Department of Health, Central Tibetan Administration declares the whole of April 2016 as the “Health Promotion and Disease Prevention” month.

We urge all Chief Representative Officer in Bangalore, Settlement Officers, Men-tsee-khang, Medical Officers, Hospital Administrators, School Heads, University Youth Hostels and heads of Monasteries in India and Nepal to organize a sustained innovative “Health Promotion and Disease Prevention” activities throughout the month of April with main focus on prevention of diseases such as Hepatitis B, Tuberculosis, Liver Cancer, Stomach/Esophageal Cancer, Hypertension, Cervical Cancer, Diabetes, and HIV AIDS.

Based on the data available from various sources, the above diseases are the common disease afflicting our community which requires priority preventive interventions. As a first step we request all to create behavior changing awareness on following diseases. As the saying goes – “Prevention Is Better Than Cure”.

Tuberculosis: We should try to detect all TB cases lying in our community to decrease the transmission and propagation of TB infection. The main emphasis of communication (health education) should be on TB symptoms (Lung TB) and need for early TB detection and Direct Observed Treatment (DOT) and Contact Tracing. If a person has cough more than 2 weeks, he/she should see a doctor and screened for TB. BCG though indicated for new-born do not seem to prevent lung TB which is the infectious type of TB. TB diagnostic facilities like Gene-Xpert and Culture/DST at Hinduja hospital are done free for those who require it and it cost DOH about rupees 5000.00 per patient to do X-pert and culture/DST. With the above two diagnostics we are able to detect drug resistant TB at the shortest possible time so that treatment could be given at the earliest which prevent further transmission of infection. People should be made aware about these facilities. In institutions (schools and monasteries), we should focus on putting in place an active surveillance systems so that students/monks with TB are detected at the earliest and outbreaks of TB are prevented. We should also see how we can reduce overcrowding in schools and monasteries and improve ventilation/air circulations in the living environments like hostels, class rooms, prayer rooms and meeting halls etc.

Hepatitis B: The most effective way to decrease the number of people who are infected with Hepatitis B (Chronic Hepatitis B Infection) and so prevent Hepatitis B induced Liver damage and Liver Cancer is to give all our new-borns, Hepatitis B vaccination at birth (within 24 hours of birth) and then again at week 6, 10 and 14. The hepatitis B prevalence rate among pregnant women in Tibetan community in India is estimated at 9%. To prevent the new-born from getting hepatitis B, we should screen all our pregnant women for Hepatitis B and if found to be positive, the new-born should get Hepatitis B vaccination and Hepatitis B immunoglobins (two different sites) within 24 hours. The risk of Hepatitis B in a family is more if one or more family members are Hepatitis B positive. The family members should be tested and if found “negative”, advise Hepatitis B vaccination at month 0, 1, 6. If we do the above three activities properly, we should be able to bring down the Hepatitis B prevalence rate which is currently estimated at 10% to less than 1% within a few decades. Taiwan has done it and so we can also do it.

Diabetes, Hypertension and other Non-communicable diseases: Tibetans living in India is going through not only epidemiological and demographic transition (Bhatia et al 1996) (Tripati et al 2006) but they may also be going through lifestyle transition. In Tibet, people are involved in moderate to heavy agricultural or nomadic activities but in India they are increasingly adopting sedentary lifestyles because of the shift in the nature of their occupation and availability of modern transport system both at public and individual level. Also the Tibetans in India have maintained their distinct culture and food habit which include among others drinking a salted tea. The Lancet NCD Action Group and the NCD Alliance (Beglehole R et al 2011) propose five priority interventions — tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects and cost-effectiveness

Also, 7th April is commemorated as World Health Day every year to mark the founding of World Health Organization. The theme for 2016 is “Beat Diabetes”. Let us all rededicate ourselves on this “World Health Day” to “Beat Diabetes”. The burden of diabetes is increasing globally, particularly in developing countries. The causes are complex, but the increase is in large part due to rapid increases in overweight, including obesity and physical inactivity. 30 minutes of moderate intensity physical activity on most days and a healthy diet can drastically reduce the risk of type 2 diabetes (type 1 diabetes cannot be prevented) and other NCDs.

HIV /AIDS: There is no single prevention bullet. Prevention would therefore require biomedical as well social/societal intervention 1) Behavioral change such as reducing multiple sexual relationships and using condoms 2) Prevention of mother-to-child transmission 3) Treatment of HIV, other viruses (ART and others) and sexually transmitted infections 4) Social justice and human rights 5) Confront the stigma and denial associated with HIV. Guiding principles for effective behavior change interventions targeted at HIV/AIDS prevention i.e. targeted Interventions should focus on well-characterized, specific target audiences.

Cancers:

1. Liver Cancer: Primary liver cancer is mainly due to complication of chronic hepatitis Infection.
Please refer to Hepatitis B above
2. Stomach Cancer: Mayo clinic gives the following information regarding stomach cancer. It’s not
clear what causes stomach cancer, so there’s no way to prevent it. But you can take steps to reduce your risk of
stomach cancer by making small changes to your everyday life. For instance, try to 1) Eat more fruits and
vegetables. Try to incorporate more fruits and vegetables into your diet each day. Choose a wide variety of
colorful fruits and vegetables. 2) Reduce the amount of salty and smoked foods you eat. Protect your stomach by
limiting these foods. 3) Stop smoking. If you smoke, quit. If you don’t smoke, don’t start. Smoking increases your
risk of stomach cancer, as well as many other types of cancer. Quitting smoking can be very difficult, so ask for
help. 4) Ask your doctor about your risk of stomach cancer. Talk with your doctor if you have an increased risk of
stomach cancer. Together you may consider periodic endoscopy to look for signs of stomach cancer.
3. Cervical Cancer: There’s no single way to completely prevent cervical cancer, but there are
things that can reduce your risk. 1) Safer sex – Most cases of cervical cancer are linked to an infection with
certain types of human papilloma virus (HPV). HPV can be spread through unprotected sex, so using a condom can
reduce your risk of developing the infection. However, the virus isn’t just passed on through penetrative sex – it
can be transmitted during other types of sexual contact, such as skin-to-skin contact between genital areas. Your
risk of developing an HPV infection increases the earlier you start having regular sex and with the more sexual
partners you have, although women who have only had one sexual partner can also develop it. 2) Cervical screening
– Regular cervical screening is the best way to identify abnormal changes in the cells of the cervix at an early
stage. It may a good idea for to do your cervical screening tests (PAP smear), even if you’ve been vaccinated for
HPV, because the vaccine doesn’t guarantee protection against cervical cancer. 3) Cervical cancer vaccination: The
vaccine is given to girls when they’re 10-12 years old, with three doses given over a six-month period. Although
the HPV vaccine can significantly reduce the risk of cervical cancer, it doesn’t guarantee that you won’t develop
the cancer. You should still attend cervical screening tests, even if you’ve had the vaccine. 4) Avoid smoking:
You can reduce your chances of getting cervical cancer by not smoking. People who smoke are less able to get rid
of the HPV infection from the body, which can develop into cancer.