CHRON2504

Archbishop Emil Paul Tscherrig, Apostolic Nuncio or Papal Representative to the region comprising the Antilles Episcopal Conference since October 2000, has completed his term of service and been reassigned to Korea and Mongolia. As the representative of the Holy Father in the region for the last four years, Archbishop Tscherrig witnessed a virtual sea-change in the leadership of the Church . Eight archbishops and bishops retired during the period, three of whom, Archbishop Samuel Carter, and bishops Simeon Oualli and Willem Ellis, died.

Three new archbishops were appointed, including Archbishop Edward Gilbert of Port-of-Spain (amidst great controversy). Archbishop Patrick Pindar of Nassau and Archbishop Michel Méranville of St. Pierre & Fort-de-France. Among the bishops appointed were Gabriel Malzaire of Roseau/Dominica, Vincent Daruis of St. George’s-in-Grenada and Francis Alleyne of Georgetown, Guyana.

Two notable events in the Archdiocese of Castries during the tenure of Archbishop Tscherrig were the Antilles Eucharistic Congress of 2000, and the assault on worshippers at the Castries Cathedral on December 31, 2000 which resulted in the deaths of Sr. Teresa Egan SJC and Fr. Charles Gaillard.

The Catholic Chronicle and the entire archdiocese wish Archbishop Tscherrig a fruitful ministry in his new assignment.

Saint of the Month
St. Therese Couderc, Religious
Marie-Victoire Couderc
by Sr. Theresa Corbie, S.J.C.

Marie Victoire Couderc was born on February 1, 1805, in Sablieres, France, to Claud and Anne Mary Coudrec, hard working, very religious French country folk. One of two girls in a family of 10 children, Victoire was skilled at housework at an early age, but found plenty of time to attend Holy Mass and make visits to the Blessed Sacrament. Prayer came naturally and she prayed as she worked.

During a retreat in Lent 1825, Victoire met a Father Terme, a priest who lived near the shrine of St. John Francis Regis, and who had founded a group of teaching Sisters at Aps. Victoire revealed to him her desire to be a religious. Couderc reluctantly Save his permission but refused to give her a dowry.

Many pilgrims visited the shrine of St. John Francis
Regis, to such an extent that the inn always
overcrowded and the innkeepers resorted to lodging men and women in the same rooms. Fr. Terme solved this problem by building a hostel for women and bringing Victoire, now Sister Therese, with two Sisters to staff it. He also brought the novitiate from Aps. Mother Therese was thus responsible for running the hostel and training the novices. Later, she was given the added responsibility of being Superior of the house near the shrine of St. John Francis Regis, and also of supplying teachers for the school. She was then 23 years old. The Sisters becarne known as the Religious of St. Regis.

The hostel was an instant success but so many women pilgrims came that the hostel was always overcrowded, with resulting noise and distractions and overwork for the novices. To prevent the novices from becoming mere innkeepers, to the detriment of their religious life, Mother Therese suggested to Fr. Terme that only pilgrims who agreed to stay for no less than three days and were willing to take part in some religious exercise should be accepted. As a result, silence and prayer reigned. Fr. Term introduced the Sisters to the Spiritual Exercises of St, Ignatius and, these exercises replaced the devotions that the Sisters had introduced to the pilgrims.
Fr. Terme. who had been co founder with Mother Therese of this fledging congregation, died early. His death brought a long period of suffering for Mother Therese.

The congregation soon divided into two branches; some Sisters continued teaching as the Sisters of St. Regis, while the others gave retreats as the Society of Our Lady of the Retreat in the Cenacle. A number of Jesuit priests helped the new congregation to lay the foundations of the interior life and acquire a good understanding of the Spiritual Exercises of St. Ignatius.

Mother Therese suffered from the Sisters she governed. Through spite, one of the assistants spread false rumours about her, thus undermining her authority and the Sisters’ confidence in her. Mother Therese was replaced as Superior by a wealthy novice, who had no concept of religious life and relaxed the rules. She was deposed and another introduced, who kept Mother Therese away form the other Sisters and prevented her form doing any apostolic and retreat work, confining her to doing manual work, which she endured for 13 years.

Re-instated as Superior, Mother Therese guided the Sisters with goodness and firmness. She suffered intensely during the last 25 years of her life. Every Thursday evening and every Friday she shared in Christ’s agony in the Garden of Gethsemane. She also prayed earnestly for the souls in Purgatory.

Mother Therese died peacefully on September 26th at 4.15pm. At her canonization by Pope Paul VI, he spoke at length of her life, emphasizing her humility, her patience, her obedience, but above all her silence.

Fr. Charles Jesse F.M.I. honoured

Fr. Charles Jesse FMI, one of the founding members of the St. Lucia Archaeological and Historical Society, was honoured during a special ceremony to mark the 50th anniversary of the society. The event took place at the Oceana Restaurant & Lounge, the Morne on Friday 23rd July, 2004. Receiving the two plaques on behalf of the late Fr. Jesse was Msgr. Patrick Anthony, himself a past vice-president of the society.

A Non-Governmental Organization, St. Lucia Archaelogical and Historical Society (S.L.A.H.S) is the oldest cultural heritage protector in the West Indies. It was founded in 1954 by Wilfred St. Clair Daniel, B.H.Easter, Fr. Charles Jesse, Harold Simmons, Eric Branford and a group of interested persons. The founding members formulated and implemented the initiatives which led to the creation of the St. Lucia National Trust and the Saint Lucia National Archives, thus making the SLAHS the parent body of these groups. Today, under the presidency of Mrs. Fortuna Anthony-Husbands, the Society provides information and advice on preservation, restoration and presentation of cultural heritage and more specifically archaeology, history and museum development. It also promotes awareness and participation in heritage conservation and supports the work of several cultural heritage organizations.

During the 50th anniversary celebration a number of long serving members were also awarded, among them : Mrs. Patricia Charles, Mr. Robert Devaux, Lady Janice Compton, Mr. Julian Hunte, Mr. Gregor Williams, Mrs. Maria Grech, Ms. Carola Wala and Mr. Benignus Henry. Presentations were made to the president, to long serving trouble chaser, Mr. Leith Thompson, as well as the president’s own awards to Dr. Bill Keegan, Mr. Peter Harris and Mr. Ripley Bullen.

H.E. Julian Hunte Honoured

The Government of Saint Lucia and the Holy See
announced that His Holiness the Pope John Paul II has given a major recognition to the Minister for External Affairs, International Trade and Civil Aviation and President of the Fifty eighth Session of the United Nations General Assembly, KE. Mr.Julian Robert Hunte.

Minister Hunte is to receive the Knight of the Grand Cross Pian Order, in recognition of’ his accomplishments at the United Nations during his Presidency of the General Assembly. Mr Hunte is especially commended for the major role he played in the consensus adoption of the General Assembly resolution entitled “Participation of the Holy See in the work of the United Nations”.

In accepting the award, Minister Hunte acknowledged the tremendous support his Presidency has received from Prime Minister the Honourable Dr. Kenny D. Anthony and the Government and people of Saint Lucia, the members of his Cabinet, the Governments of the Caribbean Community (CARICOM) and other States of the Latin American and Caribbean Group.

The award will be bestowed on Minister Hunte by His Eminence Cardinal Angelo Sodano, Secretary of State of the Holy See, at a Ceremony to be held on 19 September 2004 in New York.

The Prime Minister of Saint Lucia, Dr. the Honourable Kenny D. Anthony said, “The Government and People of Saint Lucia are justifiably proud of Minister Hunte’s accomplishments, and for the commendation he has received from His Holiness the Pope”.

Chronic Low Back Pain; Causes, Evaluation and Treatment
by Winston C. V. Parris. MD, FACPM, FACA, CMG

Every human being in his lifetime has some degree of back pain at one time or another and with varying degrees of severity. Most of the time, the pain is acute and self-limited and usually subsides on its own or with conservative treatment. On a few occasions, the back pain becomes severe, intractable, unrelenting and unresponsive to conventional medical treatment. The causes of back pain are many and are related to a variety of pathological factors including trauma, postural, congenital, inflammatory (acute and chronic), metabolic, nutritional, infective (viral, fungal and bacterial) and neoplastic (non-malignant and cancer). Most of the time the causes are benign, self limiting and are seldom life threatening.

Most back pain originates from the spine and the surrounding tissues. It is therefore relevant to review the components of the spine at this time. The vertebral column consists of a series of bones, which surround the spinal cord and offers the spinal cord and associated spinal nerves protection; the vertebral column also facilitates movement and many related activities. Human beings have 33 vertebrae. These vertebrae are divided into seven cervical (neck) vertebrae, twelve thoracic (chest) vertebrae, five lumbar (mid-back) vertebra, five fused sacral (low back) vertebra and variable coccygeal (tail remnants) vertebrae.

When man progressed from walking on four limbs to walking on two limbs, the mechanical implications of that evolutional change resulted in a redistribution of the weight with the result that the low back area in modern man supports the entire head, neck, trunk, abdomen and pelvis of the body. This makes the low back area and the related structures very susceptible to injuries including occupational, postural, traumatic and related disorders. Further, as one ages, normal degenerative (wear and tear) changes occur and osteoarthritic processes set in and these changes are almost always associated with pain. Fortunately, these changes and the associated pain is not life threatening and is of no serious consequence.

It is relevant at this point to examine a typical vertebra and the structure surrounding it. Each vertebra is separated from the one above and below by an intervertebral disc. Each disc consists of a thick outer portion called the annulus and a gelatinous and softer central portion called the nucleolus. The nucleolus contains various chemicals including irritating acids and glyco-proteinous material. When the outer portion of the disc (annulus) is worn away or disrupted by either trauma, wear and tear, old age or other disease processes, the central nucleolus area leaks out, an inflammatory lesion develops and may irritate and exert pressure on surrounding structures. There are pairs of spinal nerves, which come out at each level of the vertebra, and they are distributed to different parts of the body and to both upper and lower limbs. When pressure on these nerves occurs, not only does back pain occur, but also this pain is accompanied by pain going down the leg and this situation is referred to as a radiculopathy. Pressure and inflammation may affect the other structures close to the spine and these may include bony processes referred to as osteophytes, facets, various ligaments and tendons and muscles, which are in the area around the spine. All these areas have nerves and blood vessels and are capable of generating pain.

The cost of chronic low back pain in any society can be enormous. In the United States actuarial studies suggest that in 1997 chronic low back pain costs the United States 297 billion American dollars. This figure not only includes medical, hospital and drug related costs but also includes time lost from work, decrease in the tax revenue of persons made ill from back pain and other indirect costs. The costs from back pain in St Lucia has not yet been determined, but I was very much surprised to find out the extent and magnitude of chronic low back pain problems in St. Lucia. The resultant pain and suffering and inability to perform one’s activities of daily living as a result of chronic low back pain are inestimable and it is difficult to put a dollar value on that cost. Nevertheless, the numbers are quite high and patients go for long periods of their lives suffering silently with very little hope for significantly pain relief.

The causes of chronic low back pain include the following:
1). Congenital
2). Metabolic
3). Degenerative (osteoarthritis)
4). Traumatic (ruptured discs)
5). Inflammatory discitis
6). Postural (bad body habits)
7). Slipped discs (spondylolisthesis)
8). Structural scoliosis (crooked spine),
9). Spinal stenosis,
10). Infective eg tuberculosis, osteomyolitis
11). Tumor
a. primary osteoblastoma (vary rare)
b.secondary due to medastatic tumor from other parts of the body for example breasts or prostate
c. Multiple Myeloma (Bone marrow cancer).

The above list is by no means complete but is intended to represent a sample of the diseases that may cause chronic low back pain.

Chronic low back pain affects people of all ages and as an average person ages over 50 years and if that person has not exercised regularly; is over weight and has bad postural habits, the likelihood of developing chronic low back pain and its pathological sequelae increases. Thus, it is imperative to stress that prevention is a good strategy for treating back pain. The symptoms when they occur or the pain when it occurs may be constant or intermittent and may also be associated with radiation down one or both legs.

The investigations usually performed for back pain may include:

1). Complete history and physical examination
2). X-rays for the lumbar/sacral spine
3). CT scans (computerized tomography)
4). MRI (magnetic resonance imaging)
5). EMG (electromyographyic studies)
6). Nerve conduction studies
7). Lumbar mylography
8). Thermography
9). Neurological evaluations
10). Blood investigat
11). Bone scan
The treatment of chronic low back pain should always be conservative. Ten to twenty years ago, the mere presence of a slipped disc would have been cause for lumbar spine surgery including laminectomy and / or spinal fusion. Current studies have shown that this approach is not effective and can in fact produce more pain than the original pain before surgery. This is mainly due to the unpredictable development of scar tissue which may make the original pain worse That is not to say there are not a small number of patients who may need surgery. When properly evaluated and identified, these patients respond well following surgery. But 90-95% of the patients can be effectively treated with non surgical techniques. Some of those techniques are best utilized in a Pain Clinic or Pain Institute where these modalities may be offered after comprehensive evaluation. Some of these modalities for treating chronic pain are:

1). Use of non-narcotic drugs
2). Use of analgesic adjuvants including anticonvulsants and related drugs.
3). Physical therapy
4). Psychological strategies
5). Bio-feedback
6). Vax-D
7). Selected nerve blocks

There are a variety of nerve blocks, which have shown to be effective for treating chronic low back pain, and these include:

1). Caudal epidural steroid injections
2). Transforaminol epidural steroid injection
3). Translaminar epidural steroid injections
4). Lumbar sympathetic blocks
5). Facet nerve blocks
6). Sciatic nerve blocks
7). Radiofrequency
8). Cryotherapy
9). Implantatation technologies

When appropriately used these treatments can all be effective in controlling low back pain, relieving suffering, enhancing the quality of daily living and giving a chronic pain suffering back his life. This is a very simplistic overview of chronic low back pain and is much more complicated that is indicated in this presentation. However, it is hoped that this summary will provide a basis for understanding some of the fundamentals of low back pain.