Pap smear: Early detection saves life

I am not a public health expert nor a specialist, the reason for me to write this article is because I am concerned that people (died and )might die of the preventable cause.

So it is cervical cancer that I am going to throw a little light and the ways to prevent it. Cervical cancer affects the cervix of uterus in the female reproductive system. In Bhutan, cervical cancer is the most common cancer diagnosed in women. More than half are diagnosed in late stages, leading to high mortality.  The morbidity and mortality associated with this cancer has impact not only on the life of these women, but also on their families.

Fig. 1.shows cervix affected by cancer

(Source: Google images)

A woman with cervical cancer lives with bleeding, foul smelling discharge, leaking urine/feces or severe pain for many months. She dies when she is still socio-economically productive leaving behind children who are small or dependent. Besides, the government spends a lot of money getting these patients treated in centers outside Bhutan. Cervical cancer is still the most common cancer referred for radiation. This is a cancer that is not only curable if diagnosed early, but is also preventable if detected early, with availability of good screening program.  

   

Risk Factors

ü  Early age at marriage is one of the most important risk factors.

ü  Multiple sexual partners increase the risk of exposure to HPV infection.

ü  Low socio-economy and low education: Women of low socio-economy are more likely to either not enroll in school or drop out early leading to early marriage and have more children. Due to low literacy, they are also less likely to participate in screening due to ignorance and lack of awareness.

ü  Smoking: Nicotine and by products of smoking are thought to increase a woman’s relative risk for cervical cancer because their concentration in the cervical mucus decreases the immune capability of the cervical tissue.

ü  Immuno-suppression: Immuno-suppression due to any reason leads onto persistence of HPV infection with more likelihood of developing cellular atypia. HIV positive women are at higher risk of developing cervical cancer. Cervical cancer is one of the AIDS defining cancers.

ü  Lack of screening program: Lack of an effective screening program also acts as a risk factor. Women who regularly undergo screening and adhere to follow up and treatment are unlikely to get cancer compared to those who never do it.

Symptoms of cervical cancer;

·       Abnormal vaginal bleeding;

·       Excessive or foul smelling vaginal discharge;

·       There may be urinary frequency and backache;

·       In advanced cases, there may be:

o   Pain in the pelvic region or lower limbs;

o   Swelling of lower limbs;

o   Renal failure in late stages;

o   Passage of urine and feces from  vagina;

	Cervical cancer may remain silent for many years till it is well advanced.  Pap smear can help in early diagnosis and treatment.

Fig.2 shows the stages of cervical cancer(source;google images)

Cervical cancer can be prevented by vaccination against HPV (currently HPV vaccination is provided to girls in class VI ) and early detection through pap smear screening.

Pap smear is a proven method for cervical cancer screening. Pap smear studies the cells leading to identification of women with abnormalities in the cervix. In Bhutan, Pap smear screening services are available in BHUs and Hospitals. However, despite the free screening services, incidence and mortality due to cervical cancer did not change significantly over the past years. One of the reasons for this could be lack of awareness among women on this service. Even if women are aware, some do not avail the service. Some of the reasons I often hear is “I feel shy”. ‘I am scared it might be painful’. ‘I have no time’

If you are shy; just know that cervical cancer is even more painful than your shyness. It only takes 3 to 5 minutes to get a Pap test and it’s not a very painful procedure.

When should women get Pap smear done? 

·       Pap smear should be done 7 to 10 days after menstruation stops;

·       In women with amenorrhoea or in menopause or who had hysterectomy, it can be done any time;

·       In women who have delivered or had an abortion/miscarriage, it should be done after three months.

In Bhutan, target population for Pap smear is all women between 25 to 65 years of age regardless of HPV vaccination status. All women who are or were sexually exposed should participate in screening or do Pap smear

What does it mean to be a Bhutanese?

Have you ever asked  this question?   People might think this as an easy question. I bet this is not as easy as you think? Until you are asked to explain it to a foreigners you will never know the depth of this question.Unique identity?  Gho and kira?  Culture? That’s the first thing that’s comes to our mind.  Right? So what? Does just wearing Gho and kira make you a Bhutanese? Or having unique culture and identity make you a Bhutanese.  Will you be able to explain why you wear gho and kira apart from the answer of it being a national dress? When you think it that way, the question becomes harder? I believe that being Bhutanese is more than just wearing gho/kira and speaking dzongkha.  

Knowing our history. History is one of the most important tools that can track the story of our existence (in this case as a Bhutanese). Spiritually, understanding who we are might be a big question. But it’s not uneasy to understand yourself historically. Who has all the time to read history? plus documentation is poor in Bhutan. Find other ways, we have lots of wisdom in our older generation! Simply knowing our history will help us appreciate our identity and build a sense of pride of who we are

Understand why our Dzongs stands rather than knowing just the names.  Dzongs played such a significant role in the history of our country. Without it, we wouldn’t have survived as a Nation today. Just knowing their importance shows our gratitude for our forefathers.

 Not just waiting for the government to do everything for you. But making our little contribution to the community we live in. Small deeds matters. For a while, move away from the kidu culture mindset and start making little difference. This could make our lives lot more better!

Just knowing the definition of GNH is not important as living by it.  Our society is on the phase of transformation that we even do not know who our neighbors.  Do we? Little deeds like having courtesy to say hello to your neighbor makes you happier than dancing all night in an unknown space.

Not just going to a Lhakhang or religious gathering because you are force by someone (or you feel odd by not going) but knowing why you are going there. Most often we go to ritual or preaching just because everyone does. Do you question on such matters? Learning to question is not rude, it means you are thinking differently .

Kira and Gho. Of course, you know why we wear it. But do you know, how/when did it emerge? Who designed it? What each part symbolize? I never asked anyone. Have you? Now, don’t you think it’s important for us to know it being the citizens of the country.  

Do you know dzongkha both written and spoken? I mean at least basic for those who went to schools. Now a days it has become a trend for people to  proudly say I don’t know dzongkha (I mean the literate ones, sorry for being judgmental) . I don’t blame you, it has already become a trend, but at least don’t infect your children with this cliche. Teach them to be proud to speak and write it.

Collective efforts in times of crisis and not be divided by religious or political ideologies. Like in the recent earthquake in Nepal. I was truly moved by what a collective effort can do.

In the end, who are you if you don’t know anything about where you come from, about your origins, your family, your language, your own culture -Kelly.E

To my AMA

This is dedicated to the  most incredible women in my life, My mother, for or her love, patience and kindness. 

Dear  Ama,

This is my second letter to you. I wrote the first one when I yearned terribly  to express out what I had inside me.I know  I  am never  good at expressing out loud on  how much I love you.But I know its not too late to say it today.  I love you Ama.  It means the World  to have you in my life.

You might not be able to read this. I know you are not even aware of  Mother's Day people celebrate around the World. It does not matter anyway. Today is your day, a day where I am reminded how lucky I am to be your daughter.

Ama, I miss you every single day. I envy those who can be together always, sharing their little gossips.  My relationship with you have not been like  what people may actually describe theirs. We  never had enough time in the years gone by  to be together.  Yet  I never felt the distance  because I always had your moral support and love.

I shall always remain grateful for the sacrifice you made for our sake,  for never complaining  in times of crisis and  for being patient. I am thankful to God for sending me an Angel who gave me strength and courage to face the World.

Your little girl has grown up and become the women she  has dreamt of . Why wouldn't t she,  when she have tons of  your blessings and prayers every day. Thank you seems to be a very small word compared to all your sacrifice and handwork.Happy Mother's Day.

May God give you the happiness of the World.  I love you mother,

With  love


Your daughter
 Tashi

Condolence

My deepest condolences and prayers to the people of Nepal whose  lives were lost in the devastating earthquake. May the souls rest in peace  May the affected be healed soon. Om Mani Padme Hum

Self-improvement?

“Your purpose in life is to find your purpose and give your whole heart and soul to it” 
                                                                                                                     ―Buddha

In New Year, people often commit to do or not do something.  We make resolution in every New Year that comes by. Whoever started the culture of New Year’s resolution, I am happy that they did. It makes a person develop both short and long term goals in life. In short, it gives person a will to self-improvement. Some new year’s resolution goes from joining gym, losing weight, saving money to finding love.

Whether out of my curiosity or due to a want for self-improvement, I did make few promises to myself.   After 3 months of it, I am looking back at my new year’s resolution. I have committed to take my goals very seriously this year.

My New Year resolution are to(not in any order of preference);
1. Join a reading club
2. Observe the National reading Year by reading the double of previous year. That makes me obliged to read almost 36 books this year.
3. Learn to drive. A thing I should have done long time before. Somehow I have not taken it very seriously. It’s now a vow this year.
4. Join a volunteer group. I am yet to decide where I want to join. There are several volunteer groups in the capital that I can choose to join. Though I have been active in my college days by being in almost 4-5 volunteer groups. I have been very dormant for the last one year. It’s high time I wake up for the greater cause.
5.  Look for a spiritual guide. Well, that is the toughest of all. There are several teachers I know, but I want to feel connected to the one I choose. I want to find myself through the guidance I get (it’s tough one though!). For greater realization, understanding and transformation.

 I am deeply inspired by this quote by Sogyal Rinpoche “our master is your living link with the truth, and because of your personal connection to your master, just seeing  his or her face connects you to the inspiration and truth of your own nature.’

Unlike the other years, this year is a very special year for me solely because of the resolutions I made.  My only pray is to be able to keep all commitments and to live by it.

The Stagnant Soul

It has been so long that I neither updated my blog nor my diary. My diary is supposed to be my daily reflection but my daily ritual is now at stand still. It has been weeks. The reason is simple; my empty mind which has lead to laziness.  I have not been hard on my mind either. I have let it dawdle own its own.   Same is with my eloquence. I have remained withdrawn and silent in the conversations in all situations.  There are two things I am writing about here:  on my transition of my personality type and writer’s block.

The routine of life has made the once dynamic soul into dormant stage for time being. Is this stagnant phase a sign of freedom or lost me?

I sense the lost ‘magic’ in me for now; the magic with which I used to charm my World (although it was a small).  It’s like the long slumber of the Dark Ages of European literature. Although that might be too huge a comparison yet my soul is experiencing the same dark era.  Or I am also probably suffering from writer’s block even though I do not credit myself as a writer. My writings are purely for myself, for my own satisfaction and reference.

On my personality type: I have been an extrovert .Neither did I hesitate to talk in gatherings nor was I uneasy to start a conversation with strangers.  I was brave and out spoken.  I do not see this in me anymore.  I have become anxious and conscious of every word I speak. I rather choose silence as an ultimate solution.  

Certainly, I have all the opportunity in the world to gather all the creativity, all the knowledge and wits. Yet the mind is blank and still. Should I blame my surrounding for it? I surely would not dare that. This is what the transition to adulthood has possibly made me.

I am not supposed to be like the one I am today.  I am eager to become the person I dream of; the one that is lost for the moment.  I want this dark era for both eloquence and writing to end.   I want to write more and  talk with confidence.

As I write this, I find myself constantly in search of ‘right words’. I find my fingers carelessly pressing the backspace button every time I type a sentence.   I pause for several times before I actually finish each paragraph.

Mental Health : Let us be serious

                                                                                          

I am doubtful if the Bhutanese took mental health seriously in the past. However, at time like  this: when the   pattern of our  economy is changing, when globalization is diffusing fast into our borders, when our life style is changing, when we are bombarded with information, we must take the mental health seriously.

Time has come where number of people suffering from various mental disorders has increased over the last few years. The number of people visiting the psychiatrist in the capital has increased over the years.   The Annual Health Bulletin 2014, reports the total mental disorders of 3520 in 2013 from 3044 in 2012 in the country.

                                                                             

                                      

Photo courtesy: http://production.miningaustralia.com.au/

Anxiety, psychosis, depression and substance abuse are attributes to mental health disorders. However, whether mental disorder is caused by the consumption of alcohol and drug use( psychoactive) or if the consumption of this substance is caused by mental disorder is yet to be found.

One of the probable consequences of mental disorder is suicide.  The staggering numbers of suicide from 2010 till October 2013 is 293 cases (reported case). We saw 68 suicide cases just in this year (Zam, 2014). This is a very huge number for small nation like ours.Just few days back, we saw another two youth take their lives. 

What does this number show? It shows that something is terribly wrong somewhere. We are either overlooking or complacent about our mental well being. The suicide and suicidal attempt could be due to the ignorance of the parents to their child’s emotions, poor communication, inability of the person to cope up with depression and stress, problems amongst peers and inaccessibility to counseling services.

The increasing mental disorder in the country is the alarm to our society that we need to take mental well being very seriously. Its time where frequent dialogue and communication in the family and between friends must be revived. We must put aside our mobile phones, laptop and television for some time and sit together. Of course,  we have mails to respond, meetings to attend, urgent appointments and follow ups to be done.  Yet in our busy schedules, we should find time for our families and friends to do that little exchange of dialogues.

The government is making some intervention. The counseling facilities will be made available to all walks of life. If a person feels that he/she has mental disorders, the person must come forward to avail these services. They must talk and not hesitate to come forward to get help.

References

Ministry of Health. (2013). Annual Health Bulletin

Ministry of Health. (2014).Annual Health Bulletin

Zam, N. (2014). Bhutan Sees 68 Death By Suicide Cases So Far This Year.                                                                                                           Retrieved from www.thebhutanese.bt