Your Health & Happiness: Harm reduction –
a window of opportunity
Programme Coordinator, Health & Development Networks (HDN)
“Harm reduction recognises that some people in society
will choose to use drugs, and refuses to condemn them to the resulting
suffering. We need to remember that drug users are human beings and treat them
humanely whatever choices they make,” says Paul Hardacre, Training
Coordinator, Asian harm reduction network (AHRN).
Hardacre, AHRN Training Coordinator
Paul Hardacre spoke at the monthly NGO forum held at Health
and Development Networks (HDN) on May 31, 2005. The theme of the forum,
‘Harm Reduction – a window of opportunity’ was taken from the title of
an AHRN film which formed part of the presentation.
AHRN is an information and networking organisation that
links individuals and organisations, who are working to prevent the spread of
HIV among injecting drug users. As well as information sharing AHRN also works
on advocacy for harm reduction enabling policies, program development,
training and research.
Seeking to clarify and define what is meant by Harm
Reduction, Paul was keen to debunk the common misconception that harm
reduction is about legislating for the legalisation of drug use. Harm
reduction is essentially an attempt to reduce individual, social and economic
harms associated with drug use, with out judging the choices made by drug
users. This means providing drug users with the information and support they
need to stay healthy.
of the Window of Opportunity video.
Harm reduction is a pragmatic approach that recognises that
a drug free society is an impossible utopia. “What we are working for is not
a drug free society but a ‘drug poor’ society”, Paul said.
Harm reduction interventions can include outreach to drug
using populations, peer education, drop-in centres, provision of information
and education, voluntary counselling and testing and needle and syringe
exchange programmes. The later form of intervention is the one that most often
makes the headlines, and is often perceived quite negatively by the general
Needle and syringe exchange programmes are an important
means of preventing the spread of HIV among injecting drug users and their
communities. Despite the opposition faced by these programmes there is no
evidence to suggest they increase drug use or crime in the areas where they
Another important aspect of some harm reduction programmes
is pharmacotherapy. Pharmacotherapy is, most commonly, the use of methadone as
a replacement for heroin, though it may include other drug replacement
therapies. This form of treatment is designed to counter the compulsive
cravings suffered by many drug users, which increase the potential risks
associated with drug use. Pharmacotherapy can allow drug users to regain
control of their lives and provide a way out of drug dependency.
The ‘Window of Opportunity’ video presented us with the
image of a teenage boy injecting himself in the groin on the streets of an
Asian city and asked us; “Is this boy a criminal or does he need help?”
For more information on harm reduction please contact AHRN.
Tel: 053 893175, 893144 Website: www.ahrn.net.
The NGO forum takes place on the last Tuesday of every month. For more
information please contact Owen Elias at Health and Development Networks, 053
418 438 or [email protected]
The Doctor's Consultation: Gallstones -
the 82 percent story?
by Dr. Iain Corness
As medical students, we learned the Five F’s of
gallstones. The mnemonic went Fat, Fair, Female, Fertile and Forty as these
represented the typical gallstone sufferer. Unfortunately, like all catchy
mnemonics it isn’t quite true, as 10 percent of men also have gallstone
Unsure of where your gall bladder is hiding and what it is
supposed to be doing? It is found under your lower ribs on the right side of
your body and is attached to the underside of your liver and is involved with
digestion. In its natural healthy state it is like a hollow sausage attached
by a tube (called the bile duct) to your stomach. It is when it gets
gallstones inside it that you begin to get a problem.
So where do these gallstones come from? Well, 80 percent of
them are made of our old friend Cholesterol, or Cholesterol mixed with
pigment, that’s why you can get such pretty colours, though I am yet to see
any made into a necklace, but it could catch on, I suppose. The Cholesterol
stays in solution until something happens to slow down the emptying of the
gall bladder, or thicken the solution, such as happens during fasting or
through not drinking enough - water (sorry to have raised your hopes for an
instant). This results in what we call biliary “sludge” which then hardens
and turns into gallstones.
Factors which increase the likelihood of developing
gallstones include increasing age, obesity, a diet high in animal fats and
certain medical conditions such as diabetes. Oh yes, pregnancy also increases
the incidence. (With all these problems that can happen with procreation, it
is a wonder the human race survived this far!)
The management of gallstones has also changed dramatically
over the past 20 years because of three main factors. The first was the
development of Ultrasound visualization. At last we had a way of diagnosing
gallstones, and painlessly too. Not only could we now “see” the
gallstones, but we could tell if they were the cause of pains in the belly by
being able to pick out inflammation in the gall bladder wall.
The second development was ERCP (you know how we love
acronyms in medicine) which stands for Endoscopic Retrograde Cholangio
Pancreatography. At the end of the operating telescope (the Endoscope) the
surgeon can sneak into the bile duct and scoop out stones that are blocking
the duct which have been causing jaundice.
The third development was Laparoscopic Cholecystectomy and
was pioneered in 1987 by a French surgical team. Instead of practically sawing
you in half to get at the gall bladder, hiding under the liver as I mentioned
before, this is a much less invasive method, where the operating laparoscope
is inserted through a small incision in the abdominal wall, and the surgeon
does the job under the direct vision. While this results in less trauma,
shorter hospitalisation and quicker recovery, it is not always successful as
it may be too difficult to snare the gall bladder, and the operation may have
to be converted to the older “open” method.
It is also important to remember that gallstones can be
found incidentally, and if they are causing no problems, the answer is simply
to leave them alone. The chances of developing symptoms over 20 years are
about 18 percent, or so the good books tell me, so with an 82 percent chance
of getting off with nothing, who is going to volunteer for an operation you
probably will not ever need? What “gall” to even suggest it!
I went out for my birthday and spent some time at a few bars in some of
the naughty but nice sois then caught a motorcycle taxi to another set of
bars where I had a few, then I went around the corner where I had a few
beers in some bars and when I checked my pockets the next morning (well
afternoon really) my money was all gone other than 20 baht. Do you think I
was robbed? And should I report this to the police?
No, my little Poppet, you weren’t ripped off, you were just attacked by
the beer bug. This little creature gets into your wallet in pubs and eats
into your money, generally leaving you just enough to get home, if you are
lucky. There was a bad infestation of these little blighters at New Year,
though I believe some isolated outbreaks have even been reported since
then. The only way to beat the bug is to keep your wallet hermetically
sealed every time you go out on a bender. Of course you won’t win too
many friends, but at least it stops the money being eaten. The only other
thing you could do is to send all your money to Hillary and I’ll treat
it with bug spray and see if it happens to me. I’ll let you know whether
it was successful by email from the Bahamas.
I have a really great relationship with my new Thai girlfriend other than
one thing - she kisses funny. I have always thought that kissing is where
you put your lips on her lips and go “smack” but she doesn’t do
that. She sort of puts her lips on my upper lip and then sniffs. First
time I thought she just missed my mouth. The next time she did it I
thought she had a cold or something. The next time she did it I thought I
must have bad breath so I cleaned my teeth till the gums were practically
rubbed raw. What am I doing wrong, Hillary? Or is there something strange
about my girlfriend?
There is nothing wrong with either of you, my Petal. Well, nothing that I
can deduce from your letter anyway. You have been “sniff kissed” young
man, a unique Thai way of showing a romantic endearment. While foreigners
get all wet and mushy, the Thais can do it without even smudging their
lipstick. Enjoy your relationship. She likes you! But please do keep
brushing your teeth. You can’t be too careful.
It is obvious now to everyone that you must be a smoker. Your reply to
Anxious Annie where you suggested she set fire to her dog is cruel and
vicious, as well as being a ridiculous answer to the poor woman’s
philandering husband problem. It is people like you that have allowed
beagles to be used by tobacco companies to smoke cigarettes and get
cancer. You should be ashamed of yourself. I am disgusted that a woman in
your category would put forward such notions.
I don’t know what tablets you are supposed to be taking Mrs. Disgusted,
but I do suggest you double the dose immediately. They are not working. I
did not suggest to anyone that hot dogs were the answer for anything. And
how did the beagles get into this? Personally I didn’t think the tobacco
companies liked their dogs smoking cigarettes, as they’d much rather
sell the ciggies instead. And on my salary, what with the price of
chocolates pegged to the price of petrol, I couldn’t even afford to
smoke, even if I wanted to. Finally, what sort of “category” do you
think Hillary is in? The third category perhaps? You are certainly barking
up the wrong tree, and I suggest you take the dog with you. I really wish
you would check your facts before barking at Hillary, my Petal!
Is there something wrong with me? I’m from America and I am not used to
going into a bar to be propositioned. I don’t want to have someone ask
me where I come from. I don’t want people to know how much money I make.
How many children I have is my affair. Why doesn’t someone tell these
girls in the bars that not everyone wants to tell them personal details?
All I want is a quiet beer!
Are you one of those strong silent men? Or maybe you have something to
hide. Stop worrying, the girls aren’t from the CIA or the IRS, they are
just doing their job as well as they can, in a foreign language too, and
you’re lucky they can converse as much as they can. If you don’t want
the girls to talk to you then you have lots of choices. You can buy a
bottle of beer and sit alone in your room (I’m sure that nobody as
secretive as you shares with anyone else), or you can drink in more
up-market watering holes for starters. Finally, is there something wrong
with you? Yes, Petal, there is. You wrote to Hillary - that’s enough. I
rest my case!
Camera Class: The Nikon D2X. Is this the ultimate digital camera?
by Harry Flashman
still adhering to traditional film, but carefully watching the digital
alternatives, I had thought that I would like to have a play with the Nikon D1X.
There was only one thing stopping me - the price. Last time I looked they were
around 250,000 baht!
However, because I was so tardy in making up my mind (or
saving the bikkies), Nikon decided not to wait for me and has introduced the new
Nikon D2X this year. Officially, Nikon describe it as their 12.4 Megapixel
Digital SLR with Wi-Fi options.
Having looked at the specifications for this camera, I would
describe it as the most advanced picture taking device currently available, with
the capabilities of a small photographic studio system. Hearkening back to my
own studio, this was set up with medium format cameras, IR senders to trigger
remote Broncolor flash units, which were all independently programmable and
other ‘in-camera’ capabilities. Looking at the Nikon D2X, and incorporating
their Wi-Fi (wireless remote) control option and Nikon’s TTL Speedlight
system, this combination would beat my old system hands down. Not only total
control of all functions, but even remote triggering for the camera with five
frames per second speed.
The Speedlight system bears some explanation. Called i-TTL
Speedlight Technology, this was first seen on the D2H Nikon, and is the same (or
better) than studio multiple flash heads. Where you had to run around setting
each flash head power settings individually, the i-TTL technology in the D2X
allows photographers to wirelessly control in full TTL, up to three groups of
Speedlights, with any number of individual speedlights in each group. This works
for photographers who now do not need to ever calculate flash and distance
ratios, because the i-TTL systems is capable of making all exposure calculations
in real time, wirelessly, during the exposure to deliver a perfect flash
exposure in any situation.
Photographers can even maintain full control of each group of
Speedlights from a master, on-camera Speedlight, by dialing up or down flash
exposure values for each group. This technology can potentially distill an
entire portrait lighting system into a small set of multiple SB800 and SB600
While creative control is a bonus, if done easily, the end
result still needs to be pin-sharp and colour rendition needs to be excellent.
After digital conversion, a new processing method has been added to increase
precision for smoother display of tones from highlight portions to shadow
portions of the image and smoother gradations with consistent and smooth
transitions, all with exceptionally pure color rendition.
Professionals need their cameras to be fast. The D2X is ready
to shoot the instant it is turned on having an almost imperceptible 37
milliseconds shutter lag time, an area which has been a problem with high
resolution digitals in the past.
The time between each shot is reduced as well, so the D2X is
capable of shooting 5 frames per second at full 12.4 megapixel resolution for up
to 21 jpegs. If that is not fast enough for the action photographers, the D2X
has a High Speed Cropped Image mode that allows 8 frames per second by using a
dual area sensor that records only 6.8 million pixels in the centre of the
sensor. The D2X also has a high-speed AF system that features eleven auto-focus
sensors of which nine are cross type and placed in the rule of thirds layout.
Battery life with high performance cameras can be a problem,
but Nikon claim approximately 2,000 shots per charge, with accurate real-time
displays. This sounds almost unbelievable, but I doubt if Nikon would tell us
With the Wi-Fi option to be able to operate the camera some distance away,
this makes this the most complete camera system today, in my book. At the
beginning of this article I said there was one thing that had stopped me getting
a Nikon D1X, and that was the price. With the new D2X, there are two factors
stopping me - firstly the price, and secondly the cost! But I would certainly
like one! Go for a virtual look at http://www.niko ndigitalusa.com
Dr Byte's Computer Conundrums
by Dr Byte, Citec Asia
If you are one of the lucky ADSL users in Chiang Mai, you
have most probably been suffering the lack of zoom and speediness that we have
come to expect from these services. At one time or another over the last 3 or 4
weeks, CAT, CMNet, Loxinfo, KSC, jINet and all the others have had problems that
have impacted on our international internet connections in one way or another.
Like a deck of cards falling over, a fire in one of CAT’s Chiang Mai Telephone
Exchanges around 4 weeks ago seemed to start the pain. Failing routers,
bandwidth issues, virus attacks, and power supply outages have increased our
expected 40ms connection speeds to more than 4000ms and what that means is your
connection to your favourite web page is so slow to load, you can have
breakfast, mid-morning tea and lunch while waiting.
I was talking with Roger, Chiang Mai and he asked me about
making some e-mail stationery for his business. If you thought colourful
stationery was only for handwritten notes, think again. If you use Outlook
Express, not only does it come with a swag of built-in stationery for your use,
you can create your own and download some pretty neat stuff from the web too.
Stationery in Outlook Express usually has a background image
or colourful strip at the top or on one side. It also uses a complementary type
face so your email looks good. For business users, adding a banner or even a
small animated banner is really simple too. Outlook Express can be configured to
use a particular stationery design by default and you can then, if desired,
select a different stationery (or none at all) on a message by message basis.
Check and make sure you have selected Rich Text (HTML) for
mail format. If not, select that option from the Format menu. It won’t work
unless you do that.
Next, to add stationery to a new message, in the New Message
window, choose Format, Apply Stationery and choose a stationery to use.
To set a stationery design for all outgoing messages, choose
Tools > Options > Compose tab and, in the Stationery area, click Mail and
click Select. Click on a stationery style to view it in the Preview window
(click Show Preview if the window isn’t visible). Click OK to use this
stationery for all new messages.
If no design pleases your eagle eye, check on the internet
for other offerings. You can also use Outlook Express by selecting Tools >
Options, Compose, in the Stationery area check the Mail checkbox and click
Download More. If you’re connected to the internet, you’ll be taken to the
Outlook Express stationery download site where you’ll find a list of
downloadable stationery, together with instructions for downloading and
If you still haven’t seen what you want, create your own
custom stationery. Ideal for the business user or someone who wants a unique
style all their own. Choose Tools > Options > Compose and, in the
stationery area, click Create New - this is a better choice than Edit, which
opens an HTML editor, like FrontPage. The Outlook Express editor is much
When the Stationery Setup Wizard appears, click Next. Choose
a background from the list or click Browse to use your own picture or logo.
Choose the Position for the image and whether to tile it over the page. Choose a
background colour - if the logo is a GIF with the background made transparent,
the background colour of the stationery will show through the image. Click Next.
Now choose a font - remember to select a plain font that is
likely to be on everyone’s computer. Use the Colour option to choose a font
colour and, if desired, choose Bold or Italics. Click Next.
Adjust the placement of the text in the message. Do this if
you use an image down the left of the page or centred at the top to avoid the
message being typed over the picture. Click Next and give the stationery a name.
Click Finish then, in the Compose dialog Stationery area, click Mail, then
Select and choose the new design to make it your default stationery.
In the next column, I have a few more Questions and Answers
to share with you. Don’t forget to keep your preferred anti-virus and
spysweepers up to date. Do a full hard disc scan and sweep at least once a week.
Don’t open e-mails with funny attachments if your not expecting them and last
but not least, make sure your firewall is on. Dr Byte appears in Chiangmai
Mail every 2 weeks and if you have any questions or suggestions you would
like to make, you can contact me at Dr Byte, Chiangmai Mail.
Money Matters: European Union Savings Tax Directive - the real facts
MBMG International Ltd.
From July 1, 2005, new tax legislation will become
effective throughout the European Union. This could impact on anyone holding
deposits or savings within any EU country, and the tax havens of Gibraltar,
The Isle of Man and the Channel Islands. Knowledge of how they may affect
Europeans is vital to those people who have savings within this area.
As a culmination of long-stated EU intentions to comply
with OECD anti-money laundering standards and the increased global pressure
to act against money laundering that built up following the ‘war on
terror’, the EU Finance Ministers agreed a Savings Tax Directive which
finally comes into force this summer. This requires all registered
institutions in all the EU states to exchange information on interest
payments on savings and deposit income of non-resident private individuals
so that they can be taxed at the appropriate rates in their home country.
The majority of EU countries will adopt this method of
exchange of information. In other words, if you hold deposits in one EU
country and reside in another, the country where the deposits are held will
inform your country of residence so that you can be taxed there.
There are exceptions to this - Luxembourg, Austria and
Belgium have elected to instead deduct a withholding tax at source.
Switzerland, Isle of Man and the Channel Islands will also be adopting the
withholding tax option, even though they are not members of the EU.
In practice, this means that for the countries adopting
the exchange of information route, on an annual basis, details of interest
earned from private bank accounts and investments shall be passed to the
account holder’s home country.
In the case of countries choosing instead to levy
withholding tax, then this will be deducted at source from interest payments
at an initial rate of 15% subsequently rising to an eventual 35%. The
withholding jurisdiction will retain 25% of the tax revenue and will forward
the remaining 75% to the home country of the account holder, but without any
details of the account holder.
The legislation will cover bank deposits that pay
interest, as well as investment income that generates from fixed interest
securities (government and corporate bonds). However trusts, offshore
investment bonds and life insurance based products are excluded from the
directive and therefore offer a legitimate means of tax planning. However,
it should be remembered that under the arrangements already in place between
the government of the UK and the authorities in both The Isle of Man and the
Channel Islands then any withdrawals from such products that exceed twice
the basic rate tax band in any tax year are automatically notified to the
Inland Revenue if the policy holder is UK resident.
What this all means in practice is that:
1) Anyone whose residential address (according to the
data held by their EU bank or financial institution) needs to look at the
withholding tax and information exchange consequences of the changes in
legislation and evaluate their impact and explore alternative structures;
2) Investments and deposits of any individual who might
return to the EU or Switzerland at some future time might also be affected.
It has come to our attention that a number of
organizations have been sending out rather scare mongering communications
that have caused some considerable alarm amongst the expatriate community,
without explaining who will be affected immediately and who may be affected
in the future. Unless you currently hold EU domiciled investments or
deposits AND you also have an EU residential address, then this should just
be a matter to be addressed as part of your overall planning for the future
IF you may subsequently resume residence of an EU country. If not, then
there are unlikely to be any implications stemming from this.
We have prepared a detailed review of the arrangements for those persons
who will be affected. The introduction to this was published last year in
our weekly columns in both the Pattaya Mail and the Chiangmai Mail.
Simply email us at [email protected] if you require a full copy,
or contact us to arrange to discuss this further.
The above data and research was compiled from sources
believed to be reliable. However, neither MBMG International Ltd nor its
officers can accept any liability for any errors or omissions in the above
article nor bear any responsibility for any losses achieved as a result of
any actions taken or not taken as a consequence of reading the above
article. For more information please contact Alan Hall on
Life in the Laugh Lane: I was born in Fargo, but I take pills for it
by Scott Jones
Fargo, North Dakota, USA, almost Canada, suburb of the North
Pole. You may have seen the black comedy movie “Fargo”, which is actually a
documentary, although I’ve never personally known anyone who stuffed a body
into a wood-chipper. Yes, many people in Fargo actually do talk like that:
“Uff dah, ya sure, you betcha. I tink we might haff ta eat some lutefisk
tonight.” (Lutefisk is a Norwegian fish dish made from cod soaked in lye, an
official poison, until it’s a translucent pile of preserved, decomposed
tissue which fills the house on Christmas Day with fumes so noxious they almost
trigger the uncontrollable Vomit Reflex. I’ve never eaten it, but I have
stepped in it.)
skyline near Fargo with North Dakota State Tree on the left
For some strange reason, thousands of Scandinavians left
their beautiful, mountainous, fjord-filled homeland to settle in perhaps the
flattest place on the planet. When God was creating the earth from a ball of
clay, he dropped it, making a flat spot where it hit the floor. As a cosmic
joke, he kept this horizontal, featureless plane and called it North Dakota,
though “Frozen Rectangular Pancake” would have been more appropriate.
Winter lasts 465 days a year, interrupted by a few days of “spring” when
the snow mutates with dirt into living lumps of sludge on streets and lawns.
Fargo sits next to, or often in the middle of, the Red River, though “Smelly
Brown Ditch” would have been more appropriate. In spring when the river
overflows its banks, the highest points in eastern North Dakota, the water may
flood 75 kilometres on either side. (It’s like spilling a bucket of water on
your kitchen floor.) If summer falls on a Sunday, everyone goes outside for a
picnic. Meals match the geographic landscape: plain plains food. “Spicy” is
limited to the use of onions and “hot” is mainly coffee. Unless you love
the sky, grey and 40 below, or miles and miles of miles and miles of
monochromatic wheat fields, there’s not much beauty in North Dakota. Last
year they held the Miss Fargo Beauty Pageant and no one won. The one good thing
about being from Fargo? Wherever I go, it’s better.
So, besides the food and the weather in Thailand, I love the mountains and
valleys. And some of the roads, though you never know what will or won’t be
around the corner. Photo 1: A very, very, very steep hill near Pai. The bikers
are dead now. Photo 2: Your brakes and wheels may survive the first hill, but
not the next. Photo 3: Even if your wheels make it, there may not be a road.