Women Health – Breast & Cervical Cancer

Definition & Risk factors:

Cancer is an insidious disease characterized by the uncontrolled (excessive) growth of dysfunctional cells of the body. Cancer can affect any body-part, but there are certain body-parts (organs) that are more affected than others.

In women age 35 – 54 years, two important organs that are most affected are the breast and the cervix. The breast, in women, is a special gland that develops around the time of puberty to be able produce milk.  The cervix is part of the female’s reproductive organs that also undergoes a lot of changes during puberty. It is a ring of tissue about 2-3cm long, attached at the opening or the lower part (neck) of the womb (uterus). During labor, it opens up to allow for the baby to be delivered.

The Female reproductive organs - cervix (2-3 cm long) is located between the vagina and the body of the uterus (womb).

The cells of the cervix and the breast undergo a lot of cellular changes/transformation during puberty and at pregnancy in the lifetime of a woman; therefore these cells are more vulnerable to cancerous changes.

Breast cancer is associated with positive family history (genetic risk factor) and other modifiable risk factors – fatty western diet, cigarette smoking, alcohol consumption, and hormonal therapy. On the other hand, it is a known fact that most (95%) cervical cancers are caused by a sexually transmitted virus (Human Papilloma Viruses-HPV). The greatest risk factor for cervical cancer is infection with HPV during and around puberty through early (pre-pubertal/pubertal) unprotected sex.

Why is this relevant for woman?

In PNG and many other developing nations, access to and affordability of cancer services remains a major obstacle to the fight against cancer. Many women have died from both cervical and breast cancers due mainly to lack or absence of awareness, vaccination programs, screening services and limited treatment options. Knowing risk factors and information about these two cancers can greatly assist one to take simple steps to prevent the cancer or enable early detection and treatment, yielding a high probability of a successful treatment outcome.

What is the issue like in PNG and the World?

·         Cervical cancer accounts for 138,000 deaths in the Asia-Pacific region.

.         Breast and cervical cancers are in the top 5 leading causes of cancer deaths in PNG.

·         In PNG, 7.7% of women in the general population carry HPV-16 /18.

·         938 women are diagnosed with cancer of the cervix every year in PNG.

·         546 women die from cervical cancer in PNG annually.

·         Breast cancer accounts for 187 000 deaths in the Asia-Pacific region.

What are the preventive and control measures?

Many cancers, including breast and cervical cancers, can be prevented by living health lifestyles. These include:

1.      Avoid/Stop cigarette smoking.

2.      Reduce intake of fatty diet.

3.      Engage in regular physical activity – establish a regular exercise program.

4.      Keep your weight within your ideal body weight range.

5.      Minimise alcohol intake.

6.      Eat regular healthy, nutritious meal with adequate amounts of fruits and vegetables.

7.      Practise safe sex

8.      Minimise sexual partners.

9.      Get vaccinated against HPV.

Get regular screening for cervical and breast cancer.

1.      Pap smear is the most popular screening test used worldwide for early detection of cervical cancer. It is recommended that women between the ages of 21 and 65 years get a Pap smear screening every three years.

2.      Perform a regular breast self examination and see a doctor to make up a mammography screening schedule for you.

 

Turmoils of Labor

For the last six hours, Betty was agonizing under the excruciating spasms of child birth. Her last three deliveries were spontaneous normal deliveries but this seemed unlike before. Being an experienced young mother, she attempted to synchronise her expulsive efforts with the painful spasmodic contractions of the baby-filled uterus. She gasped for air intermittently as sweat trickled down her forehead, over her dark brown eyes, and mixed with tears of agony as she cried –‘mama’, when labour-pain was unbearable.  Betty’s mother stood beside her in the dimly lit aid post. She watched her daughter endure the anguish and pain of motherhood. Her joy of welcoming her newborn grandchild was soon overtaken by a deep concern for her beautiful daughter. All efforts seemed to have sipped out all energy from Betty.  Rising from between Betty’s parted legs; the lone male Community Health Worker (CHW) looked up to Betty, turned to Betty’s mother, and attempts to explain the situation.

Standing beside Betty’s mother, inside the dimly lit aid post was a short stout young man, whose overbearing shadow of concern plastered against the unpainted battered walls of the aid post. Chin cupped in the palm of his hands, Betty’s husband seemed lost for words. He turned his attention to the community health worker, dreading to hear any bad news as the community health worker began to explain the difficulties Betty is experiencing. As simple as he could, he explained that the baby is a big baby and is also not lying in alignment with the birth canal. It would require an urgent referral out to save the baby and Betty. Before the community health worker ended his last sentence; tears welled up Betty’s mother’s eyes, overflowed and trickled down the sun burnt freckle face. She squeezed her daughter’s hands that was in hers most of the time, and rubbed gently with a motherly love. Betty felt the concern and care of her mother that words cannot express. The words of the CHW were news Betty’s mother would rather be deaf to. She knew the difficulties and challenges that came with such news – money, transport, the rugged terrains and the bad roads, which they have to hurdle if they have to save her daughter and her grandchild.

With a bit of effort, Betty's husband degutted bitter sputum down his parched throat and cleared his voice. In a rather low cracked voice he asked “bai yumi kisim em igo Butaweng?” (Are we going to take her to Butaweng?), knowing well that was the only place to go to. Butaweng is synonymous with medical emergencies in their village and region (Finchaffen, Tewai-Siassi & Kabwum Districts).

Butaweng is an ELCPNG mission health station in Finchaffen district, Morobe Province of Papua New Guinea. The health station is nestled at the neck of what I would call the Godewac Peninsula where the majestic Mape River curls around to pour gracefully into Langema Bay. To the north is the historic site where Johann Flierl sailed into the quiet shores of Simbang village on the 12th of July, 1886, thus rightfully, Simbang village is regarded as the birthplace of the Evangelical Lutheran Church of Papua New Guinea (ELCPNG). Despite Butaweng's proximity to the historic Simbang village, it has its own remarkable history. It is widely known for the health and medical services of the Braun Memorial Rural Hospital through its dedicated doctors, nurses, paramedical and non-medical staff; and later popularized through the music industry by Mr. Jason Hershey (aka O-Shen). 



Satellite view of Butaweng, surrounding communities and the remarkable Mape River emptying into Langema Bay.

After six hours of many cycles of uterine contractions-relaxation of various intensity, there was no progress. Betty was drained of all her energy. Her skin felt cool and sweaty. She inhaled mouthfuls of the humid air and desired for more, but the contractions interrupted.

Betty's husband disappeared into the night as the aid post's door closed behind with a creaking sound. In the dark, in front of the aid-post, a crowd of men began to gather. Betty's husband informed the young men that gathered of the complications Betty is experiencing and they needed to get her to Butaweng (Braun Memorial Rural Hospital).

Eighteen months back, Betty had her third child delivered without complications at Braun Memorial Rural Hospital. During the usual obstetric ward rounds, the doctor spoke to her about family completion. She nodded in approval after the doctor informed her of the health benefits for the mother, and the benefits of having a manageable size family. Unfortunately, when the husband was asked for his informed consent for family completion, he was reluctant. He gave some reasons for his decision: (i) my wife will not be able to carry heavy loads and work in the garden after the operation, (ii) she will develop chronic (long lasting) abdominal pain. The doctor took time again to carefully explain the benefits of family completion and tried to clear the misconceptions he had, but Betty's husband's decision was firm. He assured the doctor that he will use some traditional herbal medicine to make her infertile.

The young men quickly constructed the all too familiar bush stretcher from bamboos and bags under the light of the flickering lantern. The improvised stretcher was moved into the aid-post and Betty was transferred onto the stretcher. Four brave young men carried Betty on the stretcher and walked through the night with the aid of a torch. Behind them, Betty's parents, husband, her third child straddled over his dad's shoulder, the CHW and a few other young men followed. Right at the back was Betty's mum who walked under the load of a string bag half-full with plantains and taro (taweng). Along the way, the men had to stop several times to catch their breath and change. When contractions were painful and Betty moved about, they laid the stretcher down and waited, then continued.  The journey was about two hours before they reached the nearest health centre. The nursing officer at the health centre made an assessment of Betty's condition and advised that she cannot manage her so she had to be taken  to Butaweng immediately.

Betty was taken to Butaweng in the  health centre's ambulance (trooper) where her baby was delivered.  The baby was very sick though, but was successfully managed by the dedicated staff of Braun Memorial Rural Hospital.

Three days later, Betty developed further complications and sadly passed on leaving behind her young family and loved ones. The baby will grow up without  her. I know, one day, she will manage to ask her father about her mum. It will be a pain in the throat experience for the lone father to recount the tragedy.

 

• May Anutu (God) continue to bless the hard working staff of Braun Memorial Rural Hospital in their daily strive to dispense adequate medical and health services with the meagre resources they have.
• May  one day, every Papua New Guinean especially the 87.5% rural based population will have access to better health services.



The Irony of Love

My son

My own

Love is my emotion

Guiding my motion
Across the Ocean

I have to go

You don't want to let me go

I note the look in the eyes you bear

My heartaches to see you tear

I have to be daddy in the plain

But my eyes well with tears in the plane

No, don't think daddy don't love you son

Daddy knows the game will be won

Mama tells me you don't want to eat

You put me under heat

Nor watch television

Regretting  my decision

I asked, what's up?

Mommy hangs up

Mommy tells me you're distressed.

For a while I am suppressed.

But we got to be strong, Son.

Believe me Son

It will be won

Life is a Portrait

Envied Painter

<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<

The portrait's not only what you see.

The reality of the envied is not what you perceive.

Behind the scenes are the circumstances varied.

The envied ambitiously carried.

 

Criticize on the missing ink.

Coz it's only the missing link.

 

He strokes again and again.
While you belittle with disdain

 

Time is a Healer

Coz he's a believer

Making strides with the brush
Comments only a rush

 

Time will Tell

Ah, All is well

 

Life is a portrait

Not a dose of barbiturate

Enough of the all-knowing criticizer

Rather get wisdom from the adviser

Don't remain the beholder
Rather be the wielder

 

 

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

 

 

 

BUILDING BLOCKS

"Simplicity is the Basis of all things Complex" 

In May 2013, I took my family with me to do volunteer medical work at Braun Memorial Rural Hospital in Finschaffen, Morobe Province, Papua New Guinea. For me, Braun Memorial Rural Hospital - the staff and the hospital community, have a special significance in my life and career development. I started my career as a young registered medical doctor in year 2009 out in this simple rural hospital - a humble beginning.

One evening Mr. Gelinde Narekine (initiator of Braun Health Foundation) and myself were conversing about medical science topics. We talked about molecular biology, physiology and immunology. It was very interesting and intellectual discourse. One of the topics of molecular biology that was really interesting was epi-genetics which I frankly did not have much insight into, so I learnt a lot from him. However, one thing we both agreed on is this, to really understand the complexities of the biological systems, one must have a firm understanding of the basics. This is how he simply puts it - "Simplicity is the Basis of all things Complex". Very profound statement indeed.

It has an element of truth that is cross cutting. This statement can be interpreted from different perspectives. Lets take a look at it from the view of a physicist: the basics of understanding physics is having a firm understanding of the laws that govern energy and matter. This will take us back to the basic physics taught at high school - Newton's Laws of motion, Law of Gravity, Law of Conservation of mass-energy, Thermodynamic Laws, etc. Physics builds on these basic laws or principles. They set the platform to grasp the complexities of physics. Let's look at it from the another perspective, the Economist: the basics of understanding economics depends on the basic principles of economics - e.g. the cost of something is what you give up to get, the standard of living depends on the country's production, prices rise when the government prints too much money, etc. Having a firm grasp of this basic principles, one can be the master of economics. The same can be true for other fields of science, mathematics and social science. The successful accumulation, in depth appreciation, and reasonable application of the great wealth of knowledge begins with a better understanding of the basic principles that exist in each field of study.

Now I want to take a different turn in my perspective of this statement. Take a closer look at matter. In physics, matter is defined as anything that has mass and occupies space. Physical chemistry proves that the building blocks of matter are the elements. An element (remember the periodic table) is composed of the atoms and the sub-atomic particles - electrons, protons, neutrons and nucleus, that are held together by electrostatic forces. The atoms unite to form molecules which form what we observe as matter. Ponder a while about the things around you and look at yourself: at the core are the basic sub-atomic particles that are pulled together to form what you see and feel. Take a look at living things, the human body. The basic unit is the living cell that is composed of the organelles, the organelles come together to form the cell, similar cells group together to form tissues, tissues form organs and organs form systems (cardiovascular, nervous, endocrine,etc). What you see in the physical world are the product of the cohesion and functional and structural configuration of very minute but  significant basic units of matter and life. Take away the sub-atomic particles, the atom, the cells and you are left with nothing - simplicity is the basis of all things complex.

I heard about  Professor Ben Carson as a boy in my local church during the book club times. Since then his stories have been a source of motivation and inspiration to me. He is famous for the separation of the Siamese twins (twins joined at the back of the head) in 1987. He holds more than sixty honorary doctorates, a member of many prestigious organisations and he was awarded the prestigious "Presidential Medal of Freedom" in 2008. He has a distinguished career. However, in his early childhood he had all the recipe to preclude such a distinguished career. Something happened. His third-grader mother challenged him to strive for excellence. He got his head stuck on books and he persisted. Had he not listened to his third-grader mother's advise and persevered, he would not rise to his distinguished career.It was the simple things - reading, perseverance and trusting in God, that exalted him to his distinguished career. 

The simple things, the little things, the things often taken for granted  eventually sum up. They are the building blocks of life. There is a pattern in our world that is obvious to the inquisitive mind. The pattern is perfectly summed in this profound statement - Simplicity is the Basis of all things Complex.