Breast Cancer Awareness Supplement Edition 2019

BREAST CANCER AWARENESS MONTH SUPPLEMENT 2019 EDITION

BREAST CANCER COVER PAGE SUPPLEMENTS

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Breast Cancer does not just affect women

GCF’s Bibi Hassan wants men and women to get screened

By Wendella Davidson

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BREAST CANCER AWARENESS MONTH SUPPLEMENT 2019 EDITION

REAST cancer is one of the most common kinds of cancer in women. Global statistics show that about one in every eight females is likely to get breast cancer at some point.

While it is rare in men (one in every 1,000 men will develop the disease), Founder of the Guyana Cancer Foundation (GCF), Bibi Hassan encourages both men and women to get screened.

The good news is most persons can survive breast cancer if it’s found and treated early. A mammogram is the screening test for breast cancer – can help find breast cancer early when it’s easier to treat.

Breast Cancer Awareness Month is observed annually during the month of October when several organisations, like the GCF, seek to further, raise awareness about breast cancer and the importance of being tested to individuals, families and communities.

The GCF, which was registered in 2016, is located at Lot 9 Sheriff Street & Third Avenue, Subryanville.

It is a non-Governmental Organisation (NGO) that is committed to raising funds and providing initiatives to help in the battle against cancer. Speaking with the Pepperpot Magazine, the founder said that some 14 years ago she joined the campaign in the fight against cancer while serving as the treasurer of the Avon Community Health Fund.

But she got the impetus to intensify the fight when in 2013 her mother was diagnosed with Stage Two breast cancer and Bibi Hassan was daily by her side as the caregiver. Her mom is now cancer-free but Bibi Hassan continues to relentlessly carry on the fight.

Committed to the cause, the GCF has organised several fund-raising events and volunteer services, targeting low income and uninsured area communities. Through the volunteer services, they have been offering clinical

breast examination, cervical cancer/HPV screening, glucose and cholesterol testing and free counselling, prostate cancer screening, blood pressure, and group sessions for cancer survivors and fighters.

Through early detection, education, awareness and free screening the GCF has been providing help and inspiring hope in those affected by cancer and too, seeking to re-

tal Centre, and with assistance from volunteer doctors and nurse, have seen countless persons suffering from a range of illnesses such as colon, breast, brain throat, prostate and cervical and brain cancer.

Also during the outreaches, some persons have been given referrals to the Guyana Cancer Institute or the Oncology Department at the Georgetown Public Hospital Corporation for further medical attention.

For Breast Cancer Awareness Month 2019, Hassan encourages both men and women to get screened. The GCF will in addition to participating in the Guyana Telephone and Telegraph (GTT’s `Pinktober’ active, also continue its routine outreaches and screening.

On Thursday the GCF held its annual tree wrapping exercise, which saw its members and volunteers, decorating all of the trees lining the Camp Street Avenue, between Lamaha and Church Streets with pink sashes emblazoned with the words `Get Screened for Cancer Today’. Today, a church service is scheduled to be held at Christ Church, followed by No Bra Day on October 13, in support of both men and women who have lost their breast from cancer.

October 18 will be observed as International Day ion dat n of Wear it Pink, and on the same day will also u o n celebrate National Mammography Day. er FHassa c n Ca ar As the name of the latter observance suggests, Hasna Akht a y u dah san says she is in the process of collaborating with the G ee he Dr Balwant Singh Hospital to have about 100 persons of t ibi Sa r e d F) B tested on that day. Persons desirous of benefitting from n u Fo (GC the service will, however, need to make contact with the GCF. On Saturday, October 26, 2019, the GCF with its integrate cancer survivors back into society while members and 23 cancer survivors will participate in also widening support system in respective communities. the popular `Pinktober’ 5k or 10k Cancer Walk and The GCF, during its outreaches, collaborates with Run, an activity that will see hundreds of persons, the Central Islamic Organisation of Guyana (CIOG), the some with children in tow, undertaking the distance Guyana Medical Relief Council and Cheddi Jagan Den- in recognition of cancer awareness.

BREAST CANCER AWARENESS MONTH SUPPLEMENT 2019 EDITION

EDITORIAL

Breast cancer awareness

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CTIVITIES to observe Breast Cancer Awareness Month (BCAM) 2019 continue. BCAM was founded and first observed in 1985. BCAM, an international observance from October 1 to 31 each year, was intended primarily to increase awareness of that non-communicable disease, thereby promoting vigilance, as early detection, diagnosis, and treatment significantly increases one’s chances of curing the illness.

As the month comes to a close this year, Guyanese should bear in mind that although the many activities held during the month, including walk-a-thons, workshops, seminars, vigils, and lectures, will come to an end, watchfulness against breast cancer should be a year-round activity, as the common, frequently-fatal disease can strike at any time of the year.

Breast cancer is cancer that develops from breast tissue. Symptoms of the disease include a lump in the breast, dimpling of the skin or other changes in the appearance of the breast area. Breast cancer, left untreated, usually spreads to other areas of the body, and is typically fatal. Fortunately though, if it is found early and treated, it can be completely cured.

Breast cancer can affect both men and women, because everyone has breast tissue. However, because of

physiological factors, it is more prevalent in women. In fact, it is the most common cancer in women. According to statistics, some persons are at higher risk of getting breast cancer than others. High-risk factors include obesity, family history of breast cancer, early onset of puberty, and in females, not having children.

According to the World Health Organisation (WHO), some 1.38 million persons are diagnosed worldwide each year with new cases of the disease. In Guyana, the Ministry of Public Health has reported that about 150 persons die of breast cancer annually.

The ministry reports, too, that 17 per cent of all cancers in Guyana are breast cancers, and 27 per cent of all cancers in Guyanese women begin in the breast. Evidently, this disease is a significant local health problem. Unfortunately, the majority of persons who get breast cancer in Guyana die because they do not detect the disease early enough and seek medical attention. Many times, too, according to officials, women notice the symptoms, but being fearful of the diagnosis, they delay seeking medical attention. The obvious solution is vigilance, and, if a problem is observed, the immediate pursuit of medical attention.

Chief oncologist at the Cancer Institute of Guyana, Dr. Sayan Chakraborty is on record as saying that all types of cancer-related detection and treatment, including diagnosis, chemotherapy, surgery,

and radiotherapy, can be done in Guyana. And he emphasises, “Know cancer, no cancer.”

According to the WHO, every person should be aware of changes in their bodies; any change in the feel or appearance of breast tissue should be considered suspect, unless cancer is ruled out by a competent doctor. In Guyana, the treatment of cancer, including breast cancer, is available free of cost. However, before any medical intervention can begin, there must be a diagnosis; and the onus is on all individuals to be selfaware and watchful, and

seek medical attention at the first sign of any symptoms of disease, as early detection, rapid action, and immediate medical intervention frequently results in a complete cure.

As Guyana and the rest of the world continue to observe Breast Cancer Awareness Month 2019, we are reminded that breast cancer is the most common cancer in Guyanese women.

And, as we remember and

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pay our respects to the many Guyanese who have succumbed to the disease, and acknowledge too, the many who have survived, let us remain alert, observant, and proactive in the interest of our own health.

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BREAST CANCER AWARENESS MONTH SUPPLEMENT 2019 EDITION

Banks DIH hosts cancer awareness programme

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everage giant, Banks DIH Limited, on Monday, hosted a Breast Cancer Awareness programme for employees, cancer patients and survivors at their Sports Club, Thirst Park, Georgetown.

Oncologist Dr. Latoya Gooding of the Giving Hope Foundation delivered the feature address in which she reassured the attendees that breast cancer is not a death sentence and urged women to seek early screening to ensure they are cancer-free.

“You can overcome cancer and some survivors of the disease are now living their best lives following treatment, however, early detection is necessary,” Gooding was quoted as saying in a Banks DIH release.

Dr. Gooding said that younger women are being diagnosed with breast cancer and men have also been

Mr. Andrew Carto, Human Resources Director and Dr. Latoya Gooding pose with cancer survivors

diagnosed with the illness.

She provided participants with information on the risk, treatment and recovery of the

disease.

Meanwhile, Mr. Andrew Carto, Human Resources Director, said the awareness

session was timely as more women are becoming mindful of the threat of breast cancer.

Sixteen cancer patients

and survivors attached to Georgetown Public Hospital Oncology Clinic, Cancer Institute of Guyana and the

Giving Hope Foundation, were presented with hampers and monetary donations by the Company.

Breast Cancer Awareness month is being observed in October and Banks DIH Limited has organised a series of events to coincide with activities.

Just recently, the company teamed up with Citizens Bank Inc. for a two-day Golf Tournament at Lusignan Golf Club on the East Coast Demerara, while the New Amsterdam Qik Serv hosted over 60 bikers of the Assassin Biker Club in an awareness campaign named “Bikers Against Breast Cancer”.

The bikers rode from Georgetown to New Amsterdam and later joined racing cyclists in Berbice in lap of honour around the township, before releasing balloons into the air as a sign of hope.

Cancer Institute holds successful cancer awareness walk

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ver 500 persons joined the Cancer Institute of

Guyana’s (CIG) annual cancer awareness walk Sunday morning to help

spread the word that ‘early detection saves lives.’

During the cancer awareness walk, Director of CIG, Dr. Syed Ghazi, told Guyana Chronicle that the main aim of the activity was to create awareness not only to breast cancer but all cancers.

“We have to be aware that this monster is out their which can hurt anybody, of any race or gender at any time when you least expect it,” Dr. Ghazi said.

000 women die of breast cancer and 36,000 women die of cervical cancer.

“When people come out and they hear us talking, they come to know what cancer is, so it is really a kind of energizing yourself,” he told this newspaper.

Meanwhile, breast cancer survivor Beverley Ann Munesar, in sharing experience said that she

tives and friends especially her husband.

She is urging women to get examined, noting that there are several options available – self-examination, mammograms and pap smears.

The walk started at the Burnham Basketball court and saw a number of other cancer survives taking part.

After the walk members of Genesis Fitness Gym led

The participants assembled at the Burnham Basketball court next to Parade Ground

He said the walk is a reminder that cancer is real and that early detection through regular screening can help to prevent cancer from developing. This, he said, can save thousands of lives.

Every year, 1.4 million people die of cancer worldwide, and out of this, 96,

was diagnosed with the condition on September 10, 2015. “I went through my storm; it was very challenging for me but with God all things are possible” she said confidently.

She ascribed the strength she gained to Dr. Ghazi and other staff of the cancer institute, her rela-

the group into an exercise session. That was followed by an observance of one minute of silence for those who have lost their battles to cancer.

Telecommunication giant DIGICEL donated a cheque of $500,000 to the institute to help in free screening for this month.

BREAST CANCER AWARENESS MONTH SUPPLEMENT 2019 EDITION

W.H.O’s fact sheet on

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Breast Cancer

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reast cancer is the most frequent cancer among women, impacting 2.1 million women each year, and also causes the greatest number of cancer-related deaths among women. In 2018, it is estimated that 627,000 women died from breast cancer – that is approximately 15% of all cancer deaths among women. While breast cancer rates are higher among women in more developed regions, rates are increasing in nearly every region globally.

In order to improve breast cancer outcomes and survival, early detection is critical. There are two early detection strategies for breast cancer: early diagnosis and screening.

Limited resource settings with weak health systems where the majority of women are diagnosed in late stages should prioritize early diagnosis programmes based on awareness of early signs and symptoms and prompt referral to diagnosis and treatment.

Early diagnosis

Early diagnosis strategies focus on providing timely access to cancer treatment by reducing barriers to care and/or improving access to effective diagnosis services. The goal is to increase the proportion of breast cancers identified at an early stage, allowing for more effective treatment to be used and reducing the risks of death from breast cancer. WHO Package of essential noncommunicable

(PEN) disease interventions for primary health care in low-resource settings has guidance on the approach to assessment and referral for women with suspected breast cancer in the primary care setting.

Screening

Screening consists of testing women to identify cancers before any symptoms appear. Various methods have been evaluated as breast cancer screening tools, including mammography, clinical breast exam and breast self-exam.

Mammography: uses low-energy X-rays to identify abnormalities in the breast.

It has been shown to reduce breast cancer mortality by approximately 20% in high-resource settings. WHO Position paper on mammography screening concluded that in well-resourced settings women aged 50-69 should undergo organized, population-based mammography screening if pre-specified conditions on programme implementation are met. In limited resource settings with weak health systems, mammography is not cost-effective, and early detection should focus on reducing stage at diagnosis through improved awareness. For women aged 40-49 years or 70-75 years, WHO recommends systematic mammography screening in women aged 40-49 years or 70-75 years only in the context of rigorous research and in well-resourced settings.

Clinical Breast Exam (CBE): is an examination of both breasts performed by a trained health professional. CBE seems to be a promising approach for low resource settings and could be implemented depending on the evidence from ongoing studies.

Because screening requires substantial investment and carries significant potential personal and financial costs, the decision to proceed with screening should be pursued only after (1) basic breast health services including effective diagnosis and timely treatment are available to an entire target group; (2) its effectiveness has been demonstrated in the region; and (3) resources are available to sustain the programme and maintain quality.

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BREAST CANCER AWARENESS MONTH SUPPLEMENT 2019 EDITION

Battling breast cancer

WEAK MOMENTS

‘I had to stop crying and be brave’

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T was a morning in June 2017 while showering, casually and unsuspectingly, that would change the life of Zalina Jasmin Singh forever. She felt a lump in one of her breasts and hastened to tell her husband and other family members about it.

There was no pain, even as she would squeeze the area where she was feeling the lump. In fact, there were absolutely no other indicators

that ‘Jay,’ as she’s lovingly called, would actually be spending the rest of the year frantically battling breast cancer.

The nurse at her workplace, Banks DIH Limited, where she has been employed for the past 14 years, referred her to ‘Georgetown Hospital’ where she was sent to do a Fine Needle Aspiration biopsy of the left side breast.

When the results came back, though, the doctors

were skeptical and did not want to make a definitive pronouncement, as they weren’t clear if it was in fact breast cancer that Jay had.

So they sent her to do an Excisional biopsy.

“When these results came back, I was Stage Two breast cancer positive,” Jay, 44, recalled during an interview a few days ago with the Pepperpot Magazine.

She had suspected something was amiss, though,

One of Jay’s biggest fears was to not be able to see her daughter, Maya, grow up

because when the hospital received the second set of results, they called her to go in, although they had already given her a date on which to return.

“My husband and I went a n d they

sat me down and told me that it’s cancerous and I’m Stage Two; that the option was to do surgery and to do it as early as possible.”

Her mind went blank after the doctor told her this. “I started crying right there. I didn’t know what to do; I just started crying. I cried a lot from there on.”

Jay had to spend six months away from her family and friends so as to get treatment

she thought she was going to die. “That I’m not going to see my family again; not going to see my daughter, Maya, grow up or my son, Vishal, get married; not see my parents again. It was horrific. You have your weak moments.”

Jay spoke with her husband, Heamraj, every day and he and the children even visited overseas. “But being there alone; dealing with all of this alone was really hard.” For this reason, Jay said, she is not sure she can go through all of this ever again. “It’s that hard.

Look at my nails. I still have numbness in my fingers from the treatment. My chemo was so strong my fingers were numb; my toes were numb. They had to change my chemo and give me another one. My face broke out, my hair dropped out, my eyelashes and brows were gone…and not to forget the

Jay decided to do treatment overseas and left Guyana in November to pursue such. She returned home in January and then left again in February to start her chemotherapy and radiation treatment. “When I went abroad, they took out some lymph nodes and the cancer did not spread; it was just at one spot.”

Dealing with her new reality took its toll on Jay, and what is more, she had to undergo treatment in a foreign country without being around her family and friends.

Jay had to battle alone many days, making her way to therapy and back on her own. “I go do my treatment and come back, alone and sick. But each time, I used to get up and pull myself up. I cried a lot. At times, I thought I wasn’t going to make it back home. Plenty days I felt like giving up because the ‘chemo’ wasn’t easy. I was really sick. I used to throw up; I couldn’t walk and the pain from the medication was t o o much. I was a mess.”

J a y ’s breaking point c a m e w h e n

Cancer survivor, Zalina Jasmin Singh (Adrian Narine photo)

pain from the chemo.”

GIVING UP WAS NOT AN OPTION

On many days, Jay felt like giving up all of her efforts to get well. Along with her physical pain, she also had to battle her emotions, as well as an anxiety disorder, which kicked in shortly after she was diagnosed with breast cancer.

“I had to stop crying, and I had to be brave,” she recalled, adding, “One day I cried so much till I stopped and said to myself yes I’m there alone, but I have my support group here. I’m not alone anymore; I need to get up and get going. This is not the end. Giving up is not an option. That was my turning point.”

She started fighting after adopting the right mindset and today is happy to say that she has been two months

in remission, meaning two months cancer free.

Now, she has to ensure she eats healthy and exercise regularly. “I eat a lot of fruits; no processed foods, lots of green vegetables and hardly any meat and sweet. Before, I would’ve eaten anything, gone anywhere, and done anything. But now, you have to think about yourself, your health and family. You gotta put them first and change your lifestyle if you want to live longer. I’ve slowed down a lot. I hardly go out anymore. I’m still in pain because of the chemo, but every day is a new day and every day it’s getting better.”

Jay feels that had she not acted immediately to treat the cancer, it could’ve grown and gotten out of control. So she is advising that other sufferers take it in hand and muster TURN TO PAGE H

BREAST CANCER AWARENESS MONTH SUPPLEMENT 2019 EDITION

PAHO urges greater awareness, advocacy in cancer fight

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HE need for more cancer awareness and advocacy programmes was underscored when the Guyana Telephone and Telegraph Company (GTT) hosted a symposium as its first event to kick off the company’s Pinktober 2019 calendar of activities.

The event, which was held at the Roraima’ Duke Lodge on Duke Street, Kingston, provided a platform for survivors, caregivers, patients and healthcare professionals to speak of the challenges and other areas of cancer-care management in Guyana.

Minister of Public Health Volda Lawrence, in a video message, and PAHO Representative Dr. William Adu-Krow, both gave emotional personal experiences of having been diagnosed with the disease and how they were able to cope with it.

Dr. Adu-Krow called for much more to be done if this country is to make significant inroads in tackling the scourge.

Using statistics to press home the point that cancer spares no one, Dr. Adu-Krow said that the major issue with the disease is the survival rate, with that for breast cancer

worldwide ranging from 80 per cent in North America and the developed world, to 60 per cent in middle-income countries, and as low as below 40 per cent in developing countries.

According to him, breast cancer globally takes the lives of about half-a-million people yearly, with about 50 per cent of those deaths occurring in developing countries. Noting that PAHO takes care of about 58 per cent of persons with breast cancer in the developing world,

occur in women under 65, as opposed to the developed countries where it’s women over 65.

CLOSER TO HOME Turning his attention closer to home, Dr. Adu-Krow said that here in Guyana, breast cancer has been found to rank as the Number One form of cancer overall, particularly between 2003 and 2012.

Noting that survival-wise, about 80 per cent of breast cancer victims in the United

GTT’s CEO Justin Nedd and PAHO’s Dr. William Adu-Krow in discussion at the symposium

Dr. Adu-Krow said that another baffling thing about breast cancer is that globally, almost one out of every four persons that is identified with the malady dies. A case in point, he said, is that of the 462 000 persons identified with breast cancer in 2011, some 100,000, the equivalent of 25 per cent, have died.

In Latin America and the Caribbean, meanwhile, it has been found that a great proportion of breast cancer deaths

States can survive, whereas in Guyana it is only 30 per cent, Dr. Adu-Krow, who couldn’t help but wonder why this is so, seized the opportunity at this point to call for more work to be done on the subject, if we are to ever get to the bottom of it.

Noting that in the less developed countries, it has been narrowed down to the lack of early detection programmes, compounded by the fact that a

high proportion of women present themselves during the late stage of the disease, and the lack of adequate facilities to enable an early detection of the disease, Dr. Adu-Krow harked back to a statement made earlier into the programme by Minister Lawrence, where she spoke of plans to acquire more mammogram equipment, Dr. Adu-Krow suggested that a good place to start would be to have mammogram tests done in each of the major hospitals in the regions.

The forum also featured brief remarks from GTT’s Chief Executive Officer Justin Nedd, along with presentations

by Dr. Sayan Chakraborty of the Cancer Institute of Guyana; Dr. Dazzle of the Oncology Unit of the GHPC; Ms. Latoya Gooding of Giving Hope Foundation; Ms. Marion Williams , Secretary of the Periwinkle Cancer; Mr Patrick De grookof Beacon Foundation; Mr Dwayne Butters of Courtney Butters Prostate Cancer Awareness Network and a representative from GUYOIL. A brief session of physical activity involving the participants and conducted by Diana Gittens of Rythms of Movement, lent added fillip to the forum, which also included group discussions and the presentation of an award to Cancer Warrior, Ms Fiona Legall.

Reg. 1 targeted for G cervical, breast cancer screening ─ Public Health Ministry statistics show this region has the highest cancer rate

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creening services for cervical and breast cancer will be taken to remote villages in the Barima-Waini Region.

Minister of Public Health, Hon. Volda Lawrence made this decision, as she highlighted the number of cancer-related deaths coming out of hinterland communities, especially in Region One. Globally, 530,000 new cases of cervical cancer are detected annually; approximately 266,000 women or 50.2% of people, succumb as victims of cancer. Recent data from the Public Health Ministry has indicated cervical cancer kills about 100 women in Guyana annually, and a large percentage of those cases are from the hinterland.

Minister Lawrence visited the village of Sebai during September where she engaged a section of the population, most of whom were women, young girls and children.

She informed those gathered that “the statistics for Guyana show that Region One has the highest number of women who are succumbing to cervical cancer.” Especially addressing the community of Sebai the Minister emphasised, “No one from Sebai has to die from cervical cancer, none of you women.”

The effort to safeguard the health of the country’s Indigenous population is a priority of the Ministry of Public Health.

Therefore, as it relates directly to cervical and breast cancer, medical teams conduct free screenings for Cervical Cytology (Pap smear) and Clinical Breast Examination in Sebai and its neighbouring villages. This will be the first step towards early diagnosis and treatment as similar exercises will be conducted in other regions.

“I want to ensure the Ministry of Public Health offers women, especially our Indigenous women, the opportunity to be tested early so that we can have an early diagnosis. Once that is done, we can address cancer, giving you the chance to move on and have a healthy life and be with your family, see your grandchildren grow…,” Minister Lawrence said.

It was added that the ministry has already invested monies into cancer diagnosis and treatment services. The minister used this opportunity to call on village and community leaders to encourage women to take advantage of the free services.

The ministry’s efforts are going even further with the vaccination of children between the ages of 9 to 16 years against the Human Papilloma Virus (HPV). HPV is an infectious disease, spread by sexual intercourse and affects both men and women, developing into cancers in goes undetected.

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Battling breast ...

up the strength to take action right away.

“It’s not the end of the day. Just do your treatment; do what you have to do,” she is advising others who might be experiencing the same things that she did.

“It’s hard but you need to put your mind there. You need to pull yourself together. If you don’t do it, nobody else can. It takes a lot from you but you have to be able and willing to do it. Once you can pull it through, you can beat it.

“You will feel weak and like at the end but I have found that talking about it helped me a lot. So don’t keep it to yourself. It’s not a stigma. That’s one thing my husband taught me. He told me I should talk about it and embrace it. It’s not anything to be ashamed of. Be positive and have that inner strength to help you. Find a group who is going through this same thing. Just don’t shut the door. If you shut the door, you make it worse. At some point, you reach the stage where you just want to be alone and give up but giving up is not an option, especially when you have a family,” she added.

BREAST CANCER AWARENESS MONTH SUPPLEMENT 2019 EDITION

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MAKING EACH DAY COUNT

Jay is grateful to all those who played a role in helping her through this traumatic period of her life. “I must thank Banks.

I was away for about six m o n t h s and they were there with me all through it.

Also, my friend,

Anusha, kept me there for six months. She and her family were really nice to me. Her husband, Johnny,would always tell me not to give up and to have more faith in myself.”

Jay said her parents, Doreen, and, Haroon, were also rocklike figures in her life, along with her sisters, Ryan, and Narda.

She is also

Her husband, Heamraj (at right) remained strong for the entire family. At left, is their son, Vishal

thankful to the doctors of the Georgetown Hospital Oncology Department.

As for her dear husband, she said: “He was strong. I’ve never seen him cry. He said whatever has to be done, we have to do it and we will do it together. He has never given up on me. He never broke

down in front of me. One day I asked him how come he never broke down, and he said if everyone broke down what would happen? Somebody had to be strong.”

As scary as the entire experience has been, it taught Jay some valuable lessons. “You value life more; you treasure people more. You live for every day; every day is a special day. You live every day as if it’s your last day. You

also get to see who care for you and who doesn’t. I’m no longer living in fear.

I’m positive I beat that demon. That demon is out of my body.”

She makes sure to do her follow-up hospital visits so as to ensure that the cancer does not return. “But it’s not going to come back. I’m positive. It’s not going to come back. I’ll make sure it’s not going to come back.”