Doug and Jo

The Healthcare Resource List was updated today to add a clinic which has opened in Alto Boquete in San Francisco Plaza.

Meet A Medical Professional: Britzeitha Britton Autism Specialist (Master's Degree), Phonoaudiologist (B.S) by Jo Johnson Most people who will read this article do not suffer from Autism or have a family who does, but this disturbing condition has touched many of our lives. Most of us know some family struggling with the difficult situation of a child with Autism. Simply getting the child diagnosed correctly often takes years, and once diagnosed, finding the best path for each child can be extremely frustrating. In most of the Western World, the condition is hard to treat, so one can hardly imagine the increased difficulty in a developing country like Panama with limited resources and personnel. I was fortunate to be introduced to the ONLY Phonoaudiologist in Panama using the program of M.I.A, which is an integrated method of learning. Britzy acquired a post-graduate degree here in Panama, specializing in Autism. Additionally, she has completed an associated post-graduate program in childhood development. She recently started her own foundation (CELAP), which required tremendous paperwork and government approval, and it is the ONLY Autism foundation in Panama that specializes in Autism and Childhood development. Her book is both autobiographical and a manual for parents and educators who deal with all types of children, not just the those suffering from autism. It's an inspirational story as well as a resource for any parent or teacher. She believes every person has the right to reach their full potential, and gives her insights into behavior modification and child-rearing in general. The book, titled El Diaro’ de Toda Mama’ will be introduced in Panama City on April 28, 2019, at a Health and Autism Expo. Check her website www.fundacioncelap.org for locations if you are interested in attending. You can also purchase a signed copy, and meet Britzeitha in person. I plan to encourage her to have a book-signing event locally in the Chiriqui area, hopefully at our local library. Britzeitha is a beautiful woman with a brilliant smile. I've never seen her not smiling. She also has a keen sense of humor. She has a lovely family, which is a significant understatement. She has three daughters, Keity, Christy, and Alexandra. Keity (Drennan) was Miss Panama 2016; she now works as a professional model in Milan, Italy and New York City. (Google her name. She certainly makes all Panamanians proud.) But, when meeting Britzeitha you quickly see where her daughters get their beauty. Britzeitha married Douglas Martinez six years ago and he has been running the business side of their non-profit foundation since its establishment two and a half years ago. The term "power couple" applies to these two friendly, energetic and highly-successful individuals. Within this article are links to her foundation (currently avaliable in Spanish only), however, I interviewed Britzeitha on a more personal level to find out how she works with each patient, her professional and practical approach. She is the only person in Panama treating Autism with a combination approach, which she terms a "fusion program". She uses the multiple intelligence program based on Howard Gardner's theory, combined with Eric Fromm's Cognitive Conductual Theory, and lastly a method developed by Eric Chopler known as T.E.A.C.H. which was developed specifically for Autism. In addition, she includes an intriguing nutritional component which, when strictly adhered to, is one of the most effective in changing behaviors and improving the lives of her patients and their families. It makes a difference. A big one. While Ms. Britton typically works with children and teenagers, she has also worked with patients in their 50’s. One of the unique problems in Panama is the lack of understanding of Autism by teachers, parents and even pediatricians. Children often go undiagnosed for years. We have all seen "The Miracle Worker" and what happened to Helen Keller when left in the care of people whose intentions are good, but ended up sacrificing "quality of care" for expedience. Often by the time Britzeitha's expertise is sought out, she is walking into a crisis situation. I asked her to describe an average approach to a typical new patient. On the first day, she says her only job is to observe the child and the parents, in the home environment. She usually sits at a distant table, diagonally and behind, to get the best information without adding new stress. She is noting the particular things that cause huge emotional outbursts and the typical wild mood swings. She told me that something as innocent as someone in the home wearing perfume can set off a person with Autism. Sometimes it may be a bright or flickering light, or a peculiar movement. Some patients cannot handle being touched, a pointed finger, or a sudden loud noise. The triggers are nearly countless, and unique to each patient. Britzeitha creates a file listing all the characteristics of the home environment and begins the profile of the patient. She has a number of employees who work with her, so it is important that all staff members know exactly how to interact with each patient prior to each training session. For most students, their first tasks involve no interactions with anyone else. They are given a puzzle, or an IPad with special programs designed specifically for autism. Each child is different and responds differently. She respects where they are and works within the parameters of what each child can tolerate to bring about the necessary changes so they will to be able to ultimately function in society. She and her husband, Douglas, have developed a special diet for the autistic patient. It is a very basic menu. Spices and strong flavors such as “too sweet", or “too sour", etc., usually need to be eliminated. Bland is the key to avoiding a stimulus that might provoke an unexpected reaction. She promotes a natural diet of unprocessed fruits, grains and vegetables. She prefers they eat no meat, but allows for some in moderation if the child's family insists. However, she strongly discourages eating fish as she feels there could be a connection between the high heavy metals that sometimes exist in seafood and what is going on in her patient's Autistic brains. We have all seen children who've had too much sugar or caffeine. When these are removed from the diet, in most cases children quickly become more able to listen to instructions and become more socially appropriate. This is even more important for Autistic children, as they are hypersensitive to substances in their diets. Britzeitha has studied food textures suited to each child. Some cannot tolerate hot or cold, gritty, pasty, etc. It can differ vastly in each patient. Anything in the diet that can be altered to suit the child's particular needs is changed to reach the best social and cognitive outcome. Their foundation is working on a special liquid supplement formula. It is still in the developmental stage, but they've already seen some very promising results. Douglas, Britzeitha's husband, says one of the most challenging things he's working on is to make it more palatable for children. It has to taste good or it will obviously go to waste. If you are interested in learning more about her foundation and her work, please check out the websites below. If you are interested in volunteering or donating, that is also a good place to start. Their foundation is not currently qualified as an income tax charitable contribution deduction for Panamanian income tax purposes, as they lack the required physical building from which to work, separate from their residence. They hope to have that soon, but for now CELAP is being run from their home in Los Molinos. If anyone has any specific questions, or specifically a family that you'd like to refer to Britzeitha, please feel free to contact her directly or to us at health.info@chiriqui.life Please note these important links/information for the Autism foundation: Name of foundation: Centro de Estimulacion de Lenguaje y Autism de Panama (CELAP) www.fundacioncelap.org To donate badly needed funds to the foundation, please use: Banco General, account 03-44-01-115702-0 To Contact Britzeitha Britton directly by phone or Whatsapp: +507 6949-6084 People do make a big positive difference locally in Panama. You can be part of that.

As of now, no certificate or Yellow Fever vaccination is required for travel to Cali. This information is from COPA. As with any foreign travel, it is always wise to check ahead before making final travel arrangements.

In doing some preliminary research before posting this article, I came across some interesting things to know. There is no cure for the disease, but most people recover within 5 days or so with hospitalization. But many relapse shortly thereafter, and the mortality rate among those who didn't fully recover within a week approaches 50%. It's clearly not something you want to experience.

Currently, there is an outbreak of Yellow Fever in the country of Brazil, located primarily in three states there. Although the country is trying to vaccinate its vulnerable population, the effort is far behind schedule and there is real concern that the outbreak will spread. Colombia is now requiring that foreign visitors show proof of Yellow Fever vaccination or show a certificate of exemption prior to entering the country as a preemptive measure. if you are planning to visit Colombia in the future, please follow these steps to ensure your entry to Colombia: If you have previously been vaccinated for Yellow Fever and have your vaccination record, you are in luck. It's a once in a lifetime vaccine, and you are good to go. If you haven't been vaccinated, or can't find your records, you are going to have to get vaccinated again if you are under the age of 60. At age 60 and above, the vaccine is contraindicated and you are not required to have the vaccine. However, you must still obtain a certificate. Here is the procedure for all scenarios: If you need a yellow fever vaccine and are over 60 years of age you can get a certificate instead of having to get the vaccine on a Thursday morning. If you are under 60 or need the vaccine you must follow these procedures on Monday, Wednesday or Friday morning between 8:00-12:00. You start at this building across from Hospital Cattan, near the bus terminal in David. Enter and on the right is a Caja. Tell them you need a yellow fever certificate (because you are over 60), present your residency card, and pay $5.00. The price goes up to $20 for the vaccine, and $100 for non-residents. You will get this receipt in green and white. Take the receipts around the back of the building to the Epidemiology Department. You must show your residency card and passport besides giving them the receipts. They will then fill in this certificate for you. A tip of the hat to Betty Landis who was willing to share her experiences as she prepares for her upcoming trip!

The Resource Listing has been updated to include information regarding Policlinica, which amazingly had never even been mentioned in previous versions of the listing. Tip of the hat to Betty Landis for noting the omission.

The Healthcare Resource Listing has been updated again today to add three new physicians in Boquete, a Podiatrist, and two primary care physicians. As always, we appreciate tips, suggestions, corrections from the community in order to keep the listing as current and accurate as possible.

Meet a Medical Professional--Bixby Tapiero, MS Nutrition and Dietetics By Jo Johnson During one recent Tuesday Talk (BCP) I first heard the name Bixby Tapiero, a licensed Nutritionist who obtained one of her many degrees from Andrews University in Michigan. That happens to be the alma mater of my brother and sister-in-law, so I just had to meet her. As you will see in this article, Bixby's path has crossed my family's path many, many times. It is a wonder our families haven't met her before. I cannot begin to write everything I've learned about her, but Doug and I found her to be a fascinating person. She is intelligent, pleasant, knowledgeable, practical, and determined to change people's lives one meal plan at a time. It is a much-needed skill in Panama, especially among the indigenous population. Bixby was born in Bajo Mono (near the famous rock formation/waterfall area north of town). Her parents were one of the five major pioneer families that owned property in the earliest days of Boquete. Her first introduction to good nutrition came from her paternal great-grandmother, who was a member of the Seventh-day Adventist church, whose teachings include good nutrition. She lived to be 117, her husband 109 . Bixby’s father recently passed away at age 97. Most Seventh-day Adventists are lacto-ovo vegetarians, but many often include fish, chicken, and beef several times a month. With their focus on good nutrition, church membersin the U.S. live an average of 10 years longer than the American life expectancy of about 79 years. Education was very important in Bixby's family. Her father was educated at Columbia University in the Washington, DC area (a school that both my parents graduated from 2 years earlier!) Bixby went to elementary school in the Boquete area, but High School in David because it offered better science labs. She then went to Tennessee to get her Associate Science degree in pre-dietetics, at Southern University near Chattanooga (the school where my brother is now an English professor). She then attended Andrews University to obtain her BS degree in Dietetics in 1990. Later she earned a Master's degree in teaching from the Universidad Autonoma de Chiriqui in 2010, and a second Master's degree in Nutrition with specialization in liver and kidney from the Universidad de Leon in Spain, 2012. She also got extra training in parenteral and enteral nutrition ("tube or intravenous feeding") from Kettering College of Medical Arts, In Kettering, Ohio (unbelievably, Doug's brother also went there for his anesthesia residency). She is currently working on her PhD in Nutrition from Universidad Internacional Iberoamericana in Mexico. She may never stop studying! Chiriqui province is extremely blessed to have Bixby spend her entire life here working for the country she loves to help improve life among the local Panamanians, ex-pats, and indigenous tribes. I asked her how far nutrition can go in good healthcare. Can a good diet prevent and cure diseases? She says that proper nutrition cannot only prevent diseases, it can cure certain diseases. Even if a person has spent years eating poorly and causing damage to their body, within a period of 21 days of making dietary and lifestyle changes, Bixby is able to monitor through post -treatment testing, changes in body composition, and often facilitate the reversal of the prior damage. Bixby is a serious nutritionist; don't even consider asking her to help you lose 15 pounds for your 40th High School reunion in two weeks (and don't ask me how I know this). Bixby is a liver and renal (kidney) specialist, so roughly 60% of her practice is spent in that area. Another 20% of her patients are diabetics and or have cardiovascular diseases, and about 10% is with teenagers and children with weight or obesity problems. The remainder of her practice is working with Hospice locally, where she often treats end of life cases with parenteral feedings to provide enough energy for patients to wrap up their final personal and legal matters. She treats patients age 5 and older. While her most difficult case involved a man with multiple gunshot wounds to the abdomen who had to be on parenteral nutrition for 5 months, she continues to see other serious conditions on a regular basis. One of the most serious in the Chiriqui area is a disease known as Kwashiorkor, a Swahili word that means "the evil spirit that takes the first child when the second one is born". It is caused by a diet very, very low in protein, and unfortunately is prevalent among the indigenous people of this area. A second related disease is Marasmus, a term which includes any diet lacking in a specific type of food or a combination of deficiencies (e.g., low iron plus low protein). The indigenous people have a short life expectancy due to malnutrition beginning in the womb. The children are often born with kidney and/or liver problems, and therefore end up developing many additional, non-transmittable diseases as they age. She offers some services you will not find too often even in the U.S., Canada or Europe, a personalized service she calls "supermarket savvy". She will meet you in David and take you shopping to teach you how to shop for the foods you need. She can find things in David you never dreamed existed here. For this tour she charges $75. She will also come to your home and will spend 3-4 hours (depending on the recipes you need to try) teaching food preparation for your individual needs; a fee of $40/hr for this. The most pressing nutrition need in Panama, according to Bixby, is nutritional education for pregnant teens, to show them how nutrition affects their children. She feels if this were done as a priority in Panama many of the current health problems of the indigenous would be nearly eradicated. Lack of education and willingness on the part of the government to make progress in this area frustrates her. For this reason, she has decided that training the Nutritionists in the University on the crisis within the pregnant teenaged women, feeling that if they also make it a priority in their careers, they can get the message spread throughout Panama. Bixby is an extremely busy lady, but in her spare time she loves to cook, hike, and she is currently taking classes in Hebrew. Her other passion is in-depth study of the Bible, archaeology, and ancient history. She also serves as the English translator in the bi-lingual Seventh-day Adventist church in Alto Boquete. If you wish to contact Bixby Tapiero to make an appointment in Boquete call Clinica Especializada (Drs Chen and Gomez), 720-2080 or Clinica Alfa 6949-5998. In David, an appointment can be made with her secretary, Veronica, at Mae Lewis Hospital 777-2325.

Meet a Medical Professional-- Teofilo Gozaine, MD, ENT (by Jo Johnson) The first time I met Dr. Teofilo Gozaine, I knew I wanted to find out more about him. I think our readers will find him to be extremely qualified, competent, accessible, and handsome (a quality that never hurts!) Dr. Gozaine was born in David, Panama. When he was a youngster, his father was the Senator representing Chiriqui, and today his brother is the current Senator representing David. His parents still live in David, as well as his two brothers. The Gozaine family is involved in several business enterprises. They are the producers of Rum Carta Vieja in Chiriqui. They also sell real estate, mostly in the Paso Canoas area, near Costa Rica. Besides his primary residence he maintains in David, Dr. Gozaine has land in the Boquete area, where he produces tomatoes and peppers and sells to the local markets. He and his three sons spend a lot of time in Boquete, as they do have a second home in the Volcancito area. Dr. Gozaine attended High School at Colegio Nuestra Senora de los Angeles in David. Following graduation, and seeking to become a physician, he moved to the United States to continue his education. He enrolled for a semester at Georgetown University in Washington, D.C., which required vastly improving his English skills in a short time (up until this time he had had very little English language training). With three months of practice of speaking English, he then transferred to Creighton University in Omaha, Nebraska. He says that the first semester at Creighton he still struggled a bit with the language, but after that it was not a problem. (The interviewer wishes she had that ability to learn a new language in six months!) He majored in Chemistry as an undergraduate student, and later applied and was accepted into the highly-acclaimed Medical School at the same university for his medical school training. This is a huge honor as they only admit their brightest students from the undergraduate program. Deciding that he wanted to do his residency in Otolaryngology, (Ears, Nose, Throat) he applied and was accepted at the University of Oklahoma, in Oklahoma City. The residency is an additional five years. Upon completing all the requirements and passing his medical boards, he decided to set up his private practice in Leesville, Louisiana, which is very close to the Fort Polk army base and not far from Beaumont, Texas. He had privileges with three hospitals in the area. Two years ago, after 11 years of a solo practice, Dr. Gozaine felt the desire to return to Panama to be close to his family and to offer his services in an area of great need. He first set up a practice in David, where he currently is working out of Dr. Villareal's office in the Chiriqui Hospital, 2nd floor. He hopes to move to his own office in the lobby level of the new tower being built at hospital Chiriqui. He also sees patients at Alfa clinic, usually on Thursdays, if he has appointments scheduled. He can be reached for an appointment by phone at 6675-3268 (for his location at Chiriqui Hospital). For Boquete, by calling the main number at Alfa clinic (720-2434) or (6949-5998). You will need to have an appointment to see him. While his specialty is ENT, I wasn't aware of all the types of procedures he performs here. I asked him if he was able to do all the things he was trained to do in the United States here in Chiriqui Province. He said "yes, except for performing surgeries using laser, which are actually rarely required". His general philosophy on medical care is to give his patients several options while giving his opinion on the efficiency and outcome of each option. He treats cases both medically and surgically. If there is a better treatment that can be done without surgery, he always advises they choose that option rather than surgery. His practice encompasses all areas of this training and includes pediatrics to adults. His most common clinical presentation here is kids with tonsillitis. The second most common is dizziness in adults. One ailment he finds very prevalent here, but not too much in the U.S., are airway difficulties. He has performed many reconstructive throat surgeries to remove tracheotomies in children, thus allowing them to live normal lives. So far, he has been 100% successful in removing tracheotomies from his pediatric patients. Additionally, his practice involves all levels of complexity of ear surgery, head and neck cancer, surgeries of the throat, thyroid, parathyroid, tonsils and adenoids, sinus, skin cancer, nose reconstruction and rhinoplasty, salivary gland, facial fractures and lacerations. While he is a very busy physician, he does like to relax occasionally. He enjoys tennis, golfing and travelling to new places.

On Monday, January 1, look for our interview here with an Ear, Nose and Throat specialist. We anticipate that you will discover another interesting medical professional in this upcoming profile. He was educated and licensed in the U.S., and we are fortunate that he has returned to Panama to continue his practice here. Our first profile, of Jessica Bell, physical therapist, resulted in a number of people seeking her services who stated that they had read about her here at Chiriqui.life. Our hope was that these profiles would provide interesting and useful information for the community and it appears to have gotten off to a good start. As always, if you know a medical professional you'd like to see profiled in our Meet a Medical Professional, please write to us at health.info@chiriqui.life

First of many to come.

Meet a Medical Professional Jessica Bell, Physical Therapist (By Jo Johnson) I'm excited to start our new series where we will highlight a medical professional in Chiriqui Province. I couldn't think of a better person to profile as the initial installment in this series than Jessica Bell. I had an inflamed Achilles heel last year and had allowed it to go on untreated for nearly a year. As it continued to worsen I realized I needed to undergo a procedure in Houston. I elected to try a stem cell injection, hoping to avoid surgery. I was much improved, but still not able to walk on my treadmill the 3-5 miles per day that I wanted. My Houston podiatrist suggested I go to some physical therapy sessions and simply told me to ask for "strength and agility" therapy. I was crossing my fingers that those two words were sufficient here in Panama. I was recommended three different physical therapists, and the first one that responded to my Whatsapp query was Jessica Bell, Licsa Physical Therapist. I found in Jessica a gem. She was professional, efficient, punctual, gentle, and an overall interesting person. I'd like to share a little of what I found out about her as a person and as a professional. The name "Bell" is a rare name for a Panamanian. I assumed she was married to an ex-pat. But, no, she is single. The name actually comes from her great grandfather, Saturnino Bell, who came to Panama from Barcelona, Spain in 1900-1908. He came with a Ferrocarril (railway) company working in Chiriqui and also to work on the construction of the Panama Canal. He met and married a local Chiriqui woman and had three children, one being Jessica's grandfather, Dionisio Bell. Unfortunately, Saturnino Bell, like many workers in those times, died of yellow fever while working on the Panama Canal. Her grandfather has no memory of his father, but he is a legend in the family. Jessica is proud of her heritage and unusual name, she plans to keep her name even if she marries, in order to keep the memory of her great grandfather for generations. After Jessica graduated from 4 years of college, and passed her written and practical examinations, she and a classmate, Belkys Atencio, decided to move to where Jessica's family's originated and came to Chiriqui, specifically Boquete. She chose Boquete because at the time there was no independent PT clinic in Boquete. Even today, she is the only clinic not associated with another business or group. Their office is located next to Dr. Gomez's clinic, Clinica Especializada, across the street from Melo. Jessica and Belkys run their facility much like North Americans are accustomed to, with scheduled appointments which are kept in a timely manner. However, they also spend afternoons working at the homes of people unable to get to the clinic, such as Hospice patients and others permanently or temporarily home-bound. Approximately once a month she also offers 5-minute messages at Tuesday Market, which would be a great time to get to know her. Her English is above average, but in her professional work, it is nearly perfect. She has focused on English words that helps her communicate as a health professional more than in other situations. She worries that her English isn't perfect, but most people will have no problem communicating with her. She offers ultrasonic therapies, electrotherapy, heat, ice, massage (she has warm oils and strong hands), kinesiology tapings (very avant garde), and a huge variety of routines to strengthen and limber the muscles and joints. For me, I was finished with my rehabilitation in two weeks, going 3 times a week for an hour each session (she also has Saturday clinic). My podiatrist was impressed with the progress, and said she did similarly or better than PTs he uses in Houston. I continue to use the procedures she showed me to ice or heat my heel before exercising and the simple warm up stretches to prevent a recurrence. She is excellent at devising a plan to heal and then maintain the healing. A bit more about Jessica Bell's personal life. When she isn't working hard building her practice and meeting patients, she likes to work out at a gym or go to a movie. She is also working toward obtaining her Master's Degree within the next 5 years. She regularly attends professional conferences to stay abreast of the latest technologies and reads professional journals in Physical Therapy. She has to buy and maintain all her own equipment, which often requires her to purchase from outside Panama. This means she must keep the equipment in good working order, as there is no local service available. I was impressed watching her carefully clean and return equipment to their protective cases. Every patient is treated with an individual plan, she keeps meticulous files on each patient following an initial assessment based on your history, X-rays, prescription and pain level, and personal ability to perform the recommended course of treatment. You can see her with or without a prescription, with or without an injury, and perhaps just want the best message to feel energized. You do want to make an appointment. Call 6211-7011 or 6741-8115. Jessica has agreed to take questions for the next two weeks, by email to health.info@chiriqui.life if any of our readers have questions or comments. Readers, if you know of a medical professional in Chiriqui Province that you would like to be highlighted in the future, please send suggestions by email to health.info@chiriqui.life .

"Meet Your Medical Professional on Mondays" The moderators of the Healthcare forum have been busy working on updating the healthcare provider's listing for Chiriqui.life. They have met so many interesting, professionals in this ongoing effort who would like share their stories, their medical philosophies, and what they each have to offer in their own unique profession. The first in this series will be posted tomorrow, rather than Monday, due to Christmas. However, the readers of Chiriqui.life can look forward to seeing a new profile each Monday as long as we have medical professionals willing to take the time for the in-depth interview necessary. They are a busy group in general and it's not always easy for them to find time to talk about themselves. If our readers are acquainted with a licensed medical professional they would like to see profiled in the future, please send your suggestions to health.info@chiriqui.life or PM Doug and Jo directly.

The announcement yesterday in a joint presentation by Irma and Dr Diaz at the Tuesday Talk is that Keep it Simple Panama's health advocate service will be part of the Boquete Medical Associates membership plan. Dr. Diaz did use the term "merger", but it became clear that she didn't mean that in any legal sense. Instead, KISP and BMA will share medical files on patients needing medical care or Services in David, set up appointments with specialists, procure ambulances, and obtain discounts beyond Jubilado at hospitals and clinics. Their goal is to provide health care for residents in Boquete as much as possible, but to get the best services in David at the best price for those matters that must be treated in that city. It is important to note that you don't have to have a membership with Boquete Medical Associates to be treated at Alfa Clinic or to use the services of KISP. But the membership plan does combine those services along with various discounts on Doctor appointments, dental cleanings, email consultations, death certificates, and various other benefits.

Significant updates have been made to the Healthcare Resource list this month. New healthcare professionals have been added, and some corrections have been made. Many are affiliated with Boquete Medical and Associates who will see patients at Alfa Clinica adjacent to La Reyna department store in downtown Boquete. As always, if you see anything on the listing that needs updating, correction, or even deletion, please PM or email to health.info@chiriqui.life . It requires a group effort to keep the listing current and accurate. Recommendations are welcome!

For diabetics, salt can be particularly dangerous, as their kidneys are damaged due to diabetes. The salt makes them less likely to control their glucose levels. I agree diabetes is the larger problem, for healthy adults salt seems mostly benign.

30 years ago this organism, Klebsiella pnuemonia, was extremely common in healthy patient's respiratory systems. Even then, it was very resistant to most antibiotics. But, the difference then seems to be that it didn't cause diseases. We used the organism to train students on microbiology procedures, because even if they had poor technique, they wouldn't harm themselves or others. But, the overuse and misuse of antibiotics has obviously changed all that. It is still most likely to be spread primarily in hospitals, and to be most serious in the elderly, diabetics, post-transplant patients, and people who are seriously ill in general. As with any hospital spread infection, hand washing is the key. Never hesitate to ask anyone entering your hospital room to wash their hands and put on new gloves before touching you. You need to be proactive.