Editor's Note: This article is the second of a two-part article, that is in
itself, a series of articles running this week in the Ottawa Sun.

WHEN MOMMY DRINKS (Part 2 of 2)

The community tries to keep its alcohol problem quiet, but every year
several residents are sent to outside detox centres for treatment.

For those who don't want his or anyone else's help, the band council
and elder panel can vote to send them off the reserve for the
counselling and detox programs they need.

But the treatment often fails to turn these people's lives around.
Once they return to the reserve they tend to return to their old
habits of alcohol and substance abuse.

Vezina says the problem can be solved only if children are intercepted
before they reach for their first drink. To help bring prevention
programs to Attawapiskat's children and teens, Vezina helped organize
an addiction information week at J.R. Nakogee School.

Allen Deleary, the Assembly of First Nations health commissioner, says
there isn't enough money to build a health care system on reserves
that even comes close to the quality other Canadians enjoy.

The federal and provincial governments continually argue over who
should foot the bill, he says.

"Our people often fall through the cracks," says Deleary, adding that
adequate mental health programs are needed to address problems on
reserves, which have the highest suicide and addiction rates in Canada.

Attawapiskat is lucky to have its own tiny hospital and a sparse
health unit, but its health care workers are overloaded with
day-to-day issues and therefore haven't the time to develop FAS strategies.

Alcohol abuse is hidden from outsiders in this northern Ontario
reserve. It often takes years for visiting doctors and other health
care workers to even catch a glimpse of the scope of the addiction
problems and the resulting FAS children.

Because the community prefers to keep this skeleton in the closet, the
increasing number of FAS victims are forced to live their lives with
little or no treatment and, perhaps worse, no understanding from their
family and peers.

Simone Joanisse knows life for her 14-year-old daughter Caroline is
about to become a lot more difficult.

Caroline has faced few major hurdles so far, but the mother of six
fears the worst is still to come for her daughter.

It took Simone Joanisse years to get her 14-year-old daughter Caroline
diagnosed with partial FAS, a turning point that opened the door for
proper treatment.

The problems she faces with partial FAS, combined with the everyday
challenges associated with adolescence, promise to make Caroline's
life and that of her family much tougher to deal with.

In an attempt to shelter Caroline from some of life's many problems,
Joanisse controls her adopted daughter's every move. When she's not
there, a nanny oversees her daughter's activities.

"It's almost necessary to have somebody like a nanny to live in,"
explains Joanisse, adding she tried to leave her daughter alone for
half an hour after school once, but returned to find all the doors
open and Caroline wandering through their two-acre wooded yard. "Kids
like these need constant supervision."

Simone and her husband, Dr. John Joanisse, adopted Caroline while they
were living in Kapuskasing, about 100 km north of Timmins.

Joanisse knew Caroline was a special needs child when she was adopted
at 18 months old, but didn't know the exact nature of her problem. "Up
until we adopted Caroline we didn't have a lot of understanding of
FAS," Joanisse says while keeping a watchful eye on Caroline, who is
captivated by a Power Rangers episode on television. "At the time it
was hardly known."

Joanisse says when she adopted Caroline the toddler couldn't walk or
talk. It was like she had adopted a newborn.

Joanisse called her daughter's childhood a "challenge," adding that
the girl cried constantly and screamed louder when the family tried to
hug or console her.

It became obvious that something was terribly wrong by Grade 4, when
Caroline had problems in school and needed the help of a tutor for all
subjects.

They knew their daughter's Welsh birth mother drank during her
pregnancy, so they were able to get a diagnosis of partial FAS from a
specialist at Sick Children's Hospital in 1994.

The label makes it easier for teachers to understand what makes
Caroline behave the way she does, and how to deal with it. "We've got
a lot of support at the school," says Joanisse. "Over time they
understand it's not just a behaviour problem."

Although Caroline finds it difficult to succeed on the social scene,
she graduated from Grade 8 this year and has registered at a
vocational school in Manotick where she'll be able to work on her strengths.

"We feel there's so little resources for kids with this disability,"
says Joanisse, who uses FASLINK on the Internet to stay in touch with
other parents of FAS children.

Now, all Joanisse can do is wait and see if Caroline's behavioural
problems will change when she goes through her teenage years, and deal
with them one at a time.

"I worry what would happen to her if something happened to John and
I."

FAS children are often labelled "failure to thrive
babies."

They can have heart abnormalities, skeletal defects and immune system
problems.

Father Rodrigue Vezina has tended his flock at Attawapiskat for 25
years, educating children in the hope of keeping them from
experimenting with drugs and alcohol.

But all these defects don't stop them from developing an engaging
smile and extended vocabulary at an early age.

Often parents believe they have a healthy, friendly and talkative
child until it's time to start school, when behavioural problems tend
to occur. FAS children exhibit clumsiness, slow motor development and
a lack of social skills.

A short attention span and memory problems can test the most dedicated
of teachers, requiring parents with the financial resources to hire a
tutor so their child has a chance to succeed.

FAS children don't deal well with change. They depend on routine, and
the tiniest change can provoke tantrums and unpredictable
disappearances.

As FAS children reach their teenage years they often lose most
physical features related to their birth defect, but their heads
remain small. They are mildly retarded, but the severity varies with
every case.

FAS and partial FAS children become impulsive adults with poor
judgment and social skills. They have poor organizational skills, and
don't recognize boundaries. This makes them easy prey for people who
want to take advantage of them.

Because partial FAS children have the same behavioural and learning
problems as FAS children but do not display the physical deformities,
they are often considered wilfully bad and are left
undiagnosed.

"We're now learning about damage, but we don't know what causes the
brain damage," says Koren, adding that brain damage is permanent and
cannot be treated. "We're not doing well."

As FAS children get older they become increasingly prone to abusing
drugs and alcohol. They also tend to be sexually promiscuous,
increasing their chances of giving birth to a new generation of FAS
children.

Dr. Christine Loock, a professor of developmental pediatrics at the
University of British Columbia's faculty of medicine, is a leader in
developing B.C.'s FAS programs. She has been careful not to label
particular socio-economic groups or ethnic groups, noting FAS is
present throughout all of society.

"Everybody's at risk," she explains. "We're in a society where women
use alcohol."

Those considered the highest risk for damaging their babies with
alcohol are women with poor prenatal care and nutrition, and who use a
number of drugs. She said prevention programs must focus on these groups.

Although much research remains to be done, there are a few studies
which permit doctors to counsel women on their drinking habits during
pregnancy. But few studies exist to help doctors counsel the father on
his drinking habits during conception and afterward.

Researchers do know that married women rarely drink alone, so FAS
prevention programs need to target both parents.

Alcohol affects pregnant women and their unborn children in a number
of ways, from miscarriage and premature delivery to FAS and learning
disabilities.

The more a mother drinks and the longer she has been drinking, the
higher the risk she will give birth to an FAS child.

It takes an hour for an adult to eliminate the amount of alcohol
contained in a beer or glass of wine from the blood. But a fetus takes
much longer because of its undeveloped liver.

Alcohol is easily transferred across the placenta into the circulatory
system of the fetus.

Because the fetus is forced to use its energy to process alcohol, it
can't produce new cells and tissues, causing extensive damage to
internal organs including the brain.

"It's like a huge disruption of the brain," Koren says. "For most kids
that have brain problems we do not know the reason. Here we do. It's
the most common preventable reason."

Among addictive substances, alcohol has the worst long-term effects,
doing more potential damage to the unborn child than cocaine.

But researchers haven't been able to pinpoint the amount of booze a
pregnant woman must consume in order to do permanent damage to her
unborn child.

Some women can drink heavily throughout pregnancy with no adverse
effect, while others will do permanent damage after drinking
relatively little.

"We don't know yet what saves some and what doesn't save others," says
Koren, who considers FAS a major epidemic in this country. "We're
still trying to learn.

He says the few studies that have been done on the effects of alcohol
on unborn children all point out that mild social drinking is safe.

The basic guideline is that a woman who drinks every day or drinks
more than three drinks at one sitting risks doing irreversible damage
to her unborn child.

"Most of the women who give birth to FAS children are problem
drinkers," says Koren, who adds that children must endure about three
days of tests before they can be properly diagnosed.

Symptoms of FAS include a smaller than normal head, low set ears,
small eye slits, a long face, a flat vertical groove between the nose
and upper lip, a thin upper lip and a flat upper jaw bone.

A patient must exhibit at least two facial characteristics, as well as
damage to the central nervous system and growth deficiencies, in order
to be diagnosed with full-blown FAS.

Determining that a child has partial FAS is much more difficult. These
children have brain damage but not the physical deformities, so they
cannot be clinically diagnosed. Parents must also prove the birth mom
abused alcohol.

Even with the above guidelines to work with, FAS is difficult to
diagnose because there is no single symptom that will positively
identify it.

No two children are affected by FAS in the same way and the diagnostic
tools have not yet been fully developed. "We treat cancer better than
we treat that," says Koren. "It's a problem that's most difficult to
treat."

Many children with FAS are never diagnosed. Instead, teachers, parents
and physicians may label them hyperactive, learning disabled,
distracted or simply bad kids.

The first North American diagnosis of FAS was published in the Lancet
medical journal in 1973, describing the pattern of
malformation.

The term FAS first surfaced a few years earlier after a similar study
was published in a European medical journal.

The published results gave physicians the knowledge to explain the
effect of alcohol abuse during pregnancy to expectant mothers.

Some of the most recent studies say it's risky to have two or more
drinks a day during pregnancy, but others say there is no concrete
data on how much is too much.

Regular drinkers, binge drinkers and alcoholics run a much greater
risk of damaging their unborn children. Binge drinking, solidly linked
to FAS, is a popular pastime among some young women and teenagers.

Because studies have found the occasional drink doesn't tend to do any
harm, Koren tells expectant mothers not to be concerned with social
drinking as long as there are reasonable limits.

"I know it's not a popular message," says Koren, admitting his advice
is unpopular among those who promote abstinence.

"But if it stops there, then they won't have a problem."

Checked-by: Rich O'Grady