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Cancer: Overcoming fear

By Mirta Rodríguez Calderón


Santo Domingo.– Right after famous Spanish singer Rocío Dúrcal passed away, Latin American women’s fear and cancer-related information began to grow all of a sudden.


Most women who had a small breast ball or unusual vaginal secretion or discomfort decided to put off their visits to doctors, because they were afraid of knowing the truth.


In the 8.5-million-inhabitant Dominican Republic, poor statistical data (no sex-disaggregated information) do not make it possible to identify the actual picture. It was announced, however, that the number of patients suffering from tumors or neoplasias had exceeded 37,000 in 2003.


The national health-care system is inadequate. Public spending on health amounts to 6.1 percent of the Gross Domestic Product. This is lower than average for Latin America, according to the 2005 National Human Development Report. Poor service quality also affects other areas.


Although specialized staff members are involved in 98 percent of deliveries, mother mortality rate stands at 180 women every 100,000 live births.


The reasons behind such a high rate include extremely poor care, moral flaws in staff and no sanctions on those who are responsible for current realities, the report indicated.


Cancer sufferers face a similar situation. As many of them live in poverty and isolation, they go to see the doctor when it is too late.


Fear causes more deaths

Local oncologist Natalia Frías told WFS that she is convinced cancer can be cured if it is detected on time and the patient’s lifestyle does not include major risk factors like smoking and unsafe sex.


"We now know that cervix uterine cancer is caused by a sexually transmitted virus", she added.


She is currently working for the Dominican Cancer League (a private, non-profit-making organization) and the Center for Women’s Comprehensive Health Care (under the umbrella of the NGO Women and Health).


"We are trying to solve a problem that needs to be addressed by the government. The Health Ministry plays no leading role in combating cancer. Formally, there is no institution in charge of this", she noted.


Frías believes that uterus and breast cancer rank high on the list. They are followed by ovary cancer. "As there are services available for the latter, the number of detected cases is higher. Lung cancer is the most common in the country", she emphasized.


"We have enough oncologists, but they are poorly distributed. Most of them live and work in the capital and in Santiago de los Caballeros (the second largest city in the island, two hours away by car from Santo Domingo)", she stressed.


Poor people experience the worst situation and do not get early diagnosis. The rich can afford highly- specialized privately owned clinics or seek treatment abroad.


"We can not discuss mortality rates because we do not have hospital records available. Fearing to have cancer is an important cause of death. Women should be afraid of not knowing rather than having any tumor detected on time. Early diagnosis means long life", she remarked.


Imagery and legends abound in the Dominican Republic. They play a negative role. There is a myth that says: if you are “opened”, you will die, meaning that surgery can accelerate metastatic processes. You will get cured if you drink your own urine, highlighting a fashionable therapy.


Another myth has it that, when cancer gets into the body, it spreads all over really soon. Another one that is half-true says that fat people get cancer very easily. In fact, one of the major risks has to do with metabolic disorders resulting from overweight.



There are many doubts about cancer. One of them is whether or not young people should be worried about it. Another one involves pharmaceutical drugs developed by transnational corporations that are not widely available to keep profits high.


There was a media discussion about the impact of cell phones and other electronic products on cancer occurrence; the harmful effect of smoking and breathing contaminated air in big cities; and skin cancer prevention using sun lotions on a regular basis.


There was also speculation about breast-cancer-operated women feeling better if they do aerobics twice a week.


Medical reports, scientific research works, new pharmaceuticals and natural medicines are all being developed, but cancer remains aggressive and uncompassionate, affecting both celebrities and ordinary people.



Peru: Depression, a silent enemy

By Zoraida Portillo


Lima.- "I never imagined I was suffering from depression. I only had physical symptoms: head, neck and backache. I used to say I had some spine problem", Nancy Pérez, a 36-year-old housewife told WFS.


One day, she got worse. "I had nausea and shortness of breath. I thought I was going to die". She still remembers that her children were so scared that they took her to an emergency department. After several tests, she was diagnosed with depression.


Something similar happened to Inés Martínez when she was 15 years old. She is now 23. She suffered from menstrual colic. She was so painful one day that she fainted. When she woke up, she cried and screamed that she was almost dead.


As there was no way to calm her down, we took her to a local emergency ward. She was given some sedative. "A senior doctor examined her and gave his verdict: she was suffering from severe depression", her mother recalled.


The two patients were on therapy for some time, and their symptoms disappeared a few months later.


María Cuevas, a psychiatrist working for the Hermilio Valdizán Mental Hospital, indicated that, when depression sufferers go see the doctor, they normally say they have heart or other organic problems.


Specialized tests are therefore necessary. "We should get to know the patient and his/her family background. This will give us signs", she added.


Specialists feel that pain is the way the body lets us know that something is not working properly.


"When such a discomfort is related to a psychological rather than a physical factor, we say it is a “somatic” pain. It is like a cry for help by the inner self. It is seldom given due consideration", he stressed.


International studies showed that one third of depression patients are diagnosed after five years of unsuccessful clinical diagnosis.


Depression kills neurons in the hippocampus, a section of the brain underneath the cortex. That is why, some seriously ill patients require pharmacological treatment to redress atrophy and prevent neurons from further dying.


This is achieved by increasing the level of two neurotransmitters: noradrenalin and serotonin.


Effective depression therapy, however, does not include only drugs. Experience workshops and self-help groups provide valuable support, especially for women under depression due to physical abuse.


Experts have established a direct relationship among depression, social and economic standing, and educational level. This is the same thing as saying: The more poor and uneducated you are, the more you suffer from depression. Of course, genetic factors play a part, as do environmental conditions and even child traumas.


Most women experiencing depression and having suicidal behavior have been physically abused in the past.


The Honorio Delgado-Hideyo Noguchi Mental Health Institute conducted a study showing that depression is the most frequently seen psychiatric disorder in people living in Lima, aged 18 to 24.


The study covered the capital city and some mountain and jungle regions. In the jungle, depression is the number one mental disease and is followed by alcoholism. In the mountains, the latter poses the major mental health problem.


Most depression sufferers under study were living under poverty conditions and had barely completed elementary education.


These patients often think about committing suicide. Over 75 percent of those who make such attempts suffer from depression. The remaining 25 percent is made up of mental patients, including schizophrenic and paranoid individuals.


According to the local study, 34 percent of Lima residents have considered committing suicide. Out of this percentage, one third are teenagers living under family conflicts. They have tried to kill themselves more than once and are still willing to try it again.


On the other hand, data of the Ministry of Health revealed that 60 percent of suicides in the country occur in Lima, specifically in poverty-stricken areas.


The number of people who have committed suicide has moved from 358 in 2003 to 432 in 2004 and 337 in 2005. There were over 70 cases in the first quarter of 2006.


Women make up the most vulnerable social group. Reports indicated that there has been a change in suicidal pattern. In the past, there had been three attempts by men and one by a woman. Now, there is a suicidal woman every two men, said psychiatrist Freddy Vásquez, head of the Suicide Management Unit at the Institute.


"The poor resort to suicide much more than the rich. The socio-economic factor has become an important component in the last few years", he noted.


Carla Palomino’s case provides a good example. Last September, she decided to kill her two daughters (aged four and seven) and herself. The family’s economic situation was really overwhelming. Some friends said she had changed lately. She was very anxious because she had no money to feed her daughters, a neighbor commented.


Specialists recommend paying special attention to behavioral changes in people around us, because they can be an indication of severe depression.


This is particularly important in a country like Peru, where doctors have ten minutes for each patient and mental health is not a preventive medicine priority. There is one psychiatrist every 55,000 people on average.


Facts are very cruel. There are places where there is one psychiatrist every 200,000 people.


In the 1980s and 1990s, there was only one every two million in violence-stricken areas like the Huancavelica department.


In an effort to overcome such a situation, the Ministry of Health recently included mental health on its priority list. Its strategy will focus precisely on violence victims in the Andean region, where there are health technologists and doctors of other specialties, but no psychiatrists.



Cuba: The Cuban Guitar School

By Marta María Ramírez


Havana.- The guitar is an indispensable instrument in Cuban music.


Brought by the Spanish colonizers five centuries ago, it quickly became part and parcel of the island’s culture, which also included a strong African component.


This instrument has for long been used by Son and Bolero composers, troubadours and classical musicians. Although some experts say that local music creation in the 19th century was marked by the piano, guitar did play a key part then and in the 20th century, when the national school was finally established.


The school was influenced by several trends and techniques, including those of Spain’s Emilio Pujols and Francisco Tárrega, and Cuba’s Clara Romero, her son Isaac Nicola and maestro Leo Brouwer.


"My mother’s technique was to pluck the strings with the fingers, while Pujols’ was to pluck the strings with a plectrum. When my brother Isaac came back from a training course with Pujols, I saw he had adopted his technique. He felt something did not fit in," recalled retired professor and player Clara (Cuqui) Nicola, who is now 80.


A witness of the foundation of the local guitar school, Cuqui added that Isaac had realized that the fingers made the instrument sound differently, and began plucking the strings with the fingers again, like his professor.


Contemporary guitarists have developed a very peculiar way of playing the instrument, which gives further expressive possibilities and enviable naturalness.


The really innovative push, however, came in the 1950’s, when Leo Brouwer (Havana, 1939) came up with a new technique to play his own compositions.


In 1978, he told Juventud Rebelde daily newspaper that some of his technical contributions included playing with a bow, percussing the instrument, putting it on the legs, and using a bar in the thumb to seek extension and project pizzicatos (as employed by Béla Bártok). "I incorporated them to produce a doubly percussed sound. Other contributions have to do with plucking the strings with both hands and resorting to non-traditional ways of tuning the instrument", he noted.


He added that guitar compositions should be made as if they were for an orchestra. Most of his pieces are based on improvisation and Afro-Cuban elements.


A total of 65 men and 25 women have graduated from the Cuban Guitar School since 1976, when the College for Arts was established. Tens of elementary- and intermediate-level students have also been trained there.


Massive access to guitar education after 1959 has made it possible to undertake a natural selection process. "We should not lose sight of professors, who are not many, and concentrate on a number of musicians playing really well", Cuqui stressed.


Outstanding professors have worked at the national guitar school. They include Leopoldina Núñez, Vicente González (Guyún), Marta Cuervo, Jesús Ortega, Martín Pedreira, Rey Guerra, Aldo Rodríguez, Eduardo Martín and Joaquín Clerch.


Cuqui urged to keep the original teaching tradition in place. "Isaac’s method is still being used at the elementary level thanks to Professor Martín Pedreira", she emphasized.


There is a qualitative and quantitative crisis in guitar teaching today. The former is due to the fact that many professors and players go abroad for self-realization. Cuban Culture Minister Abel Prieto has understood this. He is a brilliant man, in my view, he commented. "The latter has resulted from mechanical repetition after many years of teaching", he remarked.


The guitar will stay alive because it is portable and complete. It can be used alone or in conjunction with other instruments, including human voice. Any band, from rock to country music, needs it.


The classical instrument will remain because it is a derivation of a 700-year-old culture, he elaborated.


A local school

Famous guitar player, Carlos Molina , was one of Isaac’s students. He always said that his way of playing attracted the attention of both audiences and experts, Cuqui told WFS.


Romero, the youngest family member, became a guitar professor in the early 19th century to provide economic support to her parents.


She graduated from the Barcelona Conservatory in 1927 and asked Gonzalo Roig to include guitar as a conservatory specialty, but he did not accept the idea because no curriculum had been developed.


"As guitar books were expensive, my mother developed a method for the first three years, an album containing easy-to-play pieces and another one including Spanish Fernando Sor’s works. Everything was mimeographed to make it economical," Cuqui remembered.


"She often asked her classical students to play folk, Latin American and chamber music", Cuqui added.


She founded the Cuban Guitar Society and Guitar magazine in 1940. The idea was to promote theoretical and practical studies and highlight the significance of the guitar as a concert instrument, said Emilia Lufriú, a founding member.


Cuban guitar homo ludens

Leo Brouwer’s father had been one of Guyún’s students. His grandparents (Lecuona’s) had been outstanding musicians; and Isaac actually introduced him into the world of music and guitar.


"I initially took it as a play", he often says. His early compositions included Music (for guitar, violin and drum) and Suite (for guitar) in 1954. His debut as a player was in 1955.


Public recognition came with Prelude (1956), Runaway (1959), Praising dance (1964), Canticum (1968), Endless spiral (1971), and the ones he defined as hyper-romantic pieces: Elegiac concert (1986) and Toronto concert (1987).


He went to study at the Hartford University Music Department and Juilliard School of Music (in the United States) in 1959. His creation Simple studies ways back to that period.


He was later the director of the Sound Experimentation Group at the Cuban Film Institute (ICAIC), which was made up of composers and singers like Noel Nicola, Pablo Milanés and Silvio Rodríguez. These artists were also the founders of the New Song Movement. He became the director of the National Philharmonic Orchestra in 1985.


It was at his initiative that the Havana Guitar Contest and Festival began to be held in 1982. The 23rd (this year’s) edition has not been organized because he decided to devote all his time to composing.


The organizers of the biannual event often invited talented players from foreign countries, such as Spain’s Paco de Lucía, Greece’s Costa Cotsiolis, Japan’s Ichi Fukuda and Brazil’s Egberto Gismonti.


The event helped disseminate individual techniques and contributions, Cuqui stressed. It witnessed the debut of major local players like Rey Guerra (Second Prize in 1982), Joaquín Clerch (First Prize in 1986 and 1988) and Marcos Díaz (First Prize in 1994), as well as foreign personalities like Spain’s Ricardo Gallén (First Prize in 2002) and Mexico’s Cecilio Pereira (First Prize in 2004).


Although this “playful” man has given no concert in the last 20 years, Cuqui thinks Brouwer has really played a leading role in Cuban guitar development. "We are not fully aware of the scope of his work", she concluded.



Cuba: Dealing with violence

By Sara Más


Bayamo, Cuba.– Local experts said that building self-esteem and individual independence helps abused women overcome domestic violence.


They added that most of these women require specialized support or third-party involvement to break such a vicious circle.


They usually experience emotional dependence, and this can lead to psychological disorders and other health problems. The idea of breaking such a relationship generates affliction and frustration.


This came from sociologist María de los Ángeles Chávez and psychiatrist Raida Rodríguez, who live and work in Bayamo, 733 kilometers away from Havana.


They conducted a research work entitled Self-destructive behavior in abused women. Their cases are usually taken up by the local Family Guidance Center in Granma province.


The authors indicated that there are various manifestations of domestic violence, including disqualification, humiliation, restricted freedom and over-control. They all spark stress, physical and sexual aggression, a feeling of guilt and repentance, and low self-esteem.


The work involved 120 women, including 16 who had adopted self-destructive behavior. They showed up at the Center one day, looking for help, in the September 2002-October 2003 period.


Under the umbrella of the Federation of Cuban Women, this institution was opened in 2003 and has been implementing guidance and training programs put together by multidisciplinary teams, Chávez stressed.


The women under review came from families where decision making was always in the hands of men, the research concluded.


These women were not allowed to take full advantage of educational and labor opportunities.


The predominant age group was 28 to 37 years; they were not formally married; and 69 percent were housewives with one to three children each. As they did not work outside home and depended on their couples, abuse persisted.


Under the male-supremacy scheme, women leave aside their personal projects, negatively affecting their self-esteem, causing depression and sparking self-destructive attitudes.


As overcoming this situation was extremely difficult, only three decided to separate, and 13 went on living with violent men. There are many factors behind such a position: poor housing conditions, deeply rooted taboos, etc.


Some of these women said they were not willing to bring other men home, while some others felt they had been married for so long that they would not be able to start all over again.


By the time they were re-examined after treatment, 50 percent had managed to overcome depression.



Education: Learning from pets

By Ilse Bulit


Havana.– Women seem to have difficulties in sharing their time between their families and social commitments. Reactionary people always say women are responsible for children’s education.


Education should be understood as the art to live in happiness and build upon positive experiences and high self-esteem.


Under age-old prejudices, mothers are expected to devise the best possible formulas to raise children (especially girls) and equip them properly to deal with sex and maternity… what a daunting task!


No matter how well trained women are, many are caught off-guard when girls ask about sex, pregnancy, labor, skin color or death.


There was a grandmother in the 1950s who answered all these questions with the help of pets. Her granddaughter learned about death when she was four years old and a chick passed away. The old lady made the girl touch the animal and feel it was cold and hard.


Both of them took the dead chick to the park and buried it there. The woman told her granddaughter that the small animal would help flower plants grow. Before they went to bed that night, they thanked the Lord because the chick had lived a happy life, with a lot of affection.


When the girl turned six, her grandma gave her another important lesson with the help of Minina, a three-color cat. When she began miaowing because she was in love, the lady explained to her granddaughter many things about love, including body and soul shake, and the importance of making good choices and not falling into the trap of flattering remarks before the beau is really known.


As Minina did not pay any attention to the old lady’s calls, she got pregnant, but was never recriminated. The girl learned how to feed her properly, gently touch her belly and wait for the kitties to move inside her mother.


The magic process continued until delivery, a nature-given gift for the female. They both looked after the animals and later found them a place to live and build their own future.


As one of the kitties was adopted by a family that had a pup, the little cat very soon took some lessons about mutual acceptance and respect between two beings of different breeds and colors.


We do not need Persian cats and stock dogs; we only need healthy pets. If we are clever enough, we will realize that their natural actions provide good examples to our children. If we make them look after our pets, they will become responsible persons. And, above all, they will give love, a love that helps dilute violence.


The image of a grownup abusing an animal is very sad, but that of a child acting in such a way makes us feel there will be no peace in the future.


We have all come back home after a bad day at work and paid no attention to our happy dog welcoming us. He usually goes away, but is soon around us, waiting to be caressed and ready to forgive us.


Note: A three-month-old black cat resting on my shoulder has closely followed the writing of this note, and a 12-year-old dog lying partly on my feet has given its OK.


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