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PINK CONNE ION

Bylakuppe Milanda Jagtiani Taking challenges head on

A Tibetan settlement in the heart of Karnataka

St Jude’s India A home for children with cancer


BEHIND The Scenes

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Technology has hurtled us into new ways of living. We are smarter and more informed for sure, but we are also more frenzied. In reality, when new innovations in the form of gadgets should have freed us with more free time, we are running against time like never before. With all the machines in our office, we still have no time for ourselves. We have time neither for the spouse or the child because we are busy sending an “urgent” mail to a client, or are on a con-call even at nights. Worse, few of us can get off the smart phone, which is so smart that it is always throwing a distraction at us in the form of a new WhatsApp message or a Snapchat. How many of us can refrain from answering an urgent call while we are out for dinner, because these calls are important we believe,with little consideration for the family or friends we are with. I am surprised, how romancing couples are texting all the time during a date, and neither seems to mind the lack of attention! Technology has seeped into medicine–in fact–it is more in the medical world than anywhere else. ECG scan tell us if the heart is beating alright, while lasers can make micro-incisions in the bodies to remove unwanted gall bladder stones or work into the heart to remove a block. We can now predict too, thanks to advanced genetics, what diseases our children and our grandchildren will be predisposed to. It is a sad world indeed, if we have medicine so advanced that doctors fear touching a patient to diagnose a concern. Or, do not find the time to sit with a patient to hear him out. Do we all not remember the old-fashioned doctor who made house visits, who may not have been equipped with anything more than a stethoscope and a torchlight, yet with whom we felt comforted as he chit-chatted about this and that, not just the fever? I hope we can go back to those times, where we yearn not for a 100 likes for our post on Facebook but a cup of coffee and good conversation with a handful of friends. To a time, when doctors become the friend guiding us through the ailments of the body, rather than bundling us out for a scan at the mere mention of a headache.

Ratna Rao Shekar

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SURVIVING CANCER Milanda Jagtiani emerged from fighting breast cancer and losing her husband to colon cancer, to live life with a pragmatic, winning attitude MAKING A DIFFERENCE The St Jude India ChildCare Centres provide facilities for cancer children and their parents to make their fight against cancer bearable

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UBF DIARY A quarterly round up of events, happenings and news at the Ushalakshmi Breast Cancer Foundation

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HERITAGE A toast to Bylakuppe in the heart of Karnataka, home to the largest Buddhist Tibetan settlement in India

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MY VIEW In his quarterly column, Dr P Raghuram takes up the critical issue of tackling breast cancer in pregnant women

EDITOR Ratna Rao Shekar CONTRIBUTORS Minal Khona Anil Mulchandani DESIGN Malvika Mehra PUBLISHED BY Ushalakshmi Breast Cancer Foundation PRINTED AT Kala Jyothi Process Pvt. Ltd. 1-1-60/5, RTC Cross Roads Musheerabad Hyderabad - 500 020 KIMS-USHALAKSHMI Centre for Breast Diseases Krishna Institute of Medical Sciences, Minister Road Secunderabad - 500 003 Tel: 040-44885190 / 040-44885191 Website: www.ubf.org.in https://www.facebook.com/ ubfoundation


Cut to the present. Milanda is a busy woman, running a thriving catering business, with Bollywood celebrities as her regular customers; and a small store-cum-deli in Mumbai’s busy Pali Market in Bandra. It is remarkable the way she has bounced back from her cancer and deep financial problems. And, as she talks about her life, you realise that she has crossed the choppy waters in her life, with a “pragmatic” outlook.

SURVIVING CANCER

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he grey, almost silver hair and a smiling face are the first things you notice about Milanda Jagtiani. I first met the graceful Milanda at a close friend’s 50th birthday party in November 2008, where she had revealed that she was recovering from breast cancer.

Dressed in purple capris and a t-shirt, Milanda who seems all set to dive into the busy day ahead of her, makes time for a chat. Her Labrador, Sumo, joins us midway. She starts off her story by revealing that neither she nor her late husband had a family history of cancer. Yet, it was her practice of getting a pap smear test done every year, after she turned 32, which saved her.

Milanda Jagtiani

When life gives you lemons… Eight years ago, Milanda Jagtiani, a qualified pastry chef, was diagnosed with breast cancer when she was 53. It was around the same time her husband, who was suffering from colon cancer got worse succumbing to the disease a year later. Revisiting those terrible and trying times, the pragmatic Milanda concludes that she has learnt that in life, you have to accept the good with the bad. And, that’s the bald truth. Text: Minal Khona Photographs: Ayesha Broacha

“The pap smear test is a birthday gift to myself. Then, in July 2008, during my check-up, the gynaecologist decided to examine my breast. I remember her insisting I do a mammogram right away. I had not felt the lump myself,” she recalls. Later, she learnt that a small dimple like indentation on her right breast had prompted the doctor to get the test done. The lump was really small and measured about 0.8 mm. Milanda was only too familiar with the harrowing nature of cancer. Her husband had colon cancer since 2004, which had spread to his lungs. Her husband’s oncologist at Hinduja Hospital insisted she remove the lump even if it was so small. And, after the tumour was removed, the results showed that it was malignant. Fortunately, Milanda is not the kind who panics. “I see no point in worrying about things beyond my

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Milanda reminisces, “My husband’s cancer was painful and he was, putting it mildly, not a very good patient. I think he was in denial about the cancer and it was a really tough time for him, as the cancer had spread to the lungs. It was karmic – he had to go through what he had to – my job was to help him and give him emotional support. He didn’t take morphine, just painkillers. On the last day however, sometime in September 2009, he asked for morphine and after a few hours, he passed away. My youngest daughter, who was closest to him, was by his side when he died, having promised him that she would be with him till the end.”

Fighting back: Milanda in her new deli Asaluti in Mumbai

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Besides her annual checkup, Milanda still retains a connection with cancer even today. She says, “Once you have had the disease, you want to help others suffering from cancer. I think every person I know who has had it, contributes to cancer care in some way or another”

control. In fact, I love going under – it is like having a bottle of wine and going to sleep,” she says evocatively. This total letting go of oneself – to anaesthesia or life – is a trait that is evident in all of Milanda’s actions. She says, “You know, I just surrendered myself completely and told my anaesthetist friend Swati to do what was required. You remove yourself out of the body and let go because nothing is really in your hands, certainly not on the operating table. I told her to take the decision – whether it was to be a lumpectomy or a mastectomy. I did have a lumpectomy eventually, but they took out so many lymph nodes that I was leaking lymphatic fluid for a month afterwards.” However, Milanda did not make any changes to her diet or her lifestyle post the surgery. Since the tumour was so small, Milanda did not need chemotherapy; just 30 sessions of radiation sufficed. But, the scenario at home was an extremely challenging one. Their three children – her oldest daughter who lives in the USA, her son, who is in Hong Kong and her youngest daughter, in Dubai, were freaking out that both their parents had cancer at the same time.

There is another significant side to cancer care, which is often brushed aside amid the crushing, overwhelming fear about the disease. Many people don’t take into account the exorbitant expenses cancer patients have to incur. She reveals, “We were in Hong Kong till 1995, after which my husband, a software developer sold his product to an American firm and moved back to India. He started to create software for the insurance industry when cancer struck.” Since she was married at 18, and became a mother at 19, her husband had always pampered her, and treated her like a “princess”. She confesses, “I was quite unaware of his business or money matters. After he passed away, I would find a cheque book in one drawer, a bank statement in another folder – that is when – I learnt about all the accounts we had. I found all our finances had depleted over the years. It was a combination of bad investments and the cancer treatment. He had three chemotherapy sessions, plus all the other tests and hospital stays, it had cost a lot.” In the end, Milanda was left with no time to grieve. Instead, she had to start trouble-shooting. “With the help of my brother, son and nephew, I spent the next 18 months sorting out the financial mess I was in. We sold the office, cleared all the debts and closed the unnecessary accounts. After that, I spent the next one year being angry,”


Avedna, a hospice for terminally ill cancer patients in Mumbai. Besides, she always makes time to attend any interactive session conducted by the psychologist at Hinduja Hospital. She says, “The counsellor, Jyoti, works with cancer patients. She talks to the husbands of women suffering from cancer, and helps them deal with the sexual aspects of their relationship. Some find the women unattractive after surgery, others can’t cope emotionally with the physical changes. I go for these meetings when required and share my experiences and give these women tips on how to cope; and what to expect during chemo and radiation. These sessions are different and interesting.”

“I see no point in worrying about things beyond my control. In fact, I love going under, it is like having a bottle of wine and going to sleep,” she says evocatively. Actress Malaika Arora at the store launch with Milanda and her business partner she reminisces, tears welling up in her eyes. The point she tries to make here is that cancer can debilitate you physically and emotionally, but it is important someone should take charge of the finances in the family. She adds, “To be honest when my husband passed away, I felt a sense of relief. It was so painful to watch him gasp for breath. He used to look so helpless. But, in the end, when the life left his body so gently and peacefully my reaction was, ‘thank you god for being kind to him.’ I had my meltdown a year and a half later, when I wept all the time till I found a person who showed me the way towards a spiritual path. My questions were all answered and after that, it’s been a journey I can handle.” To get back on her feet financially, Milanda took up what she knew best – baking. “I used to run a small dessert

business back in Hong Kong, so I set up a similar business, where I took orders for pastries and cakes. I also started cooking classes, where I taught different cuisines and baking. Then, two months ago, I started a small retail business called Asaluti, which means ‘cheers’ in Italian,” she says. She runs the deli with her business partner, who is an importer of meats and other gourmet foods. The deli stocks meats, cheese, teas, Italian coffees, smoked salmon, baby ribs and other seafood. Besides her annual check-up, Milanda still retains a connection with cancer even today. She says, “Once you have had the disease, you want to help others suffering from cancer. I think every person I know who has had it, contributes to cancer care in some way or another.” On her husband’s death anniversary, she donates food at Shanti

Once, they had the designer Xerxes Bhathena, whose mother had breast cancer, talk about how women can dress to disguise the visible effects of a mastectomy. If a cousin or a friend needs some moral support, Milanda makes herself available when required. Milanda at 61 today, is a busy lady. She is living her life, without worrying too much about whether the cancer will return. She has been cancer free for the last eight years. She says, “I have made my will and don’t want to leave behind any complications for my children to handle. When my time comes, I hope I have the strength to handle whatever God has in store for me. I have never questioned him, saying ‘why me or why not me’ during the good or the bad times, and I plan to stay that way – take everything that comes along in my stride.” A good thought to raise a toast to.

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MAKING A DIFFERENCE

St Jude ChildCare Centre A Place of Hope for Cancer Children

A free shelter for cancer children from rural and poor backgrounds, the St Jude India ChildCare Centres provide a sanctuary, a small calm nook for these kids to recuperate.There are 33 centres around the country, and with plans to expand further, the difference they make to the lives of these suffering children and their care-worn, cash-strapped parents is inspiring, writes Minal Khona after a visit to the centre in Hyderabad Photographs: Lakshmi Prabhala

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n air of calm pervades the place. As I walk into this warm circle of caring, the spotlessly clean building that houses the St Jude India ChildCare Centre for children with cancer, I am struck by the sense of quietude that prevails. It helps that the centre is tucked away in a sylvan and quiet lane in Banjara Hills, Hyderabad. After removing my shoes and washing my hands with a sanitiser, Samantha Reddy, the team leader of the Hyderabad Centre, guides me indoors. We come across three kids between the ages of five and eight years, watching cartoons in front of a TV set. Their mothers are busy making jewellery out of coloured paper. They greet

me with shy smiles and a wave. The centre is clean, and we walk around the independent units which house the children and their parents. The kitchens where the residents cook their meals are also spick and span. The centre can accommodate 20 families at a given time, with some residents periodically leaving for the respective hospitals that treat them. Named after St Jude, the patron saint of the hopeless, the St Jude India ChildCare Centre (SJICC) was established in 2006 by Nihal and Shyama Kaviratne in Mumbai. Today, SJICC has grown from one centre for eight families to 33 centres for 414 families, and the centres are found in Mumbai, Kolkata, Jaipur, Delhi, and Hyderabad. The founders have a vision


The treatment is provided at low or even at no cost. Living in a clean environment helps the suffering kids immensely too. “SJICC provides holistic care, so that they can focus only on their treatment,” points out Samantha. A lot of lives have Describing the philosophy of the Centre, Samantha says, been saved because these kids and their parents had a place “We fulfil an unmet need. Survival rates of childhood cancers to stay while getting regular treatment. Like the motherless have improved drastically today, and we want to help these three-year-old cancer survivor, Ishika Jha from Jamshedpur, children to recover.” who stayed in their Mumbai centre, with her grandparents However, along with medical facilities to get treated for her blood cancer. They had and treatment, a cancer child needs nowhere to go in a strange place and the centre holistic support like an infection free A child undergoing cancer gave them that much-needed space and care to environment (because, sometimes, it is help Ishika to recover. treatment can stay at not the cancer, but other infections that The centre besides sticking to strict timelines prove fatal) and good nourishment. A the centre free of cost; and standards of hygiene; follow strict rules child undergoing cancer treatment can like providing shelter to children only in the they even provide the stay at the centre free of cost; they even age group of 0-12 years. The Hyderabad Centre provide the groceries their mothers need groceries their mothers started on August 23, 2014, admits about 100 to cook their food, and a van transports families a year, with each family staying for need to cook their food, them to the hospital and back, reveals approximately three to four months. They Samantha. She adds, “ Also, we keep the and a van transports them don’t admit pregnant mothers or single parents patients and their families involved in because of societal issues, and if a parent breaks to the hospital and back different activities, conduct outdoor trips any of the rules, they are asked to leave. and provide counselling, so they can be SJICC is also an agnostic centre, and so festivals of all faiths are tension free.” celebrated here. No one is allowed to bring idols or symbols of A lot of these children come from remote rural areas, from any religion. A teacher comes in a few days a week to teach the the borders of Odisha or interior Telangana, Andhra Pradesh children and so do the counsellors, who help just by listening and Karnataka. And, their parents, already poor, leave behind to the patients and their parents. their livelihood,and have spent their meagre savings to get Samantha is supported by her team managers, who she says their child treated. When they come to the city, they have no are the ‘wind beneath her wings’, and the centre cannot resources, and that is when St Jude centre steps in. to set up 100 centres and 1,000 units by the year 2021. As of November 2016, the centre has admitted over 9,000 children since inception.

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Lending a helping hand to parents with children battling cancer


Volunteers keep the parents and their kids occupied with different activities at the centre

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On January 27, 2006, the couple met Mr Jaffrey, the Tata function without them. The team consists of Parvati Gupta, Memorial PRO, who asked them to meet the children and a teacher, Sucharitha Palepu, the HR head at an IT firm, their families at a hospital function scheduled in February. On MS Shabbir, an ex-banker, Mohammad Abdul Haq, the that occasion, Dr Tushar Vora, the paediatric facilitator; team manager Jacinta Rao,and oncologist invited Nihal Kaviratne to the Kamlesh Mehta, conducts the activities dais and he was amazed to see the bald and for children and their parents. All work as masked cancer kids jumping about having volunteers for no pay. Only the counsellors, fun. “Seeing their inherent sense of joy made teachers and Aruna Kumari, the centre’s SJICC is also an agnostic him spontaneously promise, rather rashly, manager are paid staff. centre, and so festivals of that he would ensure these kids would The children usually suffer from different have a clean, loving place to stay in,” says all faiths are celebrated kinds of cancer and are treated at MNJIO, Shyama. And, lucky for the children he made Little Stars Children’s Cancer Hospital, here. No one is allowed that promise. Rainbow Hospital and the Basavatarakam to bring idols or symbols St Jude India receives financial support from Indo American Cancer Hospital. If the corporates, private donors, and hospitals cancer is detected too late or is at a terminal of any religion. A teacher treat these patients free of cost or charge a stage, they go for palliative care, so their comes in, a few days a minimal fee. Raising funds and creating last few days are peaceful. week, to teach the children awareness about the centre is done in Shyama Kaviratne has a story to tell about Mumbai, though Samantha says once people how these St Jude centres were born. It and so do the counsellors, come to the centre, they donate of their own seems her husband, Nihal Kaviratne, who who help just by listening free will. Recently, Anuradha Reddy, the had retired after a successful corporate daughter of Dr Anji Reddy, the founder of Dr career was always an ardent believer to the patients and Reddy’s Laboratories, held an art camp, and of Corporate Social Responsibility and the proceeds from the sale of artworks will their parents had supported several charities in his be given to the St Jude centre in Hyderabad. lifetime. “Driving past the Tata Memorial Sachin Tendulkar and Yuvraj Singh have Hospital, one day, he was horrified to see families huddled visited the children at the Mumbai centre. around a cancer patient. He felt this was not the way for a SJICC makes a pivotal difference in the lives of these little patient to recuperate, particularly a child whose immunity children, giving many a new lease of life, and most of all – like is compromised. Something had to be done about these poor the saint it takes its name from – it gives hope. Sometimes, that children, especially those who had travelled from far seeking is all a child needs. medical help, he thought,” recounts Shyama.


Diary

ROUND UP

UBF Congratulations!!

National Recognition for Dr Raghuram Inducted into Indian government expert panel The ministry of health and family welfare and National Health Mission, government of India has appointed Dr P Raghuram, CEO, Ushalakshmi Breast Cancer Foundation, as member of its Technical Advisory Group (TAG). He is the only expert from south India in this group. This group will develop training materials necessary to roll out population based breast cancer screening programmes across the nation. Dr Raghuram was hand-picked by the Indian government to be part of a high-powered steering committee and TAG, in recognition of his experience in implementing south Asia’s largest population based breast cancer screening programme in the Telugu States. Earlier in the year, as steering group member, Dr Raghuram had played a key role in approving the “operational guidelines” for breast cancer screening. In particular, his suggestion that Clinical Breast Examination (CBE) should be the ‘gold standard’ population based screening tool in the Community, was unanimously accepted and incorporated into government of India’s National Screening Guidelines (June 2016).

October 2016

RARE HONOUR Dr Raghuram’s Address in Australia at Prestigious International Conference Dr P Raghuram, President, ABSI enjoys the distinction of being the first practising surgeon from India invited to address around 500 breast care specialists comprising breast surgeons, breast radiologists, breast pathologists, breast care nurses, medical and radiation oncologists from all over Australia and New Zealand. The doctor addressed a ‘Special Interest Session’ at the prestigious 8th Leura International Breast Cancer Conference held once in four years in Australia. The Congress was held in the picturesque Blue Mountains area, near Sydney at Fairmont hotel over a five day period from October 25-30. Dr Raghuram’s 30 minute speech evoked a huge applause from the crowd, which included world-renowned guest speakers from the UK, Sweden and Netherlands. Impressed with UBF’s excellent track record in implementing a number of initiatives benefitting under-privileged people across the Telugu States, one of Australia’s leading provider of cancer services based out of Sydney, proposes to contribute to UBF’s mission, to improve breast cancer care in Telangana and Andhra Pradesh.

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The ABC of Breast Health - A UBF and Eenadu Initiative

More than 500 people participated in UBF’s latest initiative – The ABC of Breast Health – held along with the Eenadu Group in Vijayawada on October 23. The programme’s aim is to transform breast cancer from a “closet” issue to a “much commonly discussed” one in the Telugu states.

Pink Ribbon Walk at Vijayawada

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More than 5,000 enthusiastic people from all walks of life turned up at 6.30 a.m. for the first edition of the Pink Ribbon Walk at Vijaywada in Andhra Pradesh. Actor Sumanth and police commissioner, Mr Gautam Sawang flagged off the 2 km walk to raise breast cancer awareness.


Pink Walk in Warangal

In a rare display of enthusiasm, a group of Kakatiya Medical College (KMC) students staged a flash mob dance in the centre of the city, to draw attention to raising breast cancer awareness. This dance was the culmination of a hugely successful 5 km Pink Ribbon Walk in Warangal, conducted by the Ushalakshmi Breast Cancer Foundation, Eenadu Group, KMC and the Chaitanya Group, on October 18.

December 2016

Ibrahimpur Village Goes Cashless Having adopted Ibrahimpur, the remotest village in Medak district in Telangana, Dr Raghuram undertook a number of initiatives to reach out to the community. He was recently the guest of honour at a function to announce the village’s biggest distinction, of being the first in south India and second in the country, to have 100 per cent cashless transactions since the demonetization drive.

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HERITAGE

Bylakuppe Where the Heart Beats for Buddhism Bylakuppe in Karnataka hosts one of the largest Tibetan settlements in India and is the seat of many revered Buddhist monasteries. This small town boasts of the most famous Namdroling monastery, home to a majestic gold-plated Buddha, stupas, temples, impressive prayer halls and Tibetan Buddhism colleges. Anil Mulchandani admires the charms of this quaint town soaked in Tibetan culture, while Dinesh Shukla provides stunning visuals

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n the road to Coorg, you trip into Bylakuppe in the heart of Karnataka. And, it comes as a pleasant surprise and a treat for the itinerant because this small town is the site of some of India’s most beautiful Buddhist monasteries. These monasteries were built on the back of the large-scale Tibetan migration into this area in the late 50s. The story of Bylakuppe began when the 14th Dalai Lama fled to India in 1959. A huge number of Tibetan refugees followed in his footsteps to India. On the Dalai Lama’s request, Jawaharlal Nehru, the then Prime

Minister of India consulted with different state governments about rehabilitating the stateless Tibetans in settlements. Some of the states agreed to lease forest reserves and unused land to the refugees for agriculture purposes and for promoting their handicrafts. In 1960, the Mysore State generously allotted nearly 3,000 acres of land at Bylakuppe, near Kushalnagar town in present day Karnataka, to develop the first-ever exiled Tibetan settlement in India. And, Lugsung Samdupling came into existence in 1961. A few years later another settlement, Tibetan

Dickey Larsoe, was built. This was followed by three more settlements in Karnataka state, making it the state with the largest Tibetan refugee population. The Rabgayling settlement was set upin Gurupura village near Hunsur; the Dhondenling came up at Oderapalya near Kollegal and the Doeguling settlement emerged at Mundgod in Uttara Kannada district, all in Karnataka. The Tibetans started building magnificent monasteries representing the Gelug-pa, Nyingma, Sakya, and Kagyu-pa schools of Buddhism. The two large ones in the area are the


Sera and the famous Namdroling monastery. The most visited monastery here is the Namdroling, which was founded by His Holiness Pema Norbu Rinpoche, who came to Bylakuppe with 600 followers and 300 rupees in his hand. With just a handful of monks he laid the foundation stone of the three-storied main temple, which then covered an area of 80sq feet. His Holiness the Dalai Lama consecrated the spot and bequeathed its name – Namdroling monastery. Today, this monastery, also called the Thegchog Namdrol Shedrub Dargye Ling, is the largest teaching centre of the Palyul lineage of the Nyingma school of Tibetan Buddhism in the world, with about five to seven thousand lamas (including monks and nuns) studying here. It is famous for the majestic gold-plated statue of the Buddha; and also has a number of temples and stupas, primary schools, dratsang (a ritual arts college) and shedras (a monastic college), a retreat,

a guest house, a home for senior citizens and a hospital.

directed and guided by Pema Norbu Rinpoche himself.

Their shedra (college) founded in 1978, is one of the most important centres for Nyingma Buddhism. Those who have studied or are studying at the monastery include the tulkus (a custodian of a specific lineage

Tulkus of other traditions have also studied at Namdroling, including the Sakyong (Mipham Rinpoche), Minling Dungsey, and Minling Khenchen Rinpoche.

The most visited monastery here is the Namdroling, which was founded by His Holiness Pema Norbu Rinpoche, who came to Bylakuppe with 600 followers and 300 rupees in his hand of teachings in Tibetan Buddhism) and lamas (monks) of the Palyul tradition, including the fifth Karma Kuchen Rinpoche, the third ChĂśgtrul Rinpoche and the third Rago ChĂśgtrul Rinpoche. Their spiritual training is

The Ngagyur Nyingma Nunnery was added in 1993. Each year students of outstanding scholarship and deep wisdom, graduate after completing their nine-year course at the shedra. Graduates who are selected to become khenpos (a title for those who have achieved the highest levels of mastery) are then sent to teach in different Nyingmapa monasteries and centres. As you enter Bylakuppe through a gateway, you find yourself in the hub of the settlement strewn with restaurants and shops catering to tourists. The entrance of Namdroling Monastery is through an ornate Tibetan gateway adorned with Buddhist symbols like a Dharma

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Inspired by the Palri Temple in Tibet, the Golden Temple has four entrances with walls in white, blue, red and green respectively.

The largest and most popular festival at Bylakuppe is the Losar – the Tibetan New Year – which is celebrated for two weeks in February or early March. The town takes on a carnivalesque charm as monks don lively masks and costumes for the Cham dance, swaying to music played on traditional instruments

The main prayer hall in the Namdroling Monastery which can house hundreds of monks

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Wheel and a golden deer. You then stroll past gardens lined with hostels for monks, nuns and students and come to an extensive open area, which can hold a number of lamas and worshippers for rituals and festivals. The largest and most popular festival here is the Losar – the Tibetan New Year – which is celebrated for two weeks in February or early March. The town takes on a carnivalesque charm as monks don lively masks and costumes for the Cham dance, swaying to music played on traditional instruments. You can gaze at the

thangka paintings all around and soak in the traditional Lama dances and processions. To cater to tourists, there are eateries, which serve Tibetan food, and shops which sell Tibetan handicrafts and souvenirs like prayer wheels, caps, handbags and umbrellas. Some of the breathtaking sights in the complex are the Padmasambhava Buddhist Vihara, which was built in 1999, and the Zangdok Palri Temple built in 2004. They are called Golden Temples because of their artistic, multi-tiered golden turrets crowned by an arch, and the gilded murals.

The prayer hall is impressive. As you ascend the steps to the prayer hall, which can probably house hundreds of monks, you can spot lion statues flanking the entrance, and thangka paintings depicting Buddhist deities and other iconography hanging on the walls. The prayer hall is dominated by three images – Sakyamuni Buddha is flanked by Guru Padmasambhava to his right and Amitayus to the left. The columns and walls in the prayer hall are also elaborately decorated. The hall holds scriptures, relics of the Buddhist masters, small statues, and replica stupas. At prayer time, monks are seated in rows with scriptures and prayer objects in front of them. The gongs are rung to call the monks for prayer, the drums and cymbals are played to accompany the chanting. There are smaller temples like the Vajra Kilaya Temple, the Tara Temple, and stupas with relics and scriptures. The overall feel of peace and sanctity, together with a display of relics, art and artifacts, makes Bylakuppe a must visit. And, as a writer once wrote: when you listen in during the early morning prayers; the synchronised chants give Namdroling an ethereal charm.


MY VIEW

Breast Cancer in Pregnant and New Mothers Diagnosed with breast cancer during pregnancy or shortly after the birth of a baby is distressing. Caring and tending to the new baby while treating yourself for cancer can drain you physically and emotionally. In his column, Dr P Raghuram answers questions on the issue Can breast cancer be diagnosed during pregnancy? Breast cancer can rarely be diagnosed during pregnancy.

What are the treatment options when cancer is diagnosed during pregnancy? Effective treatment is possible during the pregnancy and the specialist team must discuss the options with the patient. The treatments will depend on the type and extent of the breast cancer, the trimester (stage) of pregnancy when the cancer is diagnosed in, and the patient’s individual circumstances. The specialist team must include a multi-disciplinary team involving cancer specialists and an obstetrician.

Can pregnancy be continued after diagnosis of breast cancer? It depends on the trimester (the stage of pregnancy). The decision to terminate a pregnancy is a personal one. It can be made only by the patient and her partner after discussing with the specialist team and obstetrician. There is no evidence to prove a termination will improve the outcome for women in this situation. However, termination may be discussed if chemotherapy is recommended during the first trimester. Or, if the breast cancer is the type that is growing rapidly or has spread to other parts of the body.

Can breast cancer during pregnancy affect the baby? There is no evidence to show that it affects the baby’s development in the womb. Cancer cannot pass on to the baby and neither is there studies to show the child will develop cancer later on in life because the mother had breast cancer during pregnancy.

Is breast cancer aggressive when diagnosed during pregnancy? There is no evidence. However, there may be a delay in diagnosis because it is difficult to detect cancer in the breast at this time.

Can surgery be done during pregnancy? Surgery can safely be done in all trimesters of pregnancy. As radiotherapy cannot be given during pregnancy (as it can

harm the baby), mastectomy (i.e. removal of the breast) is usually recommended. If breast-conserving surgery is considered an option, it can be done in the third trimester, as radiotherapy can be given after the baby is born. Whichever type of surgery is offered, it will involve general anesthesia. This is generally considered safe while one is pregnant, although there’s a slight risk of miscarriage especially early on in the pregnancy.

Can chemotherapy be given during pregnancy? If breast cancer is diagnosed during pregnancy, chemotherapy may be given during the second and third trimesters (between three and nine months into the pregnancy). It is not given earlier because the foetus grows quickly early on and gets affected by the drugs. Breast-feeding should be avoided during chemotherapy, as some chemotherapy drugs are passed through the blood stream into the breast milk.

Can radiotherapy and hormone therapy be given during pregnancy? Radiotherapy is not recommended at any stage of the pregnancy, as even a low dose may carry a risk to the baby. Hormone therapy is also not advisable during pregnancy and breast-feeding.

What about breast-feeding? Doctors recommend women being treated for breast cancer should stop (or not start) breast-feeding. Breast-feeding is possible for some women after their breast cancer surgery, if they don’t require chemotherapy, radiotherapy or hormone treatment. If the mother is not having any drugs, one can breast-feed from the contralateral (non-treated) breast. Although many women can produce milk from the treated breast, the amount is often reduced. Breast-feeding from a breast previously exposed to radiotherapy can cause mastitis (infection) which is difficult to treat.

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Pink connexion, february 2017  
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