96281691-pink-ribbon-pakistan.pdf

A Life Worth Living… Five Year Review

Pink Ribbon Pakistan N Caam mppaaiiggn waarreenneessss C Aw Caanncceerr A Brreeaasstt C Naattiioonnaall B

Contents Abbreviations/Acronyms Turning dreams into reality 01 01 02 04 04 07 07 07 07 07 07 08 08 09 10 11 13 13 13 15 16 18 19 20

Introducing WEG Prevailing Health Scenario Inherent Challenges The Pink Ribbon Campaign Rationale Vision Mission Ideology Objectives The Stakeholders Strategic Approach The March Starts Working with the Government Strategic Alliances Networking with Women Groups Rousing Youth Lady Health Worker’s Program Survivor’s Network Encouraging Corporate Social Responsibility Celebrity Endorsement

Campaigning Through Media Extending Friendly Hand Pink Ribbon Merchandise Moving Ahead-Future projects

Abbreviations/Acronyms ACSU AKU AIDS BBC BRCA CD CSR DFS FJMC FJWU FP GDP HIV IEC ICG IPRA

American Cancer Society University Aga Khan University Acquired Immune Deficiency Syndrome British Broadcasting Company Breast Cancer Compact Disc Corporate Social Responsibility Disease Free Survival Fatima Jinnah Medical College Fatima Jinnah Women University Family Planning Gross Domestic Product Human Immuno-defficiency Virus Information, Education and Communication Islamabad College for Women International Public Relations Association

LCWU LHW LUMS MET MoU NGO NuPA NWFP OPF OS PFOWA PID PR RH SES WEG

Lahore College fro Women University Lady Health Worker Lahore University of Management Sciences Minimal Expected Treatment Memorandum of Understanding Non Governmental Organization Nutrition and Physical Activity North West Frontier Province Overseas Pakistanis Foundation Overall Survival Pakistan Foreign Office Women Association Press Information Department Public Relations Reproductive Health Socio Economic Status Women’s Empowerment Group

Working Together Turning dreams into reality A young woman of 30 dying of CA Breast is not merely a death of an individual or a female in fact it's the first step towards the destruction of healthy home, insecurity for her children and misery for the whole family. Cancer is a growing health problem in the country. A milestone in the healthcare system of Pakistan has been achieved with the publication of this report of the Women’s Empowerment Group that provides some eye opening facts about the alarmingly high incidence of breast cancer in Pakistan.

Talking about Breast Cancer, a few years back, was an illicit thing to discuss thus resulting in hiding of the disease and delaying treatment. The efforts of Pink Ribbon Pakistan have helped to bring the awareness level from -100 (non tolerant level)of government, media and the masses to zero (neutral base) but it still has a long way to go in order to reach its target of 100% awareness level about early detection and treatment of the disease at an early stage. The realization that CA Breast can be cured… serves as a hope for reduced mortality rate associated with it in the days to come.

100 75 50 Awareness Scale

During the course of The Pink Ribbon Campaign Pakistan, it was realized that one fatal and lethal danger to women in Pakistan was regarding their health, careless towards their health, they often tend to ignore many things. With the increasing incidence of CA breast patients pouring in at the national hospitals and that too at very late stage, is enough food for thought in motivating us to launch an effective and efficient program to create awareness regarding CANCER OF BREAST.

Pakistan is hit with uninterrupted intensity of moderate to severe degree of poverty throughout its map. Poverty, as they say, has four facets; doctors link it with daily calories; the economists with daily income; the human rightists with basic rights; and the intellectuals with cerebral calibrations. Whatever form poverty acquires or whatever consequences it leads to, one thing is for sure that it needs to be taken care of… otherwise deteriorating women’s health will engulf the prosperity of our nation in the days to come…

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Omer Aftab National Coordinator Pink Ribbon Pakistan

A Life Worth Living…

Introducing WEG With a vision to become the center of excellence for gender issues in Pakistan, the Women’s Empowerment Group (WEG) came into existence in 1999. The founders of WEG included a group of young motivated professionals who planned to work for the uplift of the society with special emphasis on the rights of women and children. WEG is a not for profit, non-governmental organization registered as a Trust, aiming to accelerate the process of socioeconomic development and empowerment of unprivileged segments of the society at the grass roots level without ethnic, racial or religious discrimination. In its efforts to improve the quality of life of womenfolk in Pakistan and to provide them with equal opportunities, WEG dedicated its efforts in the following areas: Health, Economic Empowerment, Education, Gender Equity and Equality, Legal and Political Rights and Sustainable Development.

Prevailing Health Scenario Pakistan - the sixth most populous country in the world, according to estimates, the total population of the country is approximately 18 million as on 30th June 2008 with an annual growth rate of 2.6%. Women constitute approximately 52% of the total population. In Pakistan, the total spending in health sector is 0.57% of the GDP, whereas in South Asian Region, it is 4.7% of GDP. The country, on the other hand, faces an enormous challenge in delivering basic health care to its people. Its highly diverse geography, ranging from the plains of the Indus River Basin in the south to rocky plateaus in the southwest and the towering Himalayas in the north, makes travel difficult. Many Pakistanis live in remote villages and roads are often in poor condition. As a

result of the difficulty of delivering health care under these conditions, the country has one of the highest rates of maternal mortality in the world (6-8 per 1,000). In Pakistan, 1 in every 38 women dies from pregnancy-related causes while in Sri Lanka, it is 1 in 230.

In Pakistan, the total spending in health sector is 0.57% of the GDP, whereas in South Asian Region, it is 4.7% of GDP Pakistan has the highest rate of breast cancer among all the Asian countries. It is the commonest cancer observed in females, representing more than one third of female cancers and about one fourth of all malignancies. Approximately, 1 out of 9 women in Pakistan are likely to suffer from breast cancer at some point in their lives whereas, in India it is 1 in 22 (Indian Council of Medical Research - ICMR). Every 5th woman in Pakistan develops breast cancer after the age of 40. About 77 percent of invasive breast cancers occur in women over 50 years of age. Average age at diagnosis is 64. Approximately 90,000 cases are diagnosed with breast cancer every year however, the number of unreported cases is expected to be much more. Out of the reported cases, advanced breast cancer accounts for 43.7% of cases; over 40,000 deaths per year in Pakistan.

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Approximately 1 out of 9 Pakistani women are likely to suffer from breast cancer at some point in their lives Pakistan is a classic example of people having varied life style of both liberals and conservatives but surprisingly the basic characteristics of female population remains one and the same. Both live under fear of male domination. The majority of Pakistani women, thus, are reluctant to consult and be examined by doctors. Due to social stigma, the women even after discovering breast cancer conceal it. As a result, Pakistani women are at high risk of developing breast cancer.

Inherent Challenges Whenever any campaign is launched or any developmental project is initiated with an aim to bring change in the society, several impediments must be faced. Furthermore, in a country like Pakistan, change is acquired over an even extended period of time as diverse challenges exist. The inherent challenges encountered during the Pink Ribbon Campaign include: •

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Illiteracy: In Pakistan, overall female literacy rate is 36% ♣ , whereas 77% of the females have not completed higher secondary school. Lack of education, knowledge and understanding has rendered women oblivious of the

occurrence of breast cancer and its vicious effects. The greatest challenge lies in directing a message that is easy to understand, enlightening and provides early detection and self diagnosis steps for urban as well as rural women, without offending the stern social and cultural beliefs of these women and their families. •

Taboos: The success of a campaign depends on a large extent the way it is communicated to its target audience and the way they perceive it. Unwillingness to understand, resistance or rejection of sensitive matters is not an issue of the illiterate only, the masses at large have prescribed principles and indigenous cultural beliefs on the basis of which they tend to accept or reject a particular notion. The taboos affirm that the disease is a result of an evil eye, a curse or wrong doings of the sufferer. Breast cancer is a very sensitive issue and women generally shy away from addressing breast related issues and feel uncomfortable in discussing breast cancer. This reluctance further increase with a fear that disclosure of the disease will tend to affect the future of sisters and daughters of the patient by not getting married. Hence, reaching out to women, removing their shyness and misconceptions and educating them on preventive and early diagnosis method is a tremendous challenge relevant to all segments of women alike.

90,000 cases of Breast Cancer are reported every year in Pakistan, out of which over 40,000 women die of it…

Pakistan Education and School Atlas

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Myths and Misconceptions: The myths and misconceptions prevalent in the society also substantially hinder early diagnosis and even the treatment of breast cancer in Pakistan. Some of the myths and misconceptions include: o Breast cancer only affects older women o If breast cancer does not run in your family, you will not get it o Only your mother's family history of breast cancer can affect your risk o Breast cancer is a communicable disease o Breast cancer can be a result of a curse/evil eye o Breast feeding increases the chance of breast cancer, etc. All these myths and misconceptions are not true and due to lack of awareness and knowledge many women start believing these and delay the process of diagnosis and treatment.

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The B-word and Media: Running a campaign on breast cancer awareness in Pakistan required changing of mindsets. While talking about the issue of CA Breast, media in Pakistan was not ready to differentiate between education and obscenity; and refused to air any news or programs on this topic. Getting them to comply was a later challenge, just making them recognize the importance of breast cancer awareness, its high prevalence in Pakistan and the need for mass communication had been and continues to be our greatest challenge. Lack of Medical Facilities and Infrastructure: Poor access to healthcare, lack of medical facilities and infrastructure not only limits the early diagnosis of breast cancer but also hinder treatment of the deadly disease. The

existing government and private hospitals are insufficient to cater for the growing number of cancer patients and lack resources to provide adequate diagnostic and treatment facilities. There is no concept of Annual Screening or Mammogram for women aging 40 or above as either it is not available or is expensive.

The available human resource in health sector in Pakistan is dismally low as it shows a ratio of 1,254 people per doctor, 2,671 per nurse, 6,235 per midwife and 18,318 per Lady Health Visitor (Economic Survey 2006-07, Pakistan) •

Lack of Specialized Human Resource: The number of specialized human resource e.g. surgeons, oncologists and radiologists specifically female doctors is too low; as specialized facilities are limited to some main cities of the country. Furthermore, rural areas, on one hand, lack doctors and on the other hand, absenteeism of female doctors, nurses and paramedics further aggravates the situation. Women, 3

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A Life Worth Living… who after overcoming lots of obstacles at the household level, when reach a hospital for consultation and the concerned doctor is not present there find it all the more difficult to visit again. Furthermore, the rural community finds it more convenient to go to a pious man (peer/imam masjid) for a special prayer that they think will dissolve the cyst or to a Hakeem for alternative medication or to a barber shop for rudimentary surgery of the cyst. This delay in diagnosis and inappropriate treatment, in many cases, proves to be fatal for patients. •

Absence of Cancer Registry: Research and development is at its lowest in Pakistan and the absence of a Cancer Registry further substantiates this. There is no official collection of data, analysis or availability of statistics, and hence the prevailing national scenario is vague.

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Lack of National Cancer Prevention Program: Welfare countries across the globe support National Cancer Prevention Programs that operate through the amalgamated efforts of national organizations, state health agencies and other key groups to develop, implement, and promote effective cancer prevention and control practices. However, no such program exists in Pakistan.

With Early detection… the chances of surviving Breast Cancer are more than 90%

The Pink Ribbon Campaign For the past fifteen years, Pink Ribbon has symbolized support for breast cancer awareness worldwide. The campaign epitomizes femininity, support and endurance. To recognize the valor of women fighting breast cancer, each year the general public is encouraged to wear Pink Ribbons throughout the month of October. The pink ribbon is an emblem of hope for breast cancer sufferers and for those working to fight this curable disease. The Pink Ribbon Campaign was brought to Pakistan in 2004, when Women’s Empowerment Group (WEG) observed the astonishingly high breast cancer prevalence in Pakistan. It was found that breast cancer was one of the fastest growing national concerns, yet was being neglected at all levels due to social and cultural restraints. To address this concern, the Nationwide Breast Cancer Awareness Campaign was initiated, with the aim to make breast cancer emerge as a premier health concern. Pink Ribbon Pakistan, The National Breast Cancer Awareness Campaign, is a non-funded, self-sustained campaign, driven by a large number of volunteers all over the country.

Rationale Diagnosis of cancer begins a long journey that can affect physical health, mental well-being and relationships with loved ones. Quality of life - the overall well-being of a cancer patient, is greatly influenced by a number of factors and has a lot more effects on other aspects of the patient as well as her family. Some of the common contributory factors to breast cancer include early menarche, late menopause, no breast feeding, no or late pregnancy and dietary factors. In Pakistan, though, the role of BRCA (Breast Cancer) genes, relating to a positive family history, is becoming more apparent. This could be one of the reasons that younger females, early twenties and late twenties are pouring in with the 4

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A Life Worth Living… signs and symptoms of breast cancer. This, on one hand is quite contrary to the prevalent trend of the occurrence of breast cancer and on the other hand is alarming because of its repercussions on the future mothers and their children and families.

Women’s Rights Violation

In Pakistan 75 percent of breast cancer patients may die in five years if no treatment is given to them and rest of the 25 percent would die in the next five years. The treatment of breast cancer in Pakistan ranged from no treatment to quick mutilating resection, thus breast cancer is a major cause of morbidity and mortality among women in Pakistan. In a country like Pakistan, where 43% of the population is living below the poverty line, unable to meet the needs of food, clothing and shelter, the provision of treatment of breast cancer becomes more difficult . Majority of the families either find themselves unable to go for the treatment or had to discontinue it at any stage due to the financial stress associated with it. Lack of awareness and financial capacity deprive women from their basic right of treatment of the deadly disease.

Socio-economic status (SES) and survival rate

Strong association has been noted between low SES and advanced breast cancer, delay in diagnosis, limited access to Minimal Expected Treatment (MET) and inferior Disease Free Survival (DFS) and Overall Survival (OS). On the other hand, almost all rural women and a large percentage of women of urban lower income families are directly involved in income generation for the family. The family income is thus tangibly affected if the health of women is not assured.

Reproductive Health

Not having children or late motherhood tend to increase the possibility of breast cancer. Women who have their first child after

the age of 30 or who have never had children run a slightly higher risk for contracting breast cancer than do women who give birth before reaching age 30. Young women who undergo chemotherapy for breast cancer face serious consequences to their reproductive health. It is estimated that 1 in 3,000 pregnancies are complicated by breast cancer. However, newly diagnosed breast cancer in pregnancy, has no immediate effect on the fetus as breast cancer cells do not pass from the mother to the fetus. Presently, abortion, miscarriage and the use of birth control pills, are also being researched for any association with the risk for CA Breast. However, the link still remains unproven, requiring further research in this area.

Breast feeding

Multiple studies have demonstrated that breast feeding is associated with reduced risk of breast cancer. In addition, the longer a woman breast feed the better are her chances of cancer protection. Breast feeding protects the baby from various diseases, develops bond between mother and baby and is a source of natural birth spacing. However, there is evidence that breast feeding is on the decline in many developing countries. In 1991-92, a nationwide survey was conducted in Pakistan to collect baseline health information on a variety of maternal and child health issues. Survey results indicated that fewer mothers are currently breast feeding their children, and that mothers who do breast-feed often supplement breast milk unnecessarily and/or stop breast feeding earlier. Possible explanations for the decline in breast feeding need to be explored and more effective breast feeding promotion campaigns should be designed.

Mother and child health

Maternal health problems are widespread, complicated in part by frequent births. In Pakistan of every 38 women who give birth, 1 5

Report Pink Ribbon Pakistan

A Life Worth Living… dies. The infant mortality rate (101 per 1,000) and the mortality rate for children under age five (140 per 1,000 births) exceed the averages for low-income countries by 60% and 36%, respectively. In Pakistan about 19% of the population is malnourished, a higher rate than the 17% average for developing countries and 30% of children under age five are malnourished. The situation becomes adverse for children whose mothers are sufferers of breast cancer. Children, from zero to two years of age, of diseased mothers not only suffer because they could not be breast fed but also could not be properly taken care of by their mothers because of the strain of the disease. In addition to this, in a family where a cancer patient is being treated, financial stress also increases and makes it more difficult to cater the nutritional and health needs of the family. Any attempt to reduce the prevalence of breast cancer in the country will definitely, in turn, benefit the health of the children and lead to a healthier, prosperous nation.

Marital relationship… A bond to keep

For victims of breast cancer, it involves more than just physical sickness, patients and their families often suffer the psychological consequences of trying to come to grips with this deadly disease. It severely impacts women’s personal lives and relationships, sometimes shattering them completely as they feel that they cannot perform wifely acts and the disease has strong effect on sexuality. This problem is particularly pronounced in the Pakistani culture and society where relationships are so powerfully governed by social norms and rules. An increase in divorce rate amongst women who are diagnosed with breast cancer has also been seen. Thus women who are diagnosed with breast cancer not only need physical treatment but they also need the psychological and emotional support.

Nutrition and Physical Activity (NuPA)

Scientific evidence suggests that about one-third of the cancer deaths that occur in industrialized countries each year are due to nutrition and physical activity factors, including obesity. This proportion is thought to be about 20% in developing countries, but is likely to grow as other countries adopt a more “Western lifestyle”. Among women increased body weight and weight gain during adulthood are linked with a higher risk of breast cancer after menopause. Alcohol also increases risk to some extent, especially in women whose intake of folate is low.

Life is precious… in order to save it the Idea of Nutrition and Physical Activity (NuPA) emphasizes community to change their eating habits and include exercise in their daily routines. 6

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Vision Pink Ribbon Pakistan strives to significantly reduce breast cancer mortality in the country by creating widespread awareness on early detection and increased access to treatment.

Mission To create widespread awareness about breast cancer and to become a Center of Excellence for Breast Care Information in Pakistan.

Ideology The Ideology of the campaign focus on the following points: 1. The dangerously high level of incidence of breast cancer in Pakistan 2. The disease is curable and need not be made fatal 3. The disease can be detected early, even by simple self diagnosis and 4. That life after cancer is worth living

Objectives The objectives of the campaign are to: • Make Breast Cancer an acceptable topic in the public domain in Pakistan • Create widespread awareness about Breast Cancer and key aspects – its high incidence, its seriousness leading to fatality, impact on the life of the sufferer and the whole family and also the good news that if detected early, Breast Cancer may be cured • Promote understanding and practice of self diagnosis • Evoke empathy in the right quarters to support the cause • Motivate people to contribute funds for campaign execution

Pink Ribbon Campaign’s strategy is to solicit wide support for the campaign, create a nationwide awakening to the problem and build long term sustainable platform The stakeholders • • • • • • •

Women, 16+ age group, in all walks of life and both urban and rural. The Media Local, provincial and federal governments National and International funding agencies Corporate sector for their Corporate Social Responsibility The medical profession, especially female doctors The general public

Strategic Approach The framework of the campaign has been woven around the following strategies and guiding principles a) Establishing the need and the urgency to launch this campaign, b) Soliciting wide support, c) Creating a national level awakening to the problem, d) Creating a long-term, sustainable platform.

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Working with the Government

The march starts… The Pink Ribbon Campaign used multi-pronged strategies to address the needs of different stakeholders. Events and activities have been planned strategically to reflect the core relationships of the campaign. The following paragraphs will throw light on the work done so far. The diagram below shows the areas that have been focused during the campaign:

Working with Government Corporate Social Responsibility

Strategic Alliances

Pink Ribbon Campaign Pakistan

Involving Youth

Media

Networking with Women Groups

Celebrity Endorsement

The role of government could not be denied in the provision of treatment facilities for all, especially for the poorest of the poor therefore, government needs to be sensitized in this regard. Pink Ribbon being a humanitarian cause has been fortunate to have support of Government dignitaries beyond political affiliation. The Campaign started off with a Top to Bottom Approach, by working to change the mindsets and policies of the top policy makers. Towards this end, the Campaign has managed to gain support from the First Lady of Pakistan, Wife of the Prime Minister of Pakistan, Wife of the Governor Punjab and Wife of Governor Balochistan. During last several years the campaign has also been privileged to have support of different Excellencies holding the office of Minister and Secretary of Ministry of Women Development, Ministry of Health and Ministry of Information and Broadcasting at Federal and Provincial levels. To establish Public Private Partnership, Memorandum of Understanding (MoUs) have also been signed with the following ministries: • Federal Ministry of Women Development • Ministry of Women Development and Social Welfare, Government of Punjab, and • Ministry of Women Development, Government of Sindh

Pink Ribbon being a humanitarian cause has been fortunate to have support of Government dignitaries beyond political affiliation. 8

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Free Mammography Service Planned

In recognition of the struggle done by the Pink Ribbon Campaign Pakistan in promoting awareness against breast cancer, the FederalGovernment has planned to establish breast screening centers in five major public hospitals in the country to provide free mammography and screening services to women. These hospitals include: • Pakistan Institute of Medical Sciences (PIMS),Islamabad • Jinnah Post Graduate Medical Centre (JPMC), Karachi • Sheikh Zayed Medical Complex (SZMC), Lahore • Sheikh Khalifa Bin Zayed Federal Hospital, Quetta and • Federal Government Medical Centre, Peshawar Seeking More Support

Government of Pakistan has developed a population policy, which emphasizes Reproductive Health (Breast and cervical cancer being part of the RH). However about a couple of years back, after a consultative process of all the stakeholders, only four components of RH (FP, infant health, maternal health and STD/HIV) were selected as top priority. We intend to lobby with key policy planners to include breast cancer in RH package.

National Assembly, beyond political affiliations, to discuss breast cancer related issues, to raise concerns with government and other policy makers and to take action on behalf of people suffering with breast cancer.

Strategic Alliances In its efforts to expand its scope, the campaign intends to build linkages with different teaching hospitals, health related institutions and health care professionals. The strategic alliances so far developed include:

Aga Khan University

A Memorandum of Understanding (MoU) between Aga Khan University Karachi and Pink Ribbon Pakistan has been signed. Both organizations agreed to collaborate in extending advisory services, academic support and developing case studies for the Government of Pakistan for inclusion of breast cancer in reproductive health package and setting up a cancer registry in Pakistan. AKU will also provide support to Pink Ribbon in nationwide training program of lady health workers.

Similarly, a ‘Cancer Registry’ needs to be established for recording and maintaining a database that is a true representative of the country. This database could be effectively used in research and planning long term strategies to combat this deadly disease.

Formation of All Parties Parliamentary Committee Consultations are underway to form an All Parties Parliamentary Committee on breast cancer to provide a forum for Members of 9

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Fatima Jinnah Medical College, Lahore

Another MoU has been signed between National Breast Cancer Awareness Campaign and Fatima Jinnah Medical College (FJMC). According to this MoU, FJMC will facilitate with trained human resource. A Well Women Clinic has also been established in Ganga Ram Hospital as an outcome of the joint collaboration of both the organizations. The possibility of developing such linkages with other institutions is also being explored.

Fellowship Awarded by ACSU

The National Coordinator of National Breast Cancer Awareness Campaign Pakistan, Omer Aftab, was selected by American Cancer Society to receive two scholarships to attend American Cancer Society University (ACSU) training. The first training was in May 2006 in Seattle, Washington, and the follow-up training was in March 2007 in Istanbul, Turkey.

ACSU is the signature programme of the Society's international effort working to strengthen the capacity of emerging Cancer Societies in developing countries.

Networking with Women Groups Pink Ribbon Pakistan strategically plans to take advantage of already established women groups and networks to increase its

outreach. The campaign is open to requests from any organization to collaborate in spreading awareness to maximum number of women across the country.

Girl Guide Association

An orientation was given by Pink Ribbon Pakistan at Girl Guide House on the eve of annual Youth convention; ‘Voices of Young Leaders’. The audience mainly comprised of young girl guides from various educational institutes from all over the Punjab hence the occasion was quite appropriate to sensitize maximum number of young girls even from the remote areas. Since Girl Guides act as team leaders and are engaged in various social activities they were the right target audience to spread the message at a large scale.

Pakistan Foreign Office Women Association

A workshop was arranged in collaboration with the Pakistan Foreign Office Women Association (PFOWA) at Foreign Office Islamabad. This Association has been formed by the wives of the bureaucrats working in the Foreign Office. PFOWA contributes to the empowerment of women, promotion of education, provision of welfare facilities, medical assistance, disaster relief, assisting the disabled and financial aid for widows and orphans. PFOWA has also agreed to conduct more awareness and fund raising activities for Pink Ribbon Pakistan.

Masroor Air Base, Karachi

A community based awareness drive has been initiated at Masroor Air Base, Karachi by a volunteer of Pink Ribbon Pakistan. It is the largest Air Base of Pakistan with almost 4,000 households. In its efforts to impart awareness, information material about self examination and early detection has been distributed among the wives of PAF officers. The owners and workers of beauty parlors 10

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A Life Worth Living… have been contacted and Pink Ribbon brochures are being disseminated among the clients through them. The awareness drive is also looking forward to visit colleges and hospitals at the base and to equip them with necessary information about the early detection of CA Breast.

Rousing Youth

arranged by the students on a voluntary basis, reflected their passion and proved to be a source for polishing their skills as well.

Recent trends have shown that young girls in early twenties are also very likely to be hit by breast cancer and due to prevailing misconceptions no one ever suspects this deadly disease in a young girl. Pink Ribbon Youth Awareness Program was initiated on “World Cancer Day” i.e. 4th February 2007 with an aim to reach 300,000 girls through 300 girls colleges and universities of Pakistan, recognized by Higher Education Commission. It intends to provide knowledge through leaflets and posters in both English and Urdu, followed by a series of seminars and lectures of specialist doctors. Through this campaign, young women will be informed about self-examination and early diagnostic methods, and may also resultantly prove to be influencers for their mothers and other women in their families to remain health conscious and get regular check-ups.

Enthusiastic Youth… from the Mass Communication Department of Lahore College for Women University prepared two documentaries and a short play for the Pink Ribbon. This Mock Media Campaign on Awareness regarding Breast Cancer,

In continuation of this program, seminars have been held at: • Kinnaird College for Women, Lahore • Lahore University of Management Sciences (LUMS) • Fatima Jinnah Medical College, Lahore • King Edward Medical College, Lahore • Lahore College for Women University, Lahore • Punjab University, Department of Applied Psychology • Islamabad College for Girls, Islamabad • International Islamic University Women Campus, Islamabad 11

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Overseas Pakistani Foundation School and College, Islamabad Fatima Jinnah Women University, Rawalpindi Aga Khan University, Karachi

Musical concert was organized by the students of Kinnaird College for Women, Lahore. This volunteer driven event raised awareness amongst the students and also helped to generate funds for the campaign. Other than Pakistani students, many international students have also shown keen interest in the Pink Ribbon Pakistan. The campaign has hosted interns from Houston, Florida and McGill. One of the Pink Ribbon intern was given Violet Richardson Award by Soroptimist International while another intern acquired Fulbright Scholarship on the basis of the recommendation from the campaign.

A Pink Ribbon Week was celebrated at LUMS. Main events organized during the week included: Sale of Pink Ribbon Merchandise for fund raising, Panel discussion emphasizing the social and psychological aspects associated with Breast Cancer and an informal female only session on breast self examination. This volunteer driven initiative, attracted many more volunteers for the campaign.

The campaign also receives requests from international students for research projects. Some of the requests have been from: Seneca College, Toronto, Canada; Stanford University, California and Parson’s School of Design, New York.

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Lady Health Worker’s Program

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National Program for Family Planning and Primary Healthcare has 100,000 Lady Health Workers (LHWs) working in almost every part of Pakistan and providing primary healthcare facilities to the community.

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A single LHW is posted for 1,000 houses. One supervisor is assigned the task of supervising 30 LHWs. LHWs report to their supervisors once per week and submit their progress reports. Every LHW maintains a register of logistics. Pink Ribbon Pakistan intends to initiate a nationwide training program of LHWs to educate, diagnose the disease and refer new cases to tertiary care hospitals. Besides working as a support group, they can be effective counselors for those already suffering with the disease. Due to the efforts of Pink Ribbon Pakistan, as a first step, a chapter about self examination has been added into the training manual of the LHWs.

Survivor’s Network The Pink Ribbon Campaign has initiated a Breast Cancer Survivor’s Network to improve survival from Breast Cancer and the quality of life after diagnosis for patients and their loved ones… The scope of the Survivor’s Network includes: • Social and emotional support • Link survivors with patients as role models • Provide culturally specific educational materials to survivors and their families

Conduct one-to-one interviews with survivors to learn more about how they are dealing with their cancer and how their care can be improved. Connect members with other survivors

“There should be professional psychiatrists in hospitals that can provide instant consolation. Being detected with breast cancer is a great shock for a woman. Leaving aside emotional shock, only the physical pain stays for 2-3 years,” says Miss Sheikh, A Survivor…

Encouraging Corporate Social Responsibility In order to comply with the international standards and benchmarks the concept of Corporate Social Responsibility (CSR) is growing in Pakistan also. Pink Ribbon Pakistan wants to be the part of the ongoing CSR programs of the national as well as multinational businesses in order to gain support for the campaign.

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Dinner hosted by British High Commissioner

A Pink Ribbon dinner was organized, to introduce the campaign to the corporate world and to seek their support, at the British High Commission Karachi hosted by Mrs Sheila Lyall Grant and Mr Mark Lyall Grant (British High Commissioner). The event was attended by business elite and heads of the leading national and international corporations like; Karachi Chamber of Commerce and Industry, Karachi Stock Exchange, Unilever, Atlas Group of Companies, Shell, Dadabhoy Cement, Oxford University Press, Bank Al Habib, Sheraton Hotel, Novartis Pharma, Eli Lilly, Philips, Reckitt Benckiser, HSBC, ABN-Amro Bank and Citibank N.A.

‘Pink Ribbon Day’ at UniLever

‘Pink Ribbon Day’ was celebrated at the Head Office of UniLever Pakistan in Karachi. This activity served two purposes’ on one hand it provided information about breast cancer situation in Pakistan and on the other hand it also inculcated the idea of Corporate Social Responsibility. UniLever Manager CSR while speaking on the occasion said “Huge responsibility comes after taking this initiative, but since Unilever believes in the concept of Pink Ribbon, it will extend every support to the campaign”. Awareness material was also distributed among the staff.

Series of lectures at Mobilink Call Centre

Mobilink, the leading mobile network company, was approached and sensitized on the issue. As a result of which, a series of nine lectures were delivered at Mobilink Call Center, Lahore. In these

lectures almost 200 female employees were trained about the risk factors, early detection and self examination. The campaign also plans to replicate such initiatives at other corporations so as to raise awareness level of the employees regarding CA Breast and to help organizations in fulfilling their Corporate Social Responsibility.

Sponsorships – Sharing Vision Pink Ribbon Pakistan- A non funded campaign has been able to motivate many corporate companies to sponsor different endeavours. The campaign not only encourages such kind acts but also hopes that the spirit of Corporate Social Responsibility further amplifies in the days to come… Our esteemed sponsors include: Mobilink World Call PTCL Ufone Pepsi Haleeb Foods United Bank Citi Bank Askari Bank Kodak

Ferozesons Laboratories Roche’ Novartis Eli Lilly ICI Hashoo Group Dewaan Group Shell Unilever

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Celebrity Endorsement

which was considered a forbidden subject by the government and masses alike.

Support Continues…

Having lost a very dear aunt to breast cancer, I am determined to help keep women talking about the signs, how to spot them and what to do if they find a breast change. That is one of the reasons why, for the last seven years, I’ve been Patron of Breast Cancer Care, the organization that has been listening and talking to people about breast cancer for over 30 years. I’m lucky to be able to help spread a vital message that I’m passionate aboutthat all women, regardless of age or background, need to know their own bodies and should feel able to talk to their doctor should they find a change in their breast that’s unusual for them.

I send my best wishes and support you in your efforts to raise awareness of breast cancer. (Cherie Blair) Mrs. Cherie Blair, wife of former British Prime Minister Tony Blair, made a private visit to Pakistan in April 2006 on the invitation of Pink Ribbon Pakistan. Her stay was of just eight days but she accomplished a great deal in this short time for the cause

“Women in Pakistan are so shy that more than 50% of breast cancer patients do not even report to healthcare professionals and eventually fall in the trap of death” During her visit, she met the First Lady, for the confirmation of her support in this epic cause. She also met wife of Prime Minister, Patron of Friends of Pink Ribbon Pakistan, who hosted a dinner in her honor. Mrs. Blair also attended a seminar at Fatima Jinnah Medical College where she shared her experiences with leading doctors from all over the country and voiced her concern about Third World countries with regard to Breast Cancer. A fundraising dinner was also held at the Governor's House Lahore where renowned businessmen and philanthropists were present to pledge their support to the cause. 15

Report Pink Ribbon Pakistan

A Life Worth Living…

Support from Mrs. Cherie Blair still continues with an increased level of interest in the cause as she plans to revisit Pakistan in the near future.

Jagjit Singh’s tour de Pakistan

Ghazal Maestro, Jagjit Singh, was invited to Pakistan by the National Breast Cancer Awareness Campaign for a musical tour themed “Music for Peace”. The legend performed live in Pakistan for the first time. The concert was not only entertaining for thousands of people attending the event but also proved to be an excellent fund raiser for the campaign. Main objective of the event was to spread breast cancer awareness to all echelons of the society and it served its purpose well. The Prime Minister of India, sensitized on the issue of high prevalence of Breast Cancer in the region and to support Pink Ribbon Pakistan, sent Jagjit Singh as his “Goodwill Ambassador”.

Beyond Borders

Ashwariya Rai, former Miss World and a renowned Bollywood star, in recognition of the efforts being done by the campaign, showed her deep concern over the increasing number of breast cancer patients in Pakistan and lack of awareness about the disease. In response to the invitation from Pink Ribbon Pakistan she also showed interest in visiting Pakistan to support the campaign.

Campaigning through Media Impressive development of civil societies across the globe and especially in developing countries owed its development to responsible and dynamic media. A massive media campaign has been carried out by Pink Ribbon Pakistan to get maximum coverage about the issue and to disseminate the awareness message.

The word “B” … Converting media’s resent into their consent… According to the Press Freedom Report 2001-2002: “ Under the present code of ethics, the difference between obscenity and education is a blur. For example a program on breast cancer is not an educational one but a vulgar program.” Getting media to comply was a secondary challenge, just making them recognize the high prevalence of breast cancer in Pakistan, the importance of creating awareness and the need for mass communication had been our greatest trial. Pink Ribbon Campaign’s strategic approach made media realize the gravity of the issue and breast cancer has now become part of the health programs.

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Report Pink Ribbon Pakistan

A Life Worth Living… The Pink Ribbon Campaign Pakistan was selected from 239 campaigns which were judged by an international jury of 44 senior practitioners drawn from 26 countries. Criteria used by the jury included the competence and quality of each entry demonstrated in terms of research, planning, execution & evaluation, clarity of message, creativity and ethics as well as local conditions in the country of origin. Pink Ribbon Campaign is the first Pakistani campaign which has been honoured with International Public Relations Association (IPRA) Front Line Golden World Award 2005 in the 50 years history of the International Public Relations Association for excellence in public relations. IPRA is an apex body for international public relations practitioners representing the interests and professional standards of members from over 96 countries.

The media coverage gave a boost to the campaign by bringing to the limelight different events organized at the National and Provincial levels. The National Coordinator of the campaign has been invited by different TV Channels for special interviews and briefings elaborating the objectives and achievements of the campaign, especially during October, the Pink Ribbon Month. Similarly, various newspapers and magazines printed special articles on the situation of breast cancer in Pakistan and the services Pink Ribbon Pakistan is extending to curb this deadly monster. Along with these special transmissions and publications, the media also gave due coverage to various Pink Ribbon activities carried through out the country on an ongoing basis. In 2006 Press Information Department (PID) aired Public Service ads, first time ever on Breast Cancer, from all State run TV channels. These ads were aired in support of the campaign and the wife of the Prime Minister of Pakistan delivered the message.

International media also gave momentous exposure to the campaign by giving significant coverage to different events. Events that were given special coverage include: the visit of Jagjit Singh, the support from former Miss World, Ashwariya Rai, Frontline Golden World Award 2005, etc. Lots of international channels and newspapers gave coverage including Voice of America, Yahoo News, Daily Mail, The Times, Khaleej Times, Oman Times, Hindustan Times, etc. Ms Fiona Bruce and Ms Eve Conway from BBC made a documentary on the visit of Cherie Blair to Pakistan. This 30 minute documentary was woven interestingly, showing at one hand the warm welcome and celebrations organized in honor of the celebrity and on the other hand was depictive of the plight of a young girl, named Minahil residing in one of the villages of Punjab, after the death of her mother due to breast cancer. This documentary was aired from all channels of BBC throughout the world for over a month and generated lot of support for the campaign.

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Report Pink Ribbon Pakistan

A Life Worth Living…

From Distress to Hope… Minahil, 11 years old girl…living in village Rosay of Sheikhupura District of Punjab, Pakistan, shares her pain of losing her mother due to Breast Carcinoma. Every morning the family gathers to mourn at their mother’s grave. Minahil too has been coming to her mother’s grave for the last six years but the pain of the loss has not lessened with time. “We wish she was here with us…she used to make sure that we eat properly…she would buy us clothes and get us ready for school…I miss her a lot.” In an interview given to BBC during the visit of Cherie Blair to Pakistan, Minahil shared her wish of becoming doctor but her father, a poor illiterate farmer, is not able to bear the cost of it. This interview, telecasted from different channels of BBC throughout the world, make Mr Michael Seagrim, a Britisher, approach Minahil and promised to bear all the educational cost of her studies. With a sparkle in her eyes, Minahil is optimistic about a brilliant future ahead while the photo of her deceased mother still remains as one of her most prized possessions…

Extending friendly hand… Friends of Pink Ribbon are volunteer-based support groups for the Pink Ribbon Campaign. These support groups have been established in Lahore, Islamabad and Karachi and are functioning as part of the campaign to bring about awareness of breast cancer. Mrs. Sheila Lyall Grant, the wife of the then British High Commissioner in Pakistan was the founding Chairperson. A number of fundraising events have been arranged by the Friends of Pink Ribbon to gather funds for the campaign. They have also been involved in a number of other ground activities at their locations to spread the knowledge about breast cancer.

‘Friends of Pink Ribbon’ held activities among diplomatic community based in Islamabad that include: • Coffee morning at Australian High Commission • Pink Ribbon Party at the French Club • Pink Ribbon Dinner at Canadian Club and • Awareness and Fund Raiser at British High Commission and the United Nations Club. 18

Report Pink Ribbon Pakistan

A Life Worth Living… The campaign is on its way and still has a long path to follow. This journey could be facilitated by the support you offer by allocating some of your time for voluntary work or through donations, thereby ensuring that the work Pink Ribbon Pakistan is doing, will continue. Your contribution depends on your skills and interest. Essentially, the campaign wants to increase public awareness and raise money for the provision of treatment facilities. This can be accomplished through public speaking, organizing seminars, symposium, organizing fund raising events, handling the administration and maintaining media contacts, etc. As a volunteerdriven organization, the campaign absolutely depends on others to lend a helping hand in combating breast cancer in Pakistan. The ownership of the campaign by the volunteers and friends of Pink Ribbon has given a sharp boost to the campaign within a short span of time and has become a reason of its tremendous success. Doctors, also, are not only supporting the cause but also extend a long term friendship in voluntarily spreading awareness against this deadly disease.

Pink Ribbon Merchandise

Raising Funds Voluntarily… Pink Ribbon Nursery Rhyme Book and CD was prepared by volunteers of the campaign, namely, Ms Kristen Glue, Ms Karolina Thouvenin and Ms Francesca Weichert, as their attempt to raise funds for the Pink Ribbon Pakistan. It took almost five months from the inception of the idea to its realization and all the work was done voluntarily.

For the purposes of promoting the cause of Pink Ribbon and fund raising, a number of products have been designed and launched in the market. These include metal pins, ribbons, wrist bands and nursery rhyme books and CDs. Pink Ribbon Pakistan also plans to introduce more products in future. Products that have so far been developed can be purchased from the stalls arranged at Pink Ribbon events or directly from the office of Pink Ribbon Pakistan. Pink Ribbon Merchandise has also been put on sale at various commercial spots and cafes of Lahore e.g. CTC Café, Kap’s Café, Hobnob, Hall Mark and Ferozsons and at Nomad Gallery, Organic Food Shop, Canadian Health Centre and Saeed Book Depot in Islamabad. 19

Report Pink Ribbon Pakistan

A Life Worth Living…

Moving Ahead… Future Projects In addition to the ongoing programs, Pink Ribbon Pakistan aims to expand its scope by adding some service delivery components into its future projects. They include:

Training of Patients’ families

As part of the National Breast Cancer Awareness Campaign, in the future the families of the patients will also be trained to better understand the disease so that they can be pillars of emotional and psychological support for those who have breast cancer.

Mobile Mammogram

Since there is a lack of medical facilities and doctors in the rural areas, where people have to walk many miles to get to a hospital, it is extremely difficult for women to get a mammogram regularly. To aid this, the campaign plans to acquire mobile mammogram bus so that even in locations where there is no easy access to hospitals, women can get regular checkups.

Well-women breast clinics The campaign plans to set up at least four dedicated ‘Well-women Breast Clinics’ with state-of-the-art facilities in remote areas in each province like Multan for Punjab, Nawabshah for Sindh, Mardan for N.W.F.P. and Quetta for Baluchistan to reach the maximum women with the lowest socio economic status.

Initiating Research

The campaign plans on initiating research to investigate the increase in incidence rate of breast cancer in Pakistan, why the disease is appearing more in young girls and what are the high risk areas, etc. This kind of research has been sadly neglected in Pakistan, however, Pink Ribbon Pakistan aims to draw attention towards this aspect as well.

Toll Free helpline

Pink Ribbon Pakistan also plans to establish a 0-800 toll free helpline where people can call and get more information about breast cancer, its risk factors, symptoms etc. 20

Report Pink Ribbon Pakistan