PADEL

 Padel is a sport that combines elements of tennis, squash, and badminton. It is played on a smaller court with solid walls and a net, using paddles and a plastic ball. This sport has recently gained a lot of popularity worldwide. It is fun, social, and fast-paced, and it is easy to learn and play, making it accessible to people of all ages and skill levels.

My husband started playing Padel last year, and when he asked me if I was keen to try I became defensive, saying that my working hours are long and unpredictable to book anything, and have never played any racket sports in my life and I am not interested in trying anything new. On top of that, I have a toddler that I have to look after when I get home. Back then I was working very far from home and the long drive was a big challenge. I got a new job just around the corner from my house and the working hours improved. Winter was over and I was in a more outgoing mood. I met my old friends in the Bryanston sports club. I found new padel courts that night and I watched people play, and I really enjoyed the vibe. That was the time I reached out to my husband to show me the logistics of how to book a court, hire rackets, and play the game.

I loved the first Padel game! It was exciting and competitive! I was running around the court trying to get the ball, sweating and not knowing how the time is passing. It was me and my Serbian friend versus my husband and his friend. We played for one and a half hours. Then we sat down had a drink and enjoyed watching other people playing. 

It is something I would like to continue playing. It improves hand-eye coordination and reaction time which is something I need to work on. It is a good cardiovascular exercise and helps with burning calories. The social interaction is very nice and every padel court has a nice café next to them overlooking the courts. It is something I look forward to the whole week, it is extremely fun and helps with stress relief.

 

 

 

BREAT CANCER AWARENESS MONTH

 October is Breast Cancer Awareness Month. It creates an opportunity to raise awareness and funds for breast cancer research, diagnosis, treatment, and support. It is one of the most common malignancies in women. The survivors experience severe trauma and major health issues. It is scary to know that 1 in 8 women will develop breast cancer in their lifetime. Early detection and treatment improve survival rates.

Most of us have a friend or family member who has been through the breast cancer treatment journey or has surrendered the battle. One of my colleagues whom I met during community service was diagnosed with early stages of breast cancer five years ago. She has been disease-free after her operation and chemo-radiation therapy. Another friend of mine that I met in the meet-up groups is also known to have been through the breast cancer treatment process and has been disease-free for over ten years now.

There are numerous ways to help raise funds, such as participating in different fundraiser events or functions. Wearing pink clothes and accessories shows support and increases awareness for the public. We need to educate women to perform self-breast exams and get mammograms to pick up the disease at an early stage. Pay attention to the family history as well. If there are first-degree relatives who had breast or ovarian cancer before the age of fifty, there might be a need for genetic testing to pick up dangerous genes such as BRCA1 and BRCA 2. About three months ago we lost a fifty-year-old woman with advanced breast carcinoma in our gynae ward. When I spoke to the family, it turned out that the patient’s own mother was a breast cancer survivor, and yet she did not have any screening and did not even present to us as soon as she felt a lump in her breasts.

Several celebrities such as Angelina Jolie and former French First Lady Carla Bruni have helped raise breast cancer awareness. Remember, every small action counts and collective efforts can make a significant difference in the fight against breast cancer!

 

THE CONFLICTS IN THE MIDDLE EAST

 When I started this blog, I was curious about how consistent I would be with my full-time job as an OBGYN and a toddler. I have many ideas about women’s health and many interesting things happen from day to day. I enjoy sitting down and putting my thoughts in writing. It gives a sense of purpose, and peace and brings on new ideas.

One of the current burning topics is the new conflicts in the Middle East. It is a big worry that in the twenty-first century countries are invading each other. As a person who advocates for women's and children’s health, I want to elaborate on the various consequences of a new war in this region.

A new war forces a lot of families to be displaced and flee their homes. Imagine being in that situation, wondering which precious belongings besides your life you can take and go to a safer place. Wondering when will you come back, and if you ever do, will your home still be there! At times family members are forced to be separated, and this leads to emotional trauma long-term psychological effects, and PTSD. I wonder if the new generation  of kids who grow up in these situations will be able to create peace in the world.

War damages and destroys essential social infrastructure such as schools, hospitals, and community centers. The fragile economy of most of the developing countries that are already struggling becomes completely dysfunctional during a war, and this leads to more unemployment and poverty in the society.

A lot of the low and middle-income countries that have been involved in war over the years such as Lebanon, Iraq, Palestine, and Yemen have lost some of their beautiful cultural heritage sites and buildings. The effect of various chemicals and weapons on nature and all the pollution can last for years. my Lebanese friend pointed out to me that their gardens and the olive trees in the South of Lebanon were damaged after the war and they haven’t been able to grow anything on that land.

The social consequences of war can persist for generations, affecting the social fabric of societies and perpetuating cycles of violence. These consequences underscore the importance of preventing war and promoting peaceful conflict resolution. It is crucial to address the root causes of conflicts and work towards a more just and peaceful world.

Below is a photo of me as a war refugee with my mother, grannies, and uncle.  

 

The entrance to Grandma's house where I was born and raised. I absolutely love that place, and it is still standing strong

 

 

 

 

 

HERITAGE DAY

 Heritage Day is a public holiday that is celebrated on the 24^th of September every year. It is a day that celebrates the diverse cultural heritage of South Africa, including its languages, traditions, customs, and history. My favourite part of Heritage Month is people with various cultures wearing their traditional attire and sharing their traditional food. Other activities during this month are different music and dance festivals, food markets, more art and museum visits, and most importantly family and friends getting together and braaiing!

At work, we planned to celebrate Heritage Day and organize a farewell party for one of our colleagues on Friday the 27^th. It was a beautiful day with everyone wearing their traditional clothes to work and bringing a signature dish to share with everyone else. I am from the Middle East and was wondering what food item to bring. The traditional rice dishes are difficult to share. I thought about making chicken kebabs and flatbread, or small portions of the rice pudding with saffron and sprinkled with cinnamon.

We ended up going to the Turkish restaurant for lunch on the 24^th and I bought some Turkish delights as a backup plan in case everything fails. In the end, I brought Turkish delight on the celebration day. We have a lot of different signature traditional dishes, such as vegetable stews, we have crispy rice, lots of soups, and dessert recipes. My husband is not quite a fan of our traditional food and I hardly cook for him. My mom cooks the different vegetable stew dishes and because the portions are big we end up eating them for a couple of days.

A lot of things are different when I compare my conservative Middle Eastern culture to the more modern and open South African culture. I enjoy the diversity of cultures and languages in South Africa. Everyone is very warm and friendly. I have enjoyed my stay in this country for the past 11 years. I am grateful for all the various opportunities this country has offered me in my late twenties.

Heritage Day is an important part of South Africa’s reconciliation process as it promotes understanding, tolerance, and acceptance of the country’s diverse culture and history.

 

 

 

THE LIGHT WE CARRY

 I am a fan of women who have contributed to making a change in society. Michelle Obama was the first woman of colour to become the first lady of the United States of America. She carried out her duties gracefully. I enjoyed her first book “Becoming”. It was a small glimpse into her childhood, adult life, college, meeting Barak, having kids and the election campaign, and finally settling in the White House. I came across her other book "The Light We Carry" in the library and grabbed it excitedly. I read it in less than a month with my full-time job and a toddler at home. It was indeed a very good read.

She touched on the Covid-19 Pandmic. The times of fear and uncertainty and of course lockdown. I was fascinated when Michelle pointed out her knitting journey to battle with stress. “ I am not sure if I would have gotten there without the period of enforced stillness and the steadiness I found inside of knitting. I’d have to go small to think big again. Shaken by the enormity of everything that was happening, I needed my hands to reintroduce me to what was good, simple, and accomplishable. And that turned out to be a lot."

She spoke about her daughters growing up and being independent and the proud feeling every parent has when visiting their children’s house. Seeing their different behaviour compared to the times they stayed with their parents. Also looking at the new generation dating. Addressing the fear she experienced when Barak wanted to run for president, she didn’t want to stop him, knowing she might regret that decision. “How will you meet your soul mate if you don’t go on that date? How will you get ahead if you don’t take that new job, or move to a new city? How will you learn to grow if fear stops you from leaving home to go to college?

She spoke about her mother’s vital role, supporting her young daughters while Michelle and Barak were busy with their day-to-day duties in the white house. Her mother stayed with them for the whole 8 years. She spoke about herself being very self-aware of her physical difference from the other girls her age. Reading this part made me feel better about myself.

I'm tall and that’s a good thing

I'm a woman and that’s a good thing.

I'm black and that’s a good thing.

I am myself and that is a very good thing.

 

She spoke about her political motto of going high. “ When people ask me about going high, I explain that for me, it's about doing what it takes to make your work count and your voice heard, despite the despites. It helps if you're able to stay agile and adapt to change as it comes. And all of that becomes more possible, I've found when you are ready and practiced with a full range of tools. Getting high is not about what happens on a single day or month or outside one election cycle either. It happens over the course of a lifetime, the course of a generation.”

 

TURNING 39

 It was my birthday on the first of September! It is also the first day of spring in South Africa. I have never been a fan of big birthday parties since childhood. In fact, I don’t think I had any major birthday celebration since the age of five. Sweet sixteen, eighteen, twenty, and thirty went by without much of a fuss. This time we had balloons and some friends over and we all celebrated. It was a beautiful day full of laughter, and positive energy!

This is my new year, and it is the time for me to sit back and reflect on my life. I have lived quite a life and this part of the journey will determine what the rest of my life will look like in the future. In this reflection, I am going to look at various departments such as health, family, career, and finances.

Being a healthcare professional I appreciate the gift of health every day. Being able to get yourself out of your bed, take a shower, eat, and get into your car to work is an amazing thing. Dealing with patients who rely on help just to make it to the bathroom from the hospital bed gives me a different perspective on life. Knowing all this, getting a couple of grey hairs or wrinkles on my face is the least of my worries. I look good for my age, and there is no shortcut for this. I eat well, sleep well, and stay away from alcohol, cigarettes, and too much sun. we need consistency for good results. I am a bit heavier than what I used to weigh ten years ago, but I have started to eat cleaner and have increased my physical activity. I even now have a fitness watch. I have been watching my cholesterol, blood pressure and doing my pap smears and HIV tests annually. I have a strong family history of diabetes and I hope I can keep it away for as long as I can.

Family is everything. I feel blessed to have my husband and my daughter in my life. It is not always easy to keep a house running and give everyone the attention they need, but I am doing my best. I want to have a healthy family with good relationships and a happy child who will grow up to be a happy girl! Having Middle Eastern parents who will freak out at every little thing that goes wrong with a lot of tension makes me want to do better.

I love my job! I love the fact that you are not quite sure what your day will look like in labour and delivery when you leave your house. It is diverse, we teach the younger medical students and we learn from our mentors. There is room for academic growth, but I am keeping it slow and mellow. I was in a rush to specialize, but the fellowship can wait for now while I enjoy being a general ob-gyn.

Finances have had its ups and downs. We have had phases of great expenditure and growing debt but now we are in the damage control phase. Finances have never been my strong point. I grew up in a middle-class family. We were savvy with money but as soon as I moved to SA and started making more money I started spending more. I did not understand how credit card interest works and how bank interest rates work. After the pandemic, we have had a rise in interest rates and inflation. We are doing our best to pay the debt and try and save effectively for retirement. 

WEIGHT LOSS

 Conversations regarding weight loss are prevalent in the OBGYN consulting rooms. We encounter many females with obesity who have irregular menstruation and fertility struggles, and they are desperately looking for a quick fix to regulate their hormones. They do not want to hear the advice regarding healthy eating and regular exercise. I recently consulted a girl who managed to regulate her menses by losing 20 kg and came for her viability ultrasound and she was 8 weeks pregnant. She was still obese and we consider this a high-risk pregnancy, but without weight loss, we do not see the desired results. I have also met several patients who were turned away from fertility clinics to do weight loss surgery and then start fertility treatment.

Another category of patients is women in the postpartum period who are trying to lose pregnancy weight. This period has it is own unique challenges. A busy and sleep-deprived mother can hardly find the time and energy to exercise. A lot of women spend the first 6 weeks to four months postpartum period at home and they might turn to high-calorie foods and unhealthy lifestyles. I personally believe that after the COVID-19 pandemic, a lot of women stopped their gym subscriptions and outdoor activities and now prefer to stay at home and order takeaway food. Having support in the postpartum period is important for women to be able to look after themselves and shed pregnancy weight.

The menopausal period is another era where women start feeling uncomfortable with their weight. I had a patient who was in her late forties. She was a flight attendant and they needed to stay in shape for their job. And she started noticing increased central obesity and she was struggling to fit into her work clothes. We had to prescribe some anti-obesity medication for her because she needed results within a short period.

We know that there are several useful anti-obesity medications in the market, however healthy nutrition, physical activity, and behavioral modification remain key pillars of weight management. Women in whom anti-obesity medications may be indicated are those with a BMI of 30 or greater, those with a BMI of at least 27 along with at least one obesity-related comorbidity, such as hypertension, high cholesterol, diabetes, or sleep apnea. The goal of treating obesity with medications is at least a 5%-10% reduction in body weight.

There are three basic categories of anti-obesity medications. The short-term options include phentermine and diethylpropion. Long-term options are Orlistat, phentermine/topiramate ER, naltrexone/bupropion ER and lastly, we have the three GLP-1 receptor agonist drugs, liraglutide, semaglutide, and tirzepatide. The GLP-1 agonists have shown very promising results in clinical trials with most patients losing up to 20% of their body weight. I will dedicate a blog to elaborate on the dosage, regimens, and route of administration of the GLP-1 agonist agents.

 

THE SPACING OF PREGNANCIES

 The question of how long a woman should wait before becoming pregnant is something we encounter every day when we see pregnant women in our antenatal clinics. I always like to clarify family planning and pap smear on the first visit. These things may be forgotten after the baby is born and the mothers tend to neglect them. A lot of the patients often miss their six-week post-partum visits and we might not get a chance to counsel them on contraception and perform a pap smear.

The WHO advises women to wait at least 24 months between childbirth and a new pregnancy. This is more applicable if the mother has a complicated pregnancy or a caesarean delivery. According to a study published in the Lancet Regional Health using data from more than 4.7 live births in Brazil, there tend to be various cases.

in cases with shorter pregnancy intervals a lot of the time the mother’s body has not completely bounced back to its normal state and if the mother is breastfeeding there may be an element of iron deficiency. She may still have sleep deprivation looking after a toddler and more support is needed in the third trimester of the pregnancy. With a rise in maternal age in the first pregnancy a lot of the mothers tend to try for the second baby as soon as six months’ post-partum. We often see the trend of having two babies under two where the influencers promote having a smaller age gap between the kids to improve their bond and a lot of the facilities used for the firstborn is still around and can be used again.

In cases where women have more than 7 years between the pregnancies the body may behave as if it is the first pregnancy and the mother can have an increased risk of pre-eclampsia, becoming post-dates, and poor progress of labour. Longer pregnancy intervals do not increase the risk of small for gestational age fetuses.

We need more studies with many women to assess maternal and fetal outcomes in different pregnancy intervals. In the meantime, we need to assess every woman’s risks based on her age, circumstances, and the previous pregnancy outcome.

 

ME AND GRANDPA

 I had a happy childhood. There were many people around, a lot of love and support. If I had to look back into the house where I was born and raised, there would be many sweet memories. My grandparents, my uncle, my mom, and my dad were a great part of it. We had a three-story house. Grandparents were at the lower story and we were at the top part. When my brother was born I was about five years old and grandma and grandpa provided a lot of support as I was growing up. Grandma who was a teacher, would help me with my homework. I was quite clumsy and lost a lot of my stationary at school. They would ensure that we always had a storage full of pencils, coloured pencils, etc.  

Uncle was often busy with his things but we would watch TV together, I would watch him do his artistic sketching and Painting or him playing his ancient musical instrument. We would also go for a drive in the evenings and have some ice cream or nice street food. I had a brief 3-year stay in South Africa and when I got back to my grand parent’s house my uncle was married and he had moved out.

I loved spending time with my grandparents. I am sure they also enjoyed watching us grow in front of their eyes. Studies show that grandparents will have a longer and healthier life the more time they spend with their grandchildren.

Grandma was more talkative and vocal. She always had a sweet story to tell. I know almost everything. From the time she was a little girl to the time she met Grandpa. The birth of her kids and their childhood up to how my mom and dad met and got married. Grandpa was the quiet one. He was more active and worked for almost ten years after he retired from his government job. He was in charge of the shopping as well. He was of great help during the time I was in high school and needed different kinds of textbooks for the university entrance exams. I had to give him a name and he would be back with the textbook! He would also take me to different exam venues and come and fetch me after I was done. Back then I was not comfortable navigating my way in the big city.

He was very proud of me when I made it to medical school! He passed away in his 90s in August 2018 from the complications of a fall in the kitchen while making tea in the morning. I got into the registrar program the same year. I did not make it to his funeral but I flew home for the 40^th day ceremony. As we get closer to the anniversary of his passing in August I feel very emotional and being away from home makes it sadder. Grandpa will always have a special place in my heart no matter where I live!

 

 

WOMEN'S DAY IN SOUTH AFRICA

 Women’s Day in South Africa is celebrated on the 9^th of August every year. This day commemorates the 1956 march of approximately 20,000 women to the Union Buildings in Pretoria. This march was led by four women, Helen Joseph, Rahima Moosa, Sophie Williams, and Lilian Ngoyi. They were protesting against the Apartheid regime’s passbook laws. They were part of the Federation of South African Women (FEDSAW) and demanded equal rights and end discrimination against women. The March was a significant event in South Africa’s history, making it a turning point in the fight against apartheid and gender inequality.

We have come very far, but we still face many challenges concerning women's well-being and working conditions in society. According to the latest statistics about two-thirds of the global maternal mortality cases occur in Sub-Saharan Africa. This shows the lack of access to essential reproductive health services, antenatal care, safe childbirth, and contraception. The sad truth is that a lot of these women probably did not want to be pregnant in the first place. Good reproductive health ensures that women can make informed decisions about their bodies and participate in social and economic activities.

We want to ensure that the employers consider implementing policies and practices that support women’s needs such as breastfeeding areas or time off for antenatal care. Providing dedicated lactation rooms is crucial for working mothers because it enables them to breastfeed or express during their break time. employers should consider offering paid leave for prenatal visits allowing women to attend necessary medical appointments without fear of losing income or job security.

Investment in women’s education and healthcare is crucial. Governments, civil society, and private organizations must work together to ensure that girls have access to quality education and women have access to comprehensive healthcare services. We hope that better education will reduce the burden of HIV and its complications in young girls. And with a stronger generation, we can help build a prosperous society and pave the way for future generations of empowered women.

 

 

 

 

THE BEST THINGS ABOUT BEING A DOCOTR

 What was going through my mind when I decided to study medicine? I was a book warm, doing well in high school and getting good grades. I did not have any doctors in close family members to speak to and understand what lies in the future. I am enjoying what I do every day, besides compassion, developing skills, and unwavering dedication there are other wonderful things about what I do.

I appreciate having an opportunity to make a difference in people’s lives. I enjoy working with women and I try to care for the whole person and not just parts of a person’s health. The bond that is formed with patients and their trust in me is invaluable. Being an ob-gyn we often perform numerous caesarean sections and gynaecological surgeries. Witnessing the tangible results of the surgical intervention and rehabilitation of patients who had severe pain, abnormal bleeding or urinary symptoms is very rewarding. The evolution from postoperative pain to recovery and beyond, complemented by the gratitude expressed by my patients underscores the intrinsic value of the profession.

We do have patients who might experience a pregnancy loss, an adverse outcome, or a cancer diagnosis during the time they are under our care and this can be emotionally demanding for the healthcare provider. helping these women get through their health struggles is rewarding. We know that this is a calling and to be part of something greater than myself, every small victory feels like a triumph.

Medicine is not just applying science and clinical skills; it is an art that aims to improve the lives of patients. Medicine allows me to harness human ingenuity and cause people to feel better, have less pain, and do more in their lives.