I have been kept so busy that I have barely had time to update this blog! After spending a few days as a tourist in Hyderabad, I left Andhra Pradesh and have settled in Coimbatore, Tamil Nadu, where I will spend the next six weeks working at The Womens Center. This small, private hospital is remarkable. Not only does it offer lavish interiors (it’s the most pleasant hospital that I have ever been in–I stayed in a patient room for two nights and it was the nicest place that I stayed since leaving the US), it offers remarkable services at affordable prices. But enough advertisement…
While here, I will be conducting educational outreach projects. I have been busy learning about all sorts of women’s health issues, finding statistics, and trying to figure out how to present my findings to women from a culture where private parts are kept very private and sex is a very touchy subject. My first presentation will be this Friday to a group of educated women working in IT. It will be part of a longer presentation on general health given by a female colposcopist who has just returned to India after practicing for several years in the UK.
My talk will be about the importance of the Pap-smear in cervical cancer prevention. India has one of the highest rates of cervical cancer and basically no prevention program, so the aim is to raise awareness around the issue. In this first talk, I will discuss the use of Pap smears in the US and the dramatic reduction in the rate of cervical cancer. For example, with screening, incidences of cervical cancer have been reduced by 75-90% depending on which journal article one reads. This figure is quite remarkable as in 2010, only 73.3% of women in the US had a Pap smear within the last three years. Also of interest is that over half of all cervical cancer cases in the US occurred in women that have never had a Pap smear, where ~25% of cases occurred in women who haven’t had a Pap smear in the last 5 years, and the remaining 25% or so of cases occurred in women who failed to follow-up properly after an abnormal Pap smear. It is estimated that if all sexually active women received Pap smears every 3 years, the incidence of cervical cancer would be reduced by 99%! So, I must find a way to present these promising statistics to women who are very fearful of both cancer and talk of sex (especially as 99% of cervical cancer cases are caused by HPV, a virus transmitted through sexual contact).
(In the US, an estimated 80-90% of sexually active women contract the virus at some point in their lives although the majority are able to clear it to undetectable levels before it becomes a problem)
In discussing these issues with the colposcopist, she told me some startling anecdotes about the female Indian patient. The body clears most abnormal growth on the cervix naturally, so in most cases patients are asked to return for another Pap smear in 6-12 months to check on the condition. However, some patients hear “abnormal,” stop listening there, and nod their heads that yes, they will come back in 6-12 months. But instead they rush to another doctor and, if they have already had their children, they demand a hysterectomy!
Another issue with this sensitive topic is women wondering HOW they became infected with HPV in the first place. As very few women in India have had more than one sexual partner and their husbands insist that they have both been faithful and were also “pure” at the time of marriage, this creates yet another problem. I have been thinking about how to answer the questions that I might receive on this topic with something other than “Your husband is a liar.”
(HPV can be spread without actual intercourse but contact is necessary).
Another project that I will be working on involves visiting orphanages in the area and giving talks on feminine hygiene and sexual abuse. I just did some quick research on feminine hygiene in India and found some pretty startling results. For example, in India, only 6% (around 30 million women) use some sort of hygienic sanitary napkin during their monthly menstruation (compared to the 96% rate seen in developed countries). The remaining women use whatever they can find. Thus, women often endure embarrassment, infection and loss of workdays due to the negative social stigma and discomfort associated with monthly menstruation. Reproductive tract infections are 70% greater among women who lack access to hygienic supplies and as many as 31% of adult women in India note a drop in their productivity levels when they menstruate, resulting in missing an average of 2.2 days of work each month (click here to read more). Aside from these issues, I will also teach simple exercises to relieve menstrual cramps as well as exercises to help combat depression. These presentations will be a challenge as the customs and sexual culture are just so different from what I know (I still haven’t even figured out how people here get by without toilet paper).
Meanwhile, I have read about 30 journal articles and reports on different aspects of female health, evaluated sperm for male infertility tests (more observational on my end), watched mammograms and ultrasounds, watched a C-section, spent time in the NICU with preemies including one suffering from arthrogryposis, went on rounds, watched heart scans on newborns… Its been busy but I’ve learned so much and am so excited to learn more!
An update on my Widows Project:
The first widow I spoke with who was taking care of her orphaned grandson is currently making arrangements to live at the BIRDS farm where here grandson will attend the BIRDS school. On a more upsetting note, the two little boys whose parents died of AIDS and suicide, are both HIV positive. The twelve-year-old girl with tuberculosis does not have HIV. BIRDS is aware of this situation and will be doing all they can in order to get treatment for these children and support for their grandmother.
I am also still plugging along on the development of SHELTER, the non-profit sustainable women’s shelter that I am working on developing with two Indian MBAs.