Pharmacist and CEO of Merck Foundation Dr RashaKelej, has made it her mission to raise awareness about the discrimination, stigma and ostracism women undergo for their inability to have a child. Here she discusses with SunHealth how her foundation is empowering women across Africa and other developing countries.
Dr Rasha Kelej, you are CEO of Merck Foundation, can you start by introducing the Foundation for us?
Merck Foundation is the philanthropic arm of Merck KGaA Germany. It is non-profit organisation that aims to improve health and wellbeing of people and advance their lives through science and technology. Our efforts are primarily focussed on raising awareness about non-communicable diseases, empowering women and youth, improving access to innovative healthcare solutions in under-served communities, building healthcare and scientific research capacity in the fields of diabetes, hypertension, cancer and fertility care in underserved communities. Our vision is to see a world where everyone can lead a healthy and fulfilling life.
You will be launching the ‘Merck More Than a Mother’ campaign in Botswana in 2019. Can you discuss when this launch is expected to happen and what it will entail?
We will launch in Botswana sometimes in the first quarter of 2019 in partnership with Her Excellency First Lady of Botswana Madam H.E. NEO JANE MASISI, and ministry of health of Botswana. We will first launch the Merck more than a Mother campaign with Her Excellency as the Ambassador with the aim to empower infertile women through information, health and change of mindset.
As part of the campaign we will call for application for media recognition award of Merck more than a Mother. And we will also train media about health reporting and sensitive issues reporting such as infertility. We will also launch the start of producing a song about infertility stigma and sensitising the community to break its stigma.
In addition to providing training to doctors in the fields of fertility care and oncology we will also launch a pilot project called blue points where we will provide one year diabetes diploma to doctors to build Health care capacity in the country. Our vision is to develop a strong platform of specialised doctors to improve access to quality and equatable healthcare solutions in Botswana.
When did this campaign start? … What makes “Merck more than a mother” such a unique campaign and how do you hope it will be embraced by relevant stakeholders?
We started Merck more than a mother campaign in 2015 first in Kenya then Uganda and the rest of 35 countries in Africa and Asia.The campaign is an exponential success, the ambassadors of Merck more than a mother, The First Ladies of many countries, are very active and increasing every year. We have partnered with ministries of health and academia of many countries who are working closely with us.
The social media followers and videos viewers are in millions. Merck Foundation has trained more than 100 fertility specialists over the last two years in more than 30 countries in Africa and Asia. Thousands of women are sharing their stories of suffering every day; African media has started to discuss the issue every day, and we also worked with singers to write songs and produce video clips about infertility and delivering the message to all communities, since in many cultures infertile women suffer discrimination, mistreatment and physical and psychological violence. We have also supported the establishment of first ever Public IVF centres in Rwanda, Ethiopia and Uganda.
The Foundation seems to be so fond of Africa why the interest, many will ask? How do you settle on the choice of health needs or area and the countries that you engage with in Africa?
Prof Frank Stangenberg Haverkamp, the Chairperson of E-Merck KG and Merck foundation is very fond of Africa and believes in its potentiality. Furthermore, there are many challenges in Africa with regards to healthcare and this is our speciality we can help, and this is what we do and we do it well. But we also focus on Asia, we have programmes in many countries such as Sri Lanka, Bangladesh, Nepal, Myanmar and Cambodia; and we will expand to Latin America in 2020.
There was also the first Merck Health Media Training in Kenya to break the stigma around infertility in Africa, may we know the reason behind the focus on infertility and liaising with the media?
According to WHO data 2016, one in every four couples in Africa and developing countries are infertile which means that there are 180 million couples that are infertile. Incidence is much higher than in Europe and developed countries which has around maximum 8% to 9%, very high percentage of infertility due to untreated infectious diseases which result from child marriage, unsafe abortion, unsafe delivery, STDs and genital mutilation. Hence prevention is very important.
More importantly, in many cultures women suffer discrimination, mistreatment and violence due to their inability to bear children, although 50% of infertility cases are due to male infertility, therefore we need to create a culture shift to respect women whether they are mothers or not, encourage men to speak up about their infertility and support their wives through the treatment journey. I strongly believe in the power of art and media.
They are critical partners to address such sensitive topics. We have produced many projects of songs, and now we are going to produce drama (plays and documentaries) with African talents across the continent. It will be the first and we will be creating a culture shift, raising awareness and exploring African talents.
We started “Merck More Than a Mother” campaign in 2015 now it is in 35 countries in Africa and Asia. In partnership with First Ladies who are the ambassadors in their respective countries, academia, ministries of health and international fertility societies, the initiative also provides medical education and training for fertility specialists and embryologists to enable them to help and treat infertile couples in their countries.
Also, part of the campaign is our Merck Embryology & Fertility Training Programme, a three-month hands-on practical course to establish the platform of fertility specialists across Africa and Asia. Merck Foundation provides clinical and practical training for fertility specialists and embryologists in more than 35 countries across Africa and Asia such as: Chad, Niger, Central African Republic, Cote D’Ivoire, Ghana, Ethiopia, Uganda, Kenya, Tanzania, Zambia, Nigeria, Benin, Mali, Burkina Faso, Senegal, Guinea Conakry, Sierra Leon, Liberia, Cameron, Rwanda, Botswana, DR Congo, Congo Brazzaville, Gambia, Nepal, Sri Lanka, Bangladesh, Myanmar and Cambodia. So far more than 80 candidates have taken the training.
How do you envisage the future of health care in Africa and the partnerships that Merck Foundation is forging across the continent?
I think the future will be brighter if we cooperate together. The magnitude of the health challenges are very big to be addressed by one organisation. The secret is in the private public partnership and to really get things done by being hands-on. No time for talking anymore. We need to talk only when we talk about our impact and way forward.
‘Cancer took away my boobs, not my life’
Sun Health: What events led up to your diagnosis, or, how did you discover that you were suffering from cancer?
Mpho Kgaodi:My journey with Breast cancer started in 2012. Around April I felt a lump on my right breast. It was not painful at all, just slightly itchy. It was on the upper part of my breast. I ignored it for about three days but it kept nagging me and then I decided to go see my doctor. He also confirmed that there was a lump on my breast He sent me for mammogram that confirmed an abnormality on the structure of my right breast. I then went to see him with the results and he informed me that there are two ways to test that lump – Biopsy, which meant that he will be taking a piece of that lump to send it to the laboratory for examination and the other option was to totally remove the lump, Lumpectomy. I decided that he removes the whole lump, because I really didn’t want that Lump on my breast.
SH: We know that about 10% of all breast cancers are hereditary. Are there other women affected in your family?
MK: I don’t know of any other woman or even man in my family who has had cancer, though it is hereditary.
SH: What were your first thoughts when you received the diagnosis?
MK: I cried for a brief moment. I was overwhelmed with emotions, fear of death. I quickly recovered from that dreadful thought and remembered that I have a great husband and three boys. I felt that I had so much to live for.The doctor informed me about the options I had regarding treatment and he gave me time to think about it. I drove back home to Lobatse and by the time I arrived at my house, I had already made up my mind that I am going for total removal of the breast. I broke the news to my family and they were just as shocked as I was when the doctor broke the news to me. I explained to them my decision to go for surgery and they were very supportive. Few weeks later, I went for a mystectomy.
SH: How long were you in treatment
MK: The surgery was followed by Chemotherapy. The first time I walked into the oncology centre, I found so many people there already. I then realised that I am not the only person with cancer, it is so many of us. It gave me strength and courage. I had heard that the side effects of chemo are brutal, seeing those people made me realise that if others can do it so can I. I decided to go for it as I had so much will and spirit to stay alive and raise my kids. After the second session of chemo, I started losing my hair, nail beds turned black. I was never discouraged though, despite my aching body and the constant nausea after chemo. I had six cycles of it. In 2013 around April again, I experienced severe pain on my left breast, but with no Lump. My doctor again recommended I go for a mammogram. It confirmed cancer which was still at stage 1. I then insisted that they remove the breast. I would lose both my breasts but I knew staying alive for my boys was more important. Other people thought the pain was psychological, and I knew what I felt and my mind was made up. I had the second mastectomy and had to go through another cycle of chemo which I completed. I am now on oral medication. I take my tablet daily. It is recommended that I take it for ten years. I have just started on my year 6 on the tablet. I do go for regular check ups, to establish if the cancer is not back.
SH: What helped keep your spirits up and gave you support during this period?
MK: A good friend of mine and colleague told me about Journey of Hope Botswana. He introduced me to them, and I had tremendous support from them. I also went to Cancer Association Botswana to introduce myself. My family has also been my backbone, supporting me through it all. I am so greatful. On days that my spirits are low, I always take my mind to positive thoughts. I try to remind myself of the good times, sometimes I even find myself laughing out loud.
SH: How has this affected you at a psychological level?
MK: My life has not really changed for the worst. Like the saying “when life gives you lemons, make lemon aid out of them”. I lost my job after the second diagnosis of cancer. While this affected my family financially I never got discouraged, as this gave me time to take care of my family. I am a full time stay home mom. I walk this journey with my family. My boys understand that I had Cancer but now I am okay. They sometimes check if I have taken my medication, and they would even ask about my next appointment. I am blessed to have them.
SH: Facing the diagnosis of breast cancer is one of the most feared experiences in our society. What has been your experience as you worked with communities through Cancer Association of Botswana (CAB)?
MK: Working with CAB has been eye opening. Through motivational talks and other actives like the annual stiletto walk, the message has been positively received. There is still a lot to be done though, especially to make people understand that breast cancer is NOT a death sentence. So many lives can be saved.
SH: Amongst raising awareness, cancer awareness month is about celebrating individuals like yourself and their triumphs over cancer. Is there anything you would like to say to the community of cancer survivors and women in general?
MK: I have learnt so much from being diagnosed with cancer. I appreciate life more. I never used go and see a doctor without any pains or any thing “wrong” with my body. Now I do it regularly and so far I always get a clean bill of health. I encourage everybody to do regular self -breast examination. It is easy, convenient, cost-effective and can really help with early detection. I believe there is a lot to be done as far as breast cancer awareness. Remember men can also have breast cancer.
To all those who are going through cancer at the moment, remember you are not alone. Let’s walk this journey together. Let’s walk with Hope, Courage and Strength. There is life after cancer. Cancer took away my boobs it did not take my life. As October is breast cancer awareness, let’s support those affected, honour the survivors and remember the fallen.
PINK RIBBON ALWAYS
Caroline Gartland speaks on Children and Mental Health
Tell us about yourself and your background
I’m originally from the UK but have been in Botswana for eight years so this is now home! I have a Combined Honours degree in Psychology an MSc in Mental Health and have had a pretty varied career.
I started off working with offenders doing rehabilitation programmes; went on to support the victims of domestic violence then ended up working in Child and Adolescent Mental Health Services for the National Health Service.
I’ve done a lot of work, mainly voluntary, in different fields since being in Botswana but my passion is now Early Childhood Mental Health.
What does your work entail?
Early childhood mental health is mainly working with parents, caregivers and teachers to help them understand how children develop and the best ways to support their mental health and brain development as they grow. It’s about providing training and opportunities for families to bond with their children and introducing new ways of playing and interacting.
What sparked your interest in early childhood mental health?
Quite simply, having my own children! My daughter was born five years ago and I was fascinated watching her develop and grow. It occurred to me that the younger you begin to consider mental health and provide tools for resilience against life’s adversities, the better outcomes you are likely to have.
I began reading everything I could get my hands on, and completed a diploma in Infant Mental Health. I’ve worked down the lifespan but I feel I’m now where I belong, working with babies and young children.
What mental health issues have you observed in children in Botswana?
Mental Health is still stigmatised around the world and Botswana is no exception. Most people immediately think of mental illness, but mental health is about so much more; we all have mental health and some days we are fine and able to deal with life’s challenges and some days we need more support and tools under our belt to help us cope.
Young children can experience mental health problems. Anxiety is a common one, but we are more likely to focus on the behaviour we see rather than how the child is feeling. An anxious child who refuses to go to school may be labelled as ‘difficult’ or ‘naughty’ but what they are expressing is a painful emotion that they need help dealing with.
Describe one thing you find fulfilling and challenging about working in this industry.
Working with children and families is a pleasure and a privilege. To make life a little bit easier for someone is all that matters, you don’t have to be out there saving the world to make a difference.
My major challenge is time. I would love to do more, I’d love to do an MSc in play therapy and a couple of other therapeutic techniques I’ve come across in Europe but that gets put on hold as I focus on my own family and business.
Can you share an anecdote about how mental health consultation works?
I think that education, understanding and connection are the three keys to giving a child the best start in life. Led by that, SensoBaby provides classes in the community for parents and caregivers to connect with their infants.
We offer workshops on parenting and play to foster understanding of child development and wellbeing and we are available to troubleshoot specific problems an individual or agency has with the young children in their care or the systems they have in place. When it comes to individual parents, mostly what they need is to feel heard, supported and guided in their parenting choices.
You can read all the baby books in the world but they won’t give you the answers you need for your child, through responsive parenting and connection, you’ll find you have the solutions you need.
What advice do you have for child-care providers or early childhood teachers who are at their wits’ end over a child’s challenging behaviour but don’t have access to a consultant?
Empathy is an important and undervalued skill – the ability to consider another’s viewpoint. What is that child feeling? Their behaviour might be challenging and hard to deal with but often the root cause is an unmet need. There’s a famous quote from an American Clinical Psychologist, “The children who need love the most, will ask for it in the most unloving ways.”
Does a mother’s mental health affect her foetus? How important would you say is paying attention to women’s well being during pregnancy as with their physical well being?
100% yes. It is so important to support a woman’s wellbeing during pregnancy. As an example, if the mother experiences significant stress and rising levels of cortisol (the stress hormone) during pregnancy, the foetus will be affected and in some cases will be more sensitive to stress in childhood or later in life.
Pregnant women and new families (Dads as well!) deserve nurturing care themselves and shouldn’t be afraid to ask for support. SensoBaby run FREE monthly coffee mornings to support pregnant and new mothers because we understand the importance of maternal wellbeing.
Do smart phones and television make our children mentally ill as is often purported?
I don’t think technology is always the villain it’s made out to be. The key is in the relationship with that technology. Moderate use of TV’s and smart phones are fine, as long as they aren’t a substitute for outdoor play, imaginative play and meaningful interactions. If a child is crying or upset and we hand them a device to keep them quiet then we have missed an important opportunity for connection, helping them process what is going on and supporting them to calm down and settle themselves.
Now, I know you are involved in an exciting programme that helps caregivers and children to bond and get the children off to the best start in life through play. Can you say a little bit about that work and just how you are seeing it play out?
SensoBaby is our baby; a project born from passion and a desire to support families in Botswana. We offer play-based classes for children and their caregivers that are underpinned by the principles of child wellness as well as early foundations for learning.
When you provide developmentally appropriate opportunities to play, you learn so much about your child. That understanding and observation builds strong connections, which will form the basis of that child’s future relationships and self esteem. Play is so much more than ‘a fun activity.’
We offer a number of trainings and workshops for parents, nannies and community stakeholders and hope to increase our offerings this year. Our community partnerships and voluntary programmes have been successful so far and we hope to see more impact in 2018.
We currently serve the Gaborone community but would like to expand throughout Botswana as opportunities arise. The response to SensoBaby has been fantastic so far and we can’t wait to see how far we can go with the concept!