Posts Tagged ‘womyn’

Blood clot prevention now recommended for all Cesarean deliveries.

Posted: August 25, 2011 in Health
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On Aug. 22 2011, the American College of Obstetricians and Gynecologists (The College) announced new recommendations to prevent blood clots during Cesarean Deliveries.

"Wearing the Inside Out ..." by Lebanese graphic designer Rasha Rahal

The new guidelines will be published in Sept. 2011 issue of the Green Journal. Blood clots, medically known as venous thromboembolic events (VTEs), are a leading cause of maternal mortality in USA and Canada. The College now recommends that all women having a cesarean delivery receive preventive intervention at the time of delivery. The most cost effective method would be sequential compressive devices (SCDs) to be placed on the lower extremities of a patient before a Cesarean and removed after surgery only when adequate ambulation is attained.

The risk of developing blood clots is increased four folds during pregnancy and two folds during and after a Cesarean delivery. Blood clots can block blood flow and cause damage to certain organs. The most common site of a blood clot in a pregnant patient is the left lower leg but other sites are commonly affected. Symptoms include swelling and pain in affected limb. If a clot gets dislodged, it can travel to the lungs causing a life-threatening condition known as pulmonary embolism (PE). Symptoms include sudden shortness of breath, chest pain, and coughing.

The recommendations explain how to monitor women for these events, address certain risk factors, and treat suspected or acute cases of VTE. “It’s important for ob-gyns to adopt these recommendations to help reduce maternal deaths.” said Dr. Andra H. James who helped develop the guidelines.

The Society of Obstetricians and Gynecologists of Canada (SOGC) has no clear recommendations on using VTE prevention during a Cesarean delivery for patients who are at low risk. Regardless of the plethora of new research on this topic, the SOGC guidelines were last updated in 2000. (See Prevention and Treatment of Venous Thromboembolism (VTE) in Obstetrics).

If you or someone you know are undergoing a Cesarean delivery ask the doctor about methods of VTE prevention she/he are implementing.

FDA warning fuels debate: Mesh use in vaginal prolapse surgery

Posted: August 18, 2011 in Health
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Pelvic organ prolapse is a common problem that I see daily in my office.

I start my management by counselling my patient about all her available options. This usually includes a discussion about conservative management, behaviour modification, pessary trial and surgical options.

For surgery, there has been a debate between “mesh-supporters” and “mesh-avoiders”, as I like to call them. In a nutshell, using mesh increases complications and avoiding mesh increases failure.

In my opinion, the core of the discussion should always remain: what is the right option for the patient that will maximize benefits and minimizes risks? The question is easy to formulate, the answer remains more complicated.

During my training, I only learned the traditional mesh-free surgery. I also learned the arguments for and against mesh surgery.

In June 2011, I was invited to a workshop in Halifax on the application of Elevate® Anterior and Posterior Prolapse Repair Systems by American Medical Systems (AMS). This is one of many available mesh systems.

In July 2011, still before I book my first patient for the procedure, the U.S. Food and Drug Administration (FDA) released a Safety Notification regarding the use of vaginal mesh for the repair of prolapse identifying this as an area of “continuing serious concern.” Since then, the debate has fueled.

This is the second time FDA tackles mesh. In Oct. 2008, the FDA released a Public Health Notification regarding the use of mesh for the treatment of prolapse and incontinence. The report was criticized by mesh-supporters for reasons that I find valid.

The new report focuses only on prolapse treatment and states that:

  1. Mesh use is not proven to provide improved outcomes when compared with native tissue repairs
  2. Serious complications with mesh use are not rare

The American College of Obstetricians ad Gynecologists (The College) responded by advising all its fellows to read the 2011 FDA Safety Notification. The College notes that “given the limited data and frequent changes in the marketed products for vaginal surgery for prolapse repair (particularly with regard to type of mesh material itself, which is associated with several of the postoperative risks, especially mesh erosion), patients should consent to surgery with an understanding of the postoperative risks and complications and lack of long-term outcomes data.”

I like what Dr. Rebecca Rogers said in her Green Journal editorial published ahead-of-print (October 2011):

As surgeons, we want to be neither dinosaurs who are out of date with current therapies, nor cowboys, jumping on the bandwagon of new therapies the minute they become available, particularly when clinical data do not exist to inform our decisions.

At this time, we should offer our patients a detailed discussion of the risks, benefits and alternatives to the best of our knowledge with current available data. The patient will then be able to make a well informed and educated decision.

Misogyny Kills Women Around the Globe

Posted: May 2, 2011 in Human Rights
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Every day, misogyny kills women around the globe in two ways: directly through violence and indirectly through apathy, said David A. Grimes, MD, clinical professor of ob-gyn at University School of Medicine in Chapel Hill, who delivered his lecture “Misogyny and Women’s Health” today at The American College of Obstetricians and Gynecologists’ 59th Annual Clinical Meeting.

According to Dr. Grimes, women are dying needlessly because societies just don’t value them. Examples of misogyny—literally “hatred of women”—range from lack of equal treatment to emotional and physical abuse to murder. “Maltreatment of women has been institutionalized by governments and religions for millennia,” said Dr. Grimes. “This maltreatment often manifests itself as domestic violence, rape, rape as an instrument of warfare, sexual harassment, child marriage, and ‘honor killings’,” he said.

It’s not just third world countries where women continue to suffer, according to Dr. Grimes. “You don’t have to look outside the boundaries of this country—women in the US also suffer from the effects of misogyny.”

Dr. Grimes pointed out some sobering statistics from the World Health Organization. The prevalence of domestic violence worldwide is between 15-71% and abuse during pregnancy occurs among 4-12% of women. Up to one in every five women is sexually abused as a child. Nearly a quarter of Peruvian women and 40% of South African women experience a forced first intercourse. Honor killings take the lives of 5,000 women each year.

Approximately 343,000 women worldwide die each year from complications of pregnancy and childbirth, an average of one death every other minute, said Dr. Grimes. Nearly all of these deaths are preventable. Notably, half of these maternal deaths occur in just six countries (Afghanistan, Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan). These societies have yet to make the decision that these women’s lives are worth saving, he said.

By ACOG – May 2nd, 2011

Sexual health brochure for womyn who have sex with womyn

Posted: January 31, 2011 in Health
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Here is a sexual health brochure that I supervised and edited during my last trip to Lebanon.

It is produced by Meem, “a community of lesbian, bisexual, queer & questioning women and transgender persons in Lebanon”.

The brochure was recently announced in Bekhsoos, “queer Arab magazine published weekly by queer and trans folks”.

I enjoyed working with Meem’s very dynamic and motivated health coordinator. Kudos to Meem for the great services they are providing their community. The brochure will be published and distributed in Lebanon soon.

To my knowledge, there are no health brochures targeting womyn who have sex with womyn in Lebanon. The only other publication I am aware of is an Arabic sexual health booklet by Helem called “Mish 3an el Nabat” (مش عن النبات). The booklet is for both men and womyn. Below is a slideshow of the brochure.

Stop sexual aggression against womyn in The Congo

Posted: January 5, 2011 in Human Rights
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“Imagine just one woman, that she is first raped in public and then forced to sit on burning coal until her entire genitalia are destroyed. Her husband, children and family are forced to witness the torture. Her father is forced to participate in the rape. The family´s fields are then torched. Let us then imagine that during the following days 242 other women are raped, something that occurred as recently as August this year, and then consider that this aggression has been on-going for more than a decade.”

Democratic Republic of Congo - DRC

The international medical community has recently been mobilized to stand up for the rights of womyn in Democratic Republic of the Congo (DRC). Health care providers are appealling for peace and an end to sexual aggression there.

Rape is being used as a more powerful weapon than guns. In that region, rape can causes disolution of families and communities, immigration, life long illnesses, lower health status and increase in rate of suicide and furthur alienation of victims, trauma that can be as gravid and destructive as that caused by war.

I just signed the following Call for Action and I invite you to do the same. We must put an end to sexual aggression against womyn and girls in the Congo.

“We, as part of the global medical community, endorse Dr Mukwege and his colleagues´ following demands to the international community:

  1. Demand of the DRC, Rwanda and Uganda that they take control over their regular and irregular militias that wreak destruction in the area. The economic interests that entertain the chaos of the region to a great extent explain these states seeming indifference faced with the indescribable suffering taking place.
  2. Extend and strengthen the mandate for the peace-keeping troops in the region to protect civil society.
  3. Encourage the creation and training of a Congolese policing unit to large part consisting of women with the purpose to protect civilian society.”

  

The following medical organizations also endorse this call for action:

  1. The Swedish Society of Obstetrics and Gynecology (SFOG)
  2. The Swedish Society of Medicine
  3. The Swedish Medical Association
  4. Nordic Federation of Obstetrics and Gynecology (NFOG)
  5. Danish Society of Obstetrics and Gynaecology (DSOG)
  6. Finnish Gynaecologic Association (FIK)
  7. Norwegian Gynecological Association (NGF)
  8. Icelandic Society of Obstetrics and Gynecology (FÍK)
  9. The Society of Obstetricians and Gynaecologists of Canada (SOGC)
  10. The Swedish Association of Midwives
  11. AMOG- Associação Moçambicana de Obstetras e Ginecologistas
  12. Canadian Association of Midwives
  13. FIGO – the International Federation of Gynecology and Obstetrics
  14. Association of Obstetricians and Gynaecologists of Ukraine (AOGU)
  15. Scandinavian Doctors Sweden
  16. Rotary Doctors Sweden

 

If you are the health care provider, click here to endorse this appeal for peace and an end to the sexual aggression in the Congo.

Giving Birth

Posted: November 27, 2010 in Personal
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Even after “catching” hundreds of babies (“Delivering” babies in more medical terms even though all the work is done by the birthing mother), till this day, I still feel giving birth is a “miracle”.

I still experience the same overwhelming feeling I had witnessing my first delivery back in the American University of Beirut Medical Center in 2001.

I owe a lot of respect all womyn who gave birth. You are blessed with the fortune of delivering miracles.

Anatomy of a Riddle! Will your answer be right-eous?

Posted: November 23, 2010 in Human Rights, Personal
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“A dad and his son had a car accident, the father died and the son was rushed to the hospital… The Doctor said: “I can NOT do the surgery, he is my son” Explain

This was a riddle I received by a broadcast BBM (BlackBerry Messenger) from my sister today.

Before you scroll down, take a minute to think about the right answer. Please consider leaving your first answer as a comment on this post.

With my sister in Lebanon end of 2009 (Blog post and photo are published with her permission)

“The Doctor is his Mother” I replied.

“You truly are a feminist” my sister wrote back.

I read her line as I was recovering from a reality shock. I actually fell in the trap. I have to confess that it took me more than a minute to figure it out which, in my opinion, is appalling.

“I did not know the answer” she continued.

“Who else on your list knew it?” I asked

“No one”

“I loved this riddle. It is such a feminist riddle. I did not guess it automatically, it took me some time, which is a shame. It reflects traces of brainwashing by an eastern Chauvinistic society in which we were raised.”

I am still not over the fact that I did not know the answer immediately. I realized how much work I still need to rid myself of prejudice I absorbed from a patriarchal society.

My sister felt even worst: “I hated myself when I knew the answer. كرهت حالي بس عرفت الجواب We all did, especially the girls. That is sad”

Yes, it is sad. It should be a wake up call for all of us. Lebanon is only “free”, “democratic” and “open-minded” when you compare it to neighboring countries, or other Arab-speaking countries. We should aspire to better quality freedom and social liberties than that of our neighbors.

No Lebanese man, woman or other should rest their case before womyn and those who identify as such have the full rights that men have. Womyn can not offer citizenship to their non-Lebanese husband or even to their kids from a non-Lebanese partner. Womyn can not report domestic violence to authorities as no protection is provided, on the contrary, they frequently end up back in the hands of their abuser same night. Womyn feel they need to hide their sexuality while men proudly flaunt it. Charges against a rapist will be dropped if he offers to marry his victim. Police get away with verbal sexual harassment of womyn on the street. I have witnessed few incidents in Beirut (#VisceralReaction). Many womyn are discouraged from pursuing further education because they are “ripe” for marriage. Those who do, will have strong competition from men, this is reflected in fewer womyn than men holding CEO or leader-position jobs. Womyn can be ostracized for delayed or no marriage. A unique term was even coined to further alienate these womyn: “عانس Aaniss”. It is amuzing that the term is rarely, if ever, used for unmarried men.

I have to say I have doubts people raised in a Western societies will get the answer more righteously! I witnessed patriarchy in USA and Canada in my past 5 years here, but on a different level. This will be left for a different post.

Back to our riddle, if you felt bad for missing the answer, I tell you what I told my sister: “Do not feel bad, you are so righteous in saying ‘I hated myself  when I knew the answer’, that by itself is strongly feminist.”

I posted this riddle as my status on Facebook. Here are few answers I received.