Dr. Fatima Poonawala runs the department of Obstetrics and Gynaecology. She did her basic training in Mumbai, worked in Mumbai as a young post graduate in Obs. and Gynaecology and then went to the U.K. for exposure and further experience in the subject.Most of our medical books are written in the West,so the aim was to see them practise what is preached.

This indeed turned out to be a wonderful experience, both from academic point of view and socially, culturally, spiritually.
After working abroad for 7 years, she returned home to practise modern medicine in the Indian scenario, which is so unique.
.An egg can be broken in more than one ways.In India, here is no quality control, there is not much litigation, no audit, thus the professional’s attitude, knowledge, available resources and skills determines the outcome of any illness or pregnancy.
Thus the task for the doctor becomes both challenging and satisfying at the same time.

Mission at ALFA IS: Treat patients as we would like ourselves / our family members to be treated.

In obstetrics, we are aware that nature is a perfect architect and has planned the physiology of the mum to undergo such profound changes to enable her to go thru’ pregnancy without a lot of wear and tear, and provide the growing fetus, all the necessary support. Our endeavour at Alfa is to facilitate nature to ensure the best for the mum and the fetus in her womb. A lot of time is spent in counseling, allaying her fears and assuring with the help of necessary tests,the normalcy of the pregnancy.
Complications can occur in the course of pregnancy, which are handled in an appropriate, humane way, based on evidence based medicine and good medical practices.

Where, whom or How can we help?

• Adolescent girls with menstrual irregularities.
• Planning pregnancy, counselling what and when is the ideal time,
• How to avoid unplanned pregnancies.
• Monitoring the pregnancy with the necessary tests.
• Identifying and treating complications like bleeding in pregnancy, threatened miscarriage, high blood pressure, and diabetes.
• Identifying the unborn baby with a complication like a mild abnormality like a club foot, or a severe complication like a heart malformation, and planning appropriate strategy for delivery to get the best outcome.
• Identifying babies who are growing smaller than expected or larger than expected.
• Safely delivering your precious one, vaginally or otherwise.
• Repeated abortions or fetal loss.
• Menstrual problems in any age group.
• Incontinence of urine or inability to control urine.

Repeated urine infections.

• Fibroids of the uterus, how best to tackle them.
• Ovarian cysts, PCOD.
• Menopausal problems like hot flushes, vaginal dryness, sexual difficulties.
• Screening for gynaecological cancers in the elderly risk population.
• Treatment of cancer of the ovary, uterus, cervix, vulva, vagina.
• Do contact us about anything you would like to discuss.

HPV Vaccine: A Fact File

There is lot of noise in media about HPV vaccine... Get the real picture!!!

The uterus consists of two parts, the body and the neck. The neck is called the cervix. This cervix has risk of getting cancer. It is called cervical cancer, one of the common cancers in females.

A lot of research is going on in the world to prevent cervical cancer and early detection in order to reduce deaths from this disease.

Human papilloma virus (HPV) is implicated in causing cervical cancer.

There are hundreds of varieties of the papilloma virus, these are numbered, about 13 strains cause cancer, no. 16 and  no.18 cause 70% of the cancers, nos.31,35 etc. cause the rest 30%.Other strains like 6 and 11 cause the genital warts, the wart causing do not cause    cancer. Most strains cause asymptomatic infection.

HPV is contracted through sexual intercourse, both anal and vaginal. It’s a marker for sexual activity. Besides cervical cancer, it can also cause anal and vaginal cancer but the incidence of these is less than that of cervical cancer.

Once someone contracts HPV infection, the immune system in the body mounts a response and it gets cleared within 2 years in most of the people. It can lie dormant in the cells for years, without causing a problem, in a few it can initiate changes which can lead to cancer over a period of time, how long it takes to cause cancer depends on the individual immunity.

Early age at first intercourse, multiple partners, multiparity {many children}, smoking, low socio-economic status, all increase the risk of developing this cancer.

In my present urban practice in India, I see about 2 cases a year that come from a lower socioeconomic background, In the middle and higher income group, where there is one to one relationship, limited family size, I have seen only 3 cases over a period of 18 years, the first had a 8 children, the second was the second wife and had 7 children, third was married 3 times.

When I was working in the U.K, 25% of our hospital work load involved cervical cancer screening and treatment of abnormal Pap Smears. Their lifestyle is different, by the time they finally settle down with a partner, they would have had more than one partner, their partner would have had more than one partner, and this compounds the risk of HPV infection and the consequences. Smoking in women is also quite prevalent in Western population. 

In the Indian context, our tradition of chastity, sexual activity within the sanctity of the institution of marriage, non smoking, all contributes to the low incidence of cervical cancer in the middle and higher income group. These values have to be emphasized as primary preventive strategies against cervical cancer.

Primary prevention involves HPV vaccine, secondary prevention involves doing Papanicolou {Pap smears} to detect early changes in the shed cervical cells leading to cancer.

HPV Vaccine is available, it prevents infections with 16 and 18 strains{GARDASIL],it does not prevent cancer directly, it may prevent indirectly thru prevention of infections with 16 and 18 strain only, it does not prevent infection of other cancer producing strains.

CERVARIX also prevents infection with 6 and 11 strains which cause genital warts.

The vaccine should be ideally given to teenage girls well before they become sexually active. The vaccine course is over 6 months, expensive, and long term results not known. It produces immunity for 4 years, whether booster is needed after this period or not, that data is still not available.  The irony is, it is afforded by people who do not need it; those who would actually benefit from it, cannot afford it.

In Australia, even boys are offered vaccination, it’s a govt. initiated programme, to overall reduce HPV infection in the population.  

Also, we assume promiscuity when we propose to vaccinate, Of course, our children are exposed to western lifestyles, they travel at a young age away from home to study and /or to work, the media, the television exposes them to the permissive lifestyle, in anticipation, vaccine may be given but its benefits are still not satisfactorily proven.

There is a possibility that   security from cervical cancer risk after vaccination can backfire and can promote promiscuity.

Indian Govt. usually gives approval after it has been tested in the Indian population but in the context of HPV Vaccine, it has gone by the western research and given sanction to market it.

Secondary prevention thru Pap Smears has to continue because other strains can still infect and cause cancer.

If you still have any queries, do fix an appointment so we can sort out individual concerns!

Dr. Fatima Poonawala MRCOG (UK)

October 2009