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Demand for chemo in poorer countries to spike by 75 per cent

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WITH the number of people diagnosed with cancer expected to balloon in coming years, one of the nation’s leading surgeons and university professors is urging his colleagues and the Government to address current barriers to cancer care delivery.

In a sit-down with the Jamaica Observer editors and reporters last week to discuss Jamaica Cancer Society’s upcoming Relay for Life fundraiser, Professor Joseph Plummer cited a May 8 article published by The Lancet Oncology online, which says that by 2040, “there is projected a 75 per cent increase in the need for chemotherapy in low- and middle-income countries”.

“That’s exactly where Jamaica falls,” said Plummer, who is head of the Department of Surgery, Radiology, Anaesthesia, and Intensive Care at the University Hospital of the West Indies (UHWI) in St Andrew.

“It reflects both the increasing incidence of the disease and the fact that still, in these [low- and middle-income] countries, the majority of patients are advanced at the time of their diagnosis,” the surgeon said.

The study, as reported by Medscape Medical News, warns that almost all countries will face serious problems in their ability to deliver chemotherapy to cancer patients by the year 2040.

Medscape said the study predicts that the demand for chemotherapy will double by 2040, estimating that the number of patients who will require first-line chemotherapy will increase from 9.8 million in 2018 to 15 million in 2040. The largest proportion of those patients, Medscape said, will be residing in upper-middle-income countries, but of the remainder, an “estimated 75 per cent… will be living in low- and middle-income countries”.

Professor Plummer explained that in Jamaica, the incidence of cancer is increasing, and for the common ones — breast, cervical, prostate, and colorectal — at least 60 per cent of patients are locally advanced or metastatic at the time of their diagnosis.

“So either they are incurable or they need relatively expensive chemotherapy to prolong life,” he said, indicating that at the advanced state, options like surgery alone or radiotherapy alone are insufficent as oftentimes these patients need a combination of surgery, radiation and chemotherapy in an attempt to cure them.

Professor Plummer also pointed out that since chemotherapy drugs are not produced locally, increasing their accesibility would require a larger outlay of already scarce foreign exchange.

“Given the projected increase… we need to be looking forward and planning, therefore, for an increase in the number of medical oncologists in Jamaica.

“I know right now, for example, between Cornwall Regional [Hospital] and Kingston, that is KPH (Kingston Public Hospital), and University Hospital [of the West Indies], there is no other Government-sanctioned place to get chemotherapy. [At] Mandeville [Regional Hospital], there is a visiting oncologist, but we need to have more formal services in those hospitals, because that’s what will cause death…” the surgeon said.

He also highlighted the work of Jamaica Reach to Recovery, an affiliate of the Jamaica Cancer Society that offers financial, psychological, and emotional support to breast cancer survivors, and called for similar groups to be set up in light of the projections.

“One of the things we don’t do well are the support groups. So we have Jamaica Reach to Recovery, but someone who has bleeding and is worried that they may have to get a stoma bag, that is going to prevent them from ever going for a colonoscopy even when they have bleeding.

“Or a man who, just being fearful of the implications of a prostate examination, [saying] ‘I’m going to lose my potency’, without being aware that 80 per cent or more of men who have a radical prostatectomy will be potent, and those who are not, periodic use of medication and other means can help them to maintain some level of sexual activity,” he said, reiterating that the hope supportive programmes provide is necessary, but is currently lacking.

Dr Plummer was quick to point out, however, that the importance of prevention cannot be overemphasised because the country’s attitude should really be, ‘Let’s not reach the 2040 projections’. For this to happen, Professor Plummer said general education and preventative programmes are crucial.

“There is a lot to be said about societies like the Jamaica Cancer Society in terms of sensitising the public. [They are] educating the public in being aware of themselves so that they are aware of the early [symptons] of the disease, because a lot of times the disease doesn’t give early clinical features [and] the need for screening, even in the asymptomatic phase,” he said.

In the meantime, he lauded the Government for setting up two radiation oncologist centres in the island, one at St Joseph’s Hospital in Kingston and the other at Cornwall Regional Hospital in St James. He said it is increasingly being recognised that radiation alone, as a form of treatment, can cure about 20 per cent of cancers.

The 16th annual Relay for Life is scheduled for June 2-3 on the University of Technology, Jamaica campus.

Now you can read the Jamaica Observer ePaper anytime, anywhere. The Jamaica Observer ePaper is available to you at home or at work, and is the same edition as the printed copy available at http://bit.ly/epaperlive

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Today’s Horoscope — October 17, 2019

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Today’s Horoscope — October 17, 2019

Thursday, October 17, 2019

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HAPPY BIRTHDAY for Thursday, October 17, 2019: This year, you will feel more in sync with others and yourself than you have for a long time. You will draw someone very different, perhaps a foreigner. Relating to this person will help open new doors. If single, you could form a romantic bond with this person. If attached, travel appears more likely than it has in the recent past. You also might see your in-laws more often. A GEMINI plays a fun role in your life. You laugh more often if they are around. Be open to a different approach and style.

ARIES (March 21-April 19): Speak your mind but understand where others are coming from. You can be fiery in response with a key person or vice versa. Touch base with a loved one who often walks to a different tune. Tonight: Speak up.

TAURUS (April 20-May 20): Be aware of your limits when dealing with a money matter. Others might not agree with your perspective and let you know. Hold back until you have a greater perspective than you do at present. Tonight: Squeeze in some exercise.

GEMINI (May 21-June 20): Allow greater flow and understanding between you and a child or a new friend. Ideas seem to pop up out of nowhere. You feel as if you have a muse on your shoulder right now. Tonight: Go with the natural flow of the moment.

CANCER (June 21-July 22): Basics count, but you might not be willing to share anything more. Keeping certain details to yourself might feel smart, but ultimately it might not work to root out a problem. A domestic issue easily could appear out of the blue. Tonight: Stay centred.

LEO (July 23-Aug 22): You will speak your mind and others will listen carefully. If you ever wanted to make your point to others, now is the time. A meeting or a group of friends seem very open to discussion. Tonight: Get together with friends.

VIRGO (Aug 23-Sept 22): You shine at work or in the public eye. Others nearly follow your lead but could be hesitant for personal reasons. Open up discussions. You will understand where others are coming from. Still, you will naturally take the lead. Tonight: Out on the town.

LIBRA (Sept 23-Oct 22): You could be unusually tired and withdrawn, but try to stay focused. Your sense of humour emerges, and silliness could pop up out of nowhere. Do not be intimidated by another person’s news. Tonight: Be a duo.

SCORPIO (Oct 23-Nov 21): Defer to another person, knowing full well what is too much to take on for a project. One-on-one relating draws strong responses from others. Listen to a variety of ideas whether they work for you or not. Tonight: Go with a suggestion.

SAGITTARIUS (Nov 22-Dec 21): Defer to others when you realise enough is enough. Be more in tune with your long-term desires. A partner or close associate plays an important role in what occurs. Be wise and defer to this person. Tonight: Think weekend.

CAPRICORN (Dec 22-Jan 19): Pace yourself and get as much done as possible. You could be irritable because of a situation that dominates you at work or in another milieu. Stay centred and take charge of what you can handle. Tonight: Make it early.

AQUARIUS (Jan 20-Feb 18): Your fun spirit takes you down an interesting route. While others could be touchy or snappy, you seem light and easy. Use your creativity to make a point and help another person relax. Tonight: Let fun in.

PISCES (Feb 19-March 20): Tension builds around your home and family. You could have a case of the grumps or a situation could be disagreeable. No matter what, tame your words in discussions. You do not want to create any long-term damage. Tonight: Order in.

 

(c) 2019 by King Features Syndicate Inc.

 

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Brexit talks inch closer to deal before summit

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BRUSSELS, Belgium (AP) — The European Union (EU) and Britain inched ever closer to a Brexit deal yesterday, with the leaders of France and Germany saying they expected an agreement could be sealed within a day at an EU summit.

Positive vibes radiated from French President Emmanuel Macron and German Chancellor Angela Merkel at a joint news conference in Toulouse, France.

Merkel told reporters that negotiations were “in the final stretch”. Macron said: “I want to believe that a deal is being finalised and that we can approve it” Thursday, when EU leaders are due to meet British Prime Minister Boris Johnson in Brussels.

Differences between the two sides remained but were narrowing.

“Good progress, and work is ongoing,” EU chief Brexit negotiator Michel Barnier told reporters last evening as he prepared to brief the EU Parliament’s Brexit steering group.

Johnson, meanwhile, likened Brexit to climbing Mount Everest, saying the summit was in sight, though still shrouded in cloud.

Brexit negotiations have been here before — seemingly closing in on a deal that is dashed at the last moment. But with Britain’s October 31 departure date looming and just hours to go before the EU leaders’ summit, hopes were increasingly turning toward getting a broad political commitment, with the full legal details to be hammered out later. That could mean another EU summit on Brexit before the end of the month.

Negotiators were locked inside EU headquarters with few details leaking out. Wild movements in the British pound yesterday underscored the uncertainty over what, if anything, might finally be decided.

Meetings between Barnier and key EU legislators as well as with ambassadors of the member nations were rescheduled for the evening — an indication there was still momentum in the ongoing talks among technical teams from both sides.

The focus of recent talks has been the thorniest component of a deal: how goods and people will flow across the land border between EU member Ireland and Northern Ireland, which is part of the UK.

So far, all plans to keep an open and near-invisible border between the two have hit a brick wall of opposition from Johnson’s key Northern Irish ally, the Democratic Unionist Party. Leaders from the party met several times with the British prime minister yesterday as he tried to win their support. Without it, any Brexit deal is likely to be rejected by Britain’s Parliament — which has already voted down prospective deals three times.

Johnson told Conservative Party lawmakers yesterday that he believed a deal was close.

Legislator Bim Afolami quoted the prime minister as saying “the summit is in sight, but it is shrouded in cloud. But we can get there”.

Northern Ireland is not the only issue. The eventual withdrawal agreement will be a legal treaty that also lays out other aspects of the UK’s departure — including issues like the divorce bill Britain must pay to leave and the rights of UK and EU citizens living in each other’s territories. It will set up a transition period in which relations would remain as they are now at least until the end of 2020, to give people and businesses time to adjust to new rules.

But the agreement will likely leave many questions about the future unanswered, and Britain’s departure is sure to be followed by years of negotiations on trade and other issues.

Even if a deal is inked this week, moves in the British Parliament could still mean another delay to Britain’s planned October 31 departure.

UK lawmakers are determined to push for another delay rather than risk a chaotic no-deal Brexit that economists say could hurt the economies of both the UK and the EU. They have passed a law ordering Johnson’s Government to seek to delay the departure if a deal isn’t in place by Saturday.

Johnson has both promised to obey Parliament’s order and vowed to leave the bloc on October 31, deal or no deal.

Parliament has also repeatedly rejected previous attempts at a Brexit deal. With the need to get Parliament’s approval looming over negotiations, EU leaders are seeking reassurances from Johnson during this week’s summit that he has the political weight to push a new deal through the House of Commons, which is due to meet Saturday for its first weekend session in almost 40 years.

The Brexit talks plodded ahead Wednesday, further delaying preparations for the EU summit. Since the weekend, negotiators have been locked in long sessions on how to deal with detailed Customs, value-added tax and regulatory issues under British proposals to keep goods and people flowing freely across the border between Northern Ireland and Ireland.

“Talks have been constructive, but there still remains a number of significant issues to resolve,” EU Commissioner Dimitris Avramopoulos said after being briefed by Barnier.

Beyond the questions of disrupting daily life, an open Irish border underpins both the local economy and the 1998 peace accord that ended decades of Catholic-Protestant violence in Northern Ireland. But once Britain exits, that border will turn into an external EU frontier that the bloc wants to keep secure.

The big question is how far Johnson’s Government is prepared to budge on its insistence that the UK, including Northern Ireland, must leave the EU’s Customs union — something that would require checks on goods passing between the UK and the EU.

An alternative is to have checks in the Irish Sea between Britain and Northern Ireland. But Northern Ireland’s Democratic Unionist Party (DUP), the party that props up Johnson’s minority Conservative Government, strongly opposes any measures that could loosen the bonds between Northern Ireland and the rest of the UK.

Pro-Brexit Conservative British lawmaker David Davis said success in passing a Brexit deal rests on the stance of the DUP.

“If the DUP says, ‘This is intolerable to us’ that will be quite important,” he said.

DUP leader Arlene Foster said the party had not yet consented to a deal. She tweeted: “Discussions continue. Needs to be a sensible deal which unionists and nationalists can support.”

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Thousands mourn those killed in Haiti protests to oust Mose

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Thousands mourn those killed in Haiti protests to oust Mose

Thursday, October 17, 2019

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PORT-AU-PRINCE, Haiti (AP) — Thousands of people across Haiti attended funerals yesterday for protesters who have died in ongoing demonstrations aimed at ousting President Jovenel Mose.

The funerals for 11 of at least 20 people killed were held in six cities, including the capital of Port-au-Prince, where sweat mingled with tears as mourners packed a church in the neighbourhood of Delmas.

Some women shouted, rocked back and forth and fell to the floor as people yelled, “Down with Jovenel!” and “Jovenel has to go!” Tyres burned in the street outside the church.

Among the mourners was 42-year-old Jean-Mary Daniel, who said the deaths won’t halt the demonstrations that have shuttered many schools and businesses for nearly five weeks.

“A soldier died, but that doesn’t mean you can destroy the army,” he said.

Mose held a press conference on Tuesday and said it would be irresponsible for him to step down and he repeated calls for dialogue. However, Opposition leaders have rejected those calls and said they will keep organising demonstrations until Mose resigns.

The protests are fuelled by anger over corruption, inflation that has reached 20 per cent and dwindling of basic supplies, including gasoline. Sixty per cent of the people in a country of nearly 11 million make less than US$2 a day, and 25 per cent less than US$1 a day.

The funerals were held a day after the UN’s Mission for Justice Support in Haiti ended its operations, marking the first time since 2004 that there is no peacekeeping operation in the country. UN peacekeeping chief Jean-Pierre Lacroix told the Security Council that progress since 2004 has been “considerable, but the achievements of stability are still fragile and must be deeper rooted in democracy and development.”

He also said “the current context is not ideal for the end of 15 years of peacekeeping in the country”, but he said the UN is not completely leaving Haiti.

UN military peacekeepers left Haiti on October 15, 2017, after 13 years. But the stabilisation mission stayed behind to train national police, help the Government strengthen judicial and legal institutions, and monitor human rights.

Yesterday, a UN political mission known as the United Nations Integrated Office in Haiti officially replaced the stabilisation mission.

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