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ASSOCHAM - AWARENESS SUMMIT ON COMPREHENSIVE PREVENTION OF CERVICAL CANCER

ASSOCHAM - AWARENESS SUMMIT ON COMPREHENSIVE PREVENTION OF CERVICAL CANCER. DR. K. BHANDARI, DM (CARDIOLOGY) DGHS CUM SECRETARY HEALTH CARE HUMAN SERVICE & FAMILY WELFARE, GOVERNMENT OF SIKKIM. Chief Ministers Comprehensive Annual & Total Checkup for Healthy Sikkim (CATCH ) Programme.

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ASSOCHAM - AWARENESS SUMMIT ON COMPREHENSIVE PREVENTION OF CERVICAL CANCER

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  1. ASSOCHAM - AWARENESS SUMMIT ON COMPREHENSIVE PREVENTION OF CERVICAL CANCER DR. K. BHANDARI, DM (CARDIOLOGY) DGHS CUM SECRETARY HEALTH CARE HUMAN SERVICE & FAMILY WELFARE, GOVERNMENT OF SIKKIM

  2. Chief Ministers Comprehensive Annual & Total Checkup for Healthy Sikkim (CATCH) Programme Health Initiative Regarding Awareness and Prevention of Cervical Cancer

  3. SIKKIM - SOME IMPORTANT FACTS • Sikkim is one of the eight North Eastern States. • Difficult terrain with elevation ranging from 300 to 8598 meters and climate ranging from Sub tropical to Alpine. • Sikkim is small in size but has been thinking big. • We have taken some important initiatives— a). Sikkim was the first to introduce Hepatitis ‘B’ vaccine in 2001 and MMR vaccination for children in 2009 from states own resources. b). Sikkim was the first state to ban gutka and pan parag and such substances containing tobacco and nicotine.

  4. c). Also the first state to ban Tobacco smoking in public places in 2010. d). Probably the first to ban the use of plastic bags. e). Sikkim is the first state to start a unique programme like CATCH programme in August 2010. f). We are the first state to start unique programme of Mukhya Mantri Jiwan Raksha Kosh for taking care of tertiary health care. g). Mukhya Mantri Shisu Suraksha Yojana Avam Sutkeri Sahayog Yojana is another unique initiative. h). We are about to be the first to start HPV vaccination against Cervical cancer. Delayed because of one PIL in Hon’ble Supreme Court.

  5. SIKKIM : Health Scenario

  6. Cancer Scenario in Sikkim As per Population Based Cancer Registry 2011-2012: • The total number of Cancer cases is 815. • Out of the 815, female cancer cases are 401. • Out of these, 39 cases are of Cervical Cancer. • Cervical Cancer is the 2nd commonest Cancer among females closely behind Breast Cancer in Sikkim.

  7. Total Number of Cervical Cancer Cases, Percentage and Age Adjusted Rate

  8. Total Number of Cervical Cancer Cases Deaths, Percentage and Age Adjusted Mortality Rate

  9. LEADING SITES OF CANCER IN THE YEAR 2009-2011 (IN % Female)

  10. Comparison of Age Adjusted Rate(AAR) of Sikkim PBCR (2007-2008) with the AAR’s of other PBCR’s (ICD 10 : C53) Cervix Uteri (Females)

  11. Year wise total cancer cases (Females) and Cervix cancer cases

  12. World & Indian Scenario of Cervical Cancer • World Wide: 5, 29,000 new Cervical cancer cases are reported annually. • World Wide 2, 75,000 cervical cancer related deaths occur each year. • India: of the above 25% of new cases i.e. 1, 34,000 cases are reported from India and 27% of cervical cancer related deaths (i.e. 73,000) are reported from India annually. • It is the most common cancer among women in India and it is the leading cause of cancer deaths. • More than 200 women die in India everyday, 8 women die every hour and 1 woman dies every 7 minutes from the disease.

  13. Prevention, Early Detection and Treatment Realizing the status of cervical cancer, we decided to tackle cervical cancer in the following manner : 1. Early Screening and Early Detection through -- a). Existing Health System, b). Through CATCH.

  14. 2. Palliative treatment and Chemotherapy is already being provided in the State Hospitals. 3. For curative and specialized treatment patients are being referred to specialized empanelled Hospitals. 4. Primary prevention : the State is in the advanced state of implementation of HPV vaccination. It has been delayed because of a pending PIL in the Hon’ble Supreme Court.

  15. CATCH Programme CATCH Programme, a flagship programme of Government of Sikkim was launched to work towards making Sikkim a healthy State which is not only a health check-up but also an initiative to work towards promoting health, preventing disease, curing and prolonging life through community mobilization and organized efforts of policy makers, government organizations, civil society and common men to make Sikkim a healthy Society.

  16. A BRIEF DETAIL ON CATCH • CATCH Programme was launched on 26th August 2010. • The Programme was basically the brainchild of the Hon’ble Chief Minister. • It was generally to be a preventive programme as large number of programmes existed for curative aspect of Health but not for prevention.

  17. The programme was to be Comprehensive i.e. thorough in its approach, it was to be Annual ongoing and Total in the sense that it should try to cover all aspects of Health and Disease. • In order to achieve success the infrastructure had to be updated in the form of providing adequate Lab facilities to District Hospitals and Primary Health Centers. • Proper teams had to be formed and planning for conduction of each camp had to be meticulously worked out.

  18. Main emphasis was to be on : 1). Detection of Health Risk Factors like-- • Alcoholism • High Blood Sugar • High Blood Pressure • Raised Cholesterol 2). Blood Grouping and Hemoglobin of all Individuals to be done. 3). Early Detection of various Cancers. 4). Emphasis on Good Referral to Specialized Centers and Proper Treatment.

  19. 5). Health Awareness and Health Education through Community participation and participation of NGOs etc. • As of today, out of the total population of 6.07 lakhs, 5.2 Lakhs has been covered. • 12.5 Lakhs Lab Test has been done (for all individuals we conduct blood grouping & Hemoglobin and RBS & Total Cholesterol are done for 30 years and above). • Out of 52,492 females between the age group of 30-49 years, 20,367 Visual Inspection by Acetic Acid (VIA) has been performed.

  20. EARLY DETECTION OF CANCERS EARLY DETECTION OF CERVICAL CANCER— Why VIA method of screening was chosen ? a). WHO has estimated that only 5% of women in developing countries are screened appropriately for Cervical cancer. b). Reasons could be – • lack of funding. • poor access in rural areas where most of the cases are present.

  21. lack of awareness. • cumbersome method of screening e.g. PAP based screening. c). Direct visualization by Acetic Acid has proven to be an effective method of screening for Cervical cancer in many trials. d). It’s a good alternative to PAP smears in developing countries like India.

  22. e). In VIA 5% Acetic Acid (Vinegar) is Applied to the cervix with a large cotton swab and left for 30 to 60 seconds after which the cervix is examined with naked eye and a lamp. Pre cancerous lesions with a higher ratio of intra cellular proteins turn white when combined with Acetic Acid. Normal cervices do not change colour. e). Such lesions can be treated at the spot by Cryo therapy. f). The screening is cheap and any trained nurse can do the test and the result does not require a revisit to the doctor.

  23. STRATEGY - EarlyDetection of Cervical Cancer • It was decided that emphasis would be given to women in the age of 30 – 49 years. • All such women would be screened for: a).Breast Cancer by Clinical examination by the physician. b).Cervical Cancer by Visual Inspection by Acetic Acid. • For this purpose all concerned Medical Officers and Nurses were given adequate training by the Gynecologists. • Only such trained personnels were utilized for the camp.

  24. Prior to the procedure, all women above the age of Thirty years and all married women were counselled. • They were briefed on Cervical Cancer, its causes and the importance of early detection by VIA. • If anyone were found to be VIA positive, in order to prevent panic they were again counselled and referred to nearby District Hospital or State Referral Hospital (STNM) in Gangtok where Gynecological facility is available for further confirmation, management and treatment.

  25. Cancer Care Facility under the NPCDCS Programme has been established in STNM Complex. In addition, we have a panel of Hospitals outside Sikkim for referral for specialized treatment. • A tertiary Cancer Care Unit is under construction at the new multi specialty hospital complex at Sichey, at the outskirt of Gangtok. • We are also considering for the Cervical Cancer Vaccination, which is in the advanced stage and ready to be implemented.

  26. It was interesting to note that according to the provisional report 20,367 females underwent VIA Checkup out of which 530 (2.6%) were found VIA positive. • A training was conducted under International Agency for Research on Cancer, Lyon, France in which advance level training was given to all the doctors, nursing staff on screen and treat approach. • Cryotherapy equipment was also donated and is being put to use.

  27. OVERVIEW OF HOW CATCH CAMPS WERE CONDUCTED

  28. DISCUSSION WITH THE COMMUNITY LEADERS/ VHSC CATCH PROGRAMME Individual , Family & Community Initiative DISCUSSION WITH THE COMMUNITY LEADERS/ VHSC CYCLE FOR CACTH PROGRAMME ACTION PLAN BASED ON THE FINDINGS HEALTH EDUCATION & BEHAVIOURAL CHANGE COMMUNICATION ANALYSIS OF THE DATA, REPORT PREPARATION, DISCUSSION ON THE REPORT, FINALISE COMMUNITY DIAGNOSIS POLICY/ DECISION MAKING BASED ON REPORT

  29. REGISTERING THE FAMILY, FILLING UP OF FORMS DISCUSSION MEDICINE DISTRIBUTION CONDUCTION OF CATCH CAMP HEALTH EDUCATION & BCC BMI COUNSELLING DENTAL CHECK UP LAB TESTS VIA FOR SCREENING GENERAL CHECK-UP

  30. SCREENING CAMP BEING CONDUCTED AT THE COMMUNITY LEVEL

  31. Patients waiting for the Laboratory test during one of the Camps at Namchi VIA & Breast Examination behind the screen Random Blood Sugar being done EARLY DETECTION OF ORAL LESION TO PREVENT ORAL CANCER Doctor conducting the check-up Patients waiting for their turn outside the Lab

  32. SCREENING AT SCHOOLS

  33. DISEASES REFLECTED BY CATCH Provisional Findings in the Camp Approach till October 2013:

  34. SUMMARY • CATCH programme is a flagship programme of Government of Sikkim. • For any public health programme especially ambitious programme like CATCH it takes time to gain momentum, however, response of the community has been overwhelming. • Since the services are being availed close to the door step of the people, the programme is being appreciated by common men and also by the experts of Public Health.

  35. Though it takes time to see the immediate impact, some signs of transformation in the health of people can be seen. • The programme addresses the most important public health issues of the state which includes: • Cervical Cancer amongst others, and • Also tries to address the most cost effective risk reduction of major causes of death in Sikkim. • Health Cards containing basic individual health information of all screened population has been developed and is being distributed. Further, all data collected through the CATCH Programme has been stored in a database and can be retrieved and updated at any point of time.

  36. The State has realized that all Cancers including Cervical Cancer needs to be looked at very seriously and as far as Cervical Cancer is concerned the State is looking at a comprehensive Cancer Programme which includes : • Early Detection with the help of programme like CATCH. • Comprehensive treatment both curative and palliative. • Primary prevention through IEC activities, Health Education and by Vaccination Programme like HPV vaccination for Carcinoma of Cervix. • Finally, the state has made a beginning, we are still in the learning process and with each experience we hope to better the programme.

  37. CHAR DHAM, SOUTH SIKKIM BUDDHA PARK, SOUTH SIKKIM YUMTHANG VALLEY, NORTH SIKKIM Thank You GURUDONGMAR LAKE, NORTH SIKKIM ON THE WAY TO YUMTHANG VALLEY SAMDRUPTSE, SOUTH SIKKIM

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