Last week, I traveled to Mozambique with two other members of the LA Associates of Save the Children. If you look at a map of Africa, you’ll find that Mozambique is situated above South Africa on the east coast of the African continent. In order to get there, we had to fly to Atlanta, from Atlanta to Johannesburg (a flight that took over 15 hours) and from there to the capital of Mozambique, Maputo. Unfortunately just before we arrived there was a major explosion in the main power plant and as a result there was no electricity for nearly 3 days! Oh and did I mention it was in the 90s with 90% humidity?

After meeting the staff of the central Mozambique Save the Children office and a tour of the city, we flew to Chimoio where Save the Children has a district office with 45 employees. Together with the government, they develop and run programs in teacher and child education, health, nutrition, child rights and prevention of child trafficking. We drove 50 km to a very isolated rural village where families barely eke out a living farming maize and raising chickens. There was no electricity or public transportation.The roads consisted of sand tracks often washed out by floods.

   

There had been no school what so ever in this community until 2004. The children and most adults were illiterate. Several years ago, the community got together and constructed a special hut made of sticks in which untrained “volunteers”  worked with about 100 children. After several years, the government sent several trained teachers and the population of children able to occasionally go to school grew.  


The drop out rate however was high and most girls were not allowed to attend school because they were responsible for obtaining clean water and often had to walk 10 or 15 km to a well to bring the water back home. There was also concern that if they did not have separate latrines from the boys, they would be accosted or trafficked.

 

 

 

 

Once Save the Children identified the tremendous need in this community, the LA Associates of Save the Children quickly raised the funds to build a school which not only had proper classrooms but also had separate latrines for girls and boys and a well so that parents would allow girls to attend.

 

 

 


There are now 600 children in Mussathua who attend grades 1 through 7 in the 3 sessions held 5 days a week at the school. The number of female students equal that of the boys. They do not dropout.
Upon arriving in the village, we were greeted by over 600 cheering children, their parents, teachers and the committees they had formed to supervise the school and their children’s education. And there it was….a functioning 4 room solid walled school, an administration office, 6 latrines and a well. The school rooms had desks, blackboards and books! (I’ve included pictures below for you to see). An inaugural celebration with government officials was held in our honor. The children and mothers danced, acted out stories about the importance of education and the mothers gave a demonstration on nutritious cooking that they had learned through Save the Children.

We went on to see other Save the Children programs the next day including another more established school, a program at a police station to protect women and children from abuse and trafficking and a children’s parliament. After two days, the three of us flew back to Mobuto and from there drove to Kruger Park in South Africa for a brief safari. But the highlight of our trip was the highly emotional experience of seeing what one project envisioned and funded by committed women in LA had accomplished,in an area of the world few of us have seen or think about. We have made a difference in the lives of hundreds of horrifically destitute children. Some of them can now begin to have a future that was heretofore impossible. They will need more… a health clinic, an early education facility, a playground and a building to house teachers (they now live in stick huts). Hopefully now that the basic school is up and running, we and Save the Children can help. How wonderful to be able to do this!

If you want more information or wish to help you can log on to Save the Chilren LA Associates

This week I am in Mozambique to visit the school that many of you helped build through the LA Associates of Save the Children. I return the 19th of February and look forward to sharing pictures and stories about the trip in upcoming newsletters.

We all know that Bacchus was a man. Based on gender stereotypes, most of us assume that women are less likely to excessively imbibe alcohol then men. (For the sake of transparency, the Superbowl was playing while I wrote this and all that celebrated testosterone caused me to make that last statement). But not necessarily so… According to a recent CDC report in “Vital Signs,” more than 14 million US women binge drink about three times a month and consume an average of six drinks per binge. This number includes one in eight women and one in five high school girls! The report states that binge drinking is most common in young women, women who are white or Hispanic, and among women with household incomes of $75,000 or more. Oh…and half of all high school girls who drink alcohol report binge drinking.

A woman’s ability to metabolize alcohol differs significantly from that of a man. When we drink alcohol it is absorbed more quickly, deactivated by enzymes less efficiently, and gets to the brain faster. (Well, we always knew that our brains have rapid and superior circulation. ) We generally weigh less than men so we are also less likely to dilute the stuff. As a result, one drink for a women has the impact of two for a man.

The definition of binge drinking for a woman is consumption of four or more alcohol drinks on an occasion. And an occasion is considered to be 2 to 3 hours. Although binge drinking in high school or college can lead to a higher incidence of alcoholism in later life, most binge drinkers are non-alcoholics and not alcohol dependent. The CDC reports that drinking too much (which of course includes binge drinking) results in about 23,000 deaths in women and girls each year and increases the chances of breast cancer, heart disease, sexually-transmitted diseases, unintended pregnancy as well as other health problems. If a woman binge drinks while pregnant, she risks exposing her baby to high levels of alcohol during its development which can lead to miscarriage, low birth weight, sudden infant death syndrome (SIDS), attention deficit/hyperactivity disorder (ADHD), and fetal alcohol syndrome (facial disfigurement and mental deficiencies). This is where I’m supposed to say it’s not safe to drink alcohol any time during pregnancy.

Aside from giving warnings, the CDC and its Guide to Community Preventive Services recommend certain strategies for preventing excessive alcohol consumption.. These include:  

*Increasing alcohol taxes.

*Reducing the number and concentration of stores that sell alcohol in a given area.

*Continuing government controls over alcohol sales.

*Maintaining or reducing the days and hours of alcohol sales.

*Enhanced enforcement of laws prohibiting sales to minors.

*Electronic screening and counseling for excessive alcohol use.

I know some of this sounds excessive and may go against our sense of what the government should and should not do. (There are no blue laws in California, and according to that wonderful series Boardwalk Empire, prohibition doesn’t work!) To help avoid teenage binging, the best plan might be to make sure that our teens can’t get into our liquor closet and of course, maintain zero tolerance for alcohol use before, during and after school parties. And then we should listen to the anti-binge advice ourselves. Remember abstaining from that second and certainly the third drink may lessen our risk for breast cancer, heart disease, stupid behavior, and worse yet, the wrong sexual and reproductive decisions. We just don’t need that extra glass of wine, cocktail or beer to enjoy the game, the dinner or the party. The salute ” Le Chaim” (translated, for those of you who need it) to “To Life” need not be accompanied by 4 drinks…one is healthier and should suffice.

A quick personal note: I am traveling to Mozambique next week with several women to see the school we built through the LA Associates of Save the Children. I will be happy to share pictures and stories upon my return.

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I am writing this website article at 37,000 feet as I return to LA from Miami. Aside from enjoying the wonderful weather (it was 78 degrees) I had the opportunity to give a talk on women’s health to over 200 women who had gathered for a benefit luncheon for the organization “Hearing the Ovarian Cancer Whisper” or H.O.W. It was their 12th annual event in Palm Beach and was held at the beautiful Flagler Museum. The scientists/ physicians who “discovered” CA 125 and created the use of this marker in evaluating and treating ovarian cancer were there and I was honored to share the afternoon with them. So how appropriate was it to peruse the January issue of the journal Menopause and find an article in the Personal Perspective section on the controversial issue of surgical removal of the ovaries (oophorectomy) for prevention of ovarian cancer either during hysterectomy or as a primary procedure. Does oophorectomy prevent thousands of women from dying of ovarian cancer, or does it create other disorders that impact their health and shorten their longevity?

Ovarian cancer is the fifth deadliest cancer in women and will cause an estimated 15,500 deaths this year in the United States. Clearly an option to prevent this malignancy is to perform bilateral oophorectomy. And indeed, it is done together with removal of the fallopian tubes (salpingectomy) in almost half of all hysterectomies performed for benign reasons. But, as in most medical decisions, there is now a debate about the pros and cons…

Here are the pros that were outlined by the author of the article:

Sixty three percent of cases of ovarian cancer are diagnosed in late stages because there are few warnings that the disease is present in its early stages. Moreover, there are currently no recommended screening tests that have been shown to change mortality rates. (And, the current theory is that many ovarian cancers actually start in the Fallopian tubes, and by the time it spreads to the ovaries it is already a metastatic cancer!) A woman’s lifetime risk of ovarian cancer is 1 in 70. So for that 1 in 70 women, removal of the tubes and ovaries would reduce their risk. It has been estimated that 1,000 cases of ovarian cancer could be avoided annually if the tubes and ovaries are removed during the time of hysterectomy in women who are 40 or older.

Those women who are at high risk for ovarian cancer will obviously benefit the most from prophylactic removal of the Fallopian tubes and ovaries. These are women with either BRCA1 or BRAC 2 mutations or those with a very strong family history of ovarian cancer. We also know that for women with the BRCA mutations the surgery reduces their breast cancer risk. The author points out that the surgery is the only thing we have that can prevent ovarian cancer in women with increased risk. Although not great (and please don’t panic at this list), the risk factors include being white, never having been pregnant, late age of menopause, and a long number of years of ovulation.

There are also secondary benefits to removing the ovaries and tubes at time of hysterectomy. For some women this may help alleviate pain and severe PMS. And for many women, the removal of their ovaries can lead to a significant decrease in anxiety and depression related to their perceived cancer risk.

 

Now, onto the negative:

and the reasons many gynecologists now feel that the ovaries should be conserved during hysterectomy. The database from the National Center for Health Statistic, the Women’s Health Initiative and other studies have shown that there is no clear benefit for elective removal of the ovaries before the age of 65 and indeed it is detrimental to the life expectancy rate for women with average risk for ovarian cancer. Removing the ovaries increases risk of death from coronary artery disease and after the age of 65 also increases risk of death from osteoporotic fracture. If the surgery is done before the age of 55 it increases a woman’s risk of dying of coronary artery disease by the age of 82 by over 15% from a baseline risk of 7.57%. The surgery before age 55 years increases the risk of dying of osteoporotic hip fracture by the age of 82 to 4.96% from the baseline risk of 3.38%.

There is also data which shows that the surgery can be linked to cognitive impairment caused by estrogen deficiency. In a study quoted by the author, women whose estrogen decreased more than 50% six months after surgery, performed worse in all cognitive functioning tests when compared with women whose estrogen decreased by less than half. The impairment was mitigated with immediate and continuous estrogen therapy until at least age 50. And finally there is one more drawback to bilateral oophorectomy; decreased sexual function and diminished sexual desire. Years after menopause the female ovaries produce both testosterone and another hormone called androstenedione. They are both partially converted to estrogens in the fat cells. After surgical menopause the blood levels of estrogen and male hormone decrease. Lack of estrogen can cause vaginal atrophy and discomfort with intercourse, lack of male hormone has been associated with diminished libido and sexual satisfaction.

It’s possible that therapy with estrogen and perhaps testosterone will prevent these negative outcomes. Studies have even shown that women who undergo the surgery between the ages of 45 and 50 and who receive estrogen therapy have a significantly lower number of deaths related to cardiovascular disease. And we know that estrogen therapy can prevent and treat bone loss in perimenopausal and postmenopausal women.

So there you have it, the pros and cons. The decision to remove the tubes and ovaries while doing a hysterectomy should be made on an individual basis in consideration of a woman’s unique risk for ovarian cancer. The Society of Gynecologic Oncologists (and these are the experts that treat ovarian cancer) now state “Ovarian conservation before menopause may be especially important in patients with the personal or strong family history of cardiovascular or neurological disease. Conversely, women at high risk of ovarian cancer should undergo risk reducing bilateral saplings-oophorectomy.”

Bottom line: The removal of the ovaries can have serious consequences to health and longevity, before and perhaps after menopause. The decision to remove them should be based on a high risk for ovarian cancer..

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