Andalucía: Great scenery, fantastic weather and improving accessibility for those with disabilities

andalucia name

andalucia scenery andalucia beach

There can be absolutely no doubt that the area of Andalucía in the south of Spain is a lovely place to visit on holiday. There are many places to visit, fantastic and varying landscapes plus gorgeous Mediterranean beaches.

   And all this while enjoying the very best of Europe’s weather. Of course, it is a wonderful place to live, too. My wife Lisa and I moved here last November but that is another story.

   Getting around most places in Andalucía, and elsewhere in Spain for that matter, is not a problem for the majority of people. Similarly, access to buildings is largely pretty easy and not worth a second thought.

   Not worth a second thought, that is, as long as you are able-bodied. For those who have physical disabilities, however, it is not always so easy but tourist sites and hotels are fine and generally the situation is getting better. Accessibility is something that matters to me as my mobility problems, caused by multiple sclerosis (esclerosis múltiple in Spanish), mean that I’m in a wheelchair when out and about.

   Now, in more modern towns and cities, or in developments that have taken place relatively recently, there are few problems. In Andalucía, you can see real differences.

   In many towns the pedestrian crossings regularly alternate between those at road level and those at pavement height; the latter also serving as traffic calming ramps. But, for a wheelchair-user, both are easy to cross because the road-level ones have proper dropped pavements each side while the pavement-level ones are just that, flat and level.

   However, not all dropped pavements are as good. In older towns, originally built well before the invention of motor vehicles, some facilities for the disabled have been added but not always with sufficient thought.

   To see this, we need look no further than the road right behind the medical centre in Cuevas del Almanzora, in Andalucía’s Almería province.. There, someone has felt the need to install a dropped pavement, which is a good idea for wheelchairs – so close to the medical centre. But why on earth has the bottom of it been left well above the road level? Dropped from the pavement height it may be but there is still a significant step to overcome. Words fail me.

   Then there is one pedestrian crossing with a dropped pavement on one side of the road but a full height kerb on the other. Of course, tourists and my fellow British expats may be tempted to laugh at such a situation but I could show everyone an example of something similar in the UK. There, a crossing has a dropped pavement on each side but, having crossed the roadway, you are then left on an island with a kerb to negotiate to enter the car park.

   Actually, talking about car parking, that reminds me about people from other countries using disabled parking facilities.  Disabled parking cards issued by any EU country are recognised throughout Europe but how they may be used depends on the rules of the country in which you are parking.

   So, a holder of the disabled blue badge from Britain must remember that here in Spain it does NOT give you the right to park in a ‘no parking’ zone like it does on yellow lines in the UK; it simply gives the authority to park in a bay designated for that purpose.

   Finally, a word about access to buildings. Fair’s fair, this is improving throughout Spain but we have to realise that what may be desirable may not always be possible. What can we do, for example, about an old town post office with its door at the top of five steps and with no room for a ramp or a lift? Not a lot.

   However, in the same town, the branch of one bank, Banco Popular, with a step up to its door has recently been completely refurbished, including moving the door to eliminate the step and provide a flat and level entrance. Good planning for those with disabilities and parents with children in strollers.

 

 

Everyone’s vote should matter – but does it?

ballot box

Uncertainty is hanging over the heads of people in so many different countries this year as questions relating to their futures are being decided at the ballot box. Well, they should be.

In the USA, the various Democratic and Republican candidates are fighting through the primary and caucus system to win enough support to win their party’s nomination as candidate in the presidential election in November.

In Europe, there are three important decisions being made: the Irish general election; the UK referendum on whether to remain in or to leave the European Union; and the efforts In Spain to form a government following the December general election that left no party with enough seats to govern alone.

flag USA

Back in the States, there are really only two contenders for the Democrats: Hillary Clinton and Bernie Sanders. Hillary is by far the favourite although her early victories have been close – some decided by the toss of a coin and others through the help of unregistered voters. It seems that not all is as it should be in the States. My wife, Lisa, is American and she is not surprised by the shenanigans. “Votes don’t matter in America. People don’t really choose candidates or the President. Look at the New Hampshire primary; Sanders won 60% of the popular vote but, because of party rules, Clinton won the most delegates; tell me how that is fair or democratic,” she says.

On the other side of the political debate, the Republican fight seems to be only of concern now to three would-be presidents: front runner Donald Trump, Ted Cruz and Marco Rubio. Others still in the race seem to be out of contention. As the campaign heads towards ‘Super Tuesday’, it looks as though Trump may soon be in an unbeatable position to be named as the party candidate.

flag Ireland

Ireland goes to the polls tomorrow, February 26, to elect its new government. Opinion polls point to Fianna Fail replacing Labour as the second largest party. Fine Gael looks set to remain the largest party, just, but with fewer seats No-one is predicted to achieve an overall majority.

flag Spain

Spain’s parliament meets on March 2 in an attempt to install PSOE (socialist) leader Pedro Sanchez as prime minister. To do so, he will need to win the support of the majority of deputies choosing to vote. Some may abstain. If the PSOE leader cannot receive the necessary backing the PP (conservatives) may be asked once more to form a government but  they have already declined once. Should all attempts fail, Spain will go to the polls once more in June.

flag UK flag Europe

The UK faces a vote in the form of a referendum to either remain in the European Union or to leave it, the so-called Brexit. The vote takes place on June 23 and the ‘Remain’ and ‘Leave’ campaigns both have support from politicians in all the main UK-wide parties. This referendum is too distant and the campaign too long to hazard a prediction yet.

 

Time to put Spain on HSCT world map

th

Regular readers of this blog will, by now, be fully aware of my truly international way of life. I am British but, more exactly English by birth but regard myself as Welsh by adoption. My wife of almost five years (we have both been married previously) is American, in particular a New Yorker, and we live in the sunny south of Spain having moved here in November last year.

Health is a concern, especially as I have multiple sclerosis, epilepsy that is so well controlled that my last seizure was 40 years ago and atrial fibrillation which means my heartbeat is irregular. This is helped by medication.

In recent weeks, this blog has included a number of posts about stem cell transplants, notably HSCT, to treat patients with multiple sclerosis, although it can treat other auto-immune illnesses too. These posts began with January’s BBC TV programme Panorama featuring HSCT being carried out in the UK in Sheffield’s Royal Hallamshire Hospital – but has since widened to include other centres in King’s in London as well as major ones in Russia, Mexico and even Israel.

And there are many more hospitals involved worldwide but I wondered how close to my Spanish home that HSCT is available today.

Surfing the internet, two lists of HSCT facilities jumped out. One was the Immune Renewal Foundation1 and the other was HSCT stops MS2. Neither list includes Spain but as the IRF does not include the UK, hope still remained.

More research did, indeed, find a promising result – yes, right here in Spain.

fuster_josepThe barnaclinic+ runs the Hospital Clínic de Barcelona’s Hematopoietic Stem Cell Transplant (HSCT) Programme which started in June 1976 and the clinic became the first Spanish centre to perform an allogeneic transplant. During the years since then, more than 1900 transplants have been performed and, today, between 80 and 90 transplants are conducted each year.

garcia_valdecasas_juan_carlosThe programme, under the leadership of Josep Fuster Obregón (pictured left) and Juan Carlos García-Valdecasas Salogad (pictured right), has a medical team that is 100% dedicated to HSCT. As a result, patients are always seen by the same team of physicians throughout the entire procedure, from their initial hospitalisation phase to subsequent monitoring at the day hospital or outpatients’ clinic.

There is also a team made up of specially trained hospital nurses who have extensive experience in the care of these patients with a nurse-to-patient ratio that is never more than 1:5. What’s more, there is another team – this time of home nurses highly specialised in this type of care. These facts are crucial for ensuring the high quality of care required for a procedure of this complex nature.

barnaclinic+ is a private medical facility that welcomes international patients and provides a variety of stem cell treatments:

  • Autologous transplant for unusual diseases, especially autoimmune diseases. Multiple sclerosis, Crohn’s disease and lupus erythematosus. It is the only centre in Spain taking part in international studies for the treatment of these diseases.
  • Allogeneic transplant from an unrelated donor
  • Allogeneic transplant for uncommon diseases

The Hospital Clínic de Barcelona is one of the few to have JACIE3 international accreditation for HSCT programmes. This endorses the quality of care of all procedures performed there.

Furthermore, the progressive improvement of Spain’s health system has meant that more centres are performing conventional hematopoietic stem cell transplants. That is why Barcelona’s programme, in addition to conventional transplants for all types of diseases, is also developing other lines of care.

For more information, or to request an appointment, check out the Hospital Clinic de Barcelona’s barnaclinic+ website4.

barnaclínic+ accepts patients from all over the world. During your stay, the medical and nursing team will communicate with you in English or French or, if necessary, will provide an interpreter to ensure that you can communicate in your own language.

In the case of international patients, we try to ensure that your visiting time is as short as possible, scheduling all tests, physician appointments and treatments as close together as possible.

International patients are given the following services so that neither distance nor language are obstacles to receiving the best medical care available.

You can make contact at any time by e-mail at internationalpatientsbcl@clinic.cat or by phone on 00 34 93 227 93 91 from 9:00 a.m. to 8:00 p.m. (Spanish time)

Before your stay at barnaclínic+, it provides:

  • Advice on the most suitable treatment for your situation and to help you choose the right specialist.
  • Help to schedule the best appointment time according to your availability and convenience. Form to request an appointment on-line.
  • Preparation of a sample estimate.
  • Information on the location of the clinic and where to stay during your time in Barcelona.

During your stay at barnaclínic+:

  • There will always be someone who speaks your language, whether this be the physician, nurse or an interpreter.
  • Advice from our Diets department, and in special cases, preparation of special diets adapted to your eating habits.

After your stay at barnaclínic+:

  • Advice on subsequent treatment and copies of all your medical examinations/tests.

 

1 The Immune Renewal Foundation, www.the-irf.com, ‘HSCT hospitals around the world’ lists hospitals in: Canada, Denmark, Germany, Israel, Italy, Mexico, Russia, South Africa, Sweden and USA. Spain is not included.

2 HSCT stops MS, www.hsctstopsms.com ‘Full list of HSCT facilities worldwide that offer HSCT treatment for MS and other AI diseases’ (Updated 04/01/2016) gives details of facilities in Brazil, Canada, Denmark, Germany, Israel, Italy, Mexico, Philippines, Poland, Russia, Singapore, Sweden, UK and USA. Spain is not included.

3 Joint Accreditation Committee-ISCT & EBMT.

4 http://www.barnaclinic.com/en_especialidades/72/hematopoietic-stem-cell-transplant

 

Spanish Royal visit to UK postponed; HSCT for MS Gwen Higgs update

King Felipe and Queen Letizia share a touchig moment on the day of his Enthronement in June 2014, along with their two daughters.

King Felipe and Queen Letizia share a touching moment on the day of his Enthronement in June 2014, along with their two daughters.

Weeks of political instability here in Spain, with no government yet to be formed following the December 20 general election and the king’s constitutional role in resolving the situation, has led to the postponement of the March state visit to the UK.

The long-awaited royal state visit to the UK has been scrapped, at least temporarily, because of how long it is taking to form a government.

It was expected to be especially exciting because King Felipe has not visited the UK since he became king in June 2014, and it is 30 years since the last Spanish state visit to the UK by his parents King Juan Carlos and Queen Sofia in 1986.

The queen and Prince Philip paid a state visit to Spain two years later.

It was only in December that King Felipe VI accepted the invitation from Queen Elizabeth II to pay a state visit to the United Kingdom in 2016 and the Spanish royals were due to be in Britain from March 8 to 10.

During their planned state visit, the king and queen of Spain would have stayed at Windsor Castle, according to a statement from Buckingham Palace.

The Spanish foreign ministry announced the postponement as the country’s politicians struggle to form a coalition to govern the country.

Political instability brought about by the fragmented results of December 20’s general elections ended Spain’s traditional two-party system.

Although leader of the party gaining the most seats in the Congress, former PP (conservative) prime minister Mariano Rajoy turned down King Felipe’s invitation to form a new government after it became clear he wouldn’t receive the necessary support from the other main parties in order to form a coalition.

Now, the King has nominated PSOE (socialist) leader Pedro Sanchez to form a government but, since it may take up to four weeks to complete negotiations successfully, the Royals have decided that they need to remain at home.

gwen higgs2HSCT Update – Gwen Higgs

The first of a two-part blog about the life of Gwen Higgs, her MS, the HSCT she received in Russia and her life today – begins tomorrow, Saturday February 6. Be sure not to miss it.

 

Fish really is brain food – for unborn babies

fish baby

It has long been a saying, in fact more than a saying, more like an ancient wisdom but often dismissed as ‘old wives’ tale’, that fish is brain food. And this has been borne out over the years by various scientific studies that have hailed the inclusion of Omega-3 fatty acids as having numerous health benefits that are good for both mother and baby during pregnancy.

Others, though, have warned against the negative impact of mercury found in some fish, like tuna.

Now, a new study1 across Spain coordinated in Barcelona and funded by the Spanish government, has found that some of the very fish pregnant women are discouraged by some health groups from eating may be the ones associated with the most protective effects on fetal brain development.

Indeed, eating fish like tuna is linked to protective effects on cognitive development and autism symptoms

The study, just published in the American Journal of Epidemiology, looked at approximately 2,000 pregnant mothers across Spain. During pregnancy, the women reported their fish intake via food questionnaires that categorized intake by types of fish. Most of the women ate some fish during pregnancy; the average amount was three servings a week.

During birth, blood from the women’s umbilical cords was assessed for levels of mercury, a contaminant linked to neurotoxic effects, and DHA, an omega-3 fatty acid. After birth, the women’s children were tested on scales for cognitive development and a scale measuring symptoms indicative of autistic spectrum disorder, both when they were 14-months-old and five-years-old.

Eating more servings of seafood a week was associated with increases in cognitive scores and decreases in symptoms of autistic spectrum in the children. Eating 600 grams of total fish per week—about three to four servings—was linked to a 2.8 point increase in IQ score. Unexpectedly, the protective effect was particularly strong for large fatty fish like tuna, which have some of the highest levels of DHA—and mercury—among fish types.

Umbilical cord blood tests revealed higher amounts of mercury and DHA for people who ate more large fatty fish but, interestingly, researchers didn’t see negative associations with mercury and the child’s neurodevelopment.

“It seems that our mercury indicator is telling more about fish consumption, and the positive effect of fish consumption, than the neurotoxic effects of mercury,” says study co-author Jordi Julvez, research fellow at the Centre for Research in Environmental Epidemiology (CREAL) in Barcelona. The benefits tapered off when fish consumption was higher than 600 grams.

How much fish is safe for pregnant women – and what kind – is hotly debated. While the European Food Safety Authority recognizes a benefit to one to four servings of fish per week for mothers-to-be, it recommends limiting fish high in mercury. In the United States, last year’s draft recommendations from the Food and Drug Administration (FDA) revised its position on eating fish during pregnancy. Previously, they’d cautioned women not to eat too much but in the new guidelines, they encouraged women to eat more of it – but only two to three servings a week – and to choose the types lower in mercury and limit their consumption of big predatory fish, such as tuna, which have more mercury.

The study was observational, so it wasn’t designed to determine a cause. But Julvez speculates that DHA omega-3s during pregnancy are the key – especially since other biomarkers for fish intake that they looked at, like vitamin B, didn’t explain the association.

DHA is important in building neurons and cell membranes, he says. And pregnancy seems the most effective time for children to reap the benefits on brain development. “In that specific moment, a large amount of DHA is needed when the brain is growing,” Julvez says.

More research is needed, especially on the role of mercury and whether the positive brain effects last past age 5. But for now, the results suggest that current American recommendations may be too stringent, Julvez and his co-authors write. “Overall, the present results suggest no adverse associations of high seafood consumption in pregnancy with offspring neurodevelopment,” adding that high seafood consumption may even bring some brain benefits.

 

1 Maternal Consumption of Seafood in Pregnancy and Child Neuropsychological Development: A Longitudinal Study Based on a Population with High Consumption Levels

Jordi Julvez, Michelle Méndez, Silvia Fernandez-Barres, Dora Romaguera, Jesus Vioque, Sabrina Llop, Jesus Ibarluzea, Monica Guxens, Claudia Avella-Garcia, Adonina Tardón, Isolina Riaño, Ainara Andiarena, Oliver Robinson, Victoria Arija, Mikel Esnaola, Ferran Ballester and Jordi Sunyer

Am. J. Epidemiol. (2016) 183 (3): 169-182 first published online January 5, 2016 doi:10.1093/aje/kwv195

 

 

 

Act now to save Orcas from extinction by chemicals

orca

Mammoth black-and-white Killer Whales, the mammals made popular by films such as Free Willy, face the terrible danger of extinction in the seas around Europe.

The cause of the problem is of human origin – poisonous chemicals.

Like other animals at the top of the food chain, the Killer Whale is particularly at risk of poisoning from accumulation of toxins, including polychlorinated biphenyls (PCBs) and a new study is reporting that high levels of PCBs are still being pumped into the world’s oceans.

And that despite it being banned many years ago.

The report of the study, of 1,000 Killer Whale, Dolphin and Porpoise samples taken off the Strait of Gibraltar, Spain’s Canary Islands, Britain and Ireland, describes the Strait of Gibraltar, their only passage between the Atlantic and the Mediterranean, as being ‘especially bad’.

The findings of the study, published in Nature magazine, have prompted zoologists to now call for tougher regulations including more stringent penalties for those caught disposing of man-made PCBs into the seas.

Paul Jepson, speaking on behalf of the London-based Zoological Society, said: “It’s really looking bleak. We think there is a very high extinction risk for Killer Whales as a species in industrialised regions of Europe.”

An earlier survey, off Washington state’s Pacific coast, found PCB levels in Killer Whales were higher than levels that had caused health problems in harbour seals. Meanwhile whale blubber samples in the Norwegian Arctic have been found to show higher levels of PCBs, pesticides and brominated flame-retardants than in polar bears.

More properly known by its latin name Orcinus orca, the Killer Whale is also referred to as the Orca. It is a toothed whale belonging to the oceanic dolphin family, of which it is the largest member. There are four types of Killer Whales that, between them, are found in all oceans.

They have a varied diet, although individual populations often specialize in particular types of prey. Some feed exclusively on fish, while others hunt marine mammals like seals, and even large whales. They have been known to attack baleen whale calves. Killer Whales are regarded as apex predators residing at the top of a food chain – upon which no other creatures prey or one lacking natural predators.

Killer whales are highly social; some populations are composed of matrilineal, or female line, family groups which are the most stable of any animal species. Their sophisticated hunting techniques and vocal behaviour, or ‘whale song’, are often specific to a particular group and passed across generations and have been described as manifestations of culture.

MS seems affected by sun; great prescription service

Poached eggs on the way.   Poached eggs on the way.

It was good to get back behind the wheel this morning and drive for the very first time since the automatic gearbox decided enough was enough on Christmas Eve.

It was an early start too. Well, early for me as we needed to be in our nearest town where Lisa had a 9am appointment at the medical centre. Even when we lived in Wales, I was a night owl and not an early riser and there was no need to change habits when we got here. Today was different.

Actually, talking of the appointment, it was just for Lisa to get her repeat prescriptions. Back in the UK, this had to be arranged a month at a time but, here, she came back to the car with a prescription for six months’ supply of her medications. Now, that is service.

The appointment this morning was also quite an achievement for Lisa as she went through it all speaking only Spanish and understanding the doctor’s replies. That’s something I could not do yet but I am working on that.

After leaving there, we returned home and I have to say that the car was an absolute pleasure to drive; I only hope that continues. Arriving home, my beloved headed straight for the kitchen where she prepared breakfast, as we only had a cup of tea before our trip to the medical centre. In fact, breakfast marked Lisa’s second ‘first’ of the day. It was the very first time in her life that she had cooked poached eggs. For a first attempt they turned out brilliantly but the cook wasn’t happy with her own work and says she is determined to do better next time. All I can say is, ‘yes please’ and ‘the sooner the better’; you might guess that I love poached eggs.

Having now lived in Spain for more than two months, during which we have enjoyed the autumn and early winter sunshine, I can say that living in the sun seems to be having a beneficial effect on the multiple sclerosis that affects me.

Sunshine is not a cure for MS but it does have two effects. First of all it helps your body create more vitamin D and, secondly, sunny days generally lift your spirits. Bearing these facts in mind, I feel that I am maintaining my balance better and am certainly falling less frequently. In fact, thinking about it, I have not had a real fall for weeks and even the number of times when my knee has given way has reduced significantly.