XTRA Health+ Newspaper May 2016 Issue 05

Most infertile couples are not aware of their conditions, but there’s still hope

Beating infertility... pages 02-03

www.healthplus.com.my

The Pulse of the Nation

may | 2016

Clean air, our right Tobacco use is the leading preventable cause of death globally. Besides harms smoking causes to smokers, exposure to second-hand smoke is a major health hazard. Clean air is our fundamental right. Health+ supports the Blue Ribbon Campaign to inform smokers and non-smokers about the potentially-deadly effects of tobacco smoke.

See pages 14-16

More fertility options for couples

Dr Helena Lim discusses alternatives to in vitro fertilisation and their selection factors

... pages 04-05

Bringing hope to the infertile

National Population and Family Development Board offers wide range of services to couples with fertility issues

... page 09

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Beating infertility Many infertile couples are not aware of their conditions, but there’s still hope

By Syed Zaid Syed Osman

M

ark and Alice were so excited when they decided to get started with their family. They had been looking forward to this since they first got married. Unfortunately, Alice had been focusing on her career for the last few years.

They wanted to get really stable for the children to come, and had therefore been delaying their plans.

After a good long talk, they finally made up their mind.

Fast forward to a year later, Mark and Alice were stressed out.

The plan they made was pushed a whole year back, and so after trying out traditional methods, the couple thought it was time to speak to a professional. After a few visits to their fertility specialist, it was confirmed that Alice is unable

Longing turns to loving Thanks to in vitro fertilisation, two women find happiness in conceiving and starting families

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n vitro fertilisation (IVF) is one of the few assisted reproductive technologies that help people with reproductive limitations to conceive children. The process can be described as manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus.

The technology is not really new, yet the average Malaysian has a vague understanding of this

conception method. As part of the Turning Longing Into Loving campaign organised by Parker Industries, two women who had gone through the IVF treatment shared their stories to help other couples have a better understanding of the procedure.

Zaitul Izam Lebossé and Sarasunathy Kuttan Pillai were married for some time and had problems with having children, not for their lack of trying.

DYNAMIC DUO: Zaitul (left) and Sarasunathy are happy to share their experiences with IVF and how they found happiness with children in their lives.

“I was married for eight years before I had my first child. We decided to take it easy and not have children for the first four years of our marriage. Then when we tried after the first four years, we found that nothing was happening, and that was when we looked into getting help,” says Zaitul.

Sarasunathy, on the other hand, says she and her husband wanted to start a family immediately. “I started undergoing

to conceive due to her low quality eggs.

What has happened to Alice may not be something many of us are familiar with. Maybe not for the majority, but according to Dr Muhilan Parameswaran, consultant urologist at Tropicana Medical Centre (TMC), one out of ten couples faces infertility problems.

“Many think babies are sure products of marriages. Sadly that is not the case for everyone,” he says.

It is believed most couples with infertility problems are unaware of the issue themselves.

Infertility, says Dr Navdeep Singh Pannu, consultant obstetrician and gynaecologist at TMC, is “where a couple are having regular unprotected intercourse with the will to conceive but are unable to in the duration of six months”.

He explains that there are various reasons why a person is infertile and the symptoms and diagnosis differ among genders. Some were unlucky and the source could be

IUI (intrauterine insemination) treatment in 2005 after failing to conceive. It didn’t work out and (this) went on until 2009 and I was still not getting pregnant. So we decided on IVF after that. In total, we were trying but not succeeding for nine years.”

Their challenges Both Zaitul and Sarasunathy obviously were very frustrated when they couldn’t conceive. Zaitul recalls going home to celebrate Ramadhan and being pestered by family members about her inability to have children.

“The societal pressure towards having children is strong among my family members. When you are married for eight years but still have no children, they will have something to say about it,” she says.

Their state of preparedness was also key for them to go for IVF. “When my husband and I did IUI, we were not prepared. By that I mean we didn’t prepare ourselves physically as we should have when going through the process,” says Sarasunathy.

“Financial preparedness is also very important,” Zaitul adds.

“The procedure is not cheap. My

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THERE’S HOPE: “Treatments are available to those who seek.

Infertility is not the end of the world.” – Dr Navdeep

traced back to their birth deformity. In other words, they were born with the inability and this is referred to as the primary cause.

Some have lost the privilege due to multiple causes and this is known as the secondary cause.

Back in the simpler days where Google and WebMD were yet to be discovered, the blame was on women. Only a handful of men, if not at all, contributed to the infertility chart while their fingers were pointing to the women. In light of recent data, Dr Navdeep says men are contributing to about just the same amount. He says during his years of practising he has seen many couples pointing fingers at each other. “The splits are quite simple – 30% men, 30% women, and 30% both, while the remaining 10% of the cases were inconclusive.”

From Dr Muhilan’s point of view, this issue does not discriminate between races. The odds of a Chinese couple being

infertile are basically the same as the odds of the Malays and the Indians. Furthermore, the issue is often found in couples in urban areas. “When the couples are back from work and are tired, their sex drive decreases. From that, the couples tend to delay their plans to conceive until they think they are ready,” he says. “In this case, time is not your friend.”

Dr Navdeep says it also shows that the total fertility rate among women decreases in locations where the people are career-driven.

According to both specialists, age is one of the outside factors that can affect the total fertility rate. As people get older, the grade of their produce decreases.

The sperm count and quality in men decreases with the ovary’s quality. “When a man releases his semen, millions are produced and within the semen, 80 to 90 million roughly, and it takes a minimum of 45 million sperm count to impregnate a woman,” says Dr Muhilan.

“After a man gets to a certain age, there are changes in his hormones. These cause the production to reduce the sperm count when he ejaculates.” Simply put, as a person gets older, the sperm count and quality steadily drops.

Dr Muhilan advises couples who are planning to have children to accelerate their plans before the women turn into their 30s. This increases the chance to conceive for the eggs’ quality is at its peak.

On the other hand, men are able to produce sperm until they die.

Unfortunately, after a man is around 40, the hormone level will drop, causing him to have less sex

Many think babies are sure products of marriages. Sadly that is not the case for everyone.”

– Dr Muhilan couples can achieve.

Sarasunathy says she and her husband get constant support from their family and friends. “We received more than enough support from our family and friends for our problems.” Although some of their advice involves traditional or alternative methods, they feel it had fuelled them to get help.

You need to focus on the problem and what you want to achieve. You want to have children; it doesn’t matter whose fault it is. Just seek help and solve the problem together.” – Zaitul husband was particularly worried about the cost while I had to prepare myself mentally. I was dealing with the confusion as to whether the treatment would work and how we will deal with it if it doesn’t.”

Both of them however found that preparing themselves physically and mentally was much easier with the help of their doctor Datuk Dr Prashant Nadkarni, the medical director of KL Fertility Centre. “He was very straight forward with me.

He told me the details of the procedure, the physical preparation as well as the financial (aspect),” says Zaitul.

Sarasunathy says the very detailed information provided by the doctor helped her to prepare more easily.

Finding support Both women agreed that the most important part of their experience was finding support from their husbands. “My husband was very open minded on the whole thing. He was the one who suggested that we go through IVF,” says Sarasunathy.

“It’s true,” Zaitul concurs. “My husband and I believe in science.

So it was easy for us to be on board with IVF once the doctor explained in detail to us.”

Getting their husbands’ support proved to be a blessing because both agree some men have an ego problem concerning fertility. Dr Prashant had told Zaitul and Sarasunathy that the inability to conceive is usually blamed on women, even though men could

drive and, as mentioned earlier, the count drops. In addition, the count for healthy perfect-shaped sperms may also decline.

“Treatments are available to those who seek. Infertility is not the end of the world,” assures Dr Navdeep. Fertility experts are on top of the case trying to develop more ways to help infertile couples.

Counselling and surgeries are available to assist these couples.

Dr Muhilan advises infertile couples to seek the attention of a medical expert instead of trying off-the-shelf drugs, which may cause only more complications to them.

ONE HAPPY FAMILY: Sarasunathy and her loving family.

be the cause as well.

It is not easy for some people to admit that when there is a problem, the fault could lie with them. So to have their husbands understand that and support the process is not something many

Their advice Sarasunathy explains that some men have an ego problem when it comes to infertility issue. “They feel that if they can’t have children, then they must be something wrong with their wives. This (notion) needs to be addressed properly.”

“We can read about it, we can hear stories about it, we can share our experiences with everyone, but at the end of it, the experience is different for everyone. You need to focus on the problem and what you want to achieve. You want to have children; it doesn’t matter whose fault it is. Just seek help and solve the problem together,” adds Zaitul.

Both Zaitul and Sarasunathy now live happier lives with their bundles of joy, and love to share their stories and experiences with everyone.

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A helping hand to conceive In vitro fertilisation is one of several assisted reproductive technologies to help infertile couples conceive

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By Ali-Azmin Hassan

etting pregnant nowadays is a challenge for some women. One might think: “How hard is it to get pregnant anyway?” It’s a little known fact that, in general, the rate of infertility worldwide is one in 10 couples. Our lifestyle is rapidly evolving both in positive and negative ways. The negatives, which include smoking, excess alcohol consumption and promiscuity, can affect your ability to bear a child and it’s not gender bias. It affects both men and women. And to a few who have trouble getting their own children despite their healthy lifestyles, unfortunately, certain things are just beyond your control. So things didn’t go as planned, and it’s okay.

But as they say, if there’s a will, there’s a way. In this day and age, we get to experience the marvels of technology and medical advancement. In the aspect of fertility, there’s in vitro fertilisation (IVF), a fertilisation process which manually combines an egg and sperm in a laboratory dish, and then transfer the embryo to the uterus.

Dr Wong Pak Seng (pic), medical director and fertility specialist at Sunfert International Fertility Centre, sat down with Health+ to discuss the issue of fertility and possible treatments.

The Process “Basically, in a standard IVF, the woman will go through the injection and we collect the eggs. And the man produces the sperm and then we fertilise them.

After that we keep them in an incubator for about two or three days. Then we choose the best-looking ones. Before we put them back into the womb, we do a genetic test. So we take a cell out and check and make sure it’s free from genetic problems such as Down Syndrome, chromosome problems or any abnormality. Then only we put the healthy one back inside.”

Another very advanced technology in IVF is the ability to put a camera in the incubator to observe the whole process of the formation of the embryo and its subsequent

growth. The purpose is to gain more information. “It helps us select the best one to increase the pregnancy rate,” explains Dr Wong.

RISKS Just like any other medical treatment, IVF has some risks involved. One of the most concerning questions regarding IVF is whether it increases the risk of having abnormal babies. Yes, says Dr Wong. “But the absolute risk is low. If you look at any woman conceiving naturally, the chance of having abnormalities (in her baby) is 0.5% to 1.7%. Abnormalities include cleft lip or hole in the heart problems,” he says.

“But if you do IVF, the risk increases by 0.2%, so it’s 0.7% to 1.7% chance of abnormality. So you can see the risk is not that high and it’s an acceptable risk. The risks are higher because it is artificially-induced pregnancy. It’s not natural and involves using medication and drugs to stimulate the ovaries.

Other than that, the embryo or fertilised eggs need to be washed with chemicals.

But of course it’s very friendly and not toxic to the embryo, but it’s still artificial.

“Basically, when we fertilise the eggs for men with very poor sperm, we cannot let them fertilise (on their own). We have to choose one sperm and inject into the

egg. We force it in and it’s called intracytoplasmic sperm injection (ICSI). If an unhealthy sperm is selected, it may affect the fertilisation. If the embryo is unhealthy, it tends not to stick to the wall. But even if it sticks, there’s a chance of miscarriage.”

Awareness among couples Dr Wong says other advanced treatments include intrauterine insemination (IUI), which is the insemination of the sperm into the womb, and test tube baby method. The greatest advancement in technology for fertility treatment is screening the embryo or fertilised egg to ensure it’s healthy before it is put back into the womb.

In terms of awareness, he says it’s important for couples to plan for children at a younger age. “Age is very important. We advise couples to get a child before the age of 35. Along this line, we also have something which is very new and getting very popular, and that is egg freezing. Let’s say you are now about 30 coming to 40 and you don’t have a life partner or (pursuing) a career or education, your chance of getting pregnant naturally or even with IVF will diminish,” he says.

“A possible alternative to that is you may choose to freeze your eggs first. After that, when you are ready to start a family, you have the option to use the eggs that are frozen. Previously, this was not very popular because the success rate was not very good.

But now with advancement in freezing technology, the success rate is very good and it’s reasonable to do that.”

hile in vitro fertilisation (IVF) is often regarded as the go-to treatment for couples with fertility problem, there are other options available, depending on the gravity of each situation.

Health+ talks to Dr Helena Lim Yun Hsuen, consultant obstetrician and gynaecologist at KL Fertility Centre, on key alternative treatments and their selection factors.

She advises couples with fertility problem to consult an obstetrician to help them select the most suitable treatment. The obstetrician will assess the couple’s situation to find out why they have difficulty conceiving, which can either be organic – whereby the problem lies with the body – or timing problem.

Dr Helena says there is a surprisingly high incidence of couples facing trouble having babies because they are trying at the wrong time. “This type of problem can be solved simply by knowing the wife’s ovulation period and trying at the right time.”

She says the root cause of infertility for which treatments are needed is actually organic in nature such as low sperm count in male and problems with ovulation in female.

Treatment options Scanning A number of treatments are available besides IVF, and the simplest one is to do a scan to find out when the woman is ovulating and advise the right time for the couple to try naturally. This, Dr Helena explains, is known as time coitus.

Hormonal medications or injections Then there are treatments for

Take care of your reproductive organ

By Syed Zaid Syed Osman Infertility has always been a taboo subject, especially among men who often try to avoid any discussion about their reproductive health. As a result, men often neglect proper care of their precious reproductive organs while some choose to dwell in the bliss of ignorance. According to Dr Muhilan Parameswaran, a consultant urologist at Tropicana Medical Centre, improper care of one’s body may lead to infertility. Egg and sperm quality can be affected by external factors such as:

Smoking

Harmful chemicals in smoke

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More fertility options for couples Dr Helena Lim discusses alternatives to in vitro fertilisation and their selection factors

PENETRATING: IVF treatment may involve ICSI procedure.

SHORTCUT: In IUI, sperm cells are injected directly into the uterus of a woman having difficulty conceiving.

in which the husband’s sperm is extracted, concentrated and injected into the uterus. “This type of treatment somewhat creates a shortcut for the sperm to reach the fallopian tube, where it will meet and fertilisation happens.”

This treatment, she adds, may increase the women’s chances of getting pregnant by 10-15% each time.

Intracytoplasmic sperm injection in IVF treatment According to Dr Helena, IVF is

SOCIALLY SPEAKING: Besides health problems, social interactions between people with different demographics also greatly affect fertility rate, says Dr Helena. problems which are organic in nature. For example, Dr Helena explains that some women have difficulty ovulating due to hormonal imbalance.

“For such cases, treatments will include hormonal medications or injections which will stimulate eggs to grow and ovulate properly.

After the treatment, the couple can then choose to try naturally by identifying the ovulation period or go for intrauterine insemination (IUI) treatment.”

Intrauterine insemination (IUI) IUI is a form of treatment proceeding the hormonal injections This habit can harm one’s sperm production as the heat can damage the penal artery over long exposure.

true guys: impact to the “manhood area” can lead to infertility.

Surgeries, drugs and medical procedures

Steroids release a high level of testosterone when consumed. The hormone is required to produce sperms. Once the level gets to the desired amount, the production of sperm ceases from natural causes.

Sperm responds negatively to certain types of surgeries, especially chemotherapy and radiotherapy.

Those who are undergoing these procedures are unable to produce sperm. The abuse of recreational drugs can also damage sperm production.

Sexually-transmitted infections

are cancerous. The chemicals affect other parts of the body as the nicotine travels through the blood and this can lead to erectile dysfunction.

Diet

Consumption of certain foods can interrupt with one’s hormonal balance which can directly impact the production of sperm. A correct

and healthy balanced diet is always one of the first steps to improve one’s health.

Heat

Technological advancements can be handy, especially computers which have evolved from desktops to laptops and the like, which are often placed on top of or near one’s private area.

different from IUI as it involves extracting a particular egg and sperm for fertilisation in the laboratory, after which it is put back into the uterus.

An interesting procedure is carried out in the fertilisation of the egg. Particularly for men with low sperm count, the fertilisation process involves intracytoplasmic sperm injection (ICSI) whereby a single sperm cell is injected directly into the egg, outmanoeuvring the natural process of fertilisation.

“In a natural state, the egg is protected by an outer shell. The millions of sperm cells ejaculated work as an army to penetrate the outer shell, leaving one single sperm cell to come in contact with the egg,” explains Dr Helena.

“With a low sperm count, the sperm cells ejaculated may not have the strength to successfully penetrate the outer shell. So with ICSI, the process is cut short significantly, ensuring better chance of conceiving.”

Dr Muhilan says certain infections can cause the obstruction in the sexual organ, thus withdrawing sperm from being released into the womb. Those who are sexually active are advised to always use protection.

Damage to penal artery

Any damage from a bike fall during a man’s childhood can go unnoticed until it is checked. The rumours are

Usage of steroids

Dry masturbation

This causes friction which will over time damage receptors located in the penal region.

Infertility is developed through poor hygiene and improper care of one’s private part. Some signs may take as long as 15 years without showing early symptoms, while others may show as soon as they develop. Some may be inevitable which make the difference matters.

Men and women need to understand their body functions and shortcomings in their physiques, and take the necessary steps to maintain good reproductive health.

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Fertility treatments in line with Islamic teachings JAKIM sheds some light on what Islam says about infertility and methods to fix it

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By Norman Hussaini

roblem in conceiving is universal and no respecter of person, race, colour or creed. It is widely understood to be caused by a number of factors, but the good news is various treatments are available to fix it. These treatments, some of which have almost been perfected over years of medical studies and testing, are proven to effectively treat this growing problem. Unsurprisingly, religion also talks a lot about fertility as well as treatment for infertility.

Some may believe there is a clear line between religion and science, which one should never cross no matter what. Therefore, it is important to know what religions say about the issue for which science has the answer to.

As the majority of Malaysians are Muslims, Health+ approached Department of Islamic Development Malaysia (JAKIM) director-general Datuk Othman Mustapha to lend a hand in explaining the matter.

What does Islam say about fertility treatments?

“Generally, the teachings of Islam implore everyone to seek treatment for any ailments which had befallen them,” says Othman.

“It is one of the key knowledge passed down from the Prophet Muhammad. Specifically in relation to fertility treatment, the Holy Quran does tell a few stories regarding past prophets and their issues to conceive. Infertility is a condition that is advisable to be treated if the couple has the desire to raise children.

“Moreover, getting married and raising a family is highly recommended in Islam as it is part of the Hifz al-Nasab (the preservation of ancestry).”

I s l a m ’s a c c e p t a n c e o f modern treatments So, to put it in simple terms, Islam fully supports married couples to have children. Therefore, when they don’t have the ability to do so, it is highly advisable for them to seek treatment. Yet one question remains: Are the modern, scientific treatments available go against the teachings of Islam?

Not at all, says Othman.

“JAKIM often works with the Health Ministry and other

VALID TREATMENT: Islam accepts IVF treatment and other fertility treatments as they do not go against the teachings of the religion.

agencies to inform Muslims in Malaysia about various medical treatments.”

He explains that the 5th National Fatwa Council Committee Discussion on Islamic Matters held in November 1982 had already shed light on the legality of “test tube babies”, also known as in vitro fertilisation (IVF) treatment.

The resulting fatwa (edict) says: Babies born through IVF treatment from seeds of two legally married Muslim couples are valid in Islamic law, while babies born through IVF treatment from seeds of two couples who are not joined legally are not valid.

Babies born from IVF treatment have the same rights as

babies who were born without the help of treatment.

If the technique of extraction of seeds from the male and female does not go against Islamic teachings, then the treatment itself is valid.

This clearly means that fertility treatments do not go against Islamic teachings. This is beneficial information for Muslim couples in Malaysia who have problems conceiving yet are sceptical as to the legality of the procedures available.

Othman has some advice for Muslims with fertility issues. “My advice to readers with possible problems to conceive is to be patient, seek help and treatment if you can afford it, and always trust in God for guidance and peace.”

Active, passive smoking linked to infertility

Infertility is a condition that is advisable to be treated if the couple has the desire to raise children.” – Othman

Both active and passive smoking are linked to infertility problems and early menopause in women, says a US study.

Although previous studies have already found a link between infertility and active smoking, researchers at the Roswell Park Cancer Institute also wanted to look at a link between infertility and passive smoking.

The study looked at a total of 93,676 women across 40 different centres in the US, who were all part of the Women’s Health Initiative Observational Study (WHI OS)

between 1993 and 1998. All of the women were between 50 and 79 years old and had already gone through menopause.

The team collected information on smoking, lifetime fertility status and age at natural menopause.

Those who smoked, or used to smoke, were asked how many cigarettes they smoked or had smoked daily, the age they had started smoking, and for how many years they had smoked.

Those who had never smoked were asked if, and for how long, they had lived with a smoker or had

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issues, you might want to think about fertility preservation. It’s always good to get ahead of the game before it’s too late.

Dr Wong says egg freezing is a way for women to preserve their fertility for the future. When a woman is ready to start a family, then egg freezing can come in handy when she is past her prime reproductive years. Pregnancy rates from frozen eggs will depend on the woman’s age at the time she freezes her eggs, and it will not be

affected by the time she uses them.

To retrieve eggs for freezing, a patient undergoes hormoneinjection process. After the eggs are retrieved, they are frozen for a period of time of your choosing. The freezing can last many years and can be used for in vitro fertilisation (IVF) whenever one is ready. Long storage of frozen eggs does not result in any decrease in quality.

Wong says egg freezing was previously not popular due to its low success rate. But now with advanced freezing technology, the success rate has increased and it’s a reasonable option now, he adds.

worked where someone smoked in the workplace.

After taking into account other lifestyle factors, the results showed that tobacco exposure through both active and passive smoking can hasten the natural menopause to occur before age 50 and can cause fertility problems.

Smokers and ex-smokers showed a 14% greater risk of infertility and a 26% greater risk of menopause before the age of 50 compared with those who had never smoked. And from the women who had the highest level of tobacco exposure, those who had started smoking before the age of 15 experienced the onset of menopause nearly 22 months earlier. Those who smoked more than 25 cigarettes a day experienced the arrival of menopause 18 months earlier.

In non-smokers who were exposed to tobacco through passive smoking, the highest level of passive smoke exposure, defined in the

study as 10 or more years of living with a smoker as a child or working with colleagues who smoked, or 20 or more years of living with a partner who smoked at home, caused the arrival of menopause 13 months earlier. In addition, these women were 18% more likely to have had infertility problems than women who had never been exposed to passive smoking.

Commenting on the results, the researchers suggested that the results could be due to the toxins in tobacco smoke, which are known to have harmful effects on hormones and reproduction, concluding that, “This is one of the first studies of this size and statistical power to investigate and quantify active and passive smoking and women›s health issues. It strengthens the current evidence that all women need to be protected from active and passive tobacco smoke.

The results were published online in the journal Tobacco Control. – AFPRelaxnews

Freezing eggs for future pregnancy

By Ali-Azmin Hassan

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n this day and age, women are more career minded and independent. Gender equality, feminism and women’s rights are truly among the greatest achievements of our times.

Most women nowadays will not simply bow down to the dogma that women are confined to being housewives. Such an idea is slowly but surely diminishing.

However, for every action, there’re consequences, and for

most women, chasing their careers means delay in marriage or child bearing. Work or education becomes their priority. Another major reason could be difficulty in finding a life partner. And when it comes to getting pregnant, age is a key factor. Dr Wong Pak Seng, medical director and fertility specialist at Sunfert International Fertility Centre, says chances of women getting pregnant beyond the age of 35 are slimmer.

If you are considering having a child in future but are facing these Creative Commons

FERTILITY THREAT: The results showed that tobacco exposure through both active and passive smoking can hasten the natural menopause to occur before age 50 and can cause fertility problems.

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or the Internet and they try to follow everything as suggested,” says Ong. “For some, even after they made the sacrifices and changes but still without success, they get even more stressed out. So by the time they come here, they’re already very stressful.”

Yes, infertility causes stress MindBody Fertility programme helps couples achieve positive experiences while pursuing fertility journey

By Ali-Azmin Hassan

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e live in a modern society where we are conditioned to believe that almost everything is instant. Whether you get a headache, cold or flu, the medicine is there for you. Everything seems to appear easy and fast, doesn’t it? And when we are used to this instant mentality, it gives us the perception that we are in control of many things in life.

However, when you are debilitated with something you have absolutely no control of, only then you realise there’s only so much we can control. And when we reach a point in life where we want a baby, to some, this is something out of their control.

CT Ong, a fertility coach of MindBody Fertility programme at Sunfert International Fertility Centre and the only certified HypnoFertility practitioner in Malaysia, shares with Health+ his experience as a fertility coach and how he advises couples on their struggles.

“A lot of people work so hard to conceive and it’s not within their easy control – besides seeking

medical help, they look into many other ways for help, such as prayers, alternative treatment, and even their diets. For example, they may deny themselves of coffee even if they crave for one every day. They get many recommendations like these from friends

COACH’S ROLE: Ong listens, reflects and assists couples to change their perception, and provides encouragement.

Desire to be in control The known fact is infertility produces a lot of stress for some.

And that is why we want to be in control. “Coming here, some people still have that perception and they want to do all this and that to increase their chances to conceive. To me, if it works, you would have got your baby a long time ago. But the fact that it’s not working and you’re doing the same thing is making you even more stressful. Why?” asks Ong. When one has decided to use in vitro fertilisation (IVF) to try to conceive, some may get the idea the treatment can be stressful.

Hence, they get more stressed even before the start of the IVF treatment and it is not helpful at all in this journey. It is worth to note that many are stressed up trying to get rid of the stress itself.

“If you look really into it, stress is a relative perception. People come here with a lot of different perceptions. But very often they mistakenly think that IVF is stressful. Here we try to show them it is their perception that is causing their stress,” says Ong. “I’ve found a few unique characteristics of those experiencing high stress. In my research, I found people who are low in emotional stability have higher chances of experiencing high stress. In addition, I noticed many also have high desire to be in control or very result-oriented type. Some of them also go through financial stress after years of seeking fertility treatment. Some get work stress and they are in dilemma whether to continue to be stressed at work or quit which then will cause even more financial stress.

“All these are causing them a lot of stress. As I’ve said, this is something that we have no direct easy control. And the more they try to do something to overcome it without understanding the root cause, the more stressful they become. My advice to them, escaping or doing more may not be necessarily helpful, if you are stressed up, seek help and you will understand yourself more in finding the effective ways to handle

“For some, even after they made the sacrifices and changes but still without success, they get even more stressed out.

So by the time they come here, they’re already very stressful.” the stress. We are here to take care of the emotional well-being of these people whose emotions are often not being acknowledged and accepted by society,” he adds.

Ong has many years of experience working with couples going through fertility issues and dealing with their concerns. “Eventually, we want to give them better quality of life, to show them that they have a choice to change their perception and enjoy life even while enduring this fertility journey. We have to coach them, teach them some techniques and what they can do to reduce their stress and even enjoy life,” he says.

JOURNEYING TOGETHER Sunfert is the first fertility centre in Malaysia to integrate MindBody Fertility into its standard IVF programme. The MindBody Fertility programme is designed to help couples achieve a positive experience while pursuing their fertility journey. “Our aim is to give them a different experience, a positive experience during the IVF process,” explains Ong. The programme helps couples address their issues so that they can go through the entire journey positively and hopefully successfully – before, during and after IVF. “This programme really helps the couple to hold together and work as a team. As a coach, my role is to listen, reflect and assist in a change of perception, and also to encourage them in this challenging journey.

“We must admit that it is not easy for them to share. This is not something to be proud of or talk with their friends easily. It is somehow still a social taboo and we don’t want to share this partly because it affects our self-esteem and most people don’t really know how to help us. As a result, people shy away from sharing this with their friends or families. Thus having a personal coach during this difficult time is really helpful to them,” says Ong.

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Bringing hope to the infertile

About 40% of infertility cases are caused by male problems alone, which seemed to have increased over the years.

Besides chromosomal and congenital defects, some of the associated factors are smoking, sedentary lifestyle leading to lack of exercise, environmental factors (work-related), medical problems, childhood mumps and stress.

National Population and Family Development Board offers wide range of services to couples with fertility issues

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growing number of couples are seeking consultation and treatment for fertility issues. As public awareness on fertility treatments gains prevalence, more and more specialist centres have been set up to cater to the growing need.

However, fertility-related treatments are not new in Malaysia as the government has been offering such services since 1979 through the National Population and Family Development Board (NPFDB). It is an initiative under the Ministry of Women, Family and Community Development as a way to consult families for the betterment of their quality of life.

In an email interview with Health+, Dr Komathy Thiagarajan, head of NPFDB’s men and women reproductive division, sheds some light on its services and some issues pertaining to fertility treatments.

What are the treatments offered by NPFDB? A variety of safe and effective modern contraceptive methods are offered, such as barrier method (condoms), hormonal methods (oral contraceptive pills, contraceptive injectables (hormonal implants) and nonhormonal method (intrauterine contraceptive device, IUCD). Counselling is provided by trained healthcare providers and clients are assisted in choosing the most suitable method based on their health status and lifestyles.

Where are the services provided? Are they conducted in government hospitals or does NPFDB have its own centre?

The family planning services are provided mainly in the 58 NPFDB static clinics called Klinik Nur Sejahtera and promotion done on mobile clinics and during outreach programmes. Family planning motivation sessions are also conducted in post-delivery wards in government hospitals.

Family planning clinic sessions are conducted in some government hospitals that request our expert services.

Are the services provided at subsidised rates?

Yes, they are.

Is treatment for infertility also provided?

Of course. Currently there are three NPFDB infertility centres – in the headquarters in Jalan Raja Laut, Kuala Lumpur; in Ipoh, Perak and in Johor Baru. A full range of infertility treatments are offered at the headquarters, which include counselling, treatment with fertility drugs followed by advice on timed intercourse, IUI (Intrauterine or artificial insemination) or, as a last resort, ART (assisted reproductive technology) including IVF (in vitro fertilisation) and ICSI (intracytoplasmic sperm injection).

Some severe male conditions may require referral to urologists, either in government hospitals or private centres. The infertility centres in Ipoh and Johor Baru

GIVING HOPE: Dr Komathy is one of three medical practitioners attached with NPFDB’s family planning and fertility treatment services.

offer treatment up to IUI stage, and thereafter clients are referred to the headquarters for ART. Are there any statistics on fertility and infertility rates among men and women in Malaysia?

Globally the infertility rate is about 10-20%. According to the Malaysian Population and Family Survey conducted by NPFDB, the infertility rate has increased from 6.9% in 2004 to 8.6% in 2014. The total fertility rate declined from 6.7% in 1957 to 2.1% in 2012.

Is infertility among Malaysians a growing problem?

Yes. Some of the contributing factors in females are late marriage, delaying childbearing, sedentary lifestyle leading to medical problems and obesity, and stress.

According to the Malaysian

Population and Family Survey, the mean age at first marriage for males had increased over the years from 28.9 years in 2004 to 29.3 years in 2014, and for females, from 25.3 to 26.2 years. Physiologically, the fertility rate (the chances to conceive) for women deteriorates with age The involvement of females in the workforce has gradually increased and is currently on par with males (51% in 2014). So, women tend to delay marriage and childbearing which in turn may affect their chances of getting pregnant.

About 40% of infertility cases are caused by male problems alone, which seemed to have increased over the years. Besides chromosomal and congenital defects, some of the associated factors are smoking, sedentary lifestyle leading to lack of exercise, environmental factors (work-related), medical problems, childhood mumps and stress.

There are many “alternative” treatments for infertility in the market which include products and massage treatments. What is your take on them?

There are some vitamin supplements with anti-oxidant properties which may to some extent improve sperm quality in some men.

Likewise, there are some herbal preparations that have been proven through research to improve sperm quality in some men. However, there are no alternative medicines to date that have been promising in treating female infertility problems.

I would encourage whole body massage as a means of relaxation for those who are highly stressed out. I don’t see any other benefit beyond that.

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may | 2016

More than just erectile dysfunction Erection problem not only wrecks sex lives but also causes family and relationship problems

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By Prasad Chandra Segaran

rectile dysfunction (ED) is perhaps one of men’s worst nightmares.

Most men who hit 40 have that nagging fear that one day they won’t be able to get or sustain an erection. Some may think ED is just a health condition but it is more than that. It is definitely more than an erection problem that affects the sexual lives of sufferers and their partners, but it also causes family issues and relationship problems.

Men with ED are unable to get an erection or sustain that hardness while trying to have sexual intercourse. The frustrating result is that both the affected men and their partners fail to achieve their shared goal – sexual dissatisfaction.

According to studies, more than 70% of men who suffer from ED are above 50 years old. However, younger men are not spared – even those as young as 20 are known to be afflicted with this universal

erection problem.

Why do some men suffer from ED while others are seemingly blessed with a stiffed manhood well into their senior years?

Brig Gen (R) Datuk Dr Selvalingam Sothilingam, consultant urologist at the University Malaya Medical Centre, tells Health+ ED has many possible causes.

Psychogenic, organic ED He says ED can be categorised into two big groups – psychogenic and organic. Psychogenic ED is due to psychological problems and affects mainly younger men. “It can be due to depression, anxiety and even relationship problems,” he explains.

“Psychogenic ED can happen suddenly to a man – it can happen even in a day. Men who suffer from psychogenic ED still get their usual hardness during their sleep and in the morning but they come to us complaining of ED because they can’t perform well. To treat this, we provide counselling to the patients by asking what is that they are worried about and then counsel them on that,” explains Dr Selvalingam. Patients suffering from severe anxiety problems are referred to a psychologist.

Organic ED, on the other hand, is due to complications from other diseases like diabetes and high blood pressure. For men with these diseases, the blood flow to the penis is insufficient to get or sustain an erection. “Diseases like diabetes and high blood pressure can affect flow and the nerves.

(Certain) medications taken by patients can sometime lead to ED,” says Dr Selvalingam.

At times, men who had gone through major surgeries after serious accidents can also develop ED when blood supply to the penis is insufficient. Even patients who have gone through spine trauma can be affected

by ED. Symptoms “ Well, a man will obviously realise he is suffering from

Older mans will have some symptoms if they have testosterone deficiency.

They will often have mood swing, get muscle ache, feel tired and have bone pain. In such cases we will prescribe testosterone supplements to the patients.”

– Dr Selvalingam ED because he won’t be able to penetrate or sometimes there is penetration but it softens up, during which the man and his partner will definitely notice that. Then the man comes to us complaining of ED,” says Dr Selvalingam.

During the early stages of ED, the person can still get an erection, but progressively the hardness or his ability to sustain it will be wane over time, he explains.

When a man is suffering from ED in his 40s, he should seek medical attention as evidence shows that ED preceeds cardiovascular disease. This is because the penile artery has a smaller calliber than the coronary artery and often gets blocked first. If the patient doesn’t improve his lifestyle he can have a heart attack in future.”

Dr Selvalingam says a study has shown that about 10% of men in Malaysia are suffering from testosterone deficiency.

THERE IS HOPE The bad news for men with ED problem is they’ve no choice now but to live with it until someone finds a way to reverse the condition. That will indeed be a day of rejoicing for such men and their partners! Meanwhile, they still need to rely on medications like Viagra to help them get an erection and have sexual intercourse. Such medications must be prescribed by medical doctors.

“In some serious cases, we do a penile implant which is done through surgery to implant a particular device into the penis.

This will be used to pump water into the penis instead of blood to enable the man to get an erection.

“Some people are working on a new technology called low intensity shock wave therapy to overcome ED,” says Dr Selvalingam. However, to reverse ED, may be something in the far future, he adds.

Some people claim herbal products are effective but the

main concern is many of them have not been scientifically proven.

“Sometimes there is even mixture of Viagra in the herbal medicine where the percentage can be high or low. This can actually lead to side effects and in some cases, people had died after taking unreliable medication,” says Dr Selvalingam.

Testosterone deficiency Why do men often suffer from ED when they get older? “One of the factors may be because they have testosterone deficiency. Testosterone is also important to have sex urges and to help with erections,” he adds.

“Older mans will have some symptoms if they have testosterone deficiency. They will often have mood swing, get muscle ache, feel tired and have bone pain. In such cases we will prescribe testosterone supplements to the patients. A study has shown that about 10% of men in Malaysia are suffering from testosterone deficiency.”

Educating men Professor Dr Zulkifli Md Zainuddin, deputy director of human resources and development and senior consultant urologist of Hospital University Kebangsaan Malaysia (HUKM), says the hospital is educating men on ED because it is directly linked to cardiovascular disease. “Men affected

by ED are not coming forward to consult a doctor as they see it as an embarrassment. HUKM is trying to employ more male nurses in the urology department, especially for ED cases,” says Dr Zulkifli at a recent talk.

Stand-up comedian Harith Islander says it is risky for men to delay and wait for the right time to consult a doctor. “Rather than going when it’s too late, why don’t you go when everything is fine? Patient should depend on themselves. It is not fair to rely on someone else when you can’t rely on yourself.”

• 11

2016 | may

Coming strong in weak moments

The number of men having ED is quite high.

People don’t realise this because men don’t come forward to tell if they have ED.” - Dr Hemanth

Don’t be shy but come forward to seek medical help if you have ED problem

O

ur society may be more educated than ever before, but when it comes to the issue of erectile dysfunction (ED), not many are willing to confront it. Why is that men are generally hesitant to talk about something which they know shouldn’t be that way. Do they fear facing the hard reality or are they too embarrassed to talk about this taboo subject? For whatever reasons, many people still shy away from even stepping into a doctor’s clinic to seek medical help.

Tropicana Medical Centre (TMC) consultant urological consultant Dr Hemanth Kumar Ramasamy wants to change that mindset and encourages people with ED to come forward to seek medical help. Due to the shortage of urologists, Dr Hemanth also handles male fertility patients as well although TMC is essentially a fertility specialist hospital.

Taking the first step He says ED is quite prevalent among Asians and affects about 10% of men, although the severity varies from mild to severe.

“The number of men having ED is quite high. People don’t realise this because men don’t come forward to tell if they have ED.” Dr Hemanth says ED awareness among Asians is still relatively low and this is why many people feel uneasy talking about the problem. Taking the first step, which is walking into a doctor’s room, is already overcoming the first barrier,

he adds. “ED means embarrassment to most men. I have worked overseas and people there didn’t find it hard to walk into a clinic to share their problem. They walked straight to me and said ‘doctor, I am having this problem and I need some help’.”

Knowing what causes ED is crucial and so a doctor needs to understand a patient’s underlying problems. “The doctor will get the (entire) patient’s history, including psychological problems due to work and relationship stresses.

If you are having problems with your partner, getting an erection is going to be tough. In some cases, there is nothing physically wrong with the patient, and the doctor will send him to a psychiatrist to get some advice or counselling.

Physical screening will be done to determine whether the patient is suffering from any other complications like diabetes, hypertension or high cholesterol,” he adds.

Are overseas treatments for ED better than those available locally?

No, says Dr Hemanth, pointing out that medical technology in Malaysia has progressed and is on par with developed countries.

“Treatments here are the same as

Dr Hemanth explains that ED is quite a common occurence among men, yet the difficulty for them to come forward still lacking.

overseas. There’re over 100 urologists in this country and all of us are trained to treat this problem.”

Four types of drugs are used to treat ED, each performing different actions. The attending doctor will prescribe the required dosage based on a patient’s need.

COMPLICATIONS Dr Hemanth says ED may sometimes cause complications like heart disease and mega psychological problems. It can also lead to low self-esteem and

major depression. “It is proven that smoking can be a main contributing factor to impotency.

This is because cigarettes contain various kinds of chemicals which can cause arterial narrowing.

Smoking causes arteriosclerosis (thickening and hardening of the walls of arteries) which can lead to ED. People need to stop smoking to prevent various kinds of diseases.”

Dr Hemanth encourages those suffering from ED to pick up their courage to discuss their problem with a doctor as any delay may lead to other complications.

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may | 2016

Promoting public awareness on reproductive health

Fertility rate nearing replacement level Gradual drop from 3.29 children per woman in 2000 to 2.58 in 2014 in line with global trends

By Norman Hussaini

M

alaysia’s fertility rate has been declining since 2000, dropping from 3.29 children per woman to 3.07 in 2005, 2.7 in 2010 and 2.58 in 2014.

Federation of Reproductive Health Associations Malaysia (FRHAM) chairman Dr Philip Kho in revealing this to Health+ says: “Global fertility rates are in general decline and this is more pronounced in more developed countries.”

Identifying the rate To clarify how the fertility rate is calculated, he says the country’s total fertility rate in 2014 was 2.58 children born per woman. “This gives the figure for the average number of children that would be born per woman if all women lived to the end of their childbearing years and bore children according to a given fertility rate at each age.

“A rate of two children per

woman is considered the replacement rate for a population. Rates above two children indicate population growing in size and whose median age is declining.

For comparison, the total fertility rates in 2014 in neighbouring countries were 0.8 in Singapore, 1.5 in Thailand, 2.18 in Indonesia and 3.06 in the Philippines.”

Contributing factors Dr Kho says the decline is due to various factors, and in women, it’s mainly attributed to the increasing trend of delayed pregnancy.

“The chances of getting pregnant decline with age. A healthy 30-year-old has a 20% chance of getting pregnant but this declines to 5% for a 40-year-old. Success rates of assisted conceptions like test tube babies (IVF – in vitro fertilisation) also decline with age,” he says.

Yet to put the blame wholly on women is not fair. Dr Kho says that in men, environmental factor – such as diets, lifestyle habits and working conditions – play a key role in their declining fertility.

Obesity – one of the country’s biggest lifestyle diseases – is also a contributing factor.

NEVER TOO LATE: The chances of getting pregnant decline with age, says Dr Kho.

Public views Reproductive health is still a sensitive subject which people tend to steer away from, especially in public. However, public awareness on fertility in general is growing.

“More are aware about the factors leading to infertility and the help they can get to possibly treat the issue,” says Dr Kho.

The Federation of Reproductive Health Associations Malaysia (FRHAM) is the leading non-governmental organisation (NGO) dedicated to educate, promote and support Malaysians in family planning, sexual and reproductive health and responsible parenthood.

Established in 1959, it is one of the pioneering NGOs to help Malaysians be more aware of the importance of their reproductive health.

Its chairman Dr Philip Kho, a consultant obstetrician and gynaecologist based in Kuching, says FRHAM’s mission is to champion sexual and reproductive health and rights for everyone, particularly the marginalised and underserved.

Its vision is that all people in Malaysia have access to information and services on sexual and reproductive health and rights.

“FRHAM is the leading NGO in family planning services and reproductive health. FRHAM advocates for healthy mothers and babies through its mantra of pregnancies being ‘Not too early, Not too late and Not too close’.”

As an established organisation, FRHAM is well-versed with the people’s problems regarding fertility rate which is declining as infertility rate rises.

Its plans for the next seven years include: Implementing and promoting policies and programmes that respect, protect and fulfil sexual reproductive health rights and gender equality.

Informing and empowering people in Malaysia to act on sexual and reproductive health and rights. FRHAM aims to engage and reach out to government agencies, women’s groups, media and 100,000 youths.

Providing quality and integrated sexual and reproductive health services to every one, especially the marginalised and underserved, and establish aged-friendly programmes in 50% of the states.

Be a high performing, visible and accountable NGO by building a strong and committed volunteer base and having skilled and competent staff.

• 13

2016 | may

why people are diabetic, based on WHO’s report of type 2 diabetes counts for 90% of diabetes cases worldwide.

United Nations SecretaryGeneral Ban Ki-moon marked this year’s World Health Day with a urgent call to step up global efforts to halt the rise in diabetes and improve the lives of those living with the dangerous, yet preventable and treatable condition.

The WHO had outlined the measures needed to be taken by organisations around the world to commemorate World Health Day 2016. It includes expanding health-promoting environments to reduce diabetes risk factors and strengthening national capacities to help people with diabetes to receive treatment and care needed to manage their condition.

HEALTHY CROWD: The crowd following a simple exercise for diabetics during the launch of World Health Day.

Beacon of hope World Health Day 2016 focuses on halting diabetes amid growing awareness on healthier lifestyle

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By Norman Hussaini

iscussing diabetes – the modern, mostly lifestyle disease of epidemic proportions – can be as stale as the potato chips you left out on the kitchen counter a week ago. Many people already know about it, yet the need to put it into the spotlight never wavers.

This is because diabetes is very prevalent, to put it nice and simple.

The World Health Organisation’s (WHO) global report on diabetes shows 422 million people are living with it, with 1.5 million deaths each year.

On April 7, the World Health Day celebration had put diabetes into its crosshair to try and further broaden the awareness of it around the globe. Themed “Diabetes: Scale up prevention, strengthen care, and enhance surveillance”, it works as a goal set up by the WHO to halt the rise of diabetes.

World Health Day is celebrated every year to mark the anniversary of the founding of the WHO in 1948.

The theme selected annually highlights a priority area of public health currently washing over the earth’s population. It provides an opportunity for individuals in every community to get involved in activities that can lead to better health and ultimately, better future.

BEAT IT: This year’s theme is to halt the rise of diabetes globally, focusing primarily on the younger generation, as seen in this official art initiated by the WHO.

Diabetes and people The relationship between diabetes and people has existed long before any of us had ever lived. It was one of the first diseases ever recorded in the history of man, within an Egyptian manuscript from 1500 BC. The disease, however, was only a drop in the bucket of history then, as it was a rare condition.

This was probably due to people’s diet in the times of Egyptian kings and the Roman empire. The scarcity of food, the strenuous manual labour and the hardship of living in times of war seemed to have made diabetes almost non-existent.

Its prevalence now only reflects the evolution of lifestyle humans had gone through. Food now comes just as easy as a tap on a touchscreen or a press of a button, making us eat more which then leads to overweightness and obesity. Obesity is THE culprit

Beating diabetes locally Malaysia has been crowned “the fattest country in Asia” last year with current statistics showing about 3.5 million people are living with diabetes. On April 7, the Health Ministry launched World Health Day 2016 in Gombak, Kuala Lumpur, as an effort to reinforce the awareness of Malaysians towards diabetes.

In lieu of the event, the ministry launched a revised version of the national guideline for the clinical treatment of diabetes mellitus aptly named Tumpaskan Diabetes (Defeat Diabetes) which added 11 new chapters and, for the first time, discussing sexual problems faced by women with diabetes.

The programme was officiated by Deputy Health Minister Datuk Seri Dr Hilmi Yahaya, who was accompanied by Selangor Deputy Health Director Dr Murniati Hassan and Malaysian Endocrine and Metabolic Society president Professor Dr Nor Azmi Kamaruddin.

There were various activities including simple exercises for diabetics, several free health check-up booths, and health forums discussing diabetes and other related diseases.

Halting the rise – is it impossible?

Diabetes is highly unlikely to be eradicated completely. In fact, the rampant rise in diabetes cases over the years means the condition is becoming more and more synonymous with our modern way of living.

Yet with the increased number of diabetes cases, the level of awareness on the disease is also increasing. The growing awareness on a healthier lifestyle can be a beacon of hope for us to at least slow down the number of people contracting diabetes, if not completely stopping it.

So, is it impossible to halt the rise of diabetes? Of course not, but it is up to you and me to achieve what World Health Day 2016 has set out to do. It is, and always will be, in our hands.

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may | 2016

Creative Commons

Clean air, our right Research shows air pollution emitted by cigarettes is 10 times greater than diesel car exhaust

By Huang Ruifu

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e all need clean air to live healthy and enriching lives. All too often, this fundamental right seems too obvious in our increasingly urbanised world.

Since we spend so much time indoors, the question of clean air is even more important whether that be in our homes, offices, schools, health centres and wherever we go. And many of us take clean air – or the lack of it – for granted. However, in recent years, with the almost seasonal haze blanketing us and disrupting our lives, clear air is certainly a commodity we have obviously learned to treasure.

Whenever we talk about air pollution, we all tend to point our fingers at industry, traffic and open burning, among others, as the chief culprits. But, if we really analyse the air we breathe, it is fairly obvious that smoking pollutes the atmosphere and quite often the ground too.

However, it is not always obvious how much smoking pollutes the environment.

How smoking harms environment It is a common misconception among cigarette smokers that they are hurting only themselves. The truth is they are not hurting only themselves, but also the earth, and everybody and everything on it, in our generation, and the generations to come.

Studies show that cigarettes contain over 4,000 chemicals

which are exhaled and released into the air. Research shows air pollution emitted by cigarettes is 10 times greater than diesel car exhaust. Environmental tobacco smoke produces fine particulate matter, which is the most dangerous element of air pollution for health.

Trees are often compared to the lungs in our bodies because they perform basically the same functions as our lungs do, albeit on a global scale. With all the pollutants that trees already filter out for us, it is illogical for any of us to add more to the air that doesn’t need to be added. We need to breathe, but no one needs to smoke.

While the problem is invisible to us, the fact is that fine dust or particulate matter (PM) ranging from 10µm (PM10) to as tiny as 2.5µm (PM2.5) can cause serious lung and heart health problems.

The World Health Organisation (WHO) estimates that two million people die every year from small particulate matter in the air. Other health problems are coming to light. For instance, a recent study showed a

correlation between higher levels of particulate air pollution and higher numbers of babies born with low birth weights.

Second-hand smoke Thanks to the aggressive antismoking campaigns carried out by the public and private sectors, people living in Malaysia have become more and more educated on the various forms of heart disease, lung disease and cancers caused by smoking. It is also common knowledge that smoking causes discoloration of fingernails and teeth as well as other cosmetically-damaging effects.

However, one of the most overlooked issues in the whole equation is the deadly effects of second-hand smoke. According Article 8 of the WHO Framework Convention on Tobacco Control, an international health treaty signed and ratified by Malaysia, scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease and disability. It says parties should adopt and implement measures providing for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.

The WHO guidelines state there is no safe level of exposure

“Trees are often compared to the lungs in our bodies because they perform basically the same functions as our lungs do, albeit on a global scale.

With all the pollutants that trees already filter out for us, it is illogical for any of us to add more to the air that doesn’t need to be added. We need to breathe, but no one needs to smoke.”

to second-hand smoke, which contributes to a range of serious and often fatal diseases, including heart disease, respiratory illness, and lung and other cancers. Completely smoke-free environments with no exceptions are the only proven way to protect people from second-hand smoke.

It is interesting to note that the WHO guidelines stipulate that separate smoking rooms and ventilation systems do not prevent second-hand smoke exposure. Governments are expected to maintain strong support for laws once they are enacted through proactive and uniform enforcement that achieves high compliance levels.

Besides the WHO’s stronglyworded guidelines on second-hand smoke, various studies have also confirmed that second-hand smoke contains carcinogens, toxic metals and poisonous gases. Special scans carried out by some studies have revealed the deadly effects of second-hand smoke. Researchers have shown by using magnetic resonance imaging (MRI) that long-term exposure to second-hand smoke can be a killer.

The MRI scan used was a special type which uses colours to show damaged and undamaged areas of the lung. For instance, researchers from the Department of Radiology at the Children’s Hospital in Philadelphia, United States, showed that long-term exposure to second-hand smoke causes structural damage to the lungs that significantly increases the risk of lung cancer and emphysema. Emphysema is a lung disease where the alveoli collapse making it very difficult for enough oxygen to get into the bloodstream and to remove waste carbon dioxide from the bloodstream. It is common among smokers and a major killer in many countries where smoking is prevalent.

Impact on babies, children Babies of expectant mothers and newborn children exposed to second-hand smoke are more prone to sudden infant death syndrome. Smoking by parents causes respiratory symptoms and slows lung growth in their children, adds the report.

Every exposure to the cancercausing chemicals in tobacco smoke can cause grave diseases, and children are particularly vulnerable. WHO studies also found that young children exposed to second-hand smoke at home are twice as likely to start smoking as those who are not. There are also more likely to have positive thoughts about the smoking habit.

In view of the deadly effects of smoking and second-hand smoke, it is obvious that we all need to work together to restore our fundamental right to clean air, and Health+ fully supports any effort towards a cleaner and healthier environment.

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2016 | may

Blue Ribbon says no to tobacco MySihat adopts WHO initiative to rally support of local businesses for nonsmoking movement

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By Norman Hussaini

t has been proven time and time again that smoking causes various negative effects to our health and wellbeing, and the awareness for people to curb the smoking habit is almost as old as the cigarette itself.

Yet, the habit is still alive and well today. For this reason, the World Health Organisation (WHO) has initiated a campaign to tackle the unhealthy and potentiallydeadly smoking habit.

The global Blue Ribbon campaign is to rally local businesses, organisations and individuals to spread the word to promote the no-smoking lifestyle by awarding their efforts – and perpetually attracting the public to do the same.

Nationwide campaign The Malaysian Health Promotion Board (MySihat) helms the WHO initiative in Malaysia. Led by its CEO Dr Manimaran Krishnan, MySihat aims to bring Blue Ribbon campaign nationwide to tackle the widespread smoking habit.

Manimaran explains to Health+ the prevalence of smoking in Malaysia and the diseases related to it. “Looking at the data collected by the ministry (of health) over the many years, we have not seen a very significant decline in numbers of smokers and the cases of illnesses related to it. Moreover, we are seeing the average age of smokers is becoming younger. This is why the smoking habit is worrying.”

The National Strategic Plan for Tobacco Control initiated last year aims to promote, among others, the no-smoking lifestyle to youngsters born from 2009 onwards to ensure a better, healthier future for them as well as the environment.

Challenges abound Of the many challenges faced by smokers to quit the habit,

Manimaran points out that the desire to quit is perhaps the most daunting.

He explains that the awareness to live a healthier lifestyle is linked to the different cultures in which Malaysians have been brought up.

“It is because of the way we have been brought up and how our families have raised us.

“These factors result in the different ways we perceive and manage our health and well-being in general.”

This, he says, reflects how well we want to improve our health.

“To stop smoking is easier said than done, and this is a fact. So the real challenge is how strong an individual’s desire is to actually quit.”

Enforcing no smoking It is almost impossible to force any smoker to just stop smoking, and perhaps it is not the right way of doing it either. The Blue Ribbon campaign is aimed at tackling this particular factor, says Manimaran.

“The purchasing power of cigarettes in Malaysia is still very high, as with the accessibility to smoking areas, which indirectly make it even harder for smokers to let go of the habit.”

The nationwide campaign advocates a no-smoking culture by certifying and awarding organisations and businesses which had made efforts to keep their working environments tobacco-free, subject to some established criteria set by the WHO. MySihat believes that by promoting the Blue Ribbon certification to organisations, it can further induce the public to stop

ALL THE WAY: MySihat aims to bring the campaign nationwide to tackle the widespread smoking habit, says Manimaran.

The purchasing power of cigarettes in Malaysia is still very high, as with the accessibility to smoking areas, which indirectly make it even harder for smokers to let go of the habit.” smoking. This is because the move will limit accessibility to cigarettes and smoking areas in offices, restaurants and other public places.

Can it work?

The campaign is definitely an interesting initiative to raise the awareness against smoking, with the aim of developing a healthier and cleaner environment, especially in urban areas. But will it really work?

“I believe the campaign will come into fruition. There are

already hundreds of participants in the country applying to be certified with the Blue Ribbon.

The reception towards it had also been very good. We will be able to see changes in our smoking habits in Malaysia soon,” says a confident Manimaran.

With hundreds of organisations applying to be supporters of the no-smoking movement, the prospect of the campaign having a substantial impact seems imminent. Yet, at the end of the day, what truly matters is a person’s willingness to want to change and stop smoking. As stated earlier, forcing someone to quit is almost impossible. However, by creating a wider and more prominent awareness towards a healthier and more enriching life without tobacco, we as a nation might just be able to stop the unhealthy and potentiallydeadly habit, and restore the clean air that rightly belongs to all of us.

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may | 2016

Denormalising smoking in public

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he Blue Ribbon campaign was initiated by the Western Pacific Division of the Who Health Organisation (WHO) in 2012 in Singapore and was officially launched in Malaysia in 2013 by the Health Ministry.

The campaign aims to empower and recognise individuals, groups, institutions, local governments and other organisations to continue working to denormalise smoking in public and advocate for smoke-free environments.

It has been extrapolated by the WHO that exposure to secondhand smoke is a major hazard to public health. Research had shown that there is no safe level of exposure to second-hand smoke, with even a brief exposure to the chemicals emitted by it could cause cardiovascular diseases.

In 2010, it was estimated that more than 600,000 people died globally from exposure to

second-hand smoke, and 28% of the deaths were children. In Asia and the Pacific, more than half of women and children are regularly exposed to second-hand smoke in public places and at home.

These key factors prompted the WHO to come up with the campaign to raise awareness on the dangers of smoking and also the harm of second-hand smoke to the general public.

The WHO encourages health ministries of member states to take full ownership of the national campaign consistent with the objectives of the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific Region (2010-2014).

The action plan encourages member states to develop a system to publicly recognise outstanding contributions of allies and partners as well as to reinforce social mobilisation efforts in regards to a non-smoking environment.

Criteria for certification There are three categories of awards for presentation to organisations, establishments or individuals who have contributed in support of a smoke-free policy:

 Certificate

This is given to any premises or establishments which have implemented smoke-free indoor and/or outdoor.

 Media award

This is awarded to the mass media, print or electronic, in recognition of their outstanding work in publicising and creating awareness of smokefree policies in line with the Blue Ribbon campaign objectives.

 Outstanding achievement award

This is given to advocates of smokefree environment.

Criteria

Demonstrate management’s commitment with written statement indicating that the premises practise smoke-free policy.

Exhibit premises’ smoke-free policy/statement conspicuously on a signage no smaller than A3 size.

Smoke-free policy communicated to members and customers.

Install adequate “no smoking” signages in any conspicuous area of the premises, especially at the entrance.

Not selling cigarettes/tobacco products or any product associated with the brand or cigarette manufacturer.

Not putting up posters or any form of cigarette advertising/ promotion.

Does not provide any facility

for smoking, including ashtrays, litter bins with ashtrays and room/ smoking area.

Do not exhibit any smoking activities on the premises.

Install posters on the dangers of smoking and exposure to secondhand smoke hazards, including distributing leaflets to members or customers.

Facilitate/prepare/manage quit smoking services for members who smoke.

Efforts of the owner or residents of the premises in promoting creative smoke-free premises campaign.

Have available mechanism/ approach to ensure that no person smokes in the premises.

Information extracted from the Blue Ribbon Campaign website at www. myblueribbon.org.my.

How it will be implemented The WHO has established a few implementation strategies to be used by the health ministries of member states.

The first is to establish a steering committee to develop plans to recognise individuals or groups with abilities to monitor with efficiency.

Other than that, the implementation will also include orientation meetings, creating a symbol for the national campaign, deciding the timeline for nominations and receipt of applications, criteria for selection and organising public events to announce the recipients.