wanting to be thinner. 

The scariest part of that is that studies also show the younger a girl is when she starts her first diet, the more likely she is to engage in extreme weight control behaviors (get an eating disorder), gain even more weight, struggle with her weight her whole life, and even abuse alcohol by the time she’s in her 30’s.

The average woman makes 3-4 (unsuccessful) weight loss attempts every single year for her entire adult life. 

Of the rare few people who actually lose weight when they go on a diet, as many as 98% regain it all and 2/3’s of them will weigh 11lbs more than when they started within 5 years.

Here’s the thing and I want to make sure this point is made loud and clear:

WE HAVE BEEN TRYING TO DIET AND EXERCISE THE PROBLEM AWAY.

It ISN’T WORKING. It’s making people gain even more weight over time. 

We have ALL grown up in this diet obsessed culture that taught us 1) weight loss equals success and looking amazing, 2) all weight gain is equally bad… very bad… and needs to be “fixed” 3) it’s the result of being too lazy to “fix” it, unmotivated, weak-willed, having no self-control and 4) you fix it with shame, blame, willpower and band-aids that actually make things worse

It’s all lies and it’s NOT working.

Diet & exercise advice is NOT working.

Blame and shame is NOT working.

Tens of millions of people are dieting every single year and have been for generations – weight watchers has been around since the 50’s. Atkins since the 80’s or 90’s. 

The weight loss industry has been doing nothing but growing and along with it, so has the population. 

That’s not a coincidence. 

It’s NOT working.

Diet culture is built upon the back of weight stigma and promotes fat-shaming, fear, and distrust in ourselves. It feeds on our insecurities and fuels the story that we are only worthy of love, acceptance and goodness if a scale displays the “right” number or we eat the “right” things and that happiness is only found on the other side of the next diet promising miracles.

And it’s all making our population MORE unhealthy. 

This isn’t just a mental health issue, but a social justice one as well – weight stigma & fat shaming remains one of the last socially acceptable forms of discrimination in our society and diet culture has made it not only accepted but even normal and expected.

As James Corden said, it’s bullying but worse, it’s socially acceptable bullying that’s hidden under the guise of “just caring about people’s health”.

But it’s not acceptable, it’s not helpful, it’s most definitely deeply damaging our physical and mental health – and it’s making weight gain worse. 

Traditional wisdom is based on a misguided fear that if people feel too good about their bodies and themselves, they will not be motivated to engage in healthy behaviors. 

But what we now know is that the opposite is actually true. 

There are strong, negative associations between internalized weight shame and poor mental that include 2.5 times higher levels of depression and anxiety. As well as, lower self-esteem, disordered eating, eating disorders, increased binge eating, and just overall worse mental health-related qualities of life.

1 in 4 people who diet to lose weight, end up with an eating disorder – a number that’s doubled in the last 20 years. And eating disorders have the highest mortality rate of all mental illnesses.

Further, higher levels of weight bias internalization are actually strongly linked with worse physical health as it creates lower motivation for healthy behaviors, worse adherence to healthy eating attempts, worse weight maintenance, and more. 

We are simply more prone to self-sabotaging, self-punishing, and unhealthy behaviors that actually promote more weight gain when we experience the bullying that is, fat-shaming. 

The bottom line is… there are severe mental health consequences of fat-shaming and weight stigma and they become cascading effects on mental and physical heath as well. 

Just imagine for a second if we stopped all the blaming, shaming & judging.

If we all just collectively stopped obsessing over body size or what our bodies looked like and started actually just focusing on how we feel in our bodies? If we focused on how our choices were making our bodies feel and on WHY we made choices that make it feel like crap?

I don’t want one more woman to destroy her mental health in that ridiculous war with her body and her scale. I don’t want one more little girl’s life to be destroyed by an eating disorder because someone taught her she had to be skinny to be worth anything and that food rules and restrictions were the key to health, happiness and self-worth.

If the diet and exercise solution worked the planet would be skinny and happy by now. 

It’s not working because it completely ignores the brain – the WHY behind the hundreds of auto-pilot choices we make every day. 

Behavior and habit modification doesn’t happen with blame and shame and it doesn’t happen by trying to force willpower and motivation for “sticking to” a bunch of strict food rules that accompany diets or trying to force ourselves to stick an exercise program in the hope that maybe someday a few weeks or months from now, if we’re just good enough and follow it, it’ll make us skinny. 

Habit and behavior modification happen at the brain level – because our brains control everything.

They’re controlling the things we tell ourselves about ourselves, they control everything we think, everything we feel and every choice we make – and much of the time unconsciously so we don’t even realize they’re doing it.

THEY are the greatest determiners of the quality of our lives and our health – and they are where these beliefs live in us.

The reality is, we can have a society that continues judging, shaming, blaming and ineffectively band-aiding symptoms while feeding a multi-billion dollar industry at our own expense but is that really what we want?

I sure don’t. 

We have to love, respect and value allbodies… unconditionally because choices made from love, respect and acceptance are 100 times healthier than choices made from shame and hate.

Imagine the difference that would make… if we lived in a culture that didn’t even think about weight. 

A culture that just focused making choices from a place of love, self-compassion and acceptance.

If we had a culture that promoted healing our wounds instead of creating bigger ones.

If we had a culture that promoted befriending ourselves and our bodies, no matter what size they are.

If we had a culture that uplifted everyone within our orbit, rather than tearing them down.

That’s what we need.

The truth is, if you truly care about people’s health, you’ll start becoming part of the solution rather than continuing to remain a huge part of the problem that is fat-shaming.

____
If you’ve been struggling with food, dieting, your weight, and the shame that accompanies those things, help is available. Visit http://www.ronidavis.com/stonesfor more.

Roni Davis

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