Blog 15 - An Inspirational Woman - Lillian Carter

I don't think about risks much. I just do what I want to do. If you gotta go, you gotta go. ~Lillian Carter~ Every time I think that I'm getting old, and gradually going to the grave, something else happens. ~Lillian Carter~ If I had one wish for my children, it would be that each of them would reach for goals that have meaning for them as individuals. ~Lillian Carter~ Some of my young classmates probably don’t know who Lillian Carter is – she died before many of you were born. She was the mother of President Jimmy Carter and somewhat of a “character” in her time, doing her own thing and speaking her mind without much consideration for what other people might think. She was born in 1998 in Georgia and in 1917, at the age of 19, she volunteered to be a nurse in World War I (without any nursing training!) but the military nurse program was cancelled and she didn’t go. She completed her nursing degree in Atlanta in 1923. Her family disapproved of her career choice, but she forged ahead with it anyway, then met and married her husband in 1925,after her graduation from nursing school. She defied social norms by welcoming African American neighbors into her home and she provided medical care as a nurse practitioner (at times illicitly!) for both African American and White employees of her husbands business and for the community of Plains, GA. She was a liberal social activist who worked for desegregation in a time and place where that point of view was highly irregular and unpopular. In 1966, at the age of 68, she applied to the Peace Corp, and after a psychiatric evaluation, she was accepted and was sent to India for 22 months, where she worked as a nurse to those who were desperately poor and sick, including those with leprosy. “Miz” Lillian was greatly loved by those she served all her life and she loved and supported each of her children no matter what road in life they chose to travel. She left a legacy of service and an example of determination to do what she knew was right, no matter what the opinion of those around her. It’s people like Lillian Carter who help me know that “age is just a number, and old is just a state of mind.” As she said, “I don’t think about risks much. I just do what I want to do. If you gotta go, you gotta go.” REFERENCE: Wikipedia. Lillian Gordy Carter. 28 September 2010. http://en.wikipedia.org/wiki/Lillian_Gordy_Carter

Blog 14 - Finding balance

“Don’t ask what the world needs. Ask what makes you come alive, and go do it. Because what the world needs is people who have come alive.” Howard Thurman, American theologian. Finding balance in our lives is critical if we are to be happy, contented and fulfilled. Many women spend years striving and struggling to meet the expectations and goals of society and of other people, then wake up one day and find that their own goals and dreams were entirely different than those they fought so hard to realize. The first essential step to finding balance is to define what is most important to YOU personally. That might be a college degree, or masters or doctorate, or being a stay-at-home Mom with a large family or maybe having a successful and lucrative career – or maybe all of those things. The critical part of this step is to make it personal, not allowing others to define what is important to you. When the step of defining what’s important is finished, then make a plan and a timetable – this can be very detailed or more general, based on what is comfortable for you personally. Another important way to maintain balance is to learn to say no to requests that will cause you to be over-committed. Agreeing to do things that we don’t have time or energy for (or a passion for!) is a major cause of frustration, fatigue and imbalance for most women. Women should also make sure that there are periods of time in their schedules for personal renewal. The amount of time you allow for this is very individual – some women require more than others. This personal renewal time might be for reading, hobbies, a pedicure, a walk, watching a TV show or just spending time alone or with a friend. Another important step is to pursue intellectual renewal – a refreshed mind is an energized and balanced mind. Lifelong learning will keep each of us young and strong. Spiritual renewal is also important – this is very personal and individual for each woman, because each of us is spiritual in different ways. I have a personal relationship with Jesus Christ and I pray and meditate often, but others may find this spiritual renewal through different avenues. This important thing is to add this step to your quest for balance. As a woman who has been through many phases of life, I would just encourage each of you, as you seek balance, to define what’s important to you, then live your dream and wear your passion every day, making sure that the dreams and passions are your own, NOT those someone else may have defined for you.

Blog 13 World Health Organization calls for graphic pictorial warnings on tobacco packaging

"The World Health Organization (WHO) recently called for countries to provide (graphic) pictorial health warnings about the dangers of tobacco use." In May of 2009, WHO called for countries to require pictorial warnings on all tobacco product packaging to increase public awareness of the consequences of tobacco use. "Tobacco is the only legal consumer product that kills when used exactly as intended by the manufacturer(WHO)." In the United States, the FDA regulates and controls thousands of products that have been shown to be harmful to people who use or misuse them. However, despite incontrovertable evidence that tobacco use kills, it is still available for purchase, with only minimal verbal package warnings - "smoking may be hazardous to your health". Smoking is the leading cause of preventable death in the US, causing 5 millions deaths per year, and yet availability of tobacco products is minimally regulated. Brazil, Canada, Singapore and Thailand all require graphic pictorial package warnings that studies have proven to have a positive effect on smoking rates in those countries. The tobacco industry lobby in the USA is very powerful and well funded, and because of it's political clout, efforts aimed at preventing new users and helping addicted smokers to quit are rendered much less effective. The new healthcare legislation should have included some very concerted efforts to control and reduce tobacco use. Instead of addressing the cause of so much sickness and death, the focus remains on treating the lung cancer, cardiovascular disease, stroke and many other chronic, debilitating and death-dealing illnesses suffered by smokers and those exposed to their second hand smoke. REFERENCE: World Health Organization (2009). Call for pictorial warnings on tobacco packs. Retrieved from http://www.who.int/mediacentre/news/releases/2009/no_tobacco_day_20090529/en/index.html.

Blog #11 Breast Cancer in American and Africa

Breast cancer is the most commonly diagnosed cancer among American women, other than skin cancer. In 1975, the incidence rate for breast cancer in American women was 105 cases per 100,000 women and the mortality rate was 31 per 100,000. Radical mastectomy (a disabling and disfiguring surgery which involves the surgical excision of breast tissue and skin, underlying muscle and lymph nodes) was the treatment of choice. Clinical trials studying chemotherapy using multiple drugs and hormone treatment was in its earliest stages (National Cancer Institute). In 2007, the incidence rate for breast cancer in American women was 125 per 100,000 and the mortality rate was 23 per 100,000. Lumpectomy (preserving the breast) along with local radiation therapy was the accepted treatment for early stage cancers. Breast cancer susceptibility in several genes has been identified, leading to the opportunity for early warnings in women who carry these genes (National Cancer Institute). According to the National Cancer Institute, in 2010 there will be approximately 207,000 new cases of breast cancer diagnosed in the United States and about 40,000 American women will die from the disease. As noted above, the breast cancer incidence has increased by about 16% but the mortality rate has decreased by 26%, and life-saving therapies are more readily available. Mammography has become more sophisticated as well as more accessible. In the future, the use of cancer genomics will aid in the development of more targeted and less toxic chemotherapy treatments. This is good news for all of us. The story for women in Africa is very different. Breast cancer incidence in Africa is lower, but it when it does strike, it strikes at an earlier age and with greater virulence. The relative rarity of screening mammography and examinations results in more advanced disease once the diagnosis is made. Researchers have found that in African women, many breast cancers arise from a different type of cells than those of Caucasian women, and cancers arising from these cells have a worse prognosis, regardless of race. In Africa, most breast cancers strike women in their 40s. There is a great deal of stigma attached to a diagnosis of breast cancer in Africa, and women are often afraid of losing husband and children, and being ostracized by their communities. Common beliefs are that breast cancer is caused by unsavory personal habits such as wearing dirty clothing or tucking money inside a bra. Many African women believe if they see a doctor, their breast will be cut off and they will be dead within 2 years anyway. There is some truth in this because most cases are advanced at the time of diagnosis and often there is no follow-up treatment. Changing the course of breast cancer for African women will require massive education, overcoming common beliefs and superstitions and the development of early detection centers where mammography will be more available and affordable for African women. National Cancer Institute, 2010. Cancer Advances in Focus. http://www.cancer.gov/cancertopics/cancer-advances-in-focus/breast Science in Africa, April, 2005. Breast Cancer Findings in African Women. http://www.scienceinafrica.co.za/2005/april/breastcancer.htm

Blog 9 The dieting roller coaster

“Jane” is a 41 year old woman who struggles with her weight and her body image. As a young child, she was quite thin, being very physically active and having a normal appetite; however, as she entered puberty, she grew rapidly and became overweight. She was never obese but was uncomfortable with her size and shape, which soon became her major focus in life. Food was never a control issue or point of conflict as a young child, but her mother was thin and Jane always wanted to look like her. Jane’s mother was very supportive (she had been chubby as a young teen also) but she too was obsessed with weight, size and conforming to media-hyped body images. Together they were quite a pair. As a senior in high school, Jane went on a strict diet, lost about 50 pounds and exercised strenuously (she was an athlete in high school) – Jane feels she may have bordered on becoming anorexic. She said she had a lot of thoughts about making herself vomit after she ate because she had a friend who was bulimic, but she never did that. Her parents were divorced and her stepmother made constant comments about Jane’s size while her father never commented or supported her – so she thought he felt the same way her stepmother did. This just fueled her extreme dieting and exercise but no matter what she did her stepmother never had a positive comment. As she matured, she had a number of extreme weight fluctuations – she would diet until very thin, then gain all the weight back plus more. The weight gains seemed to correspond with her being content with relationships with men and the extreme dieting corresponded with periods when she was not involved with a man. After she married, the same pattern continued – happy equaled a heavier weight and times of marital struggle equaled extreme dieting and exercising. Jane has a high stress job which requires a lot of hours and she has children involved in lots of sports and activities as well, so she does not spend much time cooking or planning meals. She is always trying the next new “miracle” diet to lose weight rapidly. She knows her diet and uneven physical activity are not healthy but she feels trapped in the cycle. I asked about her goals for a healthy future and she responded that she knows that her future depends on better habits but she still searches for the “magic bullet” of weight loss.

Hormone Replacement Therapy - my choice

At the age of 30, my left ovary was removed due to a benign tumor. At 40, I had a hysterectomy due to fibroids, endometriosis and adenomyosis. I was adamant that the surgeon leave my one remaining ovary as I did not want to go through surgically induced menopause at 40 - I was really frightened at the thought of weight gain, hot flashes and looking and acting like an old woman. My doctor strongly advised that I have the one remaining ovary removed because of my history but I insisted and he finally agreed. Because of the one working ovary I didn't need to take HRT and the recovery was uneventful, as were the next 8 years. When I finally did start menopause, at 48, I elected to take HRT for hot flashes, night sweats and a host of other typical menopausal symptoms. I also had osteoporosis and the HRT was to treat that also. I took the pills for 7 years at which time my doctor advised that I stop them. I did, but at a price. The hot flashes, insomnia, "brain fog", etc returned. I chose to use some over the counter herbal remedies which did help some and after a couple of years, I was feeling comfortable again. And of course, the OTC remedies did not help the osteoporosis. I began taking Actonel, a medication to treat osteoporosis, but stopped due to the development of esophagitis. I'm not sorry I took HRT - it made a difficult time of my life more bearable and it did put off the worsening of the osteoporosis. I only take calcium, vitamin D, fish oil and a multivitamin now, and half a children's dose of benadryl at night to help with sleep (recommended by my ICU nurse daughter!). I am aware of the risks associated with HRT, but I think I would still take it if I had to do it over again - just maybe not for so long. I am opposed to taking prescription meds except in the most demanding of circumstances. I believe natural health is the way to go and it is working for me.

The Silent Partner - HIV in marriage (film)

In 2004, one third of all new HIV cases in Uganda occurred in married couples. In Zambia and Rwanda, half of all new cases were diagnosed in married or co-habiting couples. In Sub-Sahara Africa, 22 million people are living with HIV/AIDS - 5% of the total population. In some countries, the rate is 1-2% but in others, such as Swaziland and Botswana, the rate is over 20% (AVERT). Most of these Sub-Sahara African societies are patriarchal - women spend their lives being owned, first by their fathers and then by their husbands. In order to prove their strength and manhood, men have multiple sex partners outside marriage and married women are powerless to practice abstinence or demand condom use. Women's health, and even survival, depend on the sexual behavior of men and for the most part, their behavior is reckless and without regard for their own health or the health of their wives and children. For married women, there are no alternatives - they are taught to ask no questions and make no demands for the sake of their children because husbands are the providers. They are taught to always say yes to their husband's demands - if they don't, they can be physically chastised. Cultural attitudes foster acceptance of marital violence - in Kenya, 43% of women report being the victim of sexual violence from their husbands. A recent law against sexual violence in Kenya excludes marital rape as a crime. One problem is that leaders who recognize the urgency of stopping this life-threatening behavior have not identified ways to reach out to the men in these cultures. Millions of dollars in international aid have been thrown at the HIV/AIDS epidemic in Africa but until Africans themselves take ownership of the problem and begin to address the cause of the continuing epidemic it will continue. Women cannot be empowered to take control of their health until men are educated about the extreme risks posed by their behavior and until they are taught to value women. REFERENCES: AVERT, 2009. Averting HIV and AIDS. Statistics. Retrieved from http://www.avert.org/africa-hiv-aids-statistics.htm___ Population Action International, n.d. Silent Partner-HIV in Marriage. Video retrieved from http://www.populationaction.org/silentpartner/about.html#film