TNS – The News on Sunday

WP_Query Object ( [query] => Array ( [post_type] => post [orderby] => post_date [order] => DESC [post_status] => publish [cat] => 8 ) [query_vars] => Array ( [post_type] => post [orderby] => post_date [order] => DESC [post_status] => publish [cat] => 8 [error] => [m] => 0 [p] => 0 [post_parent] => [subpost] => [subpost_id] => [attachment] => [attachment_id] => 0 [name] => [static] => [pagename] => [page_id] => 0 [second] => [minute] => [hour] => [day] => 0 [monthnum] => 0 [year] => 0 [w] => 0 [category_name] => special-report [tag] => [tag_id] => [author_name] => [feed] => [tb] => [paged] => 0 [comments_popup] => [meta_key] => [meta_value] => [preview] => [s] => [sentence] => [fields] => [menu_order] => [category__in] => Array ( [0] => 8 ) [category__not_in] => Array ( ) [category__and] => Array ( ) [post__in] => Array ( ) [post__not_in] => Array ( ) [tag__in] => Array ( ) [tag__not_in] => Array ( ) [tag__and] => Array ( ) [tag_slug__in] => Array ( ) [tag_slug__and] => Array ( ) [post_parent__in] => Array ( ) [post_parent__not_in] => Array ( ) [posts_per_page] => 9 [ignore_sticky_posts] => [suppress_filters] => [cache_results] => 1 [update_post_term_cache] => 1 [update_post_meta_cache] => 1 [nopaging] => [comments_per_page] => 50 [no_found_rows] => ) [tax_query] => WP_Tax_Query Object ( [queries] => Array ( [0] => Array ( [taxonomy] => category [terms] => Array ( [0] => 8 ) [include_children] => [field] => term_id [operator] => IN ) ) [relation] => AND ) [meta_query] => WP_Meta_Query Object ( [queries] => Array ( ) [relation] => ) [queried_object] => stdClass Object ( [term_id] => 8 [name] => Special Report [slug] => special-report [term_group] => 0 [term_taxonomy_id] => 8 [taxonomy] => category [description] => [parent] => 0 [count] => 1878 [cat_ID] => 8 [category_count] => 1878 [category_description] => [cat_name] => Special Report [category_nicename] => special-report [category_parent] => 0 ) [queried_object_id] => 8 [request] => SELECT SQL_CALC_FOUND_ROWS tns05_posts.ID FROM tns05_posts INNER JOIN tns05_term_relationships ON (tns05_posts.ID = tns05_term_relationships.object_id) WHERE 1=1 AND ( tns05_term_relationships.term_taxonomy_id IN (8) ) AND tns05_posts.post_type = 'post' AND (tns05_posts.post_status = 'publish') AND tns05_posts.post_date >= '2019-10-20' AND tns05_posts.post_date <= '2019-10-21' GROUP BY tns05_posts.ID ORDER BY tns05_posts.post_date DESC LIMIT 0, 9 [posts] => Array ( [0] => WP_Post Object ( [ID] => 106506 [post_author] => 29 [post_date] => 2019-10-20 03:24:47 [post_date_gmt] => 2019-10-19 22:24:47 [post_content] => He flips PowerPoint slides briskly. He speaks in the mellow tone of an empathetic doctor. He stops at a slide, and glares at the picture of a woman’s discoloured, ulcerated and bleeding breast with unease. “This woman used Septran paste to cure a lump in her breast. She didn’t know she had advanced breast cancer.” Dr Riaz Rehman, a consultant palliative physician at Cancer Care Hospital and Research Centre has seen women suffer from breast cancer from his side of the consultation table, both “medically and socially”. “The other day a 35-year-old woman came to us for breast cancer treatment. She is a mother of a child. Her husband has kicked her out of their house because of her condition, fearing that her disease may infect their child,” he says. It’s Pinktober, the breast cancer awareness month. Some might find the campaign crass – in showcasing TV presenters sporting pink ribbons and buildings glowing in pink light – but it does remind us that breast cancer is a serious matter. According to rough estimates, some 90,000 patients are diagnosed with breast cancer every year in Pakistan, nearly 40,000 die of it. The country has the highest rate of breast cancer in Asia. But, in the absence of a central registry, these figures are guesswork at best. Experts rely on norms that may not reflect the true picture. Perhaps, the most accurate data is collected by 18 cancer hospitals run by Pakistan Atomic Energy Commission (PAEC) – where nearly 50 percent of all female cancer patients are registered for breast cancer treatment. Over 20,000 breast cancer patients were registered between 2015-2017. According to the Institute’s estimate, one in seven women is at risk of breast cancer in Pakistan. These are shocking figures even if they are sketchy. They are enough to show us that it’s time for action and moving beyond symbolism of tagging pink ribbons on royal guests visiting Pakistan. Still, it’s a far cry from the early discovery of the disease in Pakistan. “I remember when Pink Ribbon launched the awareness campaign in 2004, all TV channels said they couldn’t mention the ‘B’ word. When we started the campaign 15 years ago, our main challenge was to start a discussion on the disease,” says Omer Aftab, the Pink Ribbon CEO. He recalls, “In one case, the mother didn’t tell her family that she was suffering from breast cancer. Her daughters got to know about it at the time of her ghussal.” Practitioners and activists have fought hard against negativity surrounding breast cancer and in acknowledging that the disease exists among us. People are more aware of it now than before. “We have reports of at least 30 percent increase in patient turnout. Mammogram machines that were left to rust earlier on are now being used to full capacity. We are getting calls from men inquiring about treatment for women in their family. Earlier this was unthought of,” says Aftab. Aftab and his organisation have learned that the most effective way to spread the word is through the youth. “We have reached out to students in colleges to encourage self-examination and lifestyle changes to prevent breast cancer. When we talk to 500 students, we are actually talking to 500 households – because they go home and talk about it with their mothers and sisters – the word spreads.”  The breast cancer problem in Pakistan is deeper than raising awareness about it. One of the principal reasons for the high fatality rate is the gap between detection and cure – between what we know and what we do about women suffering from it. One way to bridge this gap would be to encourage patients to report early. “Women are visiting centres and clinics for the first time. Many already have incurable breast cancer. They are coming in with Stage 3 cancer. That’s too late,” says Dr Sana Zeeshan, an assistant professor (and breast surgeon) at Aga Khan University Hospital (AKUH). [box type="shadow" align="alignright" class="red_lines" ]Over 20,000 breast cancer patients were registered between 2015-2017. According to the PAEC estimate, one in seven women is at risk of breast cancer in Pakistan.[/box] Then again, it’s not only about encouraging girls to come in early with symptoms. There is a need also to dispel myths that surround the disease – among lay people as well as cancer care providers. “Doctors are recommending mammograms to girls as young as 20 years old. But mammograms are needed in women aged 35 and above. Breasts of young girls are too dense for screening to show results. Examination works better for them,” says Dr Sana Zeeshan. Besides, screening is much less effective if treatment is delayed. “Many patients have to wait for months for treatment at government hospitals,” says Dr Rehman. Pointing out a shortage of breast cancer care facilities, he says, “Shaukat Khanum Hospital is the only breast cancer hospital in Pakistan. It has surgery, emergency and radiation under one roof. Others are cancer departments or centres, not hospitals. We need more such hospitals – where the process from diagnosis to recovery is covered under one roof.”   Whatever has been made available to breast cancer patients in terms of awareness and treatment is concentrated at city centres. Little support has been extended to low-income patients living in rural areas. “We know that Pakistan has the highest rate of breast cancer in Asia but we do not know what’s happening in rural areas,” say Dr Sana Zeeshan. At an AKUH breast cancer camp in Hyderabad last October, Dr Zeeshan and her team were shocked to discover that out of 120 women they examined 8 had advanced breast cancer, and were not aware of changes in their breast. “We shuddered to think what would happen if these women were screened. We also shuddered to think what would be the condition of low-income women living away from Hyderabad,” she adds. Besides one mammography machine at the AKUH premises, there are two being operated in Hyderabad. “These are outdated machines. The films are black and white. We can hardly see anything in them.” But the availability of mammogram machines at grassroots is likely to solve only a part of the problem. As a first step, we need to strengthen the basic health units (BHUs) providing breast cancer care. We need to train lady health workers in how to examine women’s breasts, in creating awareness, in emphasising personal hygiene, and, more importantly, in sensitising men about the possible occurrence of breast cancer among women. “Men do not allow women to be examined or screened. And, if their wives are diagnosed with breast cancer, they simply abandon them. They must be educated that cancer is curable if detected early,” adds Dr Zeeshan. Dr Riaz Rehman’s Cancer Care Hospital and Research Centre, runs two mobile units in remote areas of the country. They are equipped with state-of-the-art mammography machines that transmit digital images to a radiologist at the central clinic in Lahore. “In the last three years we have screened 30,000 women free of cost. Out of those we detected and treated 163 cases,” says Dr Rehman. Though these mobile units take screening facilities to the doorsteps of rural, low-income women, they have a drawback. “The problem is we can do mammography on the truck but we can’t follow up with a biopsy.” The next goal for Dr Rehman’s cancer centre is to run a vehicle that will offer three services – mammography, ultrasound and biopsy. “This truck, funded by the OGDCL, will enable us to provide complete treatment to a patient in her hometown rather than dragging her to Lahore.” The road ahead is long and arduous. A multipronged approach is needed to dispel myths and improve access to better cancer care. “The governments must work hand-in-hand with the private sector. They should at least develop a central registry of breast cancer patients,” he adds. Meanwhile, let’s not keep moving our target. People must be made aware, they have to be willing to undergo treatment, human resource must be built, and the cost of treatment brought down.   The writer is a staff member [post_title] => Our breast cancer problem [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => breast-cancer-problem [to_ping] => [pinged] => [post_modified] => 2019-10-19 22:44:44 [post_modified_gmt] => 2019-10-19 17:44:44 [post_content_filtered] => [post_parent] => 0 [guid] => http://tns.thenews.com.pk/?p=106506 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw [format_content] => ) [1] => WP_Post Object ( [ID] => 106511 [post_author] => 29 [post_date] => 2019-10-20 03:22:56 [post_date_gmt] => 2019-10-19 22:22:56 [post_content] => In May 2013, I was sitting with my colleagues in a school I used to teach at. We were discussing cancer. I don’t exactly remember how or why the subject came up but since most people there, including me, at the time knew someone who had been through cancer, it was perhaps natural for the topic to come up. It was during this discussion that we started talking about breast cancer. The conversation steered to detection and that is when a colleague mentioned that lumps in the breasts could be a symptom of breast cancer. That was when I very casually mentioned a lump that I had had in my right breast for around two years. In a very nonchalant manner, I went on to tell them that it wasn’t painful and that I had never bothered about it. I just ignored it. The reaction I got was anything but casual. Despite being advised multiple times by my colleagues to get it checked, I decided to continue ignoring the lump. Summer vacation started and my family and I took a trip to Kashmir. The trip was a surprise for me and I wasn’t going to let some lump stand in the way. It was during this trip though that I noticed some physical changes in my body. My body temperature was warmer. I felt pinching in the right breast, nipples were painful and I felt a little nauseous. At that time I thought it was perhaps because of the high altitude, so I ignored it and enjoyed the vacation, which was more important to me at the time. When we returned from that trip I spoke to a friend, who is also a doctor, and she quickly arranged an appointment with an oncologist at the Fatima Memorial Hospital. I casually went there. They took a mammogram, conducted an ultrasound of breasts and did some other tests. I remember the day clearly. It was July 24, 2013 and following initial tests I was diagnosed with BI-RADS category IV cancer. I remember when the doctor saw my reports – the poor lady shouted at my ignorance and told me I should go to the Shaukat Khanum Memorial Cancer Hospital (SKMCH) at once. With some mixed feelings I drove myself to the SKMH poly clinic and luckily got checked there too the same day. They got me an appointment at the main hospital. It was when I got home in the evening and told my family that I realised that while the word cancer could be very daunting, it could also bring people together. When it entered my life though, I thought of it as another adventure and it wasn’t scary. Before I got diagnosed I had been happy but lonely in my life. My children were grown up and they needed their space and time for themselves so their mother wasn’t needed anymore. As a couple, too, our life had become stagnant. But the moment we collected the reports from the SKMCH, my husband became my shadow – he was with me 24/7. My sons and daughter became my strength when I was low in spirits. [box type="shadow" align="alignright" class="red_lines" ]My mastectomy was scheduled on December 30, 2013. It was an interesting day. It was also my 25th wedding anniversary. I was a little afraid that day, especially since I am also diabetic. Aside from this there were no other fears in my mind.[/box] After my last chemo, I came down with some infection and had to be admitted to the hospital. Due to a reaction from a medicine I was taking, I fell unconscious that day. At the time my youngest son and my sister-in-law were with me. I clearly remember the voice of my son “Mama! Mama, wake up! Wake up!” I can still hear his voice clearly. Another day I was short of breath and everyone panicked. At that moment my daughter told everyone to stop panicking and made me do some breathing exercises. After a while I felt okay. That day I met my brave daughter. During that same time, my eldest son was juggling between giving me time and working on his thesis, for which he received honours later. I had six chemotherapy sessions. The first three days of every round of chemo were tough. There was a lot of vomiting, dizziness, and I couldn’t eat much. The fun part was I got to shave my head after the first chemo because the hair fall was very messy. Before every chemo, I also went for a manicure, pedicure and a massage to boost my energy level. I would recommend that to every cancer patient. My husband became a zabardast chef during my treatment. He made soups, fresh juices, pies, and different kinds of dishes that we all enjoyed. Since chemo had stripped me of my sense of taste, my husband would make multiple dishes for each meal, making sure to wash the kitchen thoroughly for hygiene. I’d take two bites of each dish he prepared to appreciate his effort, and most days would only eat a full meal two bites at a time. Also read: Our breast cancer problem It was this love and constant support that helped me through my treatment. My mastectomy was scheduled on December 30, 2013. It was an interesting day. It was also my 25th wedding anniversary. I was a little afraid that day, especially since I am also diabetic. Aside from this there were no other fears in my mind. The loss of the breast itself was not something I was worried about. To this day, it isn’t something that bothers me. In informal gatherings I don’t use the artificial breast. These are places I know of where people will be comfortable with my missing breast. I have been a cancer survivor for six years now and over time I have become more confident about my breast removal. Though there are some things that still get to me. My hair never grew back the way it had been before – it thinned out. This is something that concerns me. Apart from the mastectomy there are other permanent changes to my body: the chemo impacted my nails – they became brittle but have improved over time; my legs have gotten weaker and I can’t walk like I used to. In all honesty, this is the one thing that bothers me the most. One can never term cancer a blessing but to me it provided an opportunity to reclaim some of the most important relationships in my life. It was an adventure my family and I were on together, which is why I never felt alone during this journey.   The writer is an educationist and a homemaker [post_title] => My cancer story [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => cancer-story [to_ping] => [pinged] => [post_modified] => 2019-10-19 22:44:51 [post_modified_gmt] => 2019-10-19 17:44:51 [post_content_filtered] => [post_parent] => 0 [guid] => http://tns.thenews.com.pk/?p=106511 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw [format_content] => ) [2] => WP_Post Object ( [ID] => 106509 [post_author] => 29 [post_date] => 2019-10-20 03:20:37 [post_date_gmt] => 2019-10-19 22:20:37 [post_content] => There is no second opinion that cancer is assuming endemic proportions in the country and the numbers are alarming. In the absence of a National Cancer Registry, there are no accurate figures but estimates abound and come from different entities in both the private and the public sectors. According to some estimates, between 150,000 and 300,000 new individuals are diagnosed with cancer every year in the country and a large number of them are not curable because of the advance stage of the disease they are suffering from. If we go by the cancer assessment mission report of the International Atomic Energy Agency (IAEA) released in 2016, 150,000 new cases of cancer are emerging in Pakistan every year. This figure was 140,000 in 2015 as reported by the Ministry of National Health Services, Regulations and Coordination (NHSRC). Keeping in view the gravity of the situation, one is compelled to look at the structure of cancer awareness, diagnosis and treatment facilities available in the country. This analysis is important because late or no diagnosis of cancer, especially breast cancer, are the major reasons of high casualty rate among patients. If diagnosed in time, the chances of cure and survival are high otherwise not. There are a few full-fledge cancer hospitals like Shaukat Khanum Memorial Cancer Hospital that provide all services under one roof whereas others offer limited facilities. To name a few, there are: Shifa International Hospital, Islamabad; Northwest General Hospital and Research Centre, Peshawar; Ziauddin Cancer Hospital, Ziauddin University Karachi; Baitul Sukoon Cancer Hospital Karachi; and The Cancer Foundation Hospital, Karachi. In the government sector, there are oncology departments in government hospitals at tehsil and district levels managed by provinces but the general perception is that they are using outdated radiation machines that do more harm than good to the patients. For example, if a new radiation machine takes a minute to complete a therapy an outdated one would take 8 to 10 minutes exposing the patient to harmful radiation. Unfortunately, the government is cash-strapped and not in a position to install new radiation machines costing tens of millions of rupees. An example of this neglect is the oncology department at Jinnah Hospital, Lahore, where there has been no oncologist for the last two years. Ghulam Mustafa, a spokesman of Pakistan Atomic Energy Commission (PAEC), points out that keeping in view the difficulties faced by cancer patients the commission has set up 18 hospitals throughout the country and is in the process of establishing more. At the moment a hospital is under construction in Gilgit that will cater to the needs of patients in this remote area. “No plan can work till the time awareness about breast cancer is incorporated in curriculum and included in the mandate of health facilities even at the level of Basic Health Units (BHUs) and Rural Health Centres (RHCs),” says Dr Ashraf Nizami, former president of Pakistan Medical Association. Mustafa says their vision is to establish a cancer hospital after every 100 kilometers in the country so that the population around it can get easier access to these. He says every year one million [caption id="attachment_106519" align="alignleft" width="300"] Diagnostic facilities at PAEC hospitals.[/caption] cancer patients out of the total 1.8 million benefit from these facilities, and the best part is that PAEC hospitals take patients regardless of the stage their disease is. “There are no refusals at all.” Though he does not mention any names, he seems to be referring to other cancer hospitals that do not accommodate patients who are suffering from advance stages of cancer. A good news, however, is that the government has given Rs 30 billion to PAEC for upgrade of existing hospitals and maintenance of equipment. He tells The News on Sunday that they have funds from Bait ul Maal and philanthropists which are spent on the treatment of deserving patients since it is a very costly process. Extreme care is taken to ensure these funds are available only to those who cannot afford the treatment otherwise, he adds. Mustafa says there are mobile breast care clinics as well, established by the PAEC, that help them arrange monthly or fortnightly visits and camps in remote areas for awareness and screening purposes. During these trips, experts deliver lectures and distribute awareness material regarding breast cancer prevention, detection and treatment among women. Dr Ashraf Nizami, a former president of Pakistan Medical Association and current head of its international committee, thinks no plan can work until awareness about breast cancer is incorporated in curriculum and included in the mandate of health facilities even at the level of Basic Health Units (BHUs) and Rural Health Centres (RHCs). No doubt the staff of BHUs and RHCs cannot be provided costly equipment to diagnose and treat cancer but they can at least be trained to tell people about the disease and its symptoms. Unfortunately, he says, talking about breast cancer has become a taboo in the society which should not have been the case. Once the symptoms are identified, the patient can be convinced to approach a facility and get tested, he adds. Also read: My cancer story The shortage of oncologists in the country and dependence on expensive imported medicines are two other issues that need to be taken care of. Oncologist Dr Riaz Rahman says there are around 120 oncologists in Pakistan which is too small a number. The reason, he points out, is that a medical practitioner does not want to give up but in case of cancer the morbidity rates are high. “This is a discouraging factor.” Besides, he says, it is almost impossible for oncologists to practice privately because cancer treatment is equipment-dependent, and very expensive. Most doctors cannot afford it and have to establish properly equipped private clinics. Similarly, he says, it is time to produce cancer medicines locally because the imported or smuggled ones are too expensive. Citing an example, he says, an imported injection priced at Rs 100,000 in Pakistan is being produced in India at less than one-tenth of this amount. Dr.Rahman says a group of businessmen in Sialkot plan to start producing cancer drugs in Pakistan and is in touch with the cancer hospital he is associated with.   The writer is a staff member and can be reached at [email protected] [post_title] => Of crumbling healthcare structures [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => crumbling-healthcare-structures [to_ping] => [pinged] => [post_modified] => 2019-10-19 22:44:56 [post_modified_gmt] => 2019-10-19 17:44:56 [post_content_filtered] => [post_parent] => 0 [guid] => http://tns.thenews.com.pk/?p=106509 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw [format_content] => ) [3] => WP_Post Object ( [ID] => 106502 [post_author] => 29 [post_date] => 2019-10-20 03:18:38 [post_date_gmt] => 2019-10-19 22:18:38 [post_content] => I lost the most resilient woman I know to breast cancer – my maternal grandmother. She was a woman who epitomised strength for me; someone who braved the loss of her youngest son and husband within the span of six months and then lost her battle to cancer. The diagnosis and treatment of cancer is something experienced by the entire family. It changes lives of all the people around the patient – like it did for us. Given the immense challenges and stress they are hit with, it is capable of impacting the stability of a family. The very definition of our daily routine changed. My mother became the primary caregiver for her mother. I saw my mother – a doctor – juggle work, family and life in general without ever complaining about the emotional stress that she was in. That stress, however, we all could feel because we were all living it. Being a doctor, my mother knew exactly what was happening to her mother and during this process I knew exactly what was happening to my mother. One of the biggest hindrances in timely diagnosis is the stigma attached to breast cancer. Just the other day, on a TV talk show, a person taunting at the current government termed their cancer awareness-creating attempts ‘hollow antics’ but while doing so avoided using the term ‘breast cancer’. He kept referring to it as ‘blood cancer in women’. In most instances, breast cancer is not reported in time and there is a string of reasons attached to it. When my grandmother brought it up with my mother, she had already crossed the early-stage diagnosis-mark. If diagnosed at an early stage, breast cancer is curable and we have success stories of survivors from around the world to prove that. Cancer is a difficult experience for the individual and the family. Going through the diagnosis and treatment is quite painful both physically and emotionally. With advances in medical technology and modern treatment methods, there are an increasing number of cancer survivors, but there is a long way to go in formally addressing the emotional and psychological impacts associated with it. Mental health in general is not taken seriously here. It is usually associated with a weak will power and disconnect with religion. The cure is summed up in a few words – toughen up; deal with it; happens to the best of us or snap out of it. Nice sounding hollow words that are practically of zero help. [box type="shadow" align="alignright" class="red_lines" ]Caregivers of cancer patients don’t have a weak will. In most cases, you will see no sign of the emotional rollercoaster they get to ride every day and still show up. At times, stringing together daily conversation takes everything they have in them.[/box] Not enough attention is given to the family’s condition. No matter what stage of cancer a patient is suffering from, it always makes a tremendous impact on the family destroying their everyday rhythm and the new dimensions of work-life balance. Most importantly, the biggest impact is facing the threat of loss and your shared future plans. It is a mix of all these emotions you go through. I recall us collectively feeling suspended between fear and hope during my grandmother’s treatment. My mother used to drive my grandmother to her chemotherapy sessions. At times, I would accompany them. My grandmother was a very lively person and naturally, I attached those traits permanently with her personality. As a teenager, I recall my grandmother’s post-chemo weakness. She would remain quiet for a very long stretch of time – an active person just going quiet. When you witness such drastic changes in someone close, it does something to you. Caregivers of patients don’t have a weak will. In most of the cases, you will never see the emotional rollercoaster they get to ride every day and still show up. At times stringing together daily conversation takes everything they have in them. With everything going on they, too, have needs which are not always possible to fulfill, and they get it. However, the biggest favour you can do is to empathise and not sympathise. These are two very different things and sadly, the focus in our society is mostly bent towards the latter and that adds to the sting. Most of them just want to have a chance to get external support where they can speak about their own problems, to vent their emotions, pain, frustrations and dread of impeding loss. They need a safe space where they can shed the brave and optimist masks that they wear for the patient’s moral support. A lack of this safe space causes long-term damage and goes beyond the loss of a loved one. Several studies have now shown that the emotional strain is more burdensome than the actual activities associated with providing medical care and the financial stress that comes with a disease like cancer. Links have also been found between chronic stress and aggravating impact on an individual’s immune system, leading to one’s own physical and mental health issues. While we are making progress on the medical front, there are other relevant factors that need to be incorporated in the system. Most importantly, when it comes to breast cancer the first and foremost thing is to shed the stigma. This can help in early diagnosis and treatment. Stigma around the caregivers’ mental health will help them survive the stress and in the case of a loss of a loved one, help deal with it. Also read: Of crumbling healthcare structures Japanese have a kind of reverence for the art of mending. A broken bowl would be valued precisely because of the exquisite nature of how it was repaired. This tradition is referred to as Kintsugi, meaning to “to patch with gold”. Often, we try to repair broken things in a way so as to conceal the repair, and make it good as new or just like it used to be – a flawed concept. One can never be the same again – it is not a normal phenomenon. The Japanese understood that by repairing the broken bowl with the distinct beauty of radiant gold, they could create an alternative to just-like-it-used-to-be and opted for a better-than-new-aesthetic. They understood that an artful repair actually adds value. Because after mending, the bowl’s unique fault lines were transformed into little rivers of gold that post repair were even more special because the bowl could then resemble nothing but itself. This is the transformation idea that needs to be adopted for healing. Be it surviving a life-threatening disease or healing from grief. The snap-out-of-it attitude is not healthy as one can never be the same again, and that is not really a bad thing. Understanding life’s fragility, experiencing loss lets people understand what is really important in life making them more accepting and empathic towards other people. Instead of badgering them to be the same again, help them expand the circle of empathy and we might have an atmosphere where others can find the support they need when life throws a few rough balls at them.   The writer is a digital communications and marketing professional. She tweets at @FatimaArif [post_title] => Patching up grief [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => patching-grief [to_ping] => [pinged] => [post_modified] => 2019-10-19 22:44:48 [post_modified_gmt] => 2019-10-19 17:44:48 [post_content_filtered] => [post_parent] => 0 [guid] => http://tns.thenews.com.pk/?p=106502 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw [format_content] => ) [4] => WP_Post Object ( [ID] => 106507 [post_author] => 29 [post_date] => 2019-10-20 03:16:38 [post_date_gmt] => 2019-10-19 22:16:38 [post_content] => In a country, where according to rough estimates, around 40,000 women die of breast cancer every year, there is still very little noise being made in the right direction. Octobers are celebrated globally as breast cancer awareness month and many in the media, like us, dedicate airtime and pages to understanding why thousands of women continue to die every year because of it. But what is of concern is that we continue to ask the same questions every October, perhaps  indicating that we fail to make much progress in generating an awareness that could potentially save our women. The country is reported to have the highest rate of breast cancer in Asia. That is no accomplishment. Activists and practitioners say some, nay, little progress has been made. In a society where saying the words ‘breast cancer’ was once taboo (perhaps still is in some quarters), the fact that online, television and print media run awareness campaigns on the disease is a somewhat encouraging sign. It definitely is for the people who dedicate their time and expertise in trying to reach out to women and helping them cope if they already suffer from it and for women benefitting from it. But it also reflects the gravity of the problem – our reluctance as a society to speak, understand and educate ourselves. Experts say the main problem lies in the fact that patients come for medical diagnosis too late. A large number of breast cancer patients are not curable when they come for medical help because of the advance stage of the disease they suffer from. The problem is aggravated by the absence of a central registry making decision makers and practitioners rely on mere estimates. There is much that remains to be done in terms of awareness campaigns and provision of on-ground easily accessible facilities and expertise. We need to further the discussion and be able to ask new questions in light of actual progress, not regurgitate information our women should have been aware of ages ago. [post_title] => Editorial [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => editorial-202 [to_ping] => [pinged] => [post_modified] => 2019-10-19 22:57:02 [post_modified_gmt] => 2019-10-19 17:57:02 [post_content_filtered] => [post_parent] => 0 [guid] => http://tns.thenews.com.pk/?p=106507 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw [format_content] => ) ) [post_count] => 5 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 106506 [post_author] => 29 [post_date] => 2019-10-20 03:24:47 [post_date_gmt] => 2019-10-19 22:24:47 [post_content] => He flips PowerPoint slides briskly. He speaks in the mellow tone of an empathetic doctor. He stops at a slide, and glares at the picture of a woman’s discoloured, ulcerated and bleeding breast with unease. “This woman used Septran paste to cure a lump in her breast. She didn’t know she had advanced breast cancer.” Dr Riaz Rehman, a consultant palliative physician at Cancer Care Hospital and Research Centre has seen women suffer from breast cancer from his side of the consultation table, both “medically and socially”. “The other day a 35-year-old woman came to us for breast cancer treatment. She is a mother of a child. Her husband has kicked her out of their house because of her condition, fearing that her disease may infect their child,” he says. It’s Pinktober, the breast cancer awareness month. Some might find the campaign crass – in showcasing TV presenters sporting pink ribbons and buildings glowing in pink light – but it does remind us that breast cancer is a serious matter. According to rough estimates, some 90,000 patients are diagnosed with breast cancer every year in Pakistan, nearly 40,000 die of it. The country has the highest rate of breast cancer in Asia. But, in the absence of a central registry, these figures are guesswork at best. Experts rely on norms that may not reflect the true picture. Perhaps, the most accurate data is collected by 18 cancer hospitals run by Pakistan Atomic Energy Commission (PAEC) – where nearly 50 percent of all female cancer patients are registered for breast cancer treatment. Over 20,000 breast cancer patients were registered between 2015-2017. According to the Institute’s estimate, one in seven women is at risk of breast cancer in Pakistan. These are shocking figures even if they are sketchy. They are enough to show us that it’s time for action and moving beyond symbolism of tagging pink ribbons on royal guests visiting Pakistan. Still, it’s a far cry from the early discovery of the disease in Pakistan. “I remember when Pink Ribbon launched the awareness campaign in 2004, all TV channels said they couldn’t mention the ‘B’ word. When we started the campaign 15 years ago, our main challenge was to start a discussion on the disease,” says Omer Aftab, the Pink Ribbon CEO. He recalls, “In one case, the mother didn’t tell her family that she was suffering from breast cancer. Her daughters got to know about it at the time of her ghussal.” Practitioners and activists have fought hard against negativity surrounding breast cancer and in acknowledging that the disease exists among us. People are more aware of it now than before. “We have reports of at least 30 percent increase in patient turnout. Mammogram machines that were left to rust earlier on are now being used to full capacity. We are getting calls from men inquiring about treatment for women in their family. Earlier this was unthought of,” says Aftab. Aftab and his organisation have learned that the most effective way to spread the word is through the youth. “We have reached out to students in colleges to encourage self-examination and lifestyle changes to prevent breast cancer. When we talk to 500 students, we are actually talking to 500 households – because they go home and talk about it with their mothers and sisters – the word spreads.”  The breast cancer problem in Pakistan is deeper than raising awareness about it. One of the principal reasons for the high fatality rate is the gap between detection and cure – between what we know and what we do about women suffering from it. One way to bridge this gap would be to encourage patients to report early. “Women are visiting centres and clinics for the first time. Many already have incurable breast cancer. They are coming in with Stage 3 cancer. That’s too late,” says Dr Sana Zeeshan, an assistant professor (and breast surgeon) at Aga Khan University Hospital (AKUH). [box type="shadow" align="alignright" class="red_lines" ]Over 20,000 breast cancer patients were registered between 2015-2017. According to the PAEC estimate, one in seven women is at risk of breast cancer in Pakistan.[/box] Then again, it’s not only about encouraging girls to come in early with symptoms. There is a need also to dispel myths that surround the disease – among lay people as well as cancer care providers. “Doctors are recommending mammograms to girls as young as 20 years old. But mammograms are needed in women aged 35 and above. Breasts of young girls are too dense for screening to show results. Examination works better for them,” says Dr Sana Zeeshan. Besides, screening is much less effective if treatment is delayed. “Many patients have to wait for months for treatment at government hospitals,” says Dr Rehman. Pointing out a shortage of breast cancer care facilities, he says, “Shaukat Khanum Hospital is the only breast cancer hospital in Pakistan. It has surgery, emergency and radiation under one roof. Others are cancer departments or centres, not hospitals. We need more such hospitals – where the process from diagnosis to recovery is covered under one roof.”   Whatever has been made available to breast cancer patients in terms of awareness and treatment is concentrated at city centres. Little support has been extended to low-income patients living in rural areas. “We know that Pakistan has the highest rate of breast cancer in Asia but we do not know what’s happening in rural areas,” say Dr Sana Zeeshan. At an AKUH breast cancer camp in Hyderabad last October, Dr Zeeshan and her team were shocked to discover that out of 120 women they examined 8 had advanced breast cancer, and were not aware of changes in their breast. “We shuddered to think what would happen if these women were screened. We also shuddered to think what would be the condition of low-income women living away from Hyderabad,” she adds. Besides one mammography machine at the AKUH premises, there are two being operated in Hyderabad. “These are outdated machines. The films are black and white. We can hardly see anything in them.” But the availability of mammogram machines at grassroots is likely to solve only a part of the problem. As a first step, we need to strengthen the basic health units (BHUs) providing breast cancer care. We need to train lady health workers in how to examine women’s breasts, in creating awareness, in emphasising personal hygiene, and, more importantly, in sensitising men about the possible occurrence of breast cancer among women. “Men do not allow women to be examined or screened. And, if their wives are diagnosed with breast cancer, they simply abandon them. They must be educated that cancer is curable if detected early,” adds Dr Zeeshan. Dr Riaz Rehman’s Cancer Care Hospital and Research Centre, runs two mobile units in remote areas of the country. They are equipped with state-of-the-art mammography machines that transmit digital images to a radiologist at the central clinic in Lahore. “In the last three years we have screened 30,000 women free of cost. Out of those we detected and treated 163 cases,” says Dr Rehman. Though these mobile units take screening facilities to the doorsteps of rural, low-income women, they have a drawback. “The problem is we can do mammography on the truck but we can’t follow up with a biopsy.” The next goal for Dr Rehman’s cancer centre is to run a vehicle that will offer three services – mammography, ultrasound and biopsy. “This truck, funded by the OGDCL, will enable us to provide complete treatment to a patient in her hometown rather than dragging her to Lahore.” The road ahead is long and arduous. A multipronged approach is needed to dispel myths and improve access to better cancer care. “The governments must work hand-in-hand with the private sector. They should at least develop a central registry of breast cancer patients,” he adds. Meanwhile, let’s not keep moving our target. People must be made aware, they have to be willing to undergo treatment, human resource must be built, and the cost of treatment brought down.   The writer is a staff member [post_title] => Our breast cancer problem [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => breast-cancer-problem [to_ping] => [pinged] => [post_modified] => 2019-10-19 22:44:44 [post_modified_gmt] => 2019-10-19 17:44:44 [post_content_filtered] => [post_parent] => 0 [guid] => http://tns.thenews.com.pk/?p=106506 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw [format_content] => ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 5 [max_num_pages] => 1 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => 1 [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => 1 [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => [is_404] => [is_comments_popup] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash] => db1169c0b02392f7845b184a6030aa64 [query_vars_changed] => 1 [thumbnails_cached] => )