It’s hard to believe we have been publishing Valley Response Magazine for almost two years. It seems like just yesterday that we were putting together our mock-up with both excitement and anxiety about how readers were going to receive our new and—as we like to consider it—cutting-edge publication. Fortunately for us, the response has been overwhelming and each issue attracts new readers.

Since we began publishing, we’ve experienced our fair share of growing pains: last-minute photo shoots, late articles, and a variety of other minor setbacks that inevitably put the staff into a state of panic. Funnily enough, if you asked anyone who works here, we’d all admit we secretly enjoy the rush of adrenaline that comes with putting the puzzle together and getting it off to the printer. It is only then that we all breathe a much-needed sigh of relief, as we high-five one another and congratulate ourselves that we’ve got yet another one down!

Growing pains aside, our current issue also represents a milestone of sorts: It is the first time we’ve made a small but significant leap in the magazine’s page count. Instead of 48 pages, we’ve grown to 56, which is not a feat we could have accomplished without the support of our loyal and long-term advertisers. In every issue we publish, we try to maintain a healthy balance between stories and ads. We strive to give our readers informative and interesting articles as well as provide a venue for advertisers to convey their message to local consumers.

We feel that we have finally begun to find our place in the community and have garnered the advertising support necessary to make a permanent name for ourselves within Tulare and Kings counties. We’d like to offer a big thank-you to our advertisers and readers; we would not be here without their contributions and validations.

We’ll continue to aim to be exactly what you’re looking for in a local publication. Our motto over the past two years has essentially evolved to, “If it isn’t working for you, it isn’t working for us.” So we ask our readers to continue to give us feedback about how to provide relevant articles that cover issues important to them. As for our advertisers: We’ve heard the wonderful things readers are saying about your ads in our magazine, but we’d like to hear how you feel about them as well.

Valley Response Magazine has become a mainstay here in our Valley and we hope that you, our readers and greatest supporters, are as excited about that as we are. We look forward to sharing many more issues with you in the months and years to come.

By Kristi Emo

“You haven’t lived until you’ve cruised!”  That’s the motto of Cruise Lines International Association, an organization that represents 24 of the major cruise lines serving North America.  Many Valley cruisers will tell you the same thing, citing the romance and adventure of sailing on the high seas.  Cruises can provide great value for your vacation dollars as meals, entertainment, activities, and kids’ clubs are all included in the price of passage. The ships offer full spas, fitness centers, casino gambling, and daytime and nighttime entertainment. It is a perfect vacation where you have the chance to do it all or do nothing at all.

Cruises are suited to families, couples and singles, and are a great way to see the world since you can cruise anywhere there is an ocean. Among the most popular destinations for Valley cruisers are the Mexican Riviera, Alaska, Europe, and the Caribbean. Cruises allow you to unpack just once and have the ship take you from port to port, so the normal hassles of land vacations are avoided and there’s more time for fun and relaxation.

One big issue for first-timers is the prospect of being seasick.  All modern cruise ships have stabilizers under the water that minimize the side-to-side motion that can make people sick. The up-and-down motion of the ship going through the water does not normally bring on that queasy feeling. There are easy ways to avoid seasickness: book a midships cabin on a lower deck where the motion is minimal; go outside often to get fresh air and look at the horizon. If you do happen to feel queasy, there are over-the-counter remedies like Dramamine and Bonine you can try, as well as “natural” remedies like ginger tea or candy, or acupressure sea bands. If you know that you tend to have severe motion sickness, your doctor can prescribe anti-nausea medication or a scopolamine patch that you wear behind your ear.

Close Quarters Can Spread Illness

There have been outbreaks of the Norovirus on several cruise lines in the past few years.  This illness is not unique to cruise ships; it can be found wherever there are many people sharing a confined area, including hotels, dormitories, and nursing homes. The outbreaks on ships are publicized because the cruise lines are required by the Centers for Disease Control to report every incidence of gastrointestinal illness. The cruise lines now all have medical forms that passengers fill out before boarding that asks them if they have been ill in the week prior to the cruise. Passengers who join the cruise while already sick and contagious can cause the illness to spread on board. The best way to avoid getting sick is to wash your hands often with soap and hot water. You can also use alcohol-based hand sanitizer that you carry with you on board and in port. Most ships now also have hand sanitizer machines at the entrance to every restaurant and buffet. You can also take some antibacterial wipes to clean items in your cabin like door handles, TV remote, and telephone.

The cruise lines consider passenger safety a top priority. Every ship has uniformed security guards and surveillance cameras on board. There are a few important tips to ensure your personal safety onboard and in ports of call. Be aware of your surroundings and use common sense, just as you would in any big city. Don’t flash a wad of cash or valuable jewelry and make yourself a target for a thief. Leave your valuables at home or use the safe in your cabin to keep them locked up when you are not in the cabin. Leave these items locked up when you go into port as well. It is safer to use your debit or credit card for purchases in port; the ship operates on a cashless system so you don’t need cash to pay for items on board.

Don’t allow yourself to become so intoxicated that you compromise your judgment and behavior. You are on vacation and having fun and that might include drinking more than usual and letting go of the stress of your everyday working life. This can mean that you let your guard down. One suggestion: ask someone in your group of family or friends to be your “designated cruiser” and stay sober to watch out for everyone else.

Cruising can be a fabulous experience. Just think safe, and it will be smooth sailing all the way.

By Jim Blanks

If you knew that you had the ability to save another person’s life, would you do it? If you had the chance to be a hero, would you take it?

There is such an opportunity, and it doesn’t require superpowers, or wealth, or any great sacrifice. All it takes is one hour; all it takes is one pint of blood.

Every community needs a reliable source of blood, and now that Kaweah Delta Medical Center has been designated a trauma center, the need locally has only increased. Victims of car accidents and patients undergoing surgery all need blood.

In 1983, former auto mechanic Ted Ganiron was involved in an automobile crash. “It was a nasty accident,” he says. “I broke both legs, broke my nose, knocked out my teeth.”

Ganiron needed several units of blood to keep him alive during surgery. The accident would become a turning point in his life.

This is just one example that makes it clear the availability of blood can be the difference between saving and losing a life.

“The units are used for those patients who are in need of a blood transfusion,” says Clinical Scientist and Blood Bank Section Chief Carol Young of Kaweah Delta. “Anyone from an infant to an older person having surgery needs blood.”

“It really is the gift of life,” Ganiron adds. “When you need blood, there really is no substitute.”

How to be a hero

Here is where the opportunity for heroism arises. If you have an hour to spare to donate blood, you can save a life.

Someone who knows the value of donated blood is Emergency Room R.N. Erin Lebow. As a donor and a nurse, she experiences the process from both sides.

“I can see the impact it has on families,” Lebow says. “It is rewarding to donate one day, and then the next day, hang a bag of blood for a patient in the emergency room.”

The process is not complicated: When you arrive at the donation center, you register and then go through a screening process. This includes answering questions about your health and medical history and having a blood sample drawn. This ensures you are healthy enough to donate blood, and that your blood is safe to give to others.

There are certain situations in which donation may be deferred. One of the most common is a low iron level. Potential donors should eat foods that are high in iron such as red meat, and dark green vegetables.

If you pass the screening, you will have your blood collected, which takes roughly fifteen minutes. The entire process (screening, blood collection, and recovery) takes about an hour.

That pint of blood is typically ready for use within twenty-four hours, which means when you donate you can have a direct impact on an emergency situation the very next day. Within twenty-four hours your own blood levels will typically return to normal, so although you will not greatly feel the impact of your donation, someone in the community certainly will.

Donors can return to the blood center every eight weeks for another collection. But it isn’t just whole blood that people need; donors can give platelets, plasma or bone marrow.

If you donate plasma, you will be able to return every four weeks to do so. Through a process called aphoresis, the blood is drawn out and a machine separates out the plasma before returning the blood to the donor’s system. Because this technique does not lower blood levels in the body, donors are eligible to return sooner for another donation.

So let’s do some quick math: If you donate one pint of blood every eight weeks, you will end up giving six pints a year. Think of what those six pints can do. Think of what you can accomplish if you and a friend donate together.

“We are always in short supply of our precious blood components,” Young says. “We wish we could inspire more people to donate.”

Why so few donors in America?

If donating blood is so easy, the question becomes: Why aren’t more people donating? Here is a sobering thought: Of all eligible blood donors in America, only about 5% donate on a regular basis. What keeps people away from donation centers?

According to the Red Cross, one of the most common reasons is that people do not like needles. But, if you walk into your blood donation center today and give a pint, you will feel that needle for, literally, seconds. Compare that discomfort to the possibility of adding years to a human life.

“It’s the fear of the unknown,” Ganiron says. “People think it’s this great big needle, but it’s really not.”

And, Lebow adds, blood donation centers are staffed by a thoughtful, knowledgeable medical team that has experience dealing with anxious donors.

“The staff knows that people are sometimes nervous or uncomfortable around needles, so they will help you,” Lebow says. “They aren’t going to sneak up on you.”

Donors are critical to the community, Young says, adding, “They are the lifelines to many recipients.”

Another reason people don’t give blood: They never really thought about it. Most days, we don’t think about medical emergencies; in fact, most of us probably don’t ever think about emergencies until we are faced with one.

“That car accident was a huge turning point,” Ganiron says. Not only did it cause him to understand the necessity of donating and receiving blood, but it changed his entire trajectory in life; following the accident, he entered the medical field and became a Registered Nurse.

According to the Central California Blood Center, which provides blood and blood products for the 31 hospitals in Tulare, Fresno, Madera, Mariposa, and Kings counties, 75% of Americans will need blood by the age of 72. This means three out of four people will need a transfusion in their lifetime. Think about your friends, your family and loved ones as you drive past the donation center.

“You shouldn’t be too busy to donate blood,” Ganiron says.

So, please, donate today. It does not take a great effort, but the rewards are immense.

It is rare that we are given the chance to so dramatically change another person’s life. Here is just such an opportunity. The question is: Will you take it?

By Gary Dowd

It’s nothing like the television programs “Cops” or “America’s Most Wanted.”  It’s just another night patrolling the streets of Visalia.

While most of us are home watching “Late Night With Jimmy Kimmel” or nestled comfortably in our beds, the officers of the Visalia Police Department are watching out for our safety and security.

Obviously, law enforcement isn’t a 9-to-5 job. But I’d always wondered what it was like for the officers who were on duty through the wee hours. Couldn’t be coffee and donuts at 7-11 all night long.

To find out what a typical Friday night might be like, I took the opportunity to ride along with Officer Jason Tejeda. He has been a patrol officer with the VPD for three years now, is easy to talk to and obviously loves his job. Currently, Officer Tejeda works swing shift, meaning he’s on duty from 2:00 p.m. until midnight. Next month he’ll work “mids.” “The nice thing about working the midnight shift is that I’ll be able to spend weekends at home,” says Officer Tejeda. “My wife will be pretty happy about that.”

It takes a special person to handle the night shifts, no question. More violent crime happens at night and what you can’t see most definitely can hurt you. A police officer working nights has to be vigilant and prepared.

Figuring that most of the “excitement” starts after the sun goes down, Officer Tejeda picks me up around 7 p.m.

“Let’s see what’s going on tonight,” he says, showing me the computer screen mounted to the dash of his 2010 Ford Crown Victoria Police Interceptor. The display shows, in real time, all officers on duty, calls being answered, and calls pending.

7:47 p.m.

No sooner have we crossed over Mooney Boulevard than we get a call to assist another officer involved in chasing a suspect—a “leg bail” in police terminology. It’s a quick U-turn and we are speeding down Whitendale. Officer Tejeda’s handling of his cruiser is impressive. While there is a clear sense of urgency, it is never at the expense of safety. Using the lights and siren to clear an intersection, we are on the scene in a matter of minutes. We find the suspect is already in custody, but it is reassuring to see two other officers show up within minutes—and to note the professionalism and courtesy with which the officers treat the suspect.

Although the suspect is already in handcuffs and being led to a waiting squad car, the other officers carefully look though his belongings. Opening a small metal cylinder and an empty, clear plastic bag, they look at each other knowingly. “They’re empty now, but I bet he had something (drugs) in there,” says Officer Tejeda.

8:09 p.m.

With that call cleared and nothing new on the screen, Officer Tejeda begins his regular patrol, cruising neighborhoods: not just those known for criminal activity, but the quiet neighborhoods as well.

“It’s important for people to see us, know we’re there.” says Officer Tejeda. “It’s also a proactive approach (to law enforcement).”

Like most modern police departments, Visalia wants to not only help residents understand how their police department operates, but also to help them feel a part of the crime-fighting team. It’s all part of a strategy to gain the trust of the community, which in turn helps reduce crime.

8:15 p.m.

We get a call to check on the arrest of a suspected shoplifter at a store across town. “We have a female in custody for shoplifting,” he tells me. “Dispatch has already let me know she has no warrants or probation hits and we’ll do our investigation when we get there. If it’s premeditated, I can get her on a felony burglary charge and then we’ll book her down at Bob Wiley (Tulare County detention facility).”

It turns out that the amount shoplifted was relatively small. The woman is extremely distraught and frightened. But, after first reading the woman her rights, Officer Tejeda’s calm demeanor and patience help keep everything under control. Depending on the circumstances, officers can exercise the option of arresting a shoplifting suspect or assigning a court appearance. After collecting her information and conducting a brief interview, Officer Tejeda releases the woman with a promise to appear and a court date.

8:45 p.m.

We head downtown to police headquarters to visit central dispatch. This is the command post where all 911 and emergency calls for both police and fire come in and are routed. It’s calm tonight, the dispatchers working with a quiet efficiency.

“There’s just no way of predicting it,” says Sergeant Brent Abbott, who is also at dispatch tonight. “You never know if it’s going to be a quiet night or a wild one. It does seem though that the warmer the weather is, the crazier it gets.”

Everyone seems relieved it’s one of the quiet nights—so far.

9:15 p.m.

More patrols, this time in areas better known for gang problems and other criminal activity. We zigzag down back alleys, searchlights on, riding slowly. Officer Tejeda is alert, looking for anything unusual or out of place.

A quick search of an abandoned house—a place often used by transients—and then it’s off to the substation to check in with the duty sergeant. En route, we pass a car with only one headlight. Officer Tejeda decides to pull the car over.

“Mostly, I wanted to check the car out, see what might be inside,” he explains. “You never know.” After running the license and registration and seeing them come back “clean,” he lets the driver off with a warning to get the headlight fixed.

10 p.m.

After a brief stop at the substation, it’s back on the streets. “It’s Friday and typically on Friday nights, we’re going to the party calls, fight calls, disturbances at the bars,” says Officer Tejeda.

“Right now it’s unusual—we have zero calls pending. Of course, when we say that it kinda jinxes us,” he says with a laugh. “But yeah, for a Friday night it’s unusual. But that gives us time to be proactive and be a deterrent. If we see anything unusual…” he shrugs. “We’ll see what happens.”

10:53 p.m.

A few more neighborhood sweeps, then it’s time to head in for the night to finish the shift and complete the inevitable paperwork. We’re back at the station at 11:45 p.m. Every incident—and I mean every contact and answered call—has a separate form to fill out to get signed off and filed. If an officer pulls a Tazer or firearm, whether they’re used or not, it means more reports, more paperwork. Finally, with everything signed off, the duty sergeant dismisses everyone at midnight.

But not to worry: Another team of officers is already taking their place out on the streets.

I admit I’m just a little disappointed that it was such a calm night. No high-speed chases, no SWAT teams, no drama. Not this night anyway. I have no doubt that the officers of the VPD are ready to handle anything that comes up. But I’d like to think that it was a quiet night because our PD is out there doing a great job each day.

What impressed me most was the obvious training and professionalism shown at all times by the officers I met that evening. And even though most Visalians aren’t aware of what goes on behind the scenes, I’ll be sleeping better knowing that we have a great team of men and women watching over us each night.

By Anna Palecek

At an early-morning presentation in the cafeteria at Tulare’s Los Tulles Middle School, Detective Andy Garcia of the Tulare Police Department asked his audience a series of questions. Who uses the Internet? Has a computer at home? Has a Facebook or MySpace page? Sends text messages? Question after question, an entire room of middle school students raised their hands.

This past April, Tulare PD completed a series of educational outreach sessions on Internet and cellphone safety within Tulare City Schools. Over the course of one month, officers spoke to nearly 3,000 sixth-, seventh-, and eighth-graders.

With young people accessing the World Wide Web more than ever, the issue is now being addressed in the Valley by a program focused specifically on Internet-related issues: the Internet Crimes Against Children task force.

The Fresno ICAC was formed in October 2007 when the Fresno County Sheriff’s Office applied for grant money to start the task force. It is one of 59 such units in the nation and is funded solely by federal grants. Housed in downtown Fresno at the Immigrations and Customs Enforcement office of investigations, the task force is overseen by the Department of Justice’s Office of Juvenile Justice and Delinquency Prevention. The Fresno ICAC includes 17 agencies in nine Central California counties.

Getting agencies on board

Detective Brian Haney of the Tulare PD began working on Internet-related investigations five years ago, partnering with FSO and ICE, though at the time the task force had yet to be formed. When the Fresno ICAC was created, his agency was one of the first to join.

Tulare PD Chief Jerry Breckinridge said the invitation from the ICAC was not only an opportunity to address the problem of child exploitation, but also for his agency to receive training and equipment from the task force.

FSO Detective Kevin Wiens focuses solely on conducting ICAC investigations and has been involved with the task force since its inception. He said that in order to join, there is a formal memorandum of understanding that’s signed by the Fresno County Sheriff and the chief or sheriff of the partnering agency. The task force provides the training and resources, in addition to potential equipment. Wiens’ goal is to have every law enforcement agency in the nine counties formally become a part of the ICAC team.

“Being a part of a national task force as a whole, we have the ability to communicate with agencies all over the United States about different investigations and resources,” Wiens said. “It’s been beneficial to us and the other agencies that are a part of the task force.”

ICAC balances proactive efforts to educate and protect children with reactive efforts, conducting investigations and gathering evidence for prosecutions.

Wiens said each agency in ICAC does some type of community outreach as part of the program. As far as educating the community, Wiens says no one age group is the focus, and as a whole, the Fresno ICAC is equipped to educate all levels from kindergarten students to parents and teachers.

“Our children are becoming so advanced at such a young age, they’re passing up the parents with their knowledge,” Wiens said. “It’s important that parents know what technology is out there and that they currently have in their homes—that their children could potentially be contacted by some form of online predator.”

Adapting to a growing need

Wiens said that the most common crime investigated by the ICAC is the possession and distribution of child pornography. Task force members like Haney, who are trained computer forensics examiners, can work undercover to catch predators, as well as gather evidence that can be used in prosecutions.

While much of the task force’s efforts focus on investigations involving child pornography, in the past two years, Wiens has also seen a spike in investigations of children producing their own sexually exploitive images. He said that children are taking pictures of themselves and distributing those images either to other children or sometimes adults.

“Children need to understand that when they’re taking (inappropriate) pictures of themselves, they’re producing child pornography, and when they send that image, they’re distributing,” Wiens said. “They’re committing multiple felony crimes where they could potentially be prosecuted and, additionally, have to register as a sex offender.”

The school presentations in Tulare warned students of this danger. Haney created a custom presentation tailored to his audience, pulling from resources like Netsmartz.org, an educational resource from the National Center for Missing and Exploited Children. Other topics included safe ways to represent themselves online on social networking sites, along with a discussion of the detrimental effects of cyber-bullying.

The Tulare PD’s educational programs began with the middle school presentations because statistics show the age range of 11-14 is most at-risk for being victimized. With the overwhelming response of students who said that they were using these technologies, Tulare PD felt their target was right on. Breckinridge said that the next group to focus on educating would most likely be parents.

Sue Ann Hillman, Director of Curriculum at Tulare City Schools, said the Tulare PD worked with the school district to create a presentation relevant to the students. Four Tulare City Schools hosted presentations for students, in addition to two parents’ informational nights.

Hillman said the district knew it was important to complete the sessions before the summer break, when students would be spending more time online. The plan was to sit down during the summer and see how the school district and police department could partner to reach more people.

The teamwork between the police department and the school district is representative of the cooperative spirit employed by the task force. ICAC members stressed that it is a joint effort among many agencies, and success would not be possible without pooling resources and experience.

“It’s a partnership; there’s not one agency that does more than the other,” Haney said. “The glory of the task force is that you can pull from all your resources.”

By Bill Corliss

Will drivers see the most important stop sign of all?  When should older people give up their licenses and no longer drive?  These questions are more important than ever since Americans are living longer and hence driving longer.  According to the California Department of Motor Vehicles, one in six drivers is over 65 years old.  The challenge of keeping them—and others on the road around them—safe is a family and public responsibility.

Nobody wants to deliver the message that “you can no longer drive.” Sadly, many times the decision to take away a senior’s driving privileges is arrived at through catastrophe or near disaster. However, many preventative measures are now available.

I now drive with many clients 70 to 93 years of age.  Some have been referred by concerned family members, physicians, physical therapists, or the Office of Traffic Safety, a branch of the DMV.  In my many hours in the car working with mature drivers, I have seen the same difficulties arise again and again.  Cognitive processing—the speed with which a driver can process information and react appropriately—is an issue. Limited short-term memory makes learning or relearning a task challenging.  Older drivers also have difficulty processing cues to danger: Most have trouble filtering out unimportant visual information.  Physically, many lack hand strength to perform basic driving maneuvers and have lost the upper body flexibility required to look over the shoulder for traffic checks.

The Automobile Association of America reports that physicians, safety specialists, and law enforcement concur that improper speed, failure to do traffic checks to the rear, slow reaction to traffic conditions, and failure to respond to road signs or signals are the leading causes of crashes in the adult years.  In my experience, I have watched mature drivers struggle with busy four-way-stop intersections and how to safely turn right on a red light.  Many of the drivers are trainable, but some cannot remember new information. In terms of properly using their eyes to check for all possible dangers beforehand, I have never had an aging driver make a safe lane change unprompted!

For families struggling with the decision to terminate an older relative’s driving privileges, there is help available. The relative’s physician could be of help: Doctors are required by law to report to the DMV cases of dementia, lapses of consciousness, or other symptoms that could cause unsafe driving.  Families may request a driver re-examination of a parent, other relative or friend and have their own names kept confidential by contacting the DMV at dmv.ca.gov. and using form DS 699.

There is testing available in Visalia for evaluating the safety of a mature driver.  DASH Therapy at dashtherapy.org evaluates visual, cognitive, and physical abilities.  Also, in-car evaluations are available through my own company (corlissdrivingschool.com).  In addition, many insurance companies offer written materials as well as 55-and-over review courses.  The DMV has an excellent pamphlet “Senior Guide for Safe Driving” (DL 625), which can be downloaded in PDF format from the DMV website.

The loss of the driving privilege is devastating to mature drivers.  Yet, at times it is the best decision.  This difficult situation creates an anxious time for families as nobody wants to be the villain.  There are now many alternatives as this issue becomes more common.  The DMV estimates the number of licensed drivers age 65 or older will increase from 2.5 million to 4 million by the year 2020.

There are many safe-driving resources available online that address mature drivers, among them:

www.car-fit.org (Car Fit Program)

www.eldersafety.org (older adult driving safety)

www.seniordrivers.org (AAA Foundation for Traffic Safety)

www.aarp.org/life/drive  (older driver safety)

http://www.nhtsa.gov/Senior-Drivers (resources from the National Highway Traffic Safety Administration)

By Kimberly Sherman

Instant gratification so often outweighs delayed reward in today’s world. While giving a man a fish is a feel-good act, teaching that man to fish takes patience and endurance that can stretch the limits of our shortened attention spans.

But the mission work of a pair of Visalia physicians reminds us that dedication to helping the world’s needy by encouraging them to participate in the betterment of their own lives pays rich dividends to everyone involved.

An early sense of mission

David Sine first traveled to Haiti in 1989 while enrolled in nursing school. During subsequent trips to the Dominican Republic and Ecuador, he realized that practicing medicine in developing countries was his true passion. Young and single, David continued his love for medical missions with trips to Cuba, Tobago, and Trinidad while studying pediatric medicine in San Diego.

His close proximity to Tijuana gave him the opportunity to hone his Spanish-speaking skills, and in 1997, his last year of residency, he went to Honduras on yet another medical mission.

Then David met Kealani, a young woman from Hawaii who was also studying pediatric medicine in San Diego. She graduated in 1999, and the two married. Dreams of hopping on a plane to serve in a giving capacity waned; David’s new passion was the need to nurture a blossoming family.

In 2002, while discussing the desire to raise their young daughters in a less urban environment, the Sines were given the opportunity to start a pediatric program for Kaweah Delta Hospital, smack dab in the middle of rural California. They packed up dreams and babies and moved to what seemed the perfect solution: Visalia, the Gateway to the Sequoias.

“We’ve made wonderful friends here,” says Kealani. “We started a program here that wasn’t in existence; the pediatric program has grown by leaps and bounds and now includes a neonatal ICU.” Thanks to the Sines’ efforts, Kaweah Delta now boasts a 25-bed intensive care unit for newborns and is equipped to provide care to babies born 3 ½ months premature and weighing as little as 2 pounds, 3 ounces. Pediatricians are available in the hospital around the clock.

Three years into the fledgling program, the Sines recruited Dr. Anna Coll, a Stanford-trained pediatric cardiologist, and her husband, Dr. Roberto Gugig, a pediatric gastroenterologist. Another addition was Dr. Francesca Geertsma, a pediatric infectious disease specialist.

Raising the bar on quality of care

“Our philosophy is: What would we want done if it was our child?” says David. Bringing in renowned doctors with specialized areas of training helped ensure local patients receive the highest quality of pediatric medicine. Says David, “We have really changed the level of care at Kaweah Delta.”

While Visalia’s pediatric services were improving, the longing to serve on another medical mission to a Third World country was building inside David. Then, while befriending the parents of a patient, he was introduced to Students International (stint.com). “I always saw myself doing Third World stuff, but with my wife and family I was nervous about bringing it up,” David admits. “It was divine intervention that I happened to work on that kid that day. The parents were comfortable taking their kid (on a mission) to the Dominican Republic.

“I’ve worked with a lot of medical mission groups, but never saw eye to eye. Most of the time you just come back feeling better about yourself,” says David. “I wanted to get involved with an organization that would have a long-term effect for the people there.” Students International turned out to be exactly what he’d been looking for.

Once Kealani was convinced, the Sines scooped up their young daughters and, with a total of 20 families from Visalia and the East Coast, headed to the Dominican Republic for a life-altering experience that they would repeat several times over—each mission designed to bring lasting change to the people they helped.

“We can treat an ear infection for a couple of weeks,” says David, “but that doesn’t change the fact that they have dirty water. The concept is that we’re here to help. We have staff who are nationals; that way it’s a team approach and not just foreigners telling them what to do. It empowers them to do things themselves.”

Going the extra mile to help

While touring the municipal hospital on their first trip together, the Sines noticed a baby in respiratory distress. No services would be rendered unless the parents paid, and the mother had no money. After much negotiating of language and cultural barriers, the Sines were allowed to provide the needed care to the child around the clock. Then the baby was abruptly discharged without the Sines’ knowledge and with nearly a week’s worth of oral antibiotics left to administer.

Kealani drove from village to village in search of the baby and her mother so that she could administer the final doses of much needed medicine. “It was serendipity that put us there to see that baby in distress,” says Kealani.

Since their first medical mission as a family, the Sines have traveled to Guatemala, both as a family trip and a women’s mission for Kealani and her daughter, and to Costa Rica on a men’s mission for David.

Of their Guatemala experience, Kealani recalls, “It’s a little squatter village where homes are made of sticks and cinder blocks with dirt floors. The school was made into a rough clinic; patients came through in a line and we’d treat them.”

In developing countries, well-child visits are an unheard of luxury. “We have such a short period of time to try and triage what’s going on,” says Kealani. “We treat a lot of intestinal parasites and anemia, and other things like ear infections and orthopedic issues.” Asthma and pneumonia are also common due to poor ventilation. The residents cook on open fires and, in turn, breathe in smoky air.

There are a variety of outreach groups within Students International that serve the needs of the developing countries’ residents, including medical, dental, construction, social work, sports, special education, and even art. “My daughters have been involved with the dental and construction groups,” says Kealani. “They can see the Third World and learn how to help.”

WORD MISSING? David says that, while providing basic needs is not as glamorous as going in to help someone with a machete laceration across their belly, he did help save a critically ill 12-year-old who had been carried on his mother’s shoulders for four hours in search of the Students International mobile clinic.

“I provided him with IV fluid and antibiotics, and that wilted flower slowly came back to life,” David recalls. “He came in dehydrated and walked home six hours later wearing my Goofy hat. He may have succumbed if we hadn’t been there that day.”

Getting priorities straight

David says the saddest sight he’s seen on a mission is a piece of highly sophisticated equipment sitting in a room that’s never going to be used due to lack of knowledge or lack of repair know-how, or both.

The critical need, as overwhelmingly determined by locals, is as fundamental as air to breathe and food to eat: clean water. It’s been a struggle, but the Sines are working consistently to help the Guatemalans achieve a dependable water source.

With an innate desire to help people prosper, the Sines have taken the same approach to their work in the Valley. “We were with Kaweah Delta, but we’re moving on,” says David.

They joined the board of CASA (Court Appointed Special Advocates) of Tulare County and spearheaded efforts to establish a federally funded rural clinic in Exeter run by the hospital. Next, they hope to focus on child abuse prevention. David also specializes in end-of-life care and serves as the Medical Director of Pediatrics for the Tulare Hospice Program, an extension of his work for the San Diego Hospital Hospice program that earned him the Circle of Life award back in 2000.

“In the late 1990s, studies showed that of kids who needed hospice, only 2% actually received it,” David says. “I enjoy helping with comfort and I have the skills to help someone be comfortable in death. I felt it was a calling.”

The Sines have harnessed a truly altruistic way of life that will be passed on to their children. “It really gives you perspective,” says Kealani of their medical mission work. “Everyday problems are nothing in the scheme of life.”

By Aaron Collins

When we think of burns and their causes, we may imagine leaping flames and the terror of being engulfed by uncontrolled fire. But according to a 2008 report by the World Health Organization, every year, the majority of burn victims worldwide are injured by electricity, hot liquids, or chemicals rather than by flames. Nevertheless, 300,000 people worldwide will die from fire-related burns this year. Millions more will survive burns from all these causes, but many of their lives will be changed forever.

Statistics also show that poverty is one major predictor of the likelihood of a burn injury. The San Joaquin Valley and its position as one of the poorest regions in the U.S. makes this factor especially troubling. Victims of severe burns face both physical and emotional complications for the rest of their lives due to disability and disfigurement. The already-poor can expect to descend further into poverty.

Everyone should be diligent about burn prevention and also understand when expert medical treatment is called for, said Dr. James Smithson of Kaweah Delta Medical Center’s Emergency Department.

To distinguish burns that require professional care from those that may only need self-care, Smithson said, calls for understanding the meaning of burn classifications: Burns are classified by depth, size, and location as either first-, second-, third- or fourth-degree burns. Unlike criminal charges, in which “first-degree” denotes the highest severity, burns are classified the opposite way, with fourth-degree the most severe.

Burn location is of utmost importance, Smithson emphasized. “Burns that cross joints, particularly of the hands and […] extremities are more likely to cause long-term mobility issues because of scarring, and therefore deserve special consideration by the acute-care and long-term-care providers.”

First-degree burns are limited to the epidermis (top layer of the human skin structure) and characterized by redness and pain. “They generally heal within several days to a week,” Smithson said. “First-degree burns—which are red, painful, tender, and devoid of blisters—may generally be managed at home. Treatment includes topical and systemic analgesia, including immediate tap water submersion or cool compresses, topical aloe vera, ibuprofen, and acetaminophen.”

One of the most common misconceptions is that ice should be applied to a burn. “There is evidence that suggests that intermediately damaged skin can become permanently damaged if cooled too aggressively, such as occurs when a burn is submerged in ice water,” Smithson explained. “Tap water submersion or cool tap water compresses are the most appropriate choices.”

If you have trouble distinguishing burn severity, you are not alone. Medical professionals, too, find the process a challenge. Assessment of burn depth can be a pitfall even for health care providers, Smithson cautioned. “Clinical estimation of burn depth is often inaccurate, despite careful examination. Serial assessments are necessary to distinguish between deep and superficial burns as the injury is dynamic and often continues to evolve after initial presentation.” As a consequence, he said, close follow-up is a key component of burn care. “A patient with a poorly healing wound should be referred to a dedicated burn clinic,” he advised.

Second-degree burns are more severe and extend through the epidermis and into the dermis. “They may be classified as either superficial or deep depending on the depth of dermal injury. [So] appropriate classification is key,” said Smithson, who trained at UC San Francisco and UC San Diego, which both have Level I trauma centers as well as dedicated burn treatment centers.

“In superficial second-degree burns, the skin is red, blistered and may be moist. The wound blanches with pressure and is painful and tender,” Smithson said. “In deep second-degree burns, the skin may appear white with areas of redness and exhibits less blanching and moisture than superficial second-degree burns.

“In general, patients should see a physician if the burn sustained may be second degree or worse, particularly if there are multiple or large blisters, or involvement of skin of a cosmetically sensitive area, like the face, or overlying a joint,” Smithson advised.

Emergency room physicians provide initial care for burn patients. “Our initial focus is on securing vital functions for our patients so that specialty care can ensue. Patients, particularly those injured in closed-space burns, are prone to develop thermal and chemical airway and pulmonary injuries that may progress rapidly,” Smithson said, adding that such patients may need an artificial airway so that adequate ventilation and oxygenation can be guaranteed.

Severe burns are a major shock to the body and can play havoc with all the body’s functions, depleting fluids and even causing serious systemic crises such as kidney failure, Smithson said. Careful administration of IV fluids—neither too little nor too much—is crucial and must be individualized based on the extent of the patient’s burns and in the context of other medical issues they may have.

Treatment of burns with blisters can be additionally challenging and is best done by an emergency physician or general surgeon with burn training, Smithson said. “Blisters that are under 2 centimeters (1 inch) in diameter can be left intact, creating a sterile, moist environment for healing of the underlying burn.” But larger blisters or blisters that have broken should be removed and an antibiotic ointment applied, keeping the wound moist until healing has occurred, he noted.

Third-degree or full-thickness burns extend through the epidermis and the dermis and appear stiff, white or tan in color. Smithson said they are dry, do not blanch, and are not painful in their central regions.

Fourth-degree burns, the most grave, have permanently damaged tissue beyond the skin, resulting in significant scarring at best, or mortality at worst. “A serious burn is one of the most painful and disfiguring injuries a person can suffer. … Burn victims deal with stigma associated mainly with visible scarring and may be challenged by scarring that limits joint mobility and therefore independence,” Smithson said. While “fourth-degree” is not considered a technical term, it is frequently used for burns which reach muscle or bone.

Victims of severe burns need inpatient care from a burn center, Smithson said, noting that burn center staff have specialized resources, such as referrals to outside or in-house support groups and a multidisciplinary approach to patient care. There are several online resources, too, such as www.burnsurvivor.com, which have helpful, current and accurate information to support burn victims in their recovery, he said.

Severely burned victims in our region face a transfer to Fresno or Bakersfield hospitals, since Kaweah Delta is not a designated burn treatment center. “[But] now that Kaweah Delta Medical Center is a level 3 trauma center, it has a more direct relationship with local burn centers, which leads to more timely transfer and coordinated care,” Smithson said. “Kaweah Delta is staffed with emergency physicians and general surgeons with specific training in burn management [who] are well equipped to provide up-to-date emergency care and stabilization of patients with burns.”

Fortunately, recent medical advances have improved severe burn treatment approaches, Smithson said. Pressure dressings have been developed that significantly reduce scarring, particularly of the face and small joints of the hand, leading to improved cosmetic outcomes and long-term functionality. “Additionally, there are newer synthetic and biosynthetic dressings that create enhanced environments for skin regeneration in regions of deep second-degree burns,” Smithson said, noting that such new treatments require coordination by a burn clinic.

Smithson foresees “a new era is on the horizon in Tulare County with Kaweah Delta Medical Center and California Emergency Physicians teaming up to begin an emergency medicine residency in 2012. The medical center is continuing a course of growth, and a burn center [of our own] may be necessary to adequately serve the county in the future.”

Sequoia Foodie Fest Turns Up the “Heat” in Law Enforcement Rivalry

By Paul Main

In May of this year, Exeter was host to the inaugural Sequoia Foodie Fest.  Organizers worked for two years to put together this fundraising event to help support the Boys & Girls Club of the Sequoias, an after school program serving more than 1,200 kids a day in 10 clubs in Exeter, Farmersville, Porterville and Tipton.

The Foodie Fest touted fun, fare, and music with its theme of “California’s Most Delicious Adventure,” spotlighting Tulare County’s agricultural riches.  Organizers were even able to offer a celebrity touch with visiting host Danny Boome from the Food Network’s “Rescue Chef” program.

One of the festival’s highlights was an Iron Chef competition held in an actual “kitchen stadium.” Modeled on the format familiar to fans of the Food Network’s popular “Iron Chef” show, with elements of the cable network’s “Chopped” series thrown in, the culinary contests featured professional chefs as well as amateurs cooking on deadline as festival-goers cheered them on.

Several Iron Chef matchups were held throughout the weekend. I was invited to join the cook-off between Farmersville Police Department and Exeter Police Department.  With a bit of local pride on the line, Police Chiefs Mario Krstic (Farmersville) and Cliff Bush (Exeter) had their respective teams prepped for an assortment of surprise ingredients that could come their way.  Farmersville’s team included Chief Krstic, Lieutenant Mike Marquez, myself, and “team coach” Chef David Vartanian of The Vintage Press restaurant in Visalia.  Exeter’s team included Chief Cliff Bush, Deputy Chief Kevin Wright, and Richard Moore, guest, friend and apparent “ringer” for the Exeter Police Department team.

When the clock ran out in what felt like the fastest 60 minutes ever recorded, it was Exeter PD that prevailed with the judges. “In the end, it was really the Boys & Girls Club that won,” Chief Bush acknowledged.  “Our part was to bring a little fun to the table.”

Apparently, Chief Krstic wasn’t bothered too much by the loss. He told Valley Response Magazine his team was treated to dinner by “Coach” Vartanian at The Vintage Press, adding, “That’s not a bad deal for second place.”

The Farmersville and Exeter Police Departments, the festival organizers, and the Boys & Girls Club of the Sequoias hope everyone enjoyed the Sequoia Foodie Fest and look forward to seeing even more folks there next year.

This month’s recipe, developed by the Farmersville PD team for the Iron Chef competition, takes us back to the grill.

Grilled Skirt Steak with Red Radish, Tomatillo & Avocado Salsa

Ingredients for skirt steak marinade:

1/4 cup            lime juice (you can also substitute fresh squeezed orange or lemon juice)

2 tablespoons olive oil or canola oil

2 tablespoons Worcestershire sauce

2 tablespoons cilantro, chopped fine

1 tablespoon dried chipotle pepper powder or chipotle pepper sauce

1 tablespoon paprika

1 tablespoon chili powder

1 teaspoon fresh garlic, minced

1 teaspoon salt

1/2 teaspoon black pepper

2-pound skirt steak

Method: In a small mixing bowl, mix together juice, oil, Worcestershire sauce, herbs, and seasonings.  Rub mixture on both sides of skirt steak.  Place the meat inside a baking dish, pan, or large re-sealable baggie and allow to marinate for at least 30 minutes or up to 24 hours.  Prepare grill.  When grill is ready, remove steak from marinade and grill over high heat to provide a quick sear.  As skirt steak is a thinner cut of beef, it will only need 3-5 minutes per side to reach medium rare, or cook longer to desired doneness.  Remove skirt steak to a plate or dish, cover lightly with foil and allow to rest for at least 5 minutes.  When ready for serving, slice meat against the grain in strips.

Red Radish, Tomatillo & Avocado Salsa

Ingredients:

4 large (or 6-8 medium) tomatillos, husks removed, washed

1 jalapeño

2 teaspoons canola oil

1/4 cup            yellow, white, or sweet onion, diced small

3 tablespoons lime juice

2 tablespoons water

1/4 cup            cilantro, chopped fine

1/2 teaspoon cumin powder

1/2 teaspoon chili powder

pinch of cayenne pepper (optional)

salt & pepper to taste

2 avocados, coarsely chopped

4 tablespoons grated red radish

Method: Grill or roast tomatillos along with jalapeño pepper until slightly charred, about 5-7 minutes.  Remove from heat and let cool slightly; set aside.  In a skillet over medium heat, add oil and begin to cook diced onion. Chop the tomatillos; finely chop the jalapeño (seeds and stem removed) and add both to onion mixture in skillet. When tomatillos begin to soften (1-2 minutes), add lime juice and cilantro. Pour mixture into a blender or use an immersion or hand mixer.  Start the blender in short spurts and continue until coarsely blended. Add water as needed to help liquefy the mixture. Add spices and seasonings. Pour mixture into a serving bowl and gently stir in the chopped avocados. Stir in grated radish, reserving some for garnish.  Serve salsa over the sliced grilled skirt steak along with warm whole-grain tortillas and your favorite side dishes.

SIDEBAR: Blender Safety Tips

In the recipe for the salsa, it suggests putting the hot mixture into a blender or using an immersion or hand mixer.  When using a blender to puree hot food, there are a few tips to consider:

• Make sure the blender is in the OFF position, the base is tight and without movement, and the blade is properly attached
• Do not fill beyond the half-way point of the blender jar
• Place lid securely on blender followed by securing a thick dish towel around top of blender (hold with light pressure)
• Start blender using a low setting, gradually working up to the desired processing speed

Be sure to review the instruction manual when operating and cleaning your blender.  Additional safety tips can be found at http://ezinearticles.com/?The-Safest-Way-to-Use-Your-Blender&id=3733003:

Tulare’s T-RATT Program Cuts Auto Crimes

By Aaron Collins

California has long been considered America’s capital of car culture, but along with that claim to fame comes a high rate of auto theft. According to 2009 statistics from the National Insurance Crime Bureau, six of the top ten “hot spots” for auto theft in the United States are in California, and of those six regions, five are in the Central Valley: Modesto (ranked No. 2), Bakersfield (No. 3), Stockton (No. 4), Fresno (No. 5), and Visalia-Porterville (No. 8).

That these areas share a high rate of auto theft is not surprising: Our region’s socio-cultural DNA ensures that our counties’ crime problems are somewhat uniform in nature.

According to Tulare County Assistant District Attorney Shani Jenkins of the agency’s Criminal Division, the Valley’s auto theft rate is attributable to high poverty, drug culture and gang problems—“a perfect storm,” as she described it. The problem is significant enough that the DA’s office has dedicated one prosecutor, Jamil Nushwat, exclusively to the task of prosecuting auto thievery.

While Jenkins said the number of convictions for auto theft in Tulare County remains steady at around 300 per year, perhaps the best recent news is that our region is following a national trend: In May, the NICB reported that 2009 marked the sixth consecutive year of declining vehicle thefts in the United States, including our region.

Locally, the car most often targeted is the Honda Accord, a perennial favorite among thieves owing in part to the car’s ubiquity, which, in turn, drives a demand for chop shoppers’ hot parts. Other frequent targets are GMC pickups and SUVs; local tastes in vehicles and trends in customization mean these are often stolen for the expensive wheel rims found on them, Jenkins said.

But even though the overall numbers may be improving, so are criminals’ methods. Cars stolen in one city are discarded in the unincorporated areas of the county or sometimes sent to another region for disassembly and reconfiguration with a new identity.

From Joy Riders to Chop Shops

Fighting our auto-theft problem in the South Valley has required increased specialization as thieves have evolved over the years from simple joy riders to more sophisticated networks of lucrative chop shops. Because these elaborate clandestine operations often span several jurisdictions, law enforcement agencies must coordinate increasingly complex efforts for deterrence and prosecution.

According to Jenkins, inter-agency cooperation has always been required, but new shifts in fighting this crime category are more proactive, rather than reactive. Rather than waiting for a crime to happen, Jenkins said, law enforcement personnel are in daily contact, sharing information and identifying trends and developments in order to alert one another to potential criminal activity.

That multi-agency, cross-jurisdictional approach is known as T-RATT (Tulare County Regional Auto Theft Team). Its concept is based on similar law enforcement programs elsewhere, such as LA TRAP and Orange County’s OCATT. Launched in April 2008, the local effort draws on personnel from the California Highway Patrol, Tulare County District Attorney’s Office, and police departments in cities around the county, including Visalia, Tulare, Porterville, and Woodlake. The group’s leader is Visalia-based Sergeant Chuck Mosley of the CHP.

T-RATT’s Efforts Pay Off in Fewer Thefts

“[Our mission is] to reduce the rate of auto theft in Tulare County. Our scope is Tulare County; however, we operate outside of the county if a nexus to Tulare County is established,” Mosley said. Prior to the initiative, Tulare County had been rated as high as third in the nation for per capita auto thefts. Mosley said that since the inception of the region-wide effort, Tulare County has seen a 27% reduction in grand theft for automobiles, according to the latest NICB statistics.

The NICB is a nonprofit organization that receives support from approximately 1,000 property/casualty insurance companies. It partners with insurers and law enforcement agencies to facilitate the identification, detection and prosecution of insurance criminals. “This is great news on the vehicle theft front,” said NICB President and CEO Joe Wehrle in a press release about the May report. “Six straight years of vehicle theft reductions are the result of a lot of hard work on the part of law enforcement, prosecutors, legislators, NICB member companies, NICB personnel and insurance industry trade groups who have contributed expertise and energy to have an impact on this crime.”

Nevertheless, T-RATT’s law enforcement personnel still face a daunting task: A total of 2,440 auto thefts were reported in Tulare County in 2009.

Mosley said T-RATT has many tactics and tools in its bag of tricks: surveillance, bait vehicles, parole and probation compliance searches, use of informants, saturation patrols, public assistance, and joint multi-agency operations.  “Couple that with the ability and skill of the assigned investigators,” he added, “and you have a true model for success.”

Since the program’s inception, Mosley said, the team has recovered 626 stolen vehicles, arrested or charged 470 individuals for vehicle theft, effected 283 other arrests, and investigated 54 chop shops in the area.

SIDEBAR:

The National Insurance Crime Bureau advises the following layered approach to vehicle theft protection:

Common sense. Common sense is the simplest and most cost-effective way to defeat would-be criminals. Secure your vehicle even when parking for brief periods. You should always:

•  Remove your keys from the ignition

•  Lock your doors /close your windows

•  Park in a well-lit area

Warning device. The second layer of protection is a visible or audible device that alerts thieves your vehicle is protected. Popular examples include:

•  Audible alarms

•  Steering column collars

•  Steering wheel/brake pedal lock

•  Brake locks

•  Wheel locks

•  Tire locks/tire deflators

•  Theft deterrent decals

•  Identification markers in or on vehicle

•  VIN etching

•  Microdot marking

Immobilizing device. The third layer of protection is a device that prevents thieves from bypassing your ignition and hot-wiring the vehicle. Some electronic devices have computer chips in ignition keys. Other devices inhibit the flow of electricity or fuel to the engine until a hidden switch or button is activated. Popular examples include:

•  Smart keys

•  Fuse cut-offs

•  Kill switches

•  Starter, ignition, and fuel pump disablers

•  Wireless ignition authentication

Tracking device. The final layer of protection is a tracking device that emits a signal to police or a monitoring station when the vehicle is stolen. Tracking devices are very effective in helping authorities recover stolen vehicles. Some systems employ telematics that combine GPS and wireless technologies to allow remote monitoring of a vehicle. If the vehicle is moved the system will alert the owner and the vehicle can be tracked via computer. Discounts are available to the public for a select group of theft deterrent and recovery devices through the NICB website.

Anyone with information concerning vehicle theft and insurance fraud can report it anonymously by calling toll-free 1-800-TEL-NICB (1-800-835-6422), or by visiting the NICB website at www.nicb.org. You may also text your information to TIP411, keyword FRAUD, and remain anonymous if you prefer.