TELEARUBA — broadcast
20261102 150000 UTC
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[00:00:03] of
[00:00:03] a
[00:00:09] of
[00:00:15] of
[00:00:24] a
[00:00:36] a of
[00:00:48] of of a
[00:00:51] of
[00:00:55] of
[00:01:02] The history of women's health is a complex journey that has been traced
[00:01:06] to ancient times. In our modern day, it has sometimes
[00:01:09] been shaped by superstition, misconceptions about women's bodies
[00:01:13] and lack of female
[00:01:16] of of
[00:01:19] of of medical professionals, but important breakthroughs in understanding women's health has improved in recent decades.
[00:01:23] This is certainly good
[00:01:24] of news as the health of our nation's women influences the wellbeing of
[00:01:28] us
[00:01:29] of all. My name's is Dr. Carise Manchester, I'm
[00:01:31] of the head of obstatrics and gynacology at the Joseph and France General Hospital here in
[00:01:35] St. Kids. I
[00:01:39] found
[00:01:41] of of in my experience as an obstatrition gynecologist and even before growing
[00:01:45] up and in my training that I
[00:01:49] guess my goal has always been that I've never
[00:01:52] of actually seen women really be empowered
[00:01:55] of to make the best reproductive choices and the best choices
[00:01:59] about their... health and for various reasons, but I mean
[00:02:03] I might be biased because I'm
[00:02:04] a female and I might be biased because I deal primarily with females, but I do
[00:02:08] believe that females and women are pretty much the
[00:02:12] center stone
[00:02:13] of the family and
[00:02:15] of the society and the community. I think that the
[00:02:18] of more we empower the women in the community and in the
[00:02:21] family,
[00:02:22] of then we're actually empowering everyone, and so
[00:02:26] empowering women, educating them more on their health, what...
[00:02:30] they should expect, what should be
[00:02:32] of accessible of to them, what they should be seeking out in terms
[00:02:36] of their health as a holistic person, I think that's where we
[00:02:40] should be focusing in terms of us as doctors, us
[00:02:44] as relatives of people who may need to access healthcare and health
[00:02:47] administrators, and the key is
[00:02:51] of education, once you educate your patient, what are the signs and symptoms to look
[00:02:55] for, then I think
[00:02:56] of they'll be able to mitigate whatever the situations may be.
[00:03:00] obstatrics is for pregnancy, gynaecology is women's
[00:03:04] health, it's a broad topic from when you're
[00:03:07] born until your last breath. with the fate of two
[00:03:11] precious lives in
[00:03:12] of the balance, obstetric care is an essential science.
[00:03:15] recent research and development in issues related specifically
[00:03:19] to women has improved the chances for healthy pregnancies.
[00:03:23] women are having children when they're older, because as opposed
[00:03:27] to 50 years ago women today we have things
[00:03:30] to do, we have goals, we have
[00:03:34] ambitions, we have responsibilities that we're
[00:03:37] focused on, and we want to achieve certain things before we
[00:03:41] embark on child bearing, when they achieve goals, when they're
[00:03:44] more, their financial health that we mentioned, their social health, all of
[00:03:48] that is in place and
[00:03:49] in a in the best state that they
[00:03:52] of can be in, then that helps with the obcetric outcome as
[00:03:55] well, more resources at your disposal, you are more
[00:03:59] with... you are more educated in most cases
[00:04:03] and that situational awareness you
[00:04:06] can
[00:04:07] you know make better choices for you and your family. the
[00:04:11] younger women who may not be in the best place in terms
[00:04:14] of the other aspects
[00:04:15] of their health, they end up having children
[00:04:19] when they may not be quite ready for it, and lot of it has to do
[00:04:23] with not being aware
[00:04:24] of the contraception options and how they work and what's best for
[00:04:28] them. methods
[00:04:30] of and lifestyle choices help to ensure pregnancies can progress
[00:04:34] with the help of both the
[00:04:36] of mother and child in mind. we always
[00:04:38] of encourage women young or old to plan their families, doesn't always
[00:04:42] work out
[00:04:42] in like that, but where you can, you plan your families and when you decide, okay, now
[00:04:46] i want to start trying for baby, that's when you go and
[00:04:50] see your healthcare provider, and they can give you all the tips, they
[00:04:54] can make
[00:04:55] in sure all your health factors are in order, they can do tests as necessary
[00:04:59] to make sure that anything that needs to be modified before pregnancy to
[00:05:03] ensure the best outcome can be modified early
[00:05:06] of and a that's always better. my name is Dr. Lesan
[00:05:09] Christian, head
[00:05:10] of the pediatric department. the Millennium Heights Medical
[00:05:14] Complex. Before you get pregnant, I think it's a very big
[00:05:17] step to make, because you have to look at you, not just having the baby, but
[00:05:21] support after having the baby, you know, like what's the long-term
[00:05:25] plan, but even so you need to sit with your partner, and both of us need to look
[00:05:29] at our sickle cell - status to know if I have the trait, and if he
[00:05:33] has the trait, there is a 25% possibility the baby can have
[00:05:37] full-blown sicker cell disease, and so it's important for the
[00:05:40] partner or the couple to... to have their cycle cell screening
[00:05:44] done as well as even the HIV and syphilis status because these are
[00:05:47] things that also have different treatment in the perinatal
[00:05:51] period so I think planning the pregnancy is important you need to start your
[00:05:55] prenatal vitamins so very important your folic acid
[00:05:59] because deficit the folic acid in the first eight
[00:06:03] weeks can result in what we call neurotube defects so
[00:06:06] you can have like your meningo milacil which is an opening around
[00:06:10] the lower aspect of your spinal cord and so increasing your folic
[00:06:14] acid will help to reduce the chances of having neural tub defects
[00:06:18] and also you want to increase your iron sources because anemia in
[00:06:22] pregnancy can also have its own complications. folic acid
[00:06:26] leads to the formation of one the building blocks for blood
[00:06:30] cells and some the other cells that are needed
[00:06:33] to form these organs that come from a part the
[00:06:37] embryo called a neural tube as i mentioned brain, spinal cord
[00:06:40] etc. and so if you're deficient in
[00:06:44] it then that can lead to defects in the development of
[00:06:48] those organs and the good thing about living in the Caribbean is
[00:06:52] most the time we get folid from all these lovely things we eat
[00:06:55] mangoes and pineapple and all of those
[00:06:59] things tend to have fool it and the dushhing and the you know
[00:07:03] sweet potato and we tend to eat those things a
[00:07:06] lot and so most the time our population
[00:07:10] doesn't tend to be deficient in but you can be deficient in
[00:07:14] fol it and so we do require that most women take
[00:07:18] that supplement. in terms of throut your
[00:07:21] pregnancy, we encourage exercise, that's one thing we do encourage,
[00:07:25] moderate level exercise. if you were someone that went to the gym
[00:07:28] regularly before, you used to go running before, walking
[00:07:32] before, you can continue at whatever level your
[00:07:36] body was already accustomed to, and then you listen to your body, you
[00:07:40] know, if you find that you get more tired now than
[00:07:43] before, then you slow it down, you decrease the intensity, but we do
[00:07:47] encourage exercise during pregnancy, you can still exercise, you can
[00:07:51] still go to work, you can still eat most
[00:07:55] things, there are certain things that we try to avoid in
[00:07:58] pregnancy, and that's that's a specific list, you know,
[00:08:02] obviously we want, we don't want you to be eating raw foods, things
[00:08:06] like that, because then you know the bacteria in there can thrive when
[00:08:09] it's not cooked all the way through, so we don't encourage raw
[00:08:13] foods necessarily, certain vined cheeses like blue cheese
[00:08:17] etc. we don't encourage buse they can have certain types of bacteria in them as
[00:08:20] well. we actually encourage smoking sessation
[00:08:24] totally, and there are safe levels of caffeine you can
[00:08:27] take, but that's hard for the average
[00:08:31] woman to gauge, so we just basically tell women to
[00:08:35] avoid caffeine and pregnancy, and it's always safer to just avoid
[00:08:39] alcohol. the diabetic patient before she gets
[00:08:42] pregnant should have what we consider as good tight
[00:08:46] glucose control, so we need to make sure that her hemoglobin
[00:08:50] A1C is within the normal range, because
[00:08:54] if she gets pregnant and her hemoglobin A1C is not
[00:08:58] control, she has increased risk of getting congenital
[00:09:02] anomalies or birth defects and
[00:09:04] organogenesis actually takes place within the first
[00:09:07] trimester, a pregnancy is divided into three
[00:09:11] trimes, and organogenesis, which is when you have organ
[00:09:15] formation, takes place in the first three months, so if
[00:09:19] that patient is not aware that she's pregnant, her
[00:09:23] sugars are not controlled, there is increased risk, so that's
[00:09:27] an example where pre-pregnancy counseling will come in. we also
[00:09:30] want to make sure that any woman who is considering getting pregnant
[00:09:34] should start taking folic acid. folic acid has been shown to
[00:09:38] help to decrease birth defects, neural tube defects, spinal if
[00:09:42] it does and all sorts of problems with your brains,
[00:09:46] so we advise you to take your medication prior to
[00:09:50] pregnancy. if you take the hypertensive patient who
[00:09:53] is thinking of getting pregnant, we may need to consider
[00:09:57] changing her medication to medication that is not
[00:10:00] tetratogenic that can cause birth effects. so she's
[00:10:04] hypertensive, she wants to get pregnant, she comes to
[00:10:08] us, we will take a good history and we may decide to change
[00:10:12] a medication, also even if
[00:10:14] you want to think about the physiology of pregnancy, during the
[00:10:18] first trimester, the blood pressure actually falls, so
[00:10:22] you may find that these women may not need to have. medication
[00:10:26] initially when they become pregnant because the whole physiological
[00:10:29] changes that takes place during pregnancy. developments and
[00:10:33] research has also increased the level of knowledge of many diseases which
[00:10:37] are particularly relevant to women. one the things i've
[00:10:41] recognized in my experience is not all
[00:10:45] women understand what a normal menstal pattern
[00:10:48] is. why is my period so long? why is my period so short? why i missing
[00:10:52] periods? all those abnormalities. "we need to educate women to be
[00:10:56] aware that, listen, this is not the normal pattern,
[00:11:00] and you should seek help, and that I think is very
[00:11:03] important, not just with menstrual irregularities,
[00:11:06] but most things with gynecology
[00:11:10] is for women to understand that these type
[00:11:13] of you know things that happen to us outside the norm
[00:11:17] aren't okay, but there is help, there is management for some the
[00:11:20] things that cause those type of
[00:11:22] irregularities." My
[00:11:26] name is Dr. Sharito, obstatucion and gynecologist here in Antigam
[00:11:30] Barbudo and you are watching Caribbean Medical
[00:11:33] TV.
[00:11:36] Endometriosis is when tissue that is normally found
[00:11:39] in the lining the womb is found in other
[00:11:43] areas where it should not be, when it is found around the
[00:11:46] ovaries, this is in the pelvis, behind the uterus, it
[00:11:50] can be as far as the lungs, we call it endometriosis, when that
[00:11:54] tissue... goes into the wall the womb, we call it
[00:11:58] adenomeyosis and this is very common condition that
[00:12:02] affects women, not just in the Caribbean but worldwide,
[00:12:05] unfortunately most women are diagnosed late,
[00:12:08] the most common presentation will be
[00:12:12] painful menses, especially when it's disruptive, when
[00:12:15] it is severe, when it is associated with nau
[00:12:19] and vomiting and it disrupts their daily routine so they're not able to
[00:12:23] go to school or they're not able to go to work, they had to be taken
[00:12:27] significant analges or pain medication to relieve the
[00:12:30] symptoms. That's a
[00:12:31] flag.
[00:12:35] Hi, I am Dr. Iran Clark, consultant radiologist,
[00:12:39] saying kids.
[00:12:43] Another pathology that I find is very frequent uh,
[00:12:47] polycystic ovaries, seen a lot in young
[00:12:50] women and also linked to hepatic
[00:12:53] steatosis. when i see a patient with polycystic
[00:12:57] ovaries, i would take a look at the liver to confirm
[00:13:01] that they have the hepatic steatosis and usually
[00:13:05] they do, the treatment for polycystic ovaries is
[00:13:09] the same as the as diabetes, the met
[00:13:12] formin, so once i see polycystic
[00:13:16] ovaries, i go and look for the fatty liver, the ultrasound
[00:13:20] can be used to check for healthy ovaries, visualizing a
[00:13:24] small over. without follicles usually indicate that the ovary
[00:13:27] may be atrophic and not producing any hormones.
[00:13:31] where in turn, if there's a big ovary with
[00:13:34] multicist around the periphery the ovary, that is
[00:13:38] usually polycystic ovaries. normal
[00:13:42] ovary should have volume up to maybe between
[00:13:46] seven, almost 10, no more than 10
[00:13:49] centimeters cube. with that volume, the ov should have maybe
[00:13:53] seven eight follicles. to be considered normal
[00:13:57] ovary you with Dr. Leon stepens consultant ofstition
[00:14:01] and gynecologist here and Tegan Babudo, I'm pretty sure
[00:14:05] everyone in the Caribbean, black, white, Asian
[00:14:08] everyone at some point in time has to deal with
[00:14:12] uterine fibroids and if not that some sort of abnormal
[00:14:15] uterine bleeding. One the major things I found over the
[00:14:19] years that have been working is the prevalence of which we actually
[00:14:23] have of uterine. fibroids persons coming in
[00:14:26] with abnormal bleeding and statistics
[00:14:30] actually do state that most black women because
[00:14:33] of our African descent and because of
[00:14:36] genetics do have predisposition
[00:14:40] to uterine fibroids. we still are not fully sure what's the
[00:14:44] main cause of it, but it has been shown that race does play a
[00:14:48] part. we also
[00:14:50] see that the size of fibroids that you see in the black population is much
[00:14:53] much bigger than. you see in the caucasian population and there always a lot of
[00:14:57] myts, is it because you have too much estrogen, is it because the foods that we
[00:15:01] eat, not necessarily, because I
[00:15:05] worked four years in the UK a
[00:15:08] basically white caucasian population, and I certainly
[00:15:12] did not see the size fibroids that we see in the
[00:15:16] Caribbean. Thank you, Dr. Nichols, we'll continue with more on
[00:15:19] this topic a short while as we focus on women's health here on
[00:15:23] Caribbean Medical TV.
[00:15:29] Republic bank is more than just financial
[00:15:32] institution, we've been a steadfast partner in the
[00:15:36] communities we serve investing in their future through our
[00:15:40] power to make difference program for more than two decades.
[00:15:44] Our aim is to drive meaningful change, expand
[00:15:48] our sustainable footprint and ultimately build more
[00:15:51] resilient communities. Our footprints spans
[00:15:55] 16 territories across the Caribbean, South America
[00:15:59] and West Africa. We understand that true
[00:16:02] success is built on the strength of our communities.
[00:16:06] That's why we're. limited to making a lasting,
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[00:16:16] about active participation. It's about
[00:16:20] providing crucial support and guidance to our
[00:16:24] valued non-governmental partners, empowering
[00:16:28] them to achieve the United Nations sustainable
[00:16:31] development goals. By working together,
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[00:16:41] operate.
[00:16:47] This is Caribbean Medical TV. Preventative care has
[00:16:51] been found to be an essential pathway to treating some the most prevalent
[00:16:55] diseases and conditions common among women. We now
[00:16:58] continue the discussion on fibroids with Dr. Camille
[00:17:02] Nichols. The definitive treatment for fibroids is a
[00:17:05] hysterectomy because can go back, we can regrow.
[00:17:09] anytime we have patients who are going to have myomectomy, which is
[00:17:13] where we're going to try and remove the fibroids and try and save
[00:17:17] or conserve the uterus, you have to understand that that is
[00:17:21] much higher risk type of
[00:17:24] surgery than just a hysterectomy, and these patients need
[00:17:28] to understand that doing myomeectomy can
[00:17:32] lead to a hysterectomy, so before we even
[00:17:36] consider doing surgery... "these patients need to be counseled,
[00:17:40] yes I'm going to try and save your uterus, but if we run into any
[00:17:43] problems, we may have to take out your uterus. cancer is
[00:17:47] a big thing, it's becoming more prevalent in our
[00:17:51] region, and sadly we are
[00:17:54] diagnosing most these gynecological cancers very
[00:17:58] late. one the reasons for that is because most
[00:18:02] persons wait a bit too late to actually come to the
[00:18:05] doctor to seek." advice and I'm just going to make a
[00:18:09] plee that if it is you have some issue, something that's
[00:18:13] not looking well, seek medical advice, that
[00:18:16] little step that you make to just seek medical
[00:18:19] advice goes very long way, and there's no
[00:18:23] limit, there's more price on your life, your life is very
[00:18:27] precious. I would encourage women the Caribbean to
[00:18:31] prioritize their health, even as they take care their
[00:18:35] families to make sure that
[00:18:36] they take care. themselves, they put themselves first, make sure that they're doing their
[00:18:40] checks, seeing their doctors every year, if you do a well woman visit
[00:18:44] then you can pick up things before they become a problem, if you
[00:18:48] get screened and you don't have to wait until you having symptoms and
[00:18:52] when conditions such as cancer may be more advanced and and
[00:18:55] encourage the men and the women to come
[00:18:59] together to help each other and encourage each other to do what they need to
[00:19:03] do to not only protect themself from cancer but many of
[00:19:07] the conditions that are common and prevolenter in the Caribbean.
[00:19:11] Cerrical cancer is a preventable cancer, so of all the
[00:19:14] cancers that affect women here in the Caribbean and in the world. What
[00:19:18] is unique about survical cancer is that we know how to prevent it all
[00:19:22] together, and the approach to preventing cervical
[00:19:26] cancer involves vaccination of boys and
[00:19:30] girls between the ages of 9 to 14
[00:19:33] ideally. Persons can be vaccinated beyond that age group, but vaccination.
[00:19:37] is most effective when persons receive it between the ages of 9 to
[00:19:41] 14. the next step would be screening. we
[00:19:44] screening, the age group for screening varies from
[00:19:48] country to country. here in antiga and barbido we start screening at age
[00:19:52] 25 and then of course after screening we talk
[00:19:55] about educating women about the
[00:19:59] signs and symptoms that may indicate cervical
[00:20:03] cancer. most persons are familiar with the papsmare.
[00:20:07] That's usually done every three years, however, the
[00:20:11] WHO has no advised that women are screened with a
[00:20:15] high performance tests, we now do testing for the actual virus that
[00:20:19] causes cervical cancer, the human papillloma virus and that
[00:20:22] testing is available in most islands,
[00:20:25] however not easily accessible in
[00:20:29] many, and that is much more sensitive way of
[00:20:32] identifying women who are risk, so HPB infection is common
[00:20:36] and what we are trying to do when we screen women is
[00:20:40] identify women who have what we call the hirus types. one
[00:20:43] the things i also think we're deficient in in terms
[00:20:47] of gynacology specifically is
[00:20:51] consistent cervical cancer screening, so
[00:20:54] papers. I have lot of women that come to me and say, "doc, I
[00:20:58] haven't done my popsmer in about 10 years, I haven't done
[00:21:02] it in 20 years, I've never done a pops mirror, and
[00:21:06] so that again is education, because you
[00:21:10] should should be doing props at least every two years
[00:21:12] and
[00:21:14] some women don't know that, some women tell me, like I didn't know I was supposed to be doing
[00:21:18] it, I've never been told I'm supposed to..." be doing it
[00:21:21] and so and and when you look at people who died from
[00:21:25] cervical cancer, it's people who have not been regularly screen for
[00:21:28] cervical cancer, and also with paps mirrors, there's
[00:21:32] a lot of fear with paps mirrors too, fear the discomfort, fear
[00:21:36] of having to, you know, it's an exposing
[00:21:40] type of test for women, and so yeah, there's a lot of fear
[00:21:44] surrounding it, and so again, it's education,
[00:21:48] it's encouragement, it's...
[00:21:50] you know risk versus benefit, mean a little bit of discomfort for few
[00:21:54] minutes versus not knowing that you could have very
[00:21:57] serious illness, and we're lucky with cervical cancer that we
[00:22:01] actually have a screening test for it, and there's a few cancers that we can screen for, cervical
[00:22:05] cancer is one, breast cancer is one cuz we have the mammogram.
[00:22:09] in terms of mammograms, the literature says
[00:22:12] start at 40, all ladies should have baseline
[00:22:16] mammogram done, because if there are any changes. in the
[00:22:20] breast, we need to go back to that baseline
[00:22:24] mammogram to see what the changes are or to see
[00:22:28] how fast is it going. i'm seeing more
[00:22:32] and more younger patients coming with
[00:22:35] breast cancers. i've had one maybe
[00:22:39] 28 years diagnosed with breast cancer. for the
[00:22:43] younger patients, i would prefer ultrasound first, and if there's something that
[00:22:47] looks suspicious, we can move to the mammogram. I would not
[00:22:51] go mamogram for patient below 40 first
[00:22:55] and then ultrasound. I would do ultrasound and then a
[00:22:58] mammogram. For patient over 40,
[00:23:01] it's mammogram as screening. As mammogram should have
[00:23:05] routine screening from the age of
[00:23:08] 40. More and more in recent years, research
[00:23:12] shows that mental health should not be disregarded. Woman's
[00:23:16] physical condition can affect her mental health and vice versa, and
[00:23:20] Medical professionals are staying aware the importance of sound
[00:23:24] mental health practices, especially at difficult periods in their
[00:23:28] patients lives. I think I speak for almost every patient that
[00:23:32] I have sat with. I often say to them
[00:23:35] that, I don't know how I would be if I was sitting in your
[00:23:39] chair. I think it's the loneliest
[00:23:42] moment that you could sit
[00:23:44] in. It is very lonely.
[00:23:48] The moment that I tell you what your... biopsy is people don't realize there
[00:23:52] other people in the room, it is where your world comes crashing
[00:23:55] down, and so the person that you chose to
[00:23:59] come with you on that day is very
[00:24:03] important person and it almost always is their partner, their
[00:24:06] husband or their loved one in that way, and
[00:24:10] support for that patient is extremely important, it
[00:24:14] will motivate her to believe that there's life to fight
[00:24:18] for and life to live, "the journey is not easy, but it is
[00:24:22] short and you will come through whole, but
[00:24:25] support is everything, and so I would say to the partners of
[00:24:29] our Caribbean women, be there for them and support them, hold their
[00:24:33] hand, they will get through it, but they will only get through it because
[00:24:37] they know that you can be there. In my practice, I see it
[00:24:41] as more of team approach. It's not just us, but
[00:24:44] also who's with her to support her, family,
[00:24:48] children, her. partner, her friends, the
[00:24:52] diagnosis is a traumatic event for
[00:24:55] anyone, and we would give them time and allowance
[00:24:59] and explain. i often invite patients to come back the next
[00:25:03] day and write their questions down.
[00:25:07] i often say to them, the positives that we know in the
[00:25:11] moment that it is treatable, that
[00:25:13] it is curable, as long as one person has been cured of breast cancer, it
[00:25:17] means that you can be, and so i believe, that out the data that
[00:25:21] you would know, someone is not a statistic, but you can use
[00:25:25] statistics to help them see what is good in front
[00:25:28] them, and I often say to them, today is the worst
[00:25:32] day, tomorrow is going to be better, today is the day you got the result, it's the worst
[00:25:36] day, you've gone from not knowing to knowing, but tomorrow is about how do
[00:25:40] you fix the problem, how do you get your life back, and I have
[00:25:44] found that that is very important way to look at
[00:25:47] things, I had many women in my
[00:25:50] life who were diagnosed with breast cancer, including
[00:25:53] classmate. you don't think of entertaining a conversation about breast
[00:25:57] cancer as teenagers or when you were in that space of young
[00:26:01] adulthood. we talked about it because it was a reality of someone that I was
[00:26:05] close with, so that was how it all started in
[00:26:09] 2002, that's miss brafit evolved. one the things that
[00:26:12] stood in my mind all the time was, even though I'm doing only bra fittings,
[00:26:16] I am going to embark into that space where I'm going to deal with every
[00:26:20] pair of breasts, and then I thought, okay, I'm going to have to deal with that woman who's
[00:26:24] also not understanding what happens if she's had diagnosis and she
[00:26:28] needs to have mastectomy, either a single mastectomy.
[00:26:32] or bilateral mastectomy so unilateral or bilateral and all these things
[00:26:36] that are playing in my mind and we have to look at care
[00:26:40] differently. in fact the world health organization has now started to look
[00:26:44] at people centric care as a dialogue. you see
[00:26:47] diagnosis doesn't come out
[00:26:49] of nowhere. when it comes, it comes with hands and feet, eyes,
[00:26:53] ears, nose, mouth, human
[00:26:55] expressions, sentiments, lot
[00:26:59] a lot a lot of urgency in term. of
[00:27:03] fair and all the things that are unknown, and inside of
[00:27:07] that, top of that, you're going to lose your pair of breasts or a
[00:27:10] breast, or maybe lump is going to be removed, and the
[00:27:14] surgeons are amazing, they're going to work on you, they're going to make sure you're fine, but
[00:27:18] what about that rehabilitative experience,
[00:27:22] what about that expression of your femininity, what about
[00:27:26] returning to your activity or your productivity
[00:27:29] after, and what inside the... you
[00:27:32] as woman that it's okay to still wear a strapless
[00:27:36] bra or to look at your femininity
[00:27:40] even after losing your breast, so inside the
[00:27:44] work that we do at miss brafit, particularly with post surgical
[00:27:47] care and postmastectomy care is we advance
[00:27:51] that dialogue around dignity through many the things we
[00:27:55] do, in terms of reconstructing a breast
[00:27:59] that has been removed or this area that has been... moved because
[00:28:03] of mastectomy or because of trauma or so, it is
[00:28:07] something which has difficulties even in the United States when I
[00:28:11] was there, it took an act of congress
[00:28:15] to demand that woman who has had mastectomy
[00:28:19] has the right to breast
[00:28:22] reconstruction, and once that was done, the flood gates
[00:28:26] open, because they were struggling with this silently in many ways,
[00:28:30] I remember one the... did in
[00:28:34] the states and on her last visit to
[00:28:37] me, we had finished talking, take my measurements and so forth,
[00:28:41] told everything is going well, and then she went
[00:28:44] into the the locker room to change
[00:28:47] back, and heard this noise
[00:28:50] and i couldn't quite make out what she was saying or so, so i
[00:28:54] said so, are you okay? he says,
[00:28:58] yes, doc, i have breath.
[00:29:02] and that was she was so happy, she was giggling to
[00:29:06] herself, i have breas, although there are still many
[00:29:09] pathways in female medicine which are still to be explored, many
[00:29:13] years of new thinking, research and insight from female
[00:29:16] professionals has created important breakthroughs which has changed
[00:29:20] the way women are treated. with continuing awareness and
[00:29:24] exploration, women's healthcare will continue to
[00:29:27] evolve. thanks for viewing Caribbean Medical
[00:29:30] TV.