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2 I Richa Bajimaya Memorial Foundation Newsletter

Being an
Elixirian
Mausam Khadka , Past President,
SOS Hermann Gmeiner School
Elixir Club, Sanothimi, Bhaktapur
Some Suggestions_Prashant Niraula, Past President, OPS Elixir club
Elixir Club is working for a movement
against, cancer. It has got its clubs in
diferent schools of Kathmandu valley
from which students are selected to be
the active member of the club. These
students actively work for the awareness
and other diferent campaigns against
cancer which is a very dangerous disease
afecting people physically and mentally
as well.
Our school i.e. SOS Hermann Gmeiner
School, is the frst member club from
Bhaktapur district. I am one of the active
members of this club. Being a member of
the club is not a big deal but fulflling the
responsibilities as a member is the bigger
challenge. As a member of the club, I
have earned great experiences, learned a
lot and have shared a lot of things. I feel
proud when I say that I am a member of
Elixir club because I feel that I am doing
something that can save someones life.
That means I can help to save the life of
a father, a brother, a son and a citizen of
the nation. So it means that I am saving
a bundle of relations and a lot of people
from this disease. This gives me immense
amount of happiness. The use of tobacco
products kills more than 15000 Nepalese
in a year. If I can save one life that means
I am saving my own brothers lives as we
are all the sons and daughters of mother
Nepal.
Yes, it may be very difcult to fulfll our
responsibilities but we Elixirians are
giving our best to fulfll the duties. I, as
an elixir member have atended many
programs against cancer like orientation
program of the wall painting program
in V.S Niketan School, wall painting
program in World No Tobacco Day at
Ideal Model School premises on June
2nd, 2012 and many other events. We
have also conducted various activities
from our club such as speeches in our
morning assembly, drama with the
Time is too fast, it seems it was only a
few months ago that I was in my school
working as an Elixirian. But, its already
been two years that I retired as the President
of Occidental Public School (OPS) Elixir
club. I am very lucky to have been a part
of this wonderful club. Moreover, what
gives me more joy is that I could work as
the frst president of our club and give the
club a good base. However, this wasnt
an easy task for me. I had many diferent,
difcult as well as wonderful experiences
throughout this period. I have compiled
these experiences as an article which I
believe will be useful to all the future
members of this club.
Time Management
Being a member gives a huge chance for
gaining many good things. But we should
never forget one thing, which is that we
are students. And therefore, our frst and
foremost duty is to study and then only
be involved in club activities. Hence, we
should manage our time very properly. We
need to have a good schedule where there
is sufcient time allocated for studies and
the rest for other activities. Club activities
can be refreshers after long tiring study
periods. So, we should utilize our leisure
time for club activities making it fun as
well as productive.
Club Management
The Club cant run unless the president has
good management skills. Management
here doesnt only include fnances but
also the club administration, meetings and
other facets. A single person can never run
the club alone, so the president should
decentralize the power to other members as
message tobacco products cause cancer
in the SOS day program, distribution
of pamphlets throughout the school
premises and around the school area
describing the efects of the cancer, etc.
It wasnt easy to fulfll these tasks but
all of this was possible due to our eforts
and cooperation between the members. I
would like to thank my other friends and
members of this cub who have helped
me and worked with me when difcult
situations arose.
At last, I want to thank Mr. Jeewan
Shrestha sir for choosing me as a member
of this club from our school. I would
also like to thank our ECA coordinator,
Mr. Durga Chhetri sir, for guiding us in
diferent situations and for the permission
to atend the diferent programs held by
the club. Even though my tenure as a
member in Elixir cub has almost fnished,
I will always be there when the club needs
me helping with the awareness programs
and the movement.
Our club is doing a great work for the
nation against this disease that is a
cause of so much despair and hope that
all students like us join hands in this
movement against cancer. At last, I want
to say from the deep core of my heart,
PROUD TO BE ELIXIRIAN.
well. In many clubs, I see that the president
is doing most of the things alone and in my
experience such clubs cant progress. So, a
good manager should distribute the roles
and responsibilities to other members too.
Listening Habits
A good listener is a good speaker, this
saying is very true and it can teach us a very
good lesson. We often organize meetings
and discussions for the various maters
and activities of our clubs. We should do
that, but if such gatherings are noisy then
such meetings are useless. Every member
in the club should respect each other and
everyone should carefully listen to the
words of others and give their points or
thoughts in their turn only. If we start
doing this we can make our discussions
interesting and more benefcial.
Creating Plans and bringing
them into action
We often create plans at our clubs and
make a list of future activities and do a lot
Truth: Cancer is not just a health
issue. It has wide-reaching social,
economic, development, and human
rights implications.
Myth 1: Cancer is just a health issue
Richa Bajimaya Memorial Foundation Newsletter I 3
A Job Well Done
Pragya Timalsina & Bismriti Pokhrel, SOS Hermann Gmeiner School, Sanothimi, Bhaktapur
It was the break of a new dawn for us.
Today was the day, yes it was. It was a
day, we have to admit it. We were the
organizing members of the CANCER
AWARENESS EVENT. We raced our
minds as we tried to recall all the jobs
that were needed to be done before the
events started.Whoa! Thats crazy, we
thought and took a deep breath to calm
our racing pulse .We read the time on the
watch,9:00 AM, 10 minutes; hmmmm
not bad we thought, after reaching the
school. The main gate wasnt open. So, we
had to use the gate east of ceramics. Got
in; no one had come yet. We had decided
to arrive by 9:00 but no one except us
was there. We raced to the hall but to
our disappointment, the gigantic lock
hanging outside the halls door smirked
at us. Having no one to help we sat on
the ground sunbathing. 10 minutes, 20
minutes, half an hour, 40 minutes, 45
minutesIt was too much, way too much.
Who makes you wait so much? And what
would you do to that person if you saw
them around after you had waited for
about an hour?
We dont know about you but we know
what comes to our mind to squeeze their
souls out of their bodies. And thats exactly
what we did, but literally. We dont know
exactly what but some kind of external ghost
got within us and brought them all down.
We, in total state of anger and devastation
called for a meeting. It was scheduled
to commence at 10:15 but they werent.
It had already been adjourned once, last
week since they all had raced back home
after school even though we had been
waiting for them in multimedia room
for more than 40 minutes. We must say
my colleagues are the most demanding
challenges we have ever faced.
of these activities as well. But, do all our
plans come to action? No, they dont. The
main reason for this is the lack of time.
We plan something good but we dont
do it on time and we cant get enough
work done to make these activities a full
success. So, my suggestion to avoid this
sort of things from happening would
be to make a yearly list of activities
before hand and work accordingly. A
thing I would like to share is we should
never laugh upon crazy plans given by
our friends, Never forget many great
inventions and discoveries are made
from crazy plans frst.
Last but not the least is that everyone
should be happy with the club activities
and all members should have friendly
relation with each other. Each should
help, educate and even correct the other
where necessary and move ahead with
the vision of meeting the objectives of the
Elixir clubs.
So, these are some of my tips to all the
Elixirians. I hope this will help everyone.
After a back-breaking wait; fnally they
came and we yelled at them that we are
working to a tight schedule, starting from
seting the chairs in the hall. To my shock,
the hall was a mess. Geting to school so
early and waiting for so long and fnally
to have to mop and sweep the foor wasnt
our idea of fun.
But, wait, we werent in the chair that
day, Minu was; and she couldnt do the
job with her recently manicured hands.
We had never been so stressed in our life
but that day it came and went with such
monotonous regularity .Thank GOD, it
Myth 3: Cancer is a death sentence
Truth: Many cancers that were once
considered a death sentence can now
be cured and for many more people
their cancer can now be treated
efectively.
Myth 2: Cancer is a disease
of the wealthy, elderly and
developed countries
Truth: Cancer does not discriminate.
It is a global epidemic, afecting all
ages, with low- and middle-income
countries bearing a disproportionate
burden.
was done under 10 minutes and chairs
were also set.
We got to the ground to wait for the guests;
the sun shone out of the clear azure sky
and a sense of relief occupied our body
and mind. The preparation was done;
speakers and projectors set, nets arranged
for the football match and our school team
was ready just waiting for the opponents
to arrive. Previously, so many thoughts
whirled around my mind but now there
was none.
The guests arrived and the matches
started. We were all cheering for our
favorite teams. It was sweltering hot then.
But it was taken away as the game came
alive in the second half. It was a tie then.
We took them to the hall, served lunch
and started our formal event. We got to
the stage for a speech and presentations
and we could sense a buzz of excitement
and expectation in the air.The excitement
really got adrenaline fowing inside
us. We gave a speech and were bidden
farewell with a huge round of applause.
There were dance performances,
songs, dramas, speeches and so on. The
performers electrifed the audience and
we were glad how the program was going.
The performers had a manic energy and
enthusiasm. Their presentation left the
entire people spell bound.
The members of the foundation who had
funded our event hadnt said anything but
I could see that their eyes were twinkling
with merriment but at the end; they
enthused that it was the most successful
event that they had ever funded. Our heart
was futering with happiness. Well, that
day was too hectic for us. Nevertheless;
we were over the moon because of our
success, because everyone atending had
learned something about cancer and
because of the excellent management and
supervising skills we had shown that day.
4 I Richa Bajimaya Memorial Foundation Newsletter
5th Annual General Meeting was successfully conducted
at Foundation Ofce, Chabahil. The 2nd Issues of the
foundation newsleter was released on the same occasion by
our advisor Mr. Shyam Sundar Bajimaya and the Token of
Appreciation were also presented to the life-time members
for their valuable support and contribution
Richa Bajimaya Memorial Foundation Newsletter I 5
On the occasion of World Cancer
Day Elixir Unit of SOS conducted
various program to mark the
day . The prgoram included
friendly football match between
Elixir Units (IMS, Samata, LRI,
SOS), video screening, slides
presentation and speeches related
to cancer and its awareness.
Richa Foundation and Womens
Federation for World Peace
(WFWP)-NEPAL in their second
collaboration, jointly organized
a forum on Breast Cancer
Awareness and Prevention as part
of a Pink November campaign
Richa Foundation in collaboration
with Rotary Club of Yala and
Dathutajhyal Tole Sudhar Samiti and
in support with Spur Engineering,
Y-Stand Dance School and School of
Creative Comunication celebrated
World Cancer Day 2013 with the
theme Cancer Did you know? at
Patan Durbar Square area.
The programs conducted this year
includes:
1. Talk program with Dr. Sudip
Shrestha, Medical Director at
Bhaktapur Cancer Hospital and
Advisor at Richa Foundation
2. Flash Mob with participants from
Y-Stand Dance School
3. Candle Walk
4. Candle Lighting
5. Information Leafet on the Myths
and Truths distributed to the public
6 I Richa Bajimaya Memorial Foundation Newsletter
Human Papilloma Virus(HPV) infection and
Cervical Cancer in Nepal- Dr. Aditi Giri and Dr. Prashant Khatiwada
Figure 1. Posterior half of uterus and
upper part of vagina. Figure 1167 from
Grays Anatomy. Source - Vectorized
in CorelDraw by Mysid from the online
edition of the 1918 Grays Anatomy.
Introduction
As of 2008, cervical cancer is the third
most common cancer in women, and the
seventh most common cancer overall.
It is estimated that 530,000 new cases of
cervical cancer were diagnosed in 2008,
of which 85% occurred in less developed
countries like Nepal. In these countries,
cervical cancer accounts for 13% of all
female cancers. There were 275,000 deaths
from cervical cancer in 2008 and, consistent
with the incidence data, 88% of deaths
occurred in developing countries [1].
Most cancers have complex etio-
pathogeneses, making it impossible
to prevent them. This is not true for
cervical cancer. With this horrendous
form of cancer, public health measures
can surely and certainly prevent it.[2,3]
Early detection of cervical cancer can be
done through the simple procedure of
pap smear and the disease will subside if
caught early, during its pre-cancer stage.
Studies have shown that 80% of cervical
cancer in Nepali women can be prevented
by HPV 16/18 vaccines.[4]
Cervical Cancer
Cervical cancer is the term for a malignant
neoplasm arising from cells originating in
the cervix uteri. One of the most common
symptoms of cervical cancer is abnormal
vaginal bleeding, but in some cases there
may be no obvious symptoms until the
cancer has progressed to an advanced
stage.[5] Treatment usually consists of
surgery (including local excision) in
early stages, and chemotherapy and/or
radiotherapy in more advanced stages of
the disease.
HPV infection appears to be a necessary
factor in the development of almost
all cases (>90%) of cervical cancer.[5,6]
HPV vaccines efective against the two
strains of this large family of viruses
that currently cause approximately 70%
of cases of cervical cancer have been
licensed in the U.S, Canada, Australia,
and the EU.[7,8] Since the vaccines only
cover some of the cancer-causing (high-
risk) types of HPV, women should seek
regular Pap smear screening, even after
vaccination.
Risk factors
Infection with some types of HPV is the
greatest risk factor for cervical cancer,
followed by smoking. [9] Other risk factors
include Human Immunodefciency
Virus(HIV). [9] Not all of the causes of
cervical cancer are known, however, and
several other contributing factors have
been implicated. [10]
Some of the common Risk factors include
1. HPV
2. Age at frst sexual intercourse
3. Multiple sexual partners
4. OCPs
5. Social economic status
6. Smoking
7. Sexually Transmited Diseases
Human Papilloma Virus
HPV is a small deoxyribonucleic acid
(DNA) virus of approximately 7900 base
pairs. Papillomaviruses are double-
stranded DNA viruses that constitute
the Papillomavirus genus of the
Papillomaviridae family. These viruses
are highly species specifc; HPV infect
only humans. There are more than 100
types of HPV, which can be subdivided
into cutaneous or mucosal categories
based upon their tissue tropism. There
are over 40 HPV types that infect the
anogenital area. It is associated with
condyloma acuminata, anogenital
(cervical, vaginal, vulval, penile, anal)
squamous intraepithelial lesions and
malignancies, and head and neck cancer.
HPV is the cause of 70% of cervical cancer
globally. [11] Women who have many
sexual partners (or who have sex with
men who have had many other partners)
have a greater risk. [12,13]
HPV infection is largely sexually
transmited with peak incidence at age
of 20-24 years. This incidence gradually
declines upto 40-45 years but may begin
to increase slowly thereafter. A total of
80% infections are transient with infection
time median range of 12 months. These
have no risk of Cancer (CIN). Around 10-
20% infections are persistent and of high
risk of cancer (CIN). Only 30% of these
progress to severe cancer if untreated
with persistence being the important
factor for disease progression. Of the 100-
200 types of HPV, types 16 and 18 are
generally acknowledged to cause about
70% of cervical cancer cases. Together
with type 31, they are the prime risk
factors for cervical cancer.[14]
Cervical Cancer in Nepal
Cervical cancer is the most common
malignancy in Nepali women. [3] Infection
with HPV, acquired through sexual
intercourse is the cause of this cancer.
2010 data show that prevalence of HPV in
Nepal among the general population was
8.6%. Prevalence of abnormal Pap smears
was 3.6%. HPV prevalence was relatively
constant across all age groups. HPV16
was the most common type. [3]
A retrospective study by Jha et al in
2009, shows that the number of cervical
carcinoma showed a rising patern over
the last 10 year period. [15] The median
age of the patients was 45 years and
maximum frequency (33%) of cases was
found in the age group 40 to 49 years.
Squamous cell carcinoma comprised 40%
of cases, Adenocarcinoma 4% and 1.1%
cases were of mixed variety. 92% of cases
were Hindu by religion. 43% of patients
were smokers, 5% had positive family
history. Chitwan, with 7.35% had the
maximum number of cases followed by
Rupandehi with 6.40% and Nawalparasi
with 5.41%.[15]
Richa Bajimaya Memorial Foundation Newsletter I 7
No Country Institution
responsible
Vaccination
areas
Vaccination
delivery model
Girls age
group
(years)
Number of
vaccination
sites
1 Nepal NGO Mixed Mixed 9-13 24
2 Bhutan MoH Mixed School 9-13 9
3 Bolivia NGO Mixed School 9-13 57
4 Bolivia NGO Mixed Mixed 9-13 258
5 Cambodia MoH Urban Health facility 11-18 1
6 Cameroon NGO Mixed School 9-18 20
7 Haiti NGO Rural Mixed 9-13 7
8 Lesotho MoH Mixed Mixed 10-18 47
Table 1. Characteristics of the 8 HPV vaccinations project included in the Gardasil
Access Program, 2009-2011[6]16
HVP Vaccination in Nepal
A HPV vaccination project was done
through the Gardasil Access Program in
2009 to 2011 in eight countries including
Nepal. The purpose of the study was to
describe the results of and key concerns
in vaccination programs conducted in
seven lowest income countries through the
Gardasil Access Program (GAP). The GAP
provides free vaccine to organizations
and institutions in eligible lowest income
countries like Nepal, including the
3 doses of the vaccine required for a
complete vaccination series and promotes/
encourages the applicant country to
follow World Health Organization (WHO)
recommendation and guidelines for HPV
vaccination. The program was started in
Nepal, on 2010 with 24 vaccination sites,
targeting a total of 3000 girls, A total of
3164 girls aged between 9 and 13 years
were vaccinated, with 104% program
coverage in Nepal, and 99.1% cumulative
adherence of all three times of vaccination.
The results suggest that local organizations
and institutions can implement successful
HPV vaccination campaigns. Mixed
models comprising both school and health
facility setings appear to be the most
efective at delivering HPV vaccine to
target girls aged 9-13 years. Such mixed
models may increase the performance of
other vaccination programs and may also
be relevant to the delivery of other care
or preventive services for school-aged
children. Partnership between schools
and health facilities may also increase
the delivery of services to girls who are
not in school, although this may require
intensive resources in order to reach those
who do not have formal or routine contact
with schools or health programs. The
details are shown in table 1. [16]
The project evaluation showed adherence
to vaccination in Nepal to be 96.1% on day
one to 90.9% on day three. Adherence was
more when vaccination was done in school
seting compared to health facility seting.
There was strong community involvement
during the project.[16] This project shows
the feasibility of such a program, which
is a big necessity in countries like Nepal
where cervical cancer causes considerable
morbidity and mortality.
Recommendation
The main obstacle to a further
improvement of the situation is the high
cost and labour intensive nature of all
screening programs; for this reason, in
most developing countries like Nepal
global preventive programs have been
rarely implemented and almost ever
sustained; the usual picture is one of
litle fnancial support which entails poor
quality and low coverage rates. These facts
alone explain why mortality rates in the
less developed countries are twice those of
the industrialized ones.
Public health eforts should be made to raise
public awareness about the spread of this
virus and about the possibility of cancer.
The public should also be made aware of
the advantages of vaccination. To decrease
stigmatization, health education to school
children, and communication strategies to
young adults should be performed in order
to prevent this in all young girls. Universal
vaccination can also be performed, but
this may be a costly option. This has to
come from the policy level. Things to
consider and which may take precedence
would include the disease burden, health
care infrastructure and capacity to start
and perpetuate immunization program,
afordability and cost-efectiveness.
Currently, the biggest problem in Nepal is
the vaccines price. [2,4]
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Ferlay J, Shin H, Baray F, Forman D, Mathers C,
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Sherpa AT, Cliford GM, Vaccarella S, Shrestha S,
Nygrd M, Karki BS, et al. Human papillomavirus
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Singh Y, Shah A, Singh M, Verma S, Shrestha BM,
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8 I Richa Bajimaya Memorial Foundation Newsletter
World Cancer Day 2013-Did You Know
Cancer is surrounded by myths as
such! Even the most educated people
from around the globe lack the general
awareness necessary to live a lifestyle
that would lead to reduced cancer risks.
Excessive smoking, alcoholism, lack of a
balanced diet and exercise, and increased
exposure to high pollution and harmful
radiation are all common in todays
society. Total incidence and mortality
rates of cancer have gone up steadily in
the last few decades and are expected to
rise even further.
World Cancer Day is marked on February
4 of every year with a goal to signifcantly
reduce death and illness caused by cancer
by year 2020. Institutions and individuals
around the world celebrate this day to
spread awareness against the disease in
their own respective communities. Richa
Bajimaya Memorial Foundation (RBMF)
has also been an active participant on this
day every year.
On February 4, 2013, RBMF partnered
with Rotary Club of Yala, Dathutajhyal
Tole Sudhar Samiti, Spur Engineering
and School of Creative Communications
to organize a series of events right in the
heart of Patan. The goal was to reach
out to a larger population quickly and
efectively. The events we organized were
diferent from what general public was
used to, with a goal to fx our message in
peoples heads for a longer time.
Details of the events are as follows:
Information Session on Cancer: Dr.
Sudip Shrestha, Director of Bhaktapur
Cancer Hospital, Bhaktapur and
Chairman of Nepal Cancer Hospital,
Harisiddhi, Lalitpur started the days
event with a detailed information session
on cancer. The hard facts about cancer
that Dr. Sudip pointed out were meant to
make people aware of the disease and to
explain the ways one should deal with it.
More than two hundred individuals from
the locality atended the session.
Flash Mob: About 40 young boys and
girls wearing the United Against
Cancer t-shirts they received from
RBMF suddenly gathered in front of the
Krishna Temple in Mangal Bazaar shortly
after the information session by Dr. Sudip
Shrestha. Their goal was simple to grab
the atention of hundreds of locals and
tourists in the area! With a combination
of the latest hit songs and unique dance
steps, they managed to spread the
message against cancer in a lively way.
Locals were seen talking about the event
even hours after the day was over.
Candle Walk: To wish good luck to their
loved ones who are currently sufering
from cancer and to commemorate those
who died due to cancer, hundreds of
individuals, locals as well as volunteers,
then walked around the Square in a line
with a lit candles. The increased number
of people joining the line this year
compared to last refected the growing
solidarity of people against cancer. It was
a clear sign that people are geting more
aware and are willing to show support in
their own respective ways.
Candle Light: The fnal event marked
the lighting of a series of oil lamps placed
together such that they formed the outline
of the World Cancer Day logo. People
assembled around the logo after the Candle
Walk to light the lamps. In just a few minutes,
those lamps brightened up the entire area,
spreading a sense of awe and hope for our
fght against cancer. The lighting design
was done by Sanjeet Maharjan.
Teenagers and young adults have been
Richa Foundations prime targets since
its establishment in 2007. The age range
is when most people develop life-long
habits. So properly educating them about
the right habits and warning them about
the wrong ones could signifcantly reduce
their chances of geting cancer over their
lifetime. On World Cancer Day, we
had sought help from a group of young
and energetic individuals to spread the
message to people their own age, and
later to their respective families.
Changing peoples mindset takes time.
Most of our batle here in Nepal is to
achieve that change. We strive to convince
people that with the right atitude towards
life and a litle bit of information on the
disease, we CAN fght cancer. Thanks to
our partners and enthusiastic volunteers,
we were able to take a small step towards
achieving our goal on that day.
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Myth 4: Cancer is my fate
Truth: With the right strategies, more
than one in every three cancers can be
prevented.

Chabahil, Kathmandu, Nepal Tel/Fax +977-01-4484691
www.richafoundation.org.np info@richafoundation.org.np P.O.Box No.:23112