Empowering Ladakhi Women: A Journey from Tragedy to Cervical Cancer Awareness

In the early stages of his medical career in southern India, Nordan Otzer, an ENT surgeon now in his mid-40s, received a life-altering call from his home in the Ladakh Himalayas. This call sparked his commitment to cervical cancer awareness, a cause that became deeply personal.

Otzer recounts the distressing moment when his mother’s health deteriorated, revealing a silent battle with cervical cancer. Despite experiencing persistent spotting and abdominal pain, she only sought medical help when the pain became intolerable. This delay, unfortunately, proved fatal. Otzer reflects, “My mother’s death due to cancer altered the course of my career, leading me to make the choice to remain and contribute to my own community.”

The World Health Organization (WHO) highlights that over 95% of cervical cancers are caused by the human papillomavirus (HPV), emphasizing the importance of early detection and prevention. The WHO recommends screening for HPV infection starting at 30 years of age, with regular screenings every 5 to 10 years.

Cervical cancer stands as the fourth most common cancer among women globally, with a substantial burden in low- and middle-income countries. In 2020, an estimated 90% of the 604,000 new cases and deaths occurred in these regions, emphasizing the urgency of addressing this issue on a global scale.

Otzer’s personal tragedy fueled his determination to make a difference in Ladakh, a remote mountainous region at an altitude exceeding 14,000 feet. Since 2009, he, along with local supporter Stanzin Dawa and visiting doctors from Singapore, has organized over 140 awareness and screening events, reaching out to women in villages scattered across challenging terrains.

“We have conducted screenings for 12,400 women thus far, among whom one out of every 10 women has precancerous lesions,” Otzer reports, underscoring the critical need for timely treatment to prevent the progression to full-blown cancer.

Beyond the logistical challenges of reaching remote areas, Otzer encountered cultural barriers. Ladakhi women, initially reticent about discussing women’s health openly, hesitated to undergo checkups. Otzer recalls, “Women in Ladakh tend to be reticent about discussing women’s health matters openly, not even with their own family members.”

However, with persistence, the community became more receptive over time. Initially avoiding eye contact and refraining from asking questions, Ladakhi women gradually started attending screening camps, breaking down the stigma surrounding cervical cancer.

In the context of India, cervical cancer ranks as the second most common cancer in women, contributing significantly to the global burden. The Indian Ministry of Health and Family Welfare aims to vaccinate 68 million girls against HPV by the end of 2025, followed by an annual vaccination of 11.2 million girls aged 9 and older.

A December 2021 study published in Springer reveals that cervical cancer accounted for 9.4% of all cancers and 18.3% (123,907) of new cases in India in 2020. It remains a leading cause of cancer-related deaths in women, particularly in low- and middle-income countries.

The study emphasizes the alarming situation in rural areas where women, often illiterate and unaware of cervical cancer hazards, face scarce healthcare resources. The availability of medical infrastructure and awareness play pivotal roles in preventing cervical cancer, as confirmed by a study in the Asian Pacific Journal of Cancer Prevention.A Lancet study from October 2023 exposes disparities in cervical cancer survival across India, with higher rates in urban areas boasting better healthcare facilities. The study calls attention to the importance of addressing inequities in the healthcare system, highlighting the need for awareness, early detection, and improvements in healthcare infrastructure.

Otzer’s journey from personal tragedy to community empowerment illustrates the transformative impact of raising awareness about cervical cancer. By breaking down cultural barriers and overcoming logistical challenges, Otzer and his team have made significant strides in Ladakh, offering hope for a future where cervical cancer is detected early, treated effectively, and lives are saved.


AAPI & WHEELS Global Announce $10,000 Award for Menstrual Health Project During Global Healthcare Summit in New Delhi

(New Delhi, India – January 3m 2024) Inspired by the physicians and engineers of Indian origin in the United States, the American Association of Physicians of Indian Origin (AAPI) in collaboration with WHEELS Global Foundation has announced a $10,000 award towards the Project – Kanya: Sanitary Napkin Machine, during APPI’s 17th annual Global Health Summit held at the All India Institute of Medical Sciences (AIIMS) in New Delhi on January 3rd, 2024.

The announcement was made during a joint panel discussion held as part of the GHS on ‘Menstrual Health’ (under the banner of ‘Kanya Conference’). The Kanya Challenge Award seeks to catalyze groundbreaking advancements in menstrual hygiene for Indian women through the development and commercialization of absorbent materials made from indigenous Indian resources.

“To accelerate the journey to a fully affordable, safe, accessible, and domestically self-reliant solution, AAPI & WHEELS are jointly announcing a $10,000 Award with the objective of using the funds to accelerate affordability and access – which when achieved gets us national scale penetration, said Dr. Anjana Samadder, President of AAPI.

The Kanya Challenge Award, Transforming Menstrual Hygiene through Indigenous Innovation will be given to the entity submitting “the best plan, using the funds, to achieve material acceleration of affordability and access of an environment-friendly imports-avoiding solution, with the submissions deadline marked for March 31st, 2024.”

WHEELS and AAPI teams will have a joint panel of experts to select the winning entry for the announcement at the appropriate forum soon after. The Project – Kanya is aimed at developing a high-performance, eco-friendly absorbent material for feminine hygiene products using locally sourced Indian materials; and, commercializing the product, achieving sales and use by 100,000 consumers with at least 50% satisfaction (based on surveys by 10% of users).

The Panel Session was led by Dr. Inderpal Chhabra, Dr. Anajana Samadder, President, AAPI, Dr. Sumul Rawal, Secretary, AAPI, Anitha Thampi (of MCup), Jayadeep Mandal: Aakar Innovations & Aakar Social Ventures, Prof Virendra Kumar Vijay (of IIT-Delhi’s UBA Program) speaking on UBA supporting Saukhyam: Dr. Meenakshi Bharat, a Gynecologist and Fertility specialist who is a green campaigner, an advocate for Clean India. Prof Satish Agnihotri: Professor, Centre for Technology Alternatives for Rural Areas (CTARA), IIT Bombay with messages from Dr. Raj Shah, Dr. Vriti Khurana Founder, Kanya Project and Ratan Agarwal, President of Wheels Global Foundation.

The panel discussion focused on the five compelling solutions we are bringing to the target beneficiaries – to not only address the unmet need for 46m rural girls and women but do it with environmentally friendly (sustainable) solutions that also eliminate India’s import bill.

The panel discussion focused on the innovations by NOBA Initiative for Menstrual Health, M-Cup by Anitha Thampi (IIT-B CTARA graduate) – supported by Prof Satish Agnihotri (IIT-B) and Prof Kannan’s Spoken Tutorials solution (to make it easy to communicate value-proposition to rural residents); Anandi Pads by Jayadeep Mandal, supported by WHEELS’ Yogesh and Arjun Malhotra, Saukhyam founded by IIT-Delhi alum Praveen Bist and Anju Bist – providing Banana fiber-based solution, and, Aashraya Seth providing a low-cost dispenser (Rs. 2,500) for schools along with education curriculum and reusable cloth-based pads.

“Kanya project” was first started by a 14-year-old girl Vriti in 2013, after she had visited a village in Telangana, deeply disturbed and saddened by the lack of support for young girls like herself. She raised funds in the US, collaborating with an Indian company “Aakaar” and had the first self-sustaining “sanitary napkin manufacturing machine” installed in Burgula, Telangana, India in 2018. Today, there are multiple companies that are working towards the same goals and we at WHEELS Global Foundation would like to take the issue of “Period Poverty” forward. (https://twitter.com/WHEELSGF/status/988154191460827136)

UNICEF reports that “in countries where menstrual hygiene is taboo, girls in puberty are typically absent for 20% of the school year”. Most girls drop out at around 11 to 12 years old and miss school not simply because they fear being teased by their classmates if they show stains from their period, but also because they are not educated about their periods, and their need for safe and clean facilities is not prioritized.

WHEELS’ objective is to drive a portfolio of solutions to address the problem at a national scale in the next 3-5 years so there is a right-fit solution to each segment – meeting affordability, accessibility, sustainability, and self-reliance for the country.

Physicians of Indian Origin in the United States are reputed to be leading health care providers, holding crucial positions in various hospitals and health care facilities around the nation and the world. Known to be a leading ethnic medical organization that represents nearly 100,000 physicians and fellows of Indian Origin in the US, and being their voice and providing a forum to its members to collectively work together to meet their diverse needs, AAPI members are proud to contribute to the wellbeing of their motherland India, and their adopted land, the United States. The convention is forum to network, share knowledge and thoughts, and thus, enrich one another, and rededicate for the health and wellbeing of all the peoples of the world. For more details, please visit: www.appiusa.org and wheelsglobal.org