Embedded Files
WOMEN TODAY DEFEND THEIR RIGHTS
WOMEN CREATED THE UNIVERSE ACCORDING TO MANY CULTURES AND MYTHOLOGIES. HERE HERA, GREEK GODDESS SPILLS HER MILK BECAUSE OF HERCULES, THEREFORE CREATING THE VIA LACTEA
HERE A WOMAN FOR FEAR OF LOSING HER BREAST DID NOT GO TO THE DOCTOR. HE WENT TO THE WITCH OF THE PEOPLE AND YEARS LATER HE RETURNED WITH THIS INJURY. SOMETHING HAPPENING DAILY IN OUR COUNTRY
OUR GIRLS SHOULD RECEIVE INFORMATION FROM EARLY AGE SO THAT THEY CAN EMPOWER THE CARE OF THEIR CHILDREN FROM EARLY AGE
THE IMPORTANCE OF TEACHING TO TEACH. THIS WOMAN WAS WELL CARED FOR BY A GENERAL DOCTOR, I MANAGED HER TRAUMA CAUSED BY THE HUSBAND. BUT DIDN'T TELL HIM THAT THIS INJURY WOULD NOT CAUSE HIM A CANCER ... THAT'S WHY HE SEARCHED FOR A SPECIALIST, JUST FOR THAT reason, TO KNOW IF HE WOULD DEVELOP A CANCER
WILLENDORF VENUS ... A MEMORY OF HOW A FEMALE DIVINITY CREATED THE UNIVERSE. THE BRANDS ON HER HEAD ARE THE STARS, SHE CREATED THEM BUT THESE ARE PART OF HER. FREUDD SAID THAT THIS WAS RECORDED IN THE UNCONSCIOUS COLLECTIVE OF WOMEN AND THERE THAT FIXATION BY THE SINUSES, THESE ARE MATERNITY EROTISM AND MORE ATTRIBUTES THAT UNITE WOMEN WITH THIS DIVINITY
OUR WOMEN ARE A PERMANENT SOURCE OF JOY. WE MUST ALWAYS FIGHT BECAUSE IT'S ALWAYS ALWAYS
WOMEN AND CHILDREN ARE ALWAYS THE FIRST VICTIMS OF THE WAR. BUT ESPECIALLY THEY, ARE RAPED, MISTREATED, THE MAN SEEMS TO HAVE FEAR AND THEREFORE IT MISREATS THEM.
TEACHING HEALTH PROMOTERS HAS BEEN A PRODUCTIVE STRATEGY. THEY ACCESS DIRECTLY TO THE SPECIALIST VIA WHATSAPP WHEN THEY FIND WOMEN WITH MAMMARY PATHOLOGY IN THEIR WALKING TRAILS THROUGH THE FIELD, IN TRAILS THAT MANY WOULD NOT BE ABLE TO DO. IT IS A TASTE FOR OUR TEAM TO PRIORITIZE YOUR CONSULTATIONS
WHY IS BREAST IMPORTANT TO WOMEN?
WHY IS BREAST IMPORTANT TO WOMEN?
We have been approximately 2,000 years as Christians, accustomed to a macho culture where we have the tendency to forget the religious history of humanity, in which, for many cultures, it was a female divinity that predominated in our world as its creator.
We still remember her when we say “mother earth” or “mother nature”, or when we say “Holy mother of God” in the Hail Mary prayer and we don’t know that this was the way in which they named the Goddess Isis and other Goddesses of the ancient world.
Our Virgin Mary inherited the attributes of this Goddess or mother nature and that makes her greater. We put stars on his head -the only one in the Christian pantheon- where Jesus, God and the saints wear simple rings. The stars are there because she created the universe and she is the universe. She did not give up on creation because she is everything, she is in everything. That is why nature was so respected in ancient times.
Milleford's Venus over 20,000 years old already shows these carved stars. We put the Virgin a crescent moon at her feet symbolizing her power in the world and underworld and shows her relationship with the Moon. (This crescent moon is seen on many statues of Isis, Astarte, and more Goddesses from the Mediterranean, Africa, India, and even America).
Every 28 days the moon changes as well as the woman, who menstruates approximately every 28 days, in most cases. The moon grows as the nubile woman and reaches its peak when it becomes the full moon, like the woman of childbearing age, to finally decrease, as well as the woman in the last stages of her life ... Thus the woman became associated to the moon as divinity.
Let's remember Hera, how when she slept, Zeus put Hercules to drink his milk and thus achieve his divinity, but a bite from him woke her up and when she took it off, her milk was watered and from there comes the Milky Way’s story, where we live as planet earth. These memories shape that importance of the goddess in the female psyche.
A message that for thousands of years was engraving in the collective unconscious: the importance of the breast, lactation and the presence of a Goddess in our lives. The woman is wisdom and as such, we put a serpent at the Virgin's feet ... No, the serpent isn’t Satan. The snake is a symbol of wisdom, otherwise doctors would be satanic to have two snakes coiled in the caduceus or symbol of medicine.
The Goddess in the old testament adopts the name of Holy Wisdom and as such, in that book she is the couple of God in the creation of the universe. So, our Virgin Mary assumes the continuity of that Goddess, who like her representation in other ancient religions of the Mediterranean, has its origin in water (Isis, Aphrodite daughter of the sea foam, Mary / sea). There are no thousand virgins but one who takes the name from where she has appeared.
In our history, we have Bachué coming out of a lagoon, she creates and educates humanity with her son and when we were ready they turned into snakes and returned to the lagoon. When the Spanish arrived, curiously, the Virgin of Chiquinquirá appears near water sources not so far from where Bachué appeared; Something similar happened with the appearance of the Virgin of Guadalupe and other Marian apparitions in Europe. I’m convinced that all the goddesses of ancient times have a thread that unites them and end today in the Virgin Mary
But where does this story go? Well, the Goddesses in ancient times, gave their milk for nutrition and to be a way to the home of the Gods. That is why Zeus used it with Hercules and thus, there is no ancient culture that doesn’t show the Goddess breastfeeding her son; Because of the sacredness of that act, because of the sacredness of milk, our Virgin Mary was portrayed breastfeeding Jesus. No longer as a way to heaven, milk began to embody purity, that purity that was needed on the way of the Holy Grail of King Arthur's sagas. These paintings by countless painters from the dawn of Christianity continued to engrave in the unconscious of women the importance of her breast. Today we know that it has a nutritious, erotic function; participates in art, mythology, is the main organ and element used in advertising
And in medieval history we can’t forget Santa Agueda, patron saint of breast cancer patients, who in Catania Sicily in the 3rd century of the Christian era, refused to marry the Roman proconsul for being pagan and he tortured him by taking away the breasts. The rest of the story doesn’t matter, what matters in our story of Santa Águeda is, first, the fact that the man always knew how to torture a woman, “remove her breasts” and second, because the way it was done was also how mastectomy was done for over a thousand years as a cancer treatment. With Professor William Halsted, at the dawn of the 20th century, it became more regulated, anatomical and radical due to the number of tissues that were removed and it remained the paradigm of treatment for this disease, "remove as much as the patient can endure". Only until the 60s-70s, the Doctor. Umberto Veronesi from the Center of Milan, Italy, began to say that Breast Cancer is a systemic disease and it wasn’t necessary to always remove the entire Breast and that is why it changed the paradigm, "remove as little as is effective", our paradigm today.
I mention this because that bloody past of the surgery remained in the collective unconscious of the woman and that is why it’s one of her current fears, which on many occasions stops a woman from consulting in time: fear or terror of radical mastectomy. Today we don’t remove breasts, in principle, it’s more, diagnosed in time, with the advances of chemotherapy, often not even surgery. (We will be out of work in the future if we are successful in early diagnosis ... there is still time)
Sometimes I show attendees of certain conferences in which I share knowledge, a woman whose torso is only seen with voluptuous breasts in a bathing suit, holding a cell phone in her hand. Passing the photo quickly I ask the men who saw ... The vast majority saw the breasts initially and then the propaganda of a cell phone in reverse of the woman ... That is why we use them in marketing, the Breasts impact as the singer from Vallenato who recently went out to sing with them almost "on air".
Researchers like Desmond Morris, an expert in animal behavior (the Human Zoo and the Naked Monkey) wrote that when we walked like our ape cousins, the rear of the females was exposed to view and we had our sexual intercourse from behind. Even many primates today have a prominent, red rear appealing to the eye. As we started walking upright, the back, the buttocks, disappeared from our sight and at that moment the breasts acquired the visual appeal that the buttocks had in ancient times. It’s a theory with good scientific support. It doesn’t matter if we agree or not, this story is to show again that importance of the Breast for a woman and therefore for the man. Importance recorded in the collective unconscious. (Freud)
Finally, sometimes when we operate on a woman with Cancer and we leave 10% of the Breast, the woman will say that only "they took a piece of the Breast from me" and even with that little bit of Breast, self-esteem hurts less than when we must do a mastectomy total.
Where does this story end... The presence of the Breasts in our history, in our mythology, in our religion, in the deepest part of the female psyche is proof of why it’s important. I could write the history of humanity narrated from the point of view of the breasts and it would be very complete indeed ...
This importance is what makes me teach young doctors that they have the possibility of treating women for breast disease, why the breast is so important to them. If we don’t understand that importance, we won’t give importance to their privacy, to listen to them, not only in what they count but in what they would like to tell.
Likewise, knowing that importance, we will be able to understand that all women take care of their breasts, but they have different beliefs and common fears, whose origin we must respect and only if we radiate credibility can we change those fears, respecting their beliefs. Hence the importance that we are giving at the University, to improve the knowledge of students in benign diseases, leadership (to participate in prevention programs) "teaching to teach", to improve communication with the patient; teaching students to put themselves in the patient's shoes to think about how they would like to be cared for.
In them and in the change that we have been proposing in the way we share knowledge with the community of women, in schools, the media, among other spaces, is our contribution in simple ideas to improve the rates of presentation of advanced cancer, improve the rates of women who do self-palpation (Before only 27% of women trained in the traditional way who did self-palpation, now we have that the women we have trained exceed 70% of those who perform self-palpation).
To achieve this, we have only had to "teach how to teach" and take advantage of what best guarantees the success of a project: the human factor. Only this human factor of nurses, promoters and doctors who have wanted to take leadership to improve the conditions of women's empowerment.
As tools we use modern teaching techniques, social communication, LEAN techniques, these have been vital to define the information that is important to share to achieve our goal, they have taught us to identify "junk information", which, although it has scientific support , isn’t important for our epidemiological objective. Not to mention the elements of neurolinguistics that allowed us to create tips to reinforce shared knowledge! And more tools that we have already described ...
But the main soul of the project has been passion, love for patients, for our profession, for knowledge, for the history of women, for respect for their rights.
It’s easy to be a doctor for women if we learn the art of understanding the anguish of a woman when she consults us, not only because of what she tells us, but because of what she would like to say or ask us and because of fear she isn’t capable of doing. The woman with her beaten breast in the photo had already received painkillers but consulted us because she wanted to know if she would get cancer.
Now we have finished collecting the experience of these years and we are ready for our 2020 project that will include training more general and rural doctors, as well as nurses and promoters as pillars to decrease the rate of advanced cases (12% of women with Globocan advanced breast cancer corresponded in 2018 to women under 30), improve self-palpation and especially improve the empowerment of women in the care of their breasts.
I’m sure it’s a "grain of sand", but they are simple ideas for the serious problem of breast cancer in our country and in Latin America. I’m convinced - even though I’m a surgical specialist and as such I like to operate - that the solution lies in improving education. It’s true, as Euronews said last year in its article on "LATIN AMERICA's economic debt to breast cancer" and as the EFE and Roche Agency forum in Peru concluded, that specialists and specialized centers are lacking, but If we do not improve education with modern and non-traditional techniques, we will continue in the trap of treating almost all cases of breast cancer in advanced states, with greater human tragedy and higher costs. (The League Against Cancer on its website in the promotion and prevention part relates how 90% of the women with cancer who attended for the first time in 2017 already had advanced disease.)
Greater human tragedy isn’t only because there is more mortality, but because of the great social and economic trauma that it represents for women, such as cancer in female heads of household, to mention just one example. We have witnessed women who neglect their farms during their treatment, the nutritional status of the family drops, children who leave school to work the farm ... We have seen lost land in the hands of relatives of patients, who do not even take care of the children of these women. The EPS cover with bureaucratic difficulties among others, but they do, but who covers the social cost of these women, for example? For all this, the breast is so important and deserves special attention ... that is why there are many more projects that are aimed at improving those conditions of early diagnosis.
It’s evident then that the importance of the breast for women has a very deep origin that deserves our attention. And today we must prepare our young people with that thought. Thus there will be respect, trust and pleasure in caring for women with breast disease, and leadership.
Finally, while the diagnostic possibility of breast cancer in a "drop of blood" increases, something still distant in our country and in Latin America, mammography as a means of screening begins to lose strength in Europe. There are already works with enormous scientific support that question this policy that has led in many cases to unnecessary biopsies and surgeries. Here I’m not going to debate whether I agree or not. What matters is to highlight as if this idea evolves will increase the responsibility of the rural doctor in the early diagnosis… we will see.
The conclusion ... our women with their breasts are Goddesses who deserve special handling when this part of their body becomes ill or simply wants answers to simple questions such as, why it hurts and its relationship with cancer.
The second conclusion… simple ideas for serious problems and “teaching to teach”, from the university… a grain of sand positive for the problem of advanced breast cancer
Prof. Ignacio Castilla Stipcianos
NURSE ASSEMBLING MUD BREAST MODELS TO WHICH WE INTRODUCE BEADS SUCH AS PEAS, BEANS AND OTHERS TO TEACH WOMEN TO DETECT MASSES IN THEIR BREASTS
MANY OF THE PEOPLES AND MUNICIPALITIES THAT WE HAVE VISITED HAVE ALREADY ADDED SLOGANS WHERE THEY SHARE MORE IMPORTANCE TO THE SHARED KNOWLEDGE OF WOMEN TO ACHIEVE THEIR EMPOWERMENT IN THE CARE OF THEIR BREASTS
REFERENCE TO THE ARTICLE ON WHICH OUR COMMENT IS MADE
REFERENCE TO THE ARTICLE ON WHICH OUR COMMENT IS MADE
CANCER IN LATIN AMERICA, HOW TO STOP YOUR EXPANSION?
CANCER IN LATIN AMERICA, HOW TO STOP YOUR EXPANSION?
2019-07-02 PERU ULACCAM
2019-07-02 PERU ULACCAM
Comment to the forum on Cancer in Latin America in Peru, financed by Efe Noticias and Roche, published in the last edition of ULALCAM.com. This article and the conclusions of the forum are published at the end.
Comment to the forum on Cancer in Latin America in Peru, financed by Efe Noticias and Roche, published in the last edition of ULALCAM.com. This article and the conclusions of the forum are published at the end.
In it the same problems already known regarding Cancer are mentioned, especially in rural or low-income populations. They relate something that had already been published in EURONEWS in Oct 2018 about the economic debt of Latin America (AL) regarding breast cancer and it was that more oncologists, resources, more specialized centers among other aspects were needed. But they do not mention that more specialists and specialized Centers will fall into the trap of following care, in our case, women with advanced Breast Cancer. Mortality will not improve as it did not happen in general in Latin America during 2018. Advanced cases do not regress. On the website of the league against cancer, in the prevention section they report that in 2017 90% of the women who consulted for the first time for Breast Cancer were already in an advanced stage of the disease. (In rural Cundinamarca, the percentage of women who consult for the first time in advanced states is 75%)
But nothing of weight was mentioned regarding the way in which prevention programs have been developed in LA. Mention in this forum regarding breast cancer prevention was simply to follow; but quality was never discussed.
Peru, as mentioned in the article, implemented the ESPERANZA plan for the care, screening and free promotion of Breast Cancer. However, the percentage of women who perform self-palpation despite having been trained does not exceed 19%.
Terrible .. it's like time wasted. In reality, no time was wasted because the effort of the people who work applying the prevention programs are very valuable.
Health promoter creating Seno with mud for prevention workshops
These people are one of the motivations that have led them to dedicate efforts for a while to improve the way in which knowledge of Cancer and benign breast diseases is shared with women, doctors, nurses and promoters.
In our region, this percentage in 2017 and 18 did not exceed 27% of trained women who take self-palpation after being trained. (With great pride, the effort we have made to improve the way of sharing knowledge shows that the women we have trained they have tripled that percentage as we will see later)
It is true that resources, specialists, centers and more are lacking, but with regard to breast cancer, they will fall into the trap of continuing to attend cases of women with advanced disease if the quality of prevention programs is not improved.
Most prevention programs define women at 55 years of age or older on average as LA most at risk. But it turns out that advanced cancer in young women progresses (12% GLOBOCAN 2018 in AL). Breast cancer in women under 49 progresses and will soon be the same as in women 50 and older. Mobilization campaigns in LA towns (in Colombia it still looks like this in most municipalities) only move a very low percentage of women in the municipality and the majority with older, unemployed, elderly or determined risk groups for the detection of many risk factors that do not have an epidemiological impact and that we use, for example, using LEAN techniques to define as of little importance to be included in promotional campaigns since, on the contrary, they have shown that they generate mistrust and little credibility. ("Trash" information against a goal that you want to achieve. Once the goal is defined, you should discard what does not serve you, even if it is valid information)
To big problems, simple solutions
There re works that talk about the barriers that women have to get to consult. Many of these barriers are myths, beliefs, legends, bad information ... we know them but it is not seen that education about these barriers is really involved in prevention programs in LA in general.
Nurses must be taught to teach, they must have better knowledge, not only to be able to clarify with scientific answers to these myths and others, but to know how to do it with respect, charisma, love, with communication techniques that generate credibility, since they do not are impacting with the information they transmit. (The recall of the information does not exceed 6 weeks)
But there is another barrier to early detection, the same general and rural doctor. They do not participate, they do not have the motivation to do so with leadership in the prevention of Breast Cancer. They have information about breast cancer but lack practical training. There are about 2800 women with mammograms with birad results 0 and 3 pending to decide definitive conduct, in only 4 municipalities of Cundinamarca Colombia.
Regular training in benign breast disease also becomes a barrier for a woman to see on time, for example .. 90% of the breast visit is for benign diseases and symptoms. Symptoms include pain. When a woman consults for pain in rural areas, the rural doctor often tells her that this is "normal"; but the patient does not understand why it is normal and, furthermore, it is not explained to her that this symptom and the associated frequent findings will not become Cancer, which is what she would like to know. She painkillers. The patient takes 2 tabs of the painkiller, improves for a while and suspends since the doctor did not explain how it would work and that she had to take it for the indicated amount of time with pain and without pain, for example. Then it becomes common to hear women who don't come back because "they always give them the same thing, it cures for a while, but the pain comes back"
When there is a mass that does not hurt (which is more associated with Cancer) the woman does not consult because there is no credibility, among other aspects ...
If we add to this that there are women who feel mistreated when they do not respect their privacy in public hospitals, so many of them do not return.
If we also add the ignorance in benign diseases by the rural general doctor, which generates unnecessary remissions, where many women do not comply due to the cost of bus tickets, time, bureaucracy, fear of traveling to the capital and getting lost, among other aspects. , which congest the consultation of specialists, it is clear that the problem of the doctor and his little leadership in prevention is evident.
We are currently starting an investigation from the Nueva Granada University of Bogotá to confirm those barriers that the doctor unintentionally puts to the prevention of Cancer from the office, to obtain a higher level of scientific evidence of the findings that we have found with well-designed observational studies. (level of evidence 3) and thus propose changes in undergraduate medical education programs to improve knowledge and leadership in this regard.
Our University is committed to improving knowledge of benign breast pathology, but introducing elements that improve medical leadership in cancer prevention, especially in rural areas where they will be in their first professional practice period.
We are "teaching them to teach", to know the history and mythology of the breast, why the breast is important for women, how to improve communication with the patient, how to teach her because a breast hurts, to give conferences to the community that they really impact (TED.com methodology for example) among other aspects that we have described in other articles on this Linkedin page.
What is most needed then out of more specialists and centers for the care of Breast Cancer, in our case?
Again .. Simple Ideas for big problems ...
Review that we are teaching for prevention, incorporating elements that improve the transmission of knowledge, such as improving techniques for giving lectures, use of neurolinguistic programming, LEAN techniques to determine what to teach by the personnel in charge of prevention programs, among others methodological aspects well known at the business level and little used in the health sector. We have had a good experience in this regard that we have already shown. To the above, we also support rural doctors in WhatsApp in consultations on clinical cases they receive in their consultations. This support has been very successful and I am proud to be able to provide it.
Simple, no ... but it is a simple idea that we have been developing, "teaching to teach" to medical nurses and promoters.
Simple ideas, incorporate younger women, students from schools where, for example, you can teach by leaving scientific and practical information. We have seen how well-informed adolescents carry the knowledge of self-palpation to their homes where there are often mothers who are heads of families who never go to prevention activities.
In response to the article that appeared in Euronews on October 19, 2018, the debt of Latin America with CANCER DE MAMA (CAM)
In response to the article that appeared in Euronews on October 19, 2018, the debt of Latin America with CANCER DE MAMA (CAM)
Regarding Colombia and Breast Cancer. We have made very important advances in technology for early diagnosis, in access to screening mammography, better specialists despite the belief that it is the Mastologist who should solve most of the specialty consultations when there are many gynecologists. and well-trained general surgeons in the area. This selection has generated that the availability for a consultation is measured in months many times. Mention must be made of the improvement of the health system and the awareness of private and public health promoting companies to develop breast cancer prevention programs.
Regarding Colombia and Breast Cancer. We have made very important advances in technology for early diagnosis, in access to screening mammography, better specialists despite the belief that it is the Mastologist who should solve most of the specialty consultations when there are many gynecologists. and well-trained general surgeons in the area. This selection has generated that the availability for a consultation is measured in months many times. Mention must be made of the improvement of the health system and the awareness of private and public health promoting companies to develop breast cancer prevention programs.
However all of this good news has not or significantly impacted breast cancer mortality in the past 20 years in my country. I could say that they have had an impact on large capitals but not on small provincial capital cities, municipalities adjacent to large capitals, and rural areas.
However all of this good news has not or significantly impacted breast cancer mortality in the past 20 years in my country. I could say that they have had an impact on large capitals but not on small provincial capital cities, municipalities adjacent to large capitals, and rural areas.
There are many reasons. We will refer to those that we have investigated, discovered, have been taught by the people we have trained and what we have learned in the last 10 years of working in rural areas and distant municipalities of Bogotá and Pereira.
There are many reasons. We will refer to those that we have investigated, discovered, have been taught by the people we have trained and what we have learned in the last 10 years of working in rural areas and distant municipalities of Bogotá and Pereira.
While in cities, such as Bogotá for example, 33% of women who consult for the first time for breast cancer (CAM) are already in advanced stages of the disease, in municipalities more than 40 minutes away, women who arrive in the same conditions are between 70-75%. (Female population of Cundinamarca 559,000 women at risk ages is the population that we seek to cover in Cundinamarca. Over 35 years of age, together with headwaters and rural areas.)
While in cities, such as Bogotá for example, 33% of women who consult for the first time for breast cancer (CAM) are already in advanced stages of the disease, in municipalities more than 40 minutes away, women who arrive in the same conditions are between 70-75%. (Female population of Cundinamarca 559,000 women at risk ages is the population that we seek to cover in Cundinamarca. Over 35 years of age, together with headwaters and rural areas.)
For many years the main prevention strategy has been both private and public training, insisting on breast self-palpation, regular consultation and mammography at age 50.
For many years the main prevention strategy has been both private and public training, insisting on breast self-palpation, regular consultation and mammography at age 50.
However, if we take self-palpation only 27% of the women trained in the areas of municipalities and rural areas outside the capitals, the self-examination is carried out. But we are not the only ones where a possible failure is seen in this strategy, Mexico reports in several articles only 29% and Peru 19% of women who, having been trained, perform self-palpation.
However, if we take self-palpation only 27% of the women trained in the areas of municipalities and rural areas outside the capitals, the self-examination is carried out. But we are not the only ones where a possible failure is seen in this strategy, Mexico reports in several articles only 29% and Peru 19% of women who, having been trained, perform self-palpation.
There are not many references as to why these women, having been trained, do not take the exam.
There are not many references as to why these women, having been trained, do not take the exam.
What we have seen ... That myths, legends, beliefs and fears are mainly the causes of this phenomenon. It is something that is not reported in a government job or job proposal, talking about these things may sound unscientific to make an improvement in knowledge, that respecting these findings do something to bring about a change. I will refer later more specifically to some of these beliefs.
What we have seen ... That myths, legends, beliefs and fears are mainly the causes of this phenomenon. It is something that is not reported in a government job or job proposal, talking about these things may sound unscientific to make an improvement in knowledge, that respecting these findings do something to bring about a change. I will refer later more specifically to some of these beliefs.
It is always mentioned that poverty, distance and ignorance among others are the main reasons for a woman being late in the areas of work.
It is always mentioned that poverty, distance and ignorance among others are the main reasons for a woman being late in the areas of work.
Although it is true they influence, their weight in the problem is not so much anymore, a woman who knows what she has, nowadays, does what is necessary to leave, she will seek help from the EPS, the mayoralties and will manage to get there ... But many Sometimes a woman does not know that she has a CAM, for example, simply because it does not hurt ... When asked women with advanced and ulcerated tumors because they did not consult before, 87% will answer "BECAUSE it did not hurt ..." or because they associated it with benign pathologies. (Aftermath of a bite by a dog years before for example) And not to mention those that went to traditional medicine or healers until when it was late.
Although it is true they influence, their weight in the problem is not so much anymore, a woman who knows what she has, nowadays, does what is necessary to leave, she will seek help from the EPS, the mayoralties and will manage to get there ... But many Sometimes a woman does not know that she has a CAM, for example, simply because it does not hurt ... When asked women with advanced and ulcerated tumors because they did not consult before, 87% will answer "BECAUSE it did not hurt ..." or because they associated it with benign pathologies. (Aftermath of a bite by a dog years before for example) And not to mention those that went to traditional medicine or healers until when it was late.
In conclusion of this aspect, the knowledge that women in the municipalities and rural areas have outside the capitals in general and despite the advances, is very deficient and is easily palpable when, without the need for large measurements, for example, in our training we pass to interactive participation with female attendees.
In conclusion of this aspect, the knowledge that women in the municipalities and rural areas have outside the capitals in general and despite the advances, is very deficient and is easily palpable when, without the need for large measurements, for example, in our training we pass to interactive participation with female attendees.
Here we find doubts like. (I will sometimes use the words with which these women express themselves)
Here we find doubts like. (I will sometimes use the words with which these women express themselves)
If the milk dries it gives cancer and they take away your Breast (SIC)
If the milk dries it gives cancer and they take away your Breast (SIC)
If they hit you with a blow, it gives you cancer and they remove your breast
If they hit you with a blow, it gives you cancer and they remove your breast
Approaching a wood burner coagulates milk and causes cancer
Approaching a wood burner coagulates milk and causes cancer
They ALWAYS remove the breast. (Questions that a nursing assistant does not answer well)
They ALWAYS remove the breast. (Questions that a nursing assistant does not answer well)
"A" consultation for pain always give acetaminophen improves for a while and pain returns so they do not return.
"A" consultation for pain always give acetaminophen improves for a while and pain returns so they do not return.
They say that coffee, cigarette and liquor cause cancer, but they are not prohibited and that is why it is not true.
They say that coffee, cigarette and liquor cause cancer, but they are not prohibited and that is why it is not true.
Mastitis causes cancer.
Mastitis causes cancer.
The bra rod gives cancer.
The bra rod gives cancer.
If you feel very hard the disease of "water"
If you feel very hard the disease of "water"
If one finds nothing, it is that the self-examination is done badly. (SIC)
If one finds nothing, it is that the self-examination is done badly. (SIC)
And that due to the isolation of social networks, many do not know the debates about deodorant, prosthetics, the use of plastic and a thousand news without scientific support that abound on the network.
And that due to the isolation of social networks, many do not know the debates about deodorant, prosthetics, the use of plastic and a thousand news without scientific support that abound on the network.
But who to blame in an age of so many communications and advances.
But who to blame in an age of so many communications and advances.
It is not to look for culprits but if points where you can improve especially taking into account the current reality.
It is not to look for culprits but if points where you can improve especially taking into account the current reality.
The main problems in our opinion are, starting with the head of the service pyramid in municipalities and rural areas:
The main problems in our opinion are, starting with the head of the service pyramid in municipalities and rural areas:
1. General practitioner
1. General practitioner
In general, they know about breast cancer, (only 8% of general practitioners and 17% of rural doctors know that the main CAM is not frequently associated with pain) but they are not well trained in the use of guidelines. that guide what exam to ask a woman first according to her reason for consultation and age and in this way many women of 50 years begin their studies with an ultrasound scan and not a mammogram.
In general, they know about breast cancer, (only 8% of general practitioners and 17% of rural doctors know that the main CAM is not frequently associated with pain) but they are not well trained in the use of guidelines. that guide what exam to ask a woman first according to her reason for consultation and age and in this way many women of 50 years begin their studies with an ultrasound scan and not a mammogram.
They do not know what risk factors they should register to request a mammogram between the ages of 40 and 50 in our country, where the mandatory mammogram is at the age of 50. Many times this causes them to be denied by EPS auditors, who can judge it with criteria. more subjective about risk.
They do not know what risk factors they should register to request a mammogram between the ages of 40 and 50 in our country, where the mandatory mammogram is at the age of 50. Many times this causes them to be denied by EPS auditors, who can judge it with criteria. more subjective about risk.
Indices such as that of the NATIONAL SURGERY ADYUVANT BREAST PROGRAM - (NSABP) are not used, which among the many measurement proposals that appear on the Internet is the most serious, with many years of study, with good utility, among other aspects. In our experience, when a woman is told that her risk is 5.1 / 1.7, the woman does not question and takes that risk much more seriously than if she is told that she is high risk because her first child was at 30, her first menstruation at 11, because she smokes, drinks, plans more than 7 years, has a family with cancer among others whose credibility sometimes questions because she sees that the neighbor was not told the same thing or because she does not understand why, among other reasons. The woman who is told that her risk index is high attends controls and training 60% more frequently than the woman who knows the risk in the traditional way. They take it very seriously ...
Indices such as that of the NATIONAL SURGERY ADYUVANT BREAST PROGRAM - (NSABP) are not used, which among the many measurement proposals that appear on the Internet is the most serious, with many years of study, with good utility, among other aspects. In our experience, when a woman is told that her risk is 5.1 / 1.7, the woman does not question and takes that risk much more seriously than if she is told that she is high risk because her first child was at 30, her first menstruation at 11, because she smokes, drinks, plans more than 7 years, has a family with cancer among others whose credibility sometimes questions because she sees that the neighbor was not told the same thing or because she does not understand why, among other reasons. The woman who is told that her risk index is high attends controls and training 60% more frequently than the woman who knows the risk in the traditional way. They take it very seriously ...
But general practitioners don't know these rates. (And many specialists far from this reality).
But general practitioners don't know these rates. (And many specialists far from this reality).
In conclusion, they do not know how to apply the official guidelines, at least they were the findings in Cundinamarca in 110 municipalities of the study and experience, but there is something else that is important in the chain of events of care for Breast Pathology that affects the diagnosis of Cancer in early form involving the general practitioner.
In conclusion, they do not know how to apply the official guidelines, at least they were the findings in Cundinamarca in 110 municipalities of the study and experience, but there is something else that is important in the chain of events of care for Breast Pathology that affects the diagnosis of Cancer in early form involving the general practitioner.
The training of the general practitioner in benign pathology is poor. And it turns out that benign pathology is 85-90% of the Breast consultation anywhere.
The training of the general practitioner in benign pathology is poor. And it turns out that benign pathology is 85-90% of the Breast consultation anywhere.
The pain as a symptom for example is managed with acetaminophen that the woman takes, improves for a while and when the pain reappears she no longer believes it and the expression appears. "Why do I go to the hospital if they always tell me the same thing and they always give me acetaminophen that doesn't cure me ..." (SIC)
The pain as a symptom for example is managed with acetaminophen that the woman takes, improves for a while and when the pain reappears she no longer believes it and the expression appears. "Why do I go to the hospital if they always tell me the same thing and they always give me acetaminophen that doesn't cure me ..." (SIC)
Then they give them other painkillers and add vitamin E in low doses, in many occasions from dubious laboratories that do not comply with the recommendations for the management of the fibrocystic condition (the main cause of breast pain) and where in itself vitamin E only has a good response in about half the women.
Then they give them other painkillers and add vitamin E in low doses, in many occasions from dubious laboratories that do not comply with the recommendations for the management of the fibrocystic condition (the main cause of breast pain) and where in itself vitamin E only has a good response in about half the women.
So what follows ..... an ultrasound and a referral to Mastology. Cost overruns and a fact. Many women do not like to leave their municipalities and rural areas because they are not bothered by the big city, they are scared, they have a lot of paperwork and they fear insecurity, among other aspects. They resort to ultrasounds of dubious origin.
So what follows ..... an ultrasound and a referral to Mastology. Cost overruns and a fact. Many women do not like to leave their municipalities and rural areas because they are not bothered by the big city, they are scared, they have a lot of paperwork and they fear insecurity, among other aspects. They resort to ultrasounds of dubious origin.
Only 7% of the doctors interviewed out of a total of 430 that we have trained knew of the use of medications such as tamoxifen, among others. But much less did they know that if a woman is adequately explained the origin of pain and fibrocystic condition, many of them stop worrying and become better empowered about the care of their breasts, however humble they are or the lack of knowledge they have.
Only 7% of the doctors interviewed out of a total of 430 that we have trained knew of the use of medications such as tamoxifen, among others. But much less did they know that if a woman is adequately explained the origin of pain and fibrocystic condition, many of them stop worrying and become better empowered about the care of their breasts, however humble they are or the lack of knowledge they have.
The use of drawings and graphics is very useful especially when the patient takes the drawing to explain at home or just to remember. (They always say, when using this "doctor I can take the drawing ..." strategy. I have never stopped using them in my private practice)
The use of drawings and graphics is very useful especially when the patient takes the drawing to explain at home or just to remember. (They always say, when using this "doctor I can take the drawing ..." strategy. I have never stopped using them in my private practice)
When the patient already examined knows that she does not have cancer, she has one year before returning to her screening, to live in peace, being well empowered in pain management, breast care, self-examination, when to consult and to whom.
When the patient already examined knows that she does not have cancer, she has one year before returning to her screening, to live in peace, being well empowered in pain management, breast care, self-examination, when to consult and to whom.
It only remains to mention an aspect not less important. Treatment, respect, and privacy are aspects sometimes viewed with indifference by the doctor and other health personnel. (Some doctor once told us "doc. Why worry so much about these things if we are in practice in the rural year ..." (SIC)
It only remains to mention an aspect not less important. Treatment, respect, and privacy are aspects sometimes viewed with indifference by the doctor and other health personnel. (Some doctor once told us "doc. Why worry so much about these things if we are in practice in the rural year ..." (SIC)
Sometimes there are no blouses or restrooms or places to change but there are still ways to maintain respect and privacy and this is what we have taught the doctors we have trained. The general practitioner must understand why the breast is so important to a woman and for that he must refer to the breast in mythology, history, advertising, art and more. Only in this way will you understand why the breast is so ingrained with certain characteristics in the collective unconscious that Freud described.
Sometimes there are no blouses or restrooms or places to change but there are still ways to maintain respect and privacy and this is what we have taught the doctors we have trained. The general practitioner must understand why the breast is so important to a woman and for that he must refer to the breast in mythology, history, advertising, art and more. Only in this way will you understand why the breast is so ingrained with certain characteristics in the collective unconscious that Freud described.
The lack of privacy means that women from the countryside or distant municipalities do not consult for the simple fear that they will be undressed.
The lack of privacy means that women from the countryside or distant municipalities do not consult for the simple fear that they will be undressed.
The conclusion of this point is that if the general practitioner does not know better the benign pathology (including the management of benign secretions in most of the times and that they do not warrant initial remissions, mycoses, identification of granulomatous mastitis, pathologies associated with glands Morgagni among others that we have seen frequently) the possibility of finding tumor masses decreases because the patient will not consult as she does not find answers to what ails her breast. In addition to increasing the distrust of women to consult, this lack of preparation has the risk of generating cost overruns and unjustified remissions.
The conclusion of this point is that if the general practitioner does not know better the benign pathology (including the management of benign secretions in most of the times and that they do not warrant initial remissions, mycoses, identification of granulomatous mastitis, pathologies associated with glands Morgagni among others that we have seen frequently) the possibility of finding tumor masses decreases because the patient will not consult as she does not find answers to what ails her breast. In addition to increasing the distrust of women to consult, this lack of preparation has the risk of generating cost overruns and unjustified remissions.
Furthermore, she does not enjoy the pleasure of feeling useful and satisfied when things are done well.
Furthermore, she does not enjoy the pleasure of feeling useful and satisfied when things are done well.
2.Nurses
2.Nurses
Regarding the personnel in charge of training women ... Most of the time the training is carried out by professional nurses or nursing assistants. But many of them do not have sufficient training to answer women's questions satisfactorily, referring not to the fact of explaining, when they have the knowledge, for example, that a blow does not cause cancer, but rather how to be convincing with that information. . They do not have training in how to transmit or teach, it is something that most learn on the go .... How to transmit knowledge in a convincing way and with that, generating credibility is a factor that is not taken into account. They themselves do not understand many times because a breast hurts for example.
Regarding the personnel in charge of training women ... Most of the time the training is carried out by professional nurses or nursing assistants. But many of them do not have sufficient training to answer women's questions satisfactorily, referring not to the fact of explaining, when they have the knowledge, for example, that a blow does not cause cancer, but rather how to be convincing with that information. . They do not have training in how to transmit or teach, it is something that most learn on the go .... How to transmit knowledge in a convincing way and with that, generating credibility is a factor that is not taken into account. They themselves do not understand many times because a breast hurts for example.
We have concluded that the nursing staff is very valuable, they have a high degree of motivation to learn, to improve aspects of care, to engage with their community, with women and prevention programs, but they need to be more trained in these aspects. and especially in the management of many symptoms and findings of the breast in places where they or the health promoters are the first contact of a woman with the health system.
We have concluded that the nursing staff is very valuable, they have a high degree of motivation to learn, to improve aspects of care, to engage with their community, with women and prevention programs, but they need to be more trained in these aspects. and especially in the management of many symptoms and findings of the breast in places where they or the health promoters are the first contact of a woman with the health system.
3.Health promoters
3.Health promoters
Among the health personnel there is a person who is very important and very underestimated by the system. The health promoter, now called GECAVIS, (I PREFER THE PREVIOUS NAME, closer to what she does with pride)
Among the health personnel there is a person who is very important and very underestimated by the system. The health promoter, now called GECAVIS, (I PREFER THE PREVIOUS NAME, closer to what she does with pride)
It is the one "lower" in the care chain (a concept that we do not share ...) the one with the least economic income, the most contractual instability, the least scientific training, the most unmotivated and least supported many times and that has the responsibility of going to walk, bike, motorbike or horse your assigned rural or urban coverage areas.
It is the one "lower" in the care chain (a concept that we do not share ...) the one with the least economic income, the most contractual instability, the least scientific training, the most unmotivated and least supported many times and that has the responsibility of going to walk, bike, motorbike or horse your assigned rural or urban coverage areas.
They are the ones with the least training in terms of breast pathology. What we have done better explains our opinion about your role.
They are the ones with the least training in terms of breast pathology. What we have done better explains our opinion about your role.
We train them according to our program that includes because the breast is important, humanitarian aspects, breast anatomy, self-palpation, cancer, breast pain, general pathology. Then we motivated them to maintain contact via wasap with the specialist, we supported them and the result has been extraordinary. Before, their participation in the findings of women with breast cancer did not exceed 8% and today they exceed 35% participation. But not only this, they have helped to solve many problems that previously remained without diagnosis and management. They began to send via wasap clinical cases of women with benign diseases and common problems, accompanied by photos and / or direct contact of the patient with the specialist. We have successfully resolved more than 150 clinical cases, either ending up in solving the problem or motivating and supporting its remission.
We train them according to our program that includes because the breast is important, humanitarian aspects, breast anatomy, self-palpation, cancer, breast pain, general pathology. Then we motivated them to maintain contact via wasap with the specialist, we supported them and the result has been extraordinary. Before, their participation in the findings of women with breast cancer did not exceed 8% and today they exceed 35% participation. But not only this, they have helped to solve many problems that previously remained without diagnosis and management. They began to send via wasap clinical cases of women with benign diseases and common problems, accompanied by photos and / or direct contact of the patient with the specialist. We have successfully resolved more than 150 clinical cases, either ending up in solving the problem or motivating and supporting its remission.
Finally the mammography support.
Finally the mammography support.
It is still a problem, here if it is valid that the geographical distance is important. But there are more things that are not taken into account. Many women do not like to leave their municipalities or rural areas because it means going to a city that they do not know, to an uncertainty that ranges from humane treatment to paperwork.
It is still a problem, here if it is valid that the geographical distance is important. But there are more things that are not taken into account. Many women do not like to leave their municipalities or rural areas because it means going to a city that they do not know, to an uncertainty that ranges from humane treatment to paperwork.
They generally travel accompanied which means more money for transportation and food costs since it can take all day to take a mammogram.
They generally travel accompanied which means more money for transportation and food costs since it can take all day to take a mammogram.
But before the trip, the paperwork meant a trip to the general doctor, many EPS do not let the general doctor ask for the mammogram, so they must go to the specialist, request the appointment, attend, receive the order, request the mammography appointment, go to take, pick up the exam, return to the specialist ... In short, many procedures that discourage the most distant patients.
But before the trip, the paperwork meant a trip to the general doctor, many EPS do not let the general doctor ask for the mammogram, so they must go to the specialist, request the appointment, attend, receive the order, request the mammography appointment, go to take, pick up the exam, return to the specialist ... In short, many procedures that discourage the most distant patients.
There are some portable mammography machines that go around some municipalities but when the results arrive they are not found for the patients and are kept in city halls and EPS ..
There are some portable mammography machines that go around some municipalities but when the results arrive they are not found for the patients and are kept in city halls and EPS ..
There are mammograms in some municipalities but they do not have quality audits and sometimes they over-diagnose findings, for example, from birads 2 to birads 3 or their readings do not meet all the standards established for reading a mammogram. (The absence of defining a birads is the most Frequent) They are sometimes used for diagnosis in women younger than 35 to 40 years where radiographs may not have the best definition because they are not very modern equipment.
There are mammograms in some municipalities but they do not have quality audits and sometimes they over-diagnose findings, for example, from birads 2 to birads 3 or their readings do not meet all the standards established for reading a mammogram. (The absence of defining a birads is the most Frequent) They are sometimes used for diagnosis in women younger than 35 to 40 years where radiographs may not have the best definition because they are not very modern equipment.
But over and above this technological problem, the most important factor in our view continues to be that related to women's knowledge and everything described in most of the article.
But over and above this technological problem, the most important factor in our view continues to be that related to women's knowledge and everything described in most of the article.
If our women know better how to take care of their breasts, with a simple and understandable knowledge, they have more trustworthy access and respect for the health system, better knowledge of the medical and paramedical personnel of the municipalities and rural areas, with committed EPS not for periods of the year where the fight against Breast Cancer is celebrated, we are sure that early diagnosis will increase and this will be the most important factor, even more so than taking mammography at an initial moment in the search for a change in that debt that we have in Latin America regarding breast cancer.
If our women know better how to take care of their breasts, with a simple and understandable knowledge, they have more trustworthy access and respect for the health system, better knowledge of the medical and paramedical personnel of the municipalities and rural areas, with committed EPS not for periods of the year where the fight against Breast Cancer is celebrated, we are sure that early diagnosis will increase and this will be the most important factor, even more so than taking mammography at an initial moment in the search for a change in that debt that we have in Latin America regarding breast cancer.
To end the knowledge problem, it is not only the women we describe in municipalities and rural areas. We have carried out training in more than 50 private companies for women at the executive level and we have found that there is also a knowledge defect. Beliefs, myths and fears are also frequent, despite the cultural level, many of these women, and for this reason some also come late ... These women have little time to attend trainings, much less to study, and they also depend on networks, newspapers among other means that often do not clarify enough.
To end the knowledge problem, it is not only the women we describe in municipalities and rural areas. We have carried out training in more than 50 private companies for women at the executive level and we have found that there is also a knowledge defect. Beliefs, myths and fears are also frequent, despite the cultural level, many of these women, and for this reason some also come late ... These women have little time to attend trainings, much less to study, and they also depend on networks, newspapers among other means that often do not clarify enough.
Everything is given to rethink the promotion and prevention program in terms of improving the way of transmitting knowledge about breast cancer and the pathologies or symptoms that affect a woman, how to deal with bad information from networks social, such as improving neurolinguistic communication and other modern situations that should improve the way we transmit knowledge to women today.
Everything is given to rethink the promotion and prevention program in terms of improving the way of transmitting knowledge about breast cancer and the pathologies or symptoms that affect a woman, how to deal with bad information from networks social, such as improving neurolinguistic communication and other modern situations that should improve the way we transmit knowledge to women today.
What has been our contribution, our grain of sand because much remains to be done ...
What has been our contribution, our grain of sand because much remains to be done ...
In particular (we are in practice the only Foundation or private institution that has moved to distant municipalities) or accompanying the Government or Mayors or Hospitals we have been carrying out a continuous training program that it offers.
In particular (we are in practice the only Foundation or private institution that has moved to distant municipalities) or accompanying the Government or Mayors or Hospitals we have been carrying out a continuous training program that it offers.
1Training for general and rural doctors
1Training for general and rural doctors
2. Training of women and adolescents from municipalities, public companies and private companies
2. Training of women and adolescents from municipalities, public companies and private companies
3. Training of Health Promoters and other Health personnel
3. Training of Health Promoters and other Health personnel
Telephone or wasap support with the General Surgery-Mastology specialist to doctors and health promoters
Telephone or wasap support with the General Surgery-Mastology specialist to doctors and health promoters
Reinforcement of the knowledge acquired during the following days through neuroliguistics techniques.
Reinforcement of the knowledge acquired during the following days through neuroliguistics techniques.
Periodic evaluation of the knowledge acquired.
Periodic evaluation of the knowledge acquired.
In conclusion, we DO have an economic debt to Breast Cancer, but it is a debt that includes quality in the transmission of knowledge as the best option, not to prevent the onset of Breast Cancer, but so that its diagnosis is made early. which should be the objective of a current program for the promotion and prevention of this cancer, in addition to providing a quality guarantee on the knowledge transmitted, a use of neurolinguistic techniques, better training in the way of transmitting knowledge by health personnel and a use in favor of social networks.
In conclusion, we DO have an economic debt to Breast Cancer, but it is a debt that includes quality in the transmission of knowledge as the best option, not to prevent the onset of Breast Cancer, but so that its diagnosis is made early. which should be the objective of a current program for the promotion and prevention of this cancer, in addition to providing a quality guarantee on the knowledge transmitted, a use of neurolinguistic techniques, better training in the way of transmitting knowledge by health personnel and a use in favor of social networks.
Dr. IGNACIO CASTILLA STIPCIANOS
Dr. IGNACIO CASTILLA STIPCIANOS
En respuesta artículo aparecido en Euronews octubre 19 de 2018 la deuda de América Latina con el CANCER DE MAMA( CAM)
En respuesta artículo aparecido en Euronews octubre 19 de 2018 la deuda de América Latina con el CANCER DE MAMA( CAM)
Con respecto a Colombia y el Cáncer de Seno. Hemos hecho avances muy importantes en tecnología para el diagnóstico temprano, en el acceso a la mamografía de tamizaje, mejores especialistas a pesar de que se ha impulsado la creencia que es el Mastologo quién debe resolver la mayoría de las consultas de especialidad cuando existen muchos ginecólogos y cirujanos generales muy bien formados en el área. Esta selección ha generado que la disponibilidad para una consulta sea medida en meses muchas veces . Hay que mencionar la mejoria del sistema de salud y la conciencia de las empresas promotoras de salud privadas y públicas para desarrollar programas de prevención del cáncer de Seno.
Sin embargo todas estas buenas noticias no han o impactado significativamente en la mortalidad por cáncer de Seno en los últimos 20 años en mi país. Podría decir que han impactado en las grandes capitales pero no en las pequeñas ciudades capitales de provincia, municipios adyacentes a las grandes capitales y áreas rurales.
Razones hay muchas. Nos referiremos a las que hemos investigado, descubierto, nos han enseñado las personas que hemos capacitado y lo que hemos aprendido en los últimos 10 años de trabajo en áreas rurales y municipios distantes de Bogotá y Pereira.
Mientras en ciudades, como Bogotá por ejemplo, las mujeres que consultan por primera vez por cáncer de Mama (CAM) un 33% ya está en estadíos avanzados de la enfermedad, en los municipios distantes a más de 40 minutos las mujeres que llegan en iguales condiciones son entre el 70-75% . (Población femenina de Cundinamarca 559.000 mujeres en edades de riesgo es la población que buscamos cubrir en Cundinamarca. Mayores de 35 años unidas cabeceras y áreas rurales.)
Durante muchos años la principal estrategia de prevención ha sido tanto a nivel privado como público la capacitación insistiendo en la autopalpacion del Seno , la consulta periódica y la mamografía a los 50 años.
Sin embargo si tomamos la autopalpacion solo el 27% de las mujeres capacitadas en las áreas de municipios y áreas rurales fuera de las capitales, se realiza el autoexamen. Pero no somos los únicos donde se ve un posible fracaso en esta estrategia, México reporta en varios artículos solo el 29% y Perú el 19% de mujeres que habiendo sido capacitadas se realizan la autopalpacion.
No hay muchas referencias del porque estas mujeres habiendo sido capacitadas no se realizan el examen.
Que hemos visto nosotros... Que los mitos, las leyendas, creencias y temores principalmente son las causantes de este fenómeno. Es algo que no se reporta en un trabajo o propuesta de trabajo gubernamental , hablar de estas cosas puede sonar poco científico para realizar una mejora en el conocimiento, que respetando estos hallazgos haga algo para procurar un cambio. Ya me referiré adelante mas específicamente a algunas de estas creencias.
Siempre se hace mención que la pobreza, la distancia y la ignorancia entre otros son las principales razones para que una mujer llegué tarde en las áreas del trabajo.
Si bien es cierto influyen, su peso en el problema ya no es tanto, una mujer que sepa lo que tiene, hoy en día, hace lo necesario para salir, buscará ayuda en la EPS, las alcaldías y logrará llegar... Pero muchas veces una mujer no sabe que tiene un CAM, sencillamente por ejemplo, porque no le duele... Al preguntarle a las mujeres con tumores avanzados y ulcerados porque no consultaron antes, el 87% contestará "PORQUE no dolía ..." o porque lo asociaban a patologías benignas . (Secuelas de una mordida por un perro años antes por ejemplo) Y ni mencionar las que fueron a medicina tradicional o curanderos hasta cuándo fue tarde.
En conclusión de este aspecto, el conocimiento que tienen las mujeres de los municipios y áreas rurales fuera de las capitales en general y a pesar de los avances, es muy deficiente y es fácilmente palpable cuando sin necesidad de grandes mediciones por ejemplo , en nuestras capacitaciones pasamos a la participación interactiva con las mujeres asistentes.
Aquí encontramos dudas como. (Usaré en ocasiones las palabras con las que se expresan estás mujeres)
Si se seca la leche da cáncer y le quitan a una el Seno (SIC)
Si le dan a una un golpe le da cáncer y le quitan el Seno
Acercarse a un Fogón de leña se coagula la leche y da cáncer
SIEMPRE le quitan el Seno. (Preguntas que no responde bien una auxiliar de enfermería )
"Una" consulta por dolor le dan siempre acetaminofén se mejora un rato y vuelve el dolor por eso no vuelven.
Dicen que el café el cigarrillo y el licor dan cáncer pero no están prohibidos y por eso no es cierto.
La mastitis da cáncer.
La varilla del brasier da cáncer.
Si uno se palpa muy duro la enfermedad de "riega"
Si una no encuentra nada es que se hace mal el autoexamen. (SIC)
Y eso que por el aislamiento de las redes sociales muchas no conocen los debates del desodorante , las prótesis, el uso de plástico y mil noticias sin soporte cientifico que abundan en la red.
Pero a quien culpar en una época de tantas comunicaciones y avances.
No es de buscar culpables pero si puntos donde se puede mejorar sobretodo tomando en cuenta la realidad actual.
Los principales problemas a nuestro parecer son, comenzando con la cabeza de la pirámide de atención en municipios y áreas rurales.:
1. Médico General
En general conoce del cáncer de Seno, (sólo un 8% de los Médicos generales y un 17 %de los médicos Rurales sabe que el principal CAM no se asocia con frecuencia con el dolor) pero no está bien entrenado en el uso de las guías que orientan que examen pedir en primer lugar a una mujer según su motivo de consulta y edad y de esta manera muchas mujeres de 50 años comienzan sus estudios con una ecografia y no una mamografía .
No saben que factores de riesgo deben registrar para pedir una mamografía entre los 40 y 50 años en nuestro país donde la mamografía obligatoria es a los 50. Muchas veces esto ocasiona que sean negadas por los auditores de las EPS, quienes pueden megarla con un criterio más subjetivo acerca del riesgo.
No se usan índices como por ejemplo el del NATIONAL SURGERY ADYUVANT BREAST PROGRAM - (NSABP) que entre las muchas propuestas de medición que aparecen en internet es la más seria, con muchos años de estudio, con una buena utilidad entre otros aspectos . En nuestra experiencia cuando a una mujer se le dice que su riesgo es del 5.1/1.7 la mujer no cuestiona y asume ese riesgo con mucha más seriedad que si se le dice que es de alto riesgo porque su primer hijo fue a los 30,su primera menstruación a los 11, porque fuma, bebe, planifica más de 7 años, tiene familia con cáncer entre otros cuya credibilidad a veces cuestiona porque ve que no le dijeron lo mismo a la vecina o porque no entiende el porque entre otras razones. A la mujer que se le dice que su índice riesgo es alto asiste un 60% más frecuentemente a controles y capacitaciones que la que conoce el riesgo de la forma tradicional. Lo toman muy en serio...
Pero los médicos generales no conocen estos índices . ( Y muchos especialistas alejados de esta realidad).
En conclusión no saben aplicar las guías oficiales , al menos fueron los hallazgos en Cundinamarca en 110 municipios del estudio y experiencia.Pero hay algo más que es importante en la cadena de eventos de la atención por Patología mamaria que incide en el diagnóstico del Cáncer en forma temprana que involucra al médico general.
La formación del médico general en patología benigna es deficiente. Y resulta que la patología benigna es el 85-90 % de la consulta de Seno en cualquier parte.
El dolor como síntoma por ejemplo es manejado con acetaminofén que la mujer toma , mejora un rato y al reaparecer el dolor ya no le cree y aparece la expresión. " para que voy al hospital si siempre me dicen lo mismo y siempre me dan acetaminofén que no me cura..." (SIC)
Entonces les dan otros analgésicos y les agregan vitamina E en dosis bajas, en muchas ocasiones de laboratorios dudosos que no cumplen las recomendaciones para el manejo de la condición fibroquistica ( la principal causa de dolor mamario) y dónde de por sí la vitamina E solo tiene una buena respuesta en la mitad de las mujeres aproximadamente.
Entonces que sigue.....una ecografia y una remisión a Mastologia. Sobrecostos y un hecho. A muchas mujeres no les gusta salir de sus municipios y áreas rurales porque no les molesta la ciudad grande, se asustan, les toca mucha tramitologia y temen a la inseguridad entre otros aspectos. Recurren a ecografías de dudosa procedencia.
Solo un 7% de los médicos entrevistados de un total de 430 que hemos capacitado sabían del uso de medicamentos como el tamoxifen entre otros. Pero mucho menos sabían que si a una mujer se le explica adecuadamente el origen del dolor y la condición fibroquistica muchas de ellas dejan de preocuparse y se empoderan mejor del cuidado de sus Senos, por muy humilde que sean o la falta de conocimiento que tengan.
El uso de dibujos y gráficos es muy útil máxime cuando la paciente se lleva el dibujo para explicar en su casa o solo para recordar. (Siempre dicen, cuando se usa esta estrategia "doctor me puedo llevar el dibujo...". Nunca he dejado de usarlos en mi consulta privada )
Cuando la paciente ya examinada sabe que no tiene cáncer tiene un año antes de regresar a su tamizaje, para vivir tranquila estando bien empoderada en el manejo del dolor, del cuidado de sus senos, del autoexamen, de cuando consultar y a quién.
Solo falta mencionar un aspecto no menos importante. El trato, el respeto, la privacidad son aspectos a veces visto con indiferencia por el médico y resto de personal sanitario. (Algún médico nos dijo una vez "doc. Para que tanta preocupación con estas cosas si en el año rural estamos como en práctica..." (SIC)
A veces no hay blusas o baños o sitios para cambiarse pero aún así hay maneras de mantener un respeto y privacidad y así lo hemos enseñado a los médicos que hemos capacitado . El médico general debe comprender porqué el seno es tan importante para una mujer y para eso debe remitirse al Seno en la mitología, la historia , la publicidad, el arte y mas . Solo así comprenderá porque el seno está tan arraigado con ciertas características en el inconsciente colectivo que describía Freud.
La falta de privacidad hace que mujeres del campo o municipios distantes no consulten por el simple temor a que las desnuden.
La conclusión de este punto es que si el médico general no conoce mejor la patología benigna (incluyendo el manejo de las secreciones benignas en la mayoría de las veces y que tampoco ameritan remisiones iniciales, micosis, identificación de mastitis granulomatosas, patologías asociadas a las glándulas de Morgagni entre otras más que hemos visto con frecuencia) la posibilidad de encontrar masas tumorales disminuye porque la paciente no consultará al no encontrar respuestas a lo que le aqueja a su seno . Además de aumentar la desconfianza de las mujeres a consultar, esta falta de preparación tiene el riesgo de generar sobrecostos y remisiones injustificadas.
Además no disfruta del placer de sentirse útil y satisfecho cuando las cosas se hacen bien.
2.Enfermeras
Con respecto al personal a cargo de capacitar las mujeres... La mayoría de las veces la capacitacion está a cargo de de enfermeras profesionales o auxiliares de enfermería. Pero muchas de ellas no tienen la formación suficiente para contestar las dudas de las mujeres en forma satisfactoria refiriéndonos no al hecho de explicar, cuando tiene el conocimiento por ejemplo, que un golpe no causa cancer, sino a la forma de ser convincente con esa información. No tienen formación en como transmitir o enseñar, es algo que la mayoría aprende sobre la marcha.... Como transmitir un conocimiento en forma convincente y con eso generar credibilidad es un factor que no es tenido en cuenta. Ellas mismas no comprenden muchas veces porque duele un seno por ejemplo.
Hemos concluido que el personal de enfermería es muy valioso, tiene un alto grado de motivación a aprender , a mejorar los aspectos de la atención, a vincularse con su comunidad,con las mujeres y los programas de prevención pero necesitan ser más entrenadas en estos aspectos y sobretodo en el manejo de muchos síntomas y hallazgos del seno en sitios donde ellas o las promotoras de salud son el primer contacto de una mujer con el sistema de salud.
3.Promotoras de Salud
Entre el personal de salud hay una persona que es muy importante y muy subestimada por el sistema. La promotora de salud, llamada ahora GECAVIS, (PREFIERO EL NOMBRE ANTERIOR, más cercano a lo que hace con orgullo)
Es la de "más abajo" en la cadena de atención (concepto que no compartimos...) la de menos ingresos económicos, mas inestabilidad contractual, menor formación científica, más desmotivada y menos apoyada muchas veces y que tiene la responsabilidad de recorrer a pie, en bicicleta , moto o caballo sus áreas de cobertura rural o urbana asignadas.
Son las que tienen menor formación en cuanto a Patología mamaria se refiere. Lo que hemos hecho explica mejor nuestra opinión acerca de su papel.
Las capacitamos conforme a nuestro programa que incluye porque es importante el Seno, aspectos humanitarios, Anatomía del Seno, Autopalpacion, cáncer, dolor en el seno patología general. Luego las motivamos a mantener contacto vía wasap con el especialista , las apoyamos y el resultado ha sido extraordinario. Antes su participación en los hallazgos de mujeres con cáncer de Seno no pasaba del 8% y hoy pasan del 35% de participación. Pero no solo esto, han ayudado a solucionar muchos problemas que antes permanecían sin diagnóstico y manejo. Comenzaron a enviar vía wasap casos clínicos de mujeres con enfermedades benignas y problemas comunes , acompañadas de fotos y / o contacto directo de la paciente con el especialista. Hemos resuelto más de 150 casos clínicos en forma exitosa bien sea terminando en solución del problema o motivando y apoyando su remisión.
Finalmente el apoyo de mamografia.
Sigue siendo un problema, aquí si es válido que la distancia geográfica es importante. Pero hay más cosas que no se tienen en cuenta . A muchas mujeres no les gusta salir de sus municipios o áreas rurales porque significa ir a una ciudad que no conocen a una incertidumbre que va desde el trato humano hasta la tramitologia.
Generalmente viajan acompañadas lo que significa más dinero para transporte y costos de alimentación ya que les puede tomar todo el día la toma de una mamografía.
Pero antes del viaje la tramitologia significó un viaje para ir al médico general, muchas EPS no dejan al médico general pedir la mamografía así que deben ir al especialista, pedir la cita , asistir, recibir la orden, pedir la cita de la mamografía, ir a la toma, recoger el examen, volver al especialista.... En fin muchos trámites que desalientan a las pacientes más lejanas.
Hay algunos mamógrafos portátiles que recorren algunos municipios pero cuando llegan los resultados no se encuentran a las pacientes y quedan guardadas en alcaldías y EPS..
Hay mamografos en algunos municipios pero no tienen auditorías de calidad y en ocasiones sobrediagnostican hallazgos por ejemplo de birads 2 a birads 3 o sus lecturas no cumplen con todas las normas establecidas para la lectura una mamografía.(La ausencia de definir un birads es lo más frecuente) A veces se usan para diagnóstico en mujeres menores de 35 a 40 años donde las radiografías pueden no tener la mejor definición debido a que no son equipos muy modernos.
Pero por encima de este problema tecnológico elfactor más importante a nuestro modo de ver sigue siendo el relacionado con el conocimiento de las mujeres y todo lo descrito en la mayor parte del artículo.
Si nuestras mujeres conocen mejor como empoderarse del cuidado sus senos , con un conocimiento sencillo y comprensible , tienen un acceso de mas confianza y respeto al sistema de salud, mejor conocimiento del personal médico y paramédico de los municipios y áreas rurales , con unas EPS comprometidas no por periodos del año donde se celebra la lucha contra el Cáncer del Seno, estamos seguros que el diagnóstico temprano aumentará y esto será el factor más importante, aún más que la toma de la mamografía en un momento inicial en la búsqueda de un cambio en esa deuda que tenemos en América Latina con respecto al cáncer de Mama .
Para terminar el problema del conocimiento no es sólo de las mujeres que describimos en municipios y áreas rurales. Hemos realizado capacitaciones en más de 50 empresas privadas a mujeres del nivel ejecutivo y hemos encontrado que también existe un defecto del conocimiento . Las creencias mitos y temores también son frecuentes a pesar del nivel cultural muchas de estas mujeres y por eso algunas también llegan tarde... Estás mujeres tienen poco tiempo para asistir a capacitaciones y mucho menos para estudiar y dependen también de las redes , los periódicos entre otros medios que muchas veces tampoco aclaran lo suficiente .
Todo está dado para replantear el programa de promoción y prevención en cuanto se refiere a la mejora de la manera de transmitir el conocimiento acerca del cáncer de Seno y las patologías o síntomas que afectan a una mujer, en como enfrentar la mala información de las redes sociales, como mejorar la comunicación neurolingüistica y demás situaciones modernas que deben mejorar la forma como transmitimos el conocimiento a las mujeres hoy en día.
Cual ha Sido nuestro aporte, nuestro grano de arena porque falta mucho por hacer...
En forma particular(somos en la práctica única Fundación o institución privada que se ha desplazado a municipios distantes ) o acompañando a la Gobernación o Alcaldías u Hospitales venimos realizando un programa continuo de capacitación que ofrece.
1Capacitacion a los médicos generales y rurales
2. Capacitación de mujeres y adolescentes tanto de municipios, empresa pública y empresa privada
3. Capacitación de Promotoras de Salud y otro personal de Salud
Apoyo telefónico o via wasap con el especialista de Cirugía General-Mastologia a los médicos y promotoras de Salud
Refuerzo del conocimiento adquirido durante los días siguientes mediante técnicas de neuroligüistica.
Evaluación periódica del conocimiento adquirido .
En conclusión, SÍ tenemos una deuda económica con el Cáncer de Mama, pero es una deuda que incluye calidad en la transmisión del conocimiento como la mejor opción, no para prevenir la aparición del cáncer de Mama, sino para que su diagnóstico se realice temprano lo cual debe ser el objetivo de un programa actual de promoción y prevención de este Cáncer, ademas brindar una garantía de calidad sobre el conocimiento transmitido, una utilización técnicas de neurolingüistica, una mejor formación en la manera de transmitir conocimiento por parte del personal de salud y un uso a favor de las redes sociales.
Dr. IGNACIO CASTILLA STIPCIANOS
Esp. Cirugia General- Mastologia
CSO FUNDAVENUS
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