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No matter your age, it’s important to keep your breasts healthy and have a basic understanding of what’s normal. That way you can nip problems in the bud, should they arise. Dr Sundar Shrestha, general consultant at Bir Hospital in Kathmandu, who specializes in Endocrine, GI, and Laparoscopic surgery, runs us through the basics of breast care in a conversation with ApEx.

What are the symptoms of breast health issues?

Usually, breast health issues come with the symptoms of breast pain, heaviness, and nipple discharge, whether bloody, watery, or black/blue. Also, you should pay attention to changes in your breasts, like lumps, changes in size or shape, persistent pain, tenderness, and skin texture. One should be mindful of changes in breast temperature as well, as heat could be indicative of some problems. To avoid risks, it’s better to do routine self-checks and seek medical help if you notice any unusual signs.

How do you differentiate between a normal breast and an abnormal one?

During puberty, girls typically experience natural breast growth and some women may feel like their breasts are getting heavier before, during, or after their menstrual period. These are normal. However, unusual discharges (bloody or greenish), the presence of breast lumps, tenderness, hot areas (with or without fever), and uneven nipple position or size (either up and down or the nipple turning inward or to the side) can indicate some abnormality within the breast tissues.

What are some of the common breast health issues?

Some women have breast abscesses. These are usually common in lactating mothers. Fibroadenoma are little lumps which are also called ‘breast mice’ and they are usually found in women aged 15 to 35. It’s important to take notice of these issues and consult a doctor. A retracted nipple, where your nipple dips into the areola and doesn’t stick out as it should, can be a cause for concern. Breast eczema may cause itchy and scaly areas around the nipple. Uneven breast size can be considered normal unless there are other signs and symptoms or it’s congenital. Ductal ectasia, causing discharge from some nipple ducts, is another issue you should be aware of. If you’re facing any of these problems, it’s very crucial to seek medical help as soon as possible.

What are the main risk factors for breast cancer?

It’s important to know if breast cancer runs in your family. If you haven’t had children, you should pay extra attention to your breast health as nulliparity comes with a higher breast cancer risk. If you have been exposed to radiation, whether for medical reasons or at work, that’s something to think about too. 

As we get older, the chances of breast cancer increases. Carrying heavy loads can also increase your risk. Drinking alcohol and smoking are also risk factors. The onset of menstruation before the early age of 12 or experiencing menopause after 55 can also impact breast cancer risk. It also depends on ethnicity, with white women at higher risk. 

Do the menstrual cycle and contraceptives affect breast health?

The menstrual cycle and the use of contraceptives impact a woman’s breasts in different ways. During menopause, the decline in estrogen and progesterone levels may affect breast tissue, while the reduction in breast density can result in abnormalities later. Throughout the menstrual cycle, hormonal fluctuations can alter breast tissue density and sensitivity, causing breast tenderness in some women. While modern contraceptives with low estrogen are safe and don’t increase the risk like some pills do, it’s important to consult a doctor before taking anything. Also, be careful with other hormone treatments and try to avoid radiation exposure. 

What can be done to prevent breast health issues?

To keep your breasts healthy and lower the chance of getting breast cancer, you can do a few things. First, make sure to go for regular check-ups, like mammograms, which are x-ray checks for breast health. Catching problems early can help fix them with minimal hassle. Also, check your breasts yourself each month and look for any changes. Eating good, nutritious food, not smoking or drinking too much alcohol, and staying active by exercising can also go a long way. 

How can we self-check for problems and what’s the right age to start regular mammogram screenings?

It’s a good idea for women in their reproductive years to check their breasts for any changes every month. For that, stand in front of a mirror and look at your breasts. Check if they look different in size, shape, or skin texture. Lift your arms and use your fingers to feel your breasts for lumps or anything unusual. You can start with mammograms after you turn 40, and I recommend the test every couple of years. 

Prime Minister Pushpa Kamal Dahal has completed one year in office. In this period, Dahal visited the key countries India, China and US, and also attended some multilateral platforms. In this context, ApEx  talked with Rupak Sapkota, prime minister’s foreign affairs advisor, about the Dahal’s accomplishments and foreign policy. 

How do you assess the situation of Nepal’s foreign policy under the leadership of Prime Minister Pushpa Kamal Dahal?

The foreign policy of Nepal, under the leadership of Prime Minister Pushpa Kamal Dahal, has been independent, balanced, and committed to non-alignment movement. The nation has successfully cultivated friendly and balanced relations with neighboring countries, development partners, and major powers. This has fostered an environment of mutual trust, conducive to international cooperation and economic collaboration.

Prime Minister Dahal conducted official visits to India and China, and also visited the US to attend the United Nations General Assembly. At the UN General Assembly, he highlighted Nepal's achievements in the peace process and underscored the adverse impacts of climate change faced by the country. Additionally, in his capacity as the President of the 47 Least Developed Countries (LDCs), the prime minister effectively advocated for the interests of LDCs on the international stage. 

Many see this government as pro-Indian and pro-Western, do you agree?

Early on, there were speculations regarding the foreign policy that Dahal might adopt. But Prime Minister Dahal proved them wrong, as he has already undertaken visits to various countries, including both neighboring nations and the United Nations. These visits have resulted in crucial agreements and understandings.

Notably, a historic agreement has been reached with India to export 10,000 MW of power within a 10-year timeframe. During the visit to China, long-term agreements of importance, particularly in the realm of connectivity, were reached. These include the operation of new trading points and an agreement on a power transmission line. The agreement to open the Korala border has recently been put into operation. The Covid-19 pandemic, natural calamities, etc. had affected Nepal's cooperation with China for some years, but after Prime Minister Dahal’s visit, the relationship between the two countries has gained a new momentum.

Furthermore, the prime minister’s participation in the United Nations General Assembly was noteworthy. UN Secretary-General Guterres also visited Nepal at the prime minister's invitation. During Guterres's four-day visit, Nepal’s key agendas were presented to the global audience. The discussions covered topics such as Nepal’s aspiration to graduate from least developed countries by 2026, the unique and original character of Nepal’s peace process, and the pressing issue of climate change.

But some critics say the prime minister failed to take up key issues with major powers, what is your take on it?

On the contrary, Prime Minister Dahal's tenure has seen notable achievements, thanks to his prudent and mature foreign policy leadership in the face of challenging global circumstances. 

The Covid-19 pandemic disrupted international relations for a considerable period, and ongoing conflicts like the Russia-Ukraine and Israel-Hamas wars, along with heightened global power competition, has added complexity. Against the backdrop of the Galwan Valley clash between China and India in 2020, regional tensions escalated which affected Nepal due to its geographical proximity with China and India. Major world powers sought to enlist Nepal into their strategic plans and alliances, creating a challenging and intricate situation. 

Despite these challenges, the current government has steadfastly pursued an independent, balanced, and non-aligned foreign policy. It has effectively communicated that Nepal aims to avoid entanglement in any geopolitical camp. This stance has laid the groundwork for Nepal’s future international relations, focusing on economic and political development aspirations.

Are you suggesting that Nepal has successfully resisted attempts by powerful nations to influence its alliances, and there are no such risks moving forward?

Not definitively. The nation faces a pressing need to chart its own course in the coming days. The evolving dynamics among major powers indicate a trend towards rivalry, disrupting the existing international security system. This can lead to challenges for Nepal. We should be able to steer clear of these challenges while steadfastly pursuing the chosen path of economic and political cooperation.

What are these challenges, could you please explain them ?

First, there is the heightened military competition and the potential for strategic conflicts. This is a growing concern globally, with superpowers engaging in a military showdown that raises alarms in countries, both large and small. Like Nepal, many countries in the southern hemisphere are hesitant to engage in the current geopolitical conflict and are more concerned about their own economic development. They want to avoid unnecessary entanglements between the eastern and western hemispheres, recognizing the potential negative impact on economic cooperation.

Upholding this policy is crucial to ensuring stability and avoiding distractions in the future. 

Second challenge is the emergence of new political polarization. Unlike the Cold War era, today's rivalry is characterized by ideological competition through trade and technology wars. This shift in political dynamics can lead to the creation of camps. 

And lastly, there is the shift of strategic interests towards economic and political cooperation. Nepal should strive to avoid being caught in such dynamics. The country has already conveyed its stance that it won't participate in such polarization.

After taking both neighbors into confidence, where will be the emphasis of the government in terms of foreign policy?

We must prioritize international cooperation for economic development. Determining the key agenda and effectively managing cooperation are imperative aspects of reshaping our foreign policy and international relations. For a long time, Nepal has championed economic diplomacy as its central approach for development. However, the current global scenario reveals a shift towards military engagements among international powers. This shift has prompted countries, irrespective of size, to escalate military spending. This may affect the dynamics of financial grants and aid that Nepal has historically received. Despite this evolving landscape, Nepal will stick to economic diplomacy. But the pillars of 'economic diplomacy' which we are adopting should be refined and made more comprehensive. So far we have promoted foreign aid, trade, investment, tourism and labor as important pillars of economic diplomacy. Now, the government is broadening the scope of ‘economic diplomacy’ by incorporating ‘climate diplomacy.

A prominent folk singer, Roshni Rasaili is a familiar figure in the Nepali music scene.  recognized as a prominent folk singer. Beyond her vocal prowess, Roshni excels in lyric writing and rhythm creation. Her musical repertoire extends beyond folk, encompassing various genres, which highlights her versatility. Roshni has played a vital role in preserving and promoting Nepali folk songs and music. With over three dozen albums to her credit, she has made a substantial impact on the musical landscape. In a recent interview with Ashmita Chhetri, Roshni shared insights into her musical journey. Here are some excerpts:

What is your perspective on life?

The understanding of life becomes more intricate as one delves deeper. Life's definition varies based on individual experiences. For a poet, life may be poetry, for politicians, it can be politics, and for me, being a singer and artist, life encompasses the activities, reactions, rituals, and cultural aspects that people encounter from birth to death. Music, in my view, encapsulates life itself.

How do you define music?

Music and life traverse similar paths. The only difference is that music serves as a condensed representation of life, society, country, and situations through the lens of the mind and technology. Life, as often said, is a stage, and we are the actors on this earthly stage. Music is not just entertainment; it is the lifeblood of human existence.

From an artist's standpoint, how do you perceive music?

Music takes on countless forms that we can incorporate into our lives as needed. Touching songs emerge from the convergence of words, while melodious music flows from the fusion of seven tunes and sargams. The perspective varies based on individual principles.

How does music impact the human body?

Research indicates that music possesses healing properties and enhances the well-being of individuals. It stimulates deep sensations and emotions, maintaining hormonal balance and benefiting the mind. Music, when played at a low volume during meditation and yoga, enhances concentration and brings peace to the mind. Continuous immersion in music contributes to mental well-being.

What is the connection between music and people?

The bond between music and people is very strong and has existed since the inception of sound. Whether in times of pain or happiness, individuals seek solace in music. Music helps in balancing emotions, alleviating depression, and enhancing mood. Music has also been used as a therapy. In Nepali society, songs and music are deeply intertwined with rituals and festivals, evolving and being passed down through generations. Various music genres have established a significant presence in the Nepali music industry. What was once primarily dominated by radio, CDs, and VCDs has now shifted to a dominance of videos. There's a growing preference among people for visual experiences. This marks a notable transition in the industry.

How did you embark on your musical journey?

I was born in Indreni, Baglung Municipality-10, in Baglung district. Music has been both a hobby and a chosen field since my childhood. I found joy in humming and actively participated in various events such as weddings and festivals in my village. I consistently secured the top position in weekly extracurricular activities at school, particularly in cultural programs. My proficiency as a singer earned me numerous awards at the school, inter-school, regional, district, and zonal levels. In 2007, after successfully completing the SLC examination, I embarked on a journey to Kathmandu with a golden dream of forging a future in music while continuing my studies. I enrolled at Ratna Rajya Laxmi Campus where I delved into the study of music. This marked the formal initiation of my journey into the field.

How many albums have you released to date?

I have released over three dozen albums. 'Mutu Bijhaune,' 'Murchha Pari Chheumai Dhalda Ni,' 'Saai Ch Umer' (Teej song), 'Facebookma' (Teej song), 'Selfie Kichhinkeen' (Teej song), 'Tettis Kilo Sun,' 'Garchu Love,' and 'Maitighar’ are some of my popular albums.

How has your career been recognized in society?

I have earned considerable respect and recognition in various capacities. I am an honorary member in prominent organizations such as the Nepal Music Industry Association and the National Folk Cultural Association, and a lifetime member of the National Folk and Dohori Song Foundation. Additionally, I am an active member of the Presenters Society and the Dhaulagiri Cultural Committee. In acknowledgment of my contributions, I have been honored with several awards, including the '8th Chhayachhavi Teej Music Award-2021,' 'Star Music and Film Award-2021,' 'Jyoti Films Music Award-2021,' 'South Asian Business Excellence Award-2021 (Colombo, Sri Lanka),' 'National Creative Citizen Award-2072,' and 'Spiny Babbler Sangeetkarmi Samman-2023.' Furthermore, I have shouldered the responsibility of serving as a judge for the Genius Music Award in 2021.

Anja Strelec is a Croatian film and audiovisual director and photographer, who lives and works in Brussels. Her award-winning documentaries, which have focused mainly on social issues, have been shown around the world at international festivals and on television. She has also participated in solo and group exhibitions of photography and new media in Croatia and abroad, including in France, Slovenia, Germany, Italy, Greece and Belgium.

Anja Strelec has obtained a Master's degree in Audiovisual and Film Production from the Paul-Valéry Faculty in Montpellier and a Master's degree in Audiovisual and Film Directing from the University of Toulouse-Mirail, France.

In addition to artistic activities through various visual formats, she has been working as an independent audiovisual and film director for Belgian television, the European Commission and international organizations such as UNICEF for the past 15 years. She also conducts film, audiovisual and photography workshops, among others, for European Union delegations and film students in countries such as Eritrea, Guinea, Ghana, Senegal and Bangladesh.

Directed by Strelec, ‘Where Have All The Smiles Gone’ is also being screened among others at 11th Nepal Human Rights International film Festival (NHRIFF) from 9-12 December at Tourism Development Board and Film Development Board. Ken Subedi conversed with Anja Strelec regarding her own experiences with the documentary.

You filmed the documentary 'Where Have All The Smiles Gone’ at the invitation of a Nepali production company. How did the collaboration start and how did you react when he offered you to shoot a film about Nepali migrant workers?

I have been working on social topics for several years through TV reports and documentaries, even more intensively after my arrival in Brussels eight years ago, where I am associated with a number of organizations and associations that focus on migration, minorities, social injustice and similar topics.

Producer Chandra Kant Jha from the production company Mountain River Films contacted me through LinkedIn and presented me with the idea for the project. He saw my portfolio and thought that I fit the profile he was looking for, considering my previous work. It is also about the technical aspects, because the directors are often also sound and video recordists and come with their own equipment. I found the topic extremely interesting and important, and started researching it more intensively. After agreeing on logistical and creative aspects, we made some framework for the story of what it should look like. This process took a few weeks. 

How long and in what way did you research the topic before starting to realize the story?

The preparations were extensive and the research lasted longer than the recording itself, we had to be very careful not to get any wrong information. Of course, it is impossible to control everything, especially since sometimes you have to improvise in order to make the story as authentic as possible. We received information from different sources and it was necessary to somehow make a selection and study the statistics well, but since the main idea came from the Nepali production, it was much easier because they had the right picture on the ground and they needed someone to shape it into a movie story.

The documentary shows the plights and blues of migrant Nepali workers where the production team has to deal with emotions of the interviewees which can be challenging. How did you manage to cover the emotions without being carried away?

It was very difficult to interview the people and listen to their tragic stories. However, they felt the need to share their stories and experiences so that others would have a better picture of what is happening to migrant workers. So, no matter how difficult it was to listen to their stories, there was this greater goal of transmitting it objectively to the world.

Which situations had the most impact, what was the most shocking for you?

Working on a project like this and with a topic like this inevitably brings a series of new, striking situations, conversations and information and undoubtedly leaves a mark. For example, take the airport in Kathmandu, which is a place of great contrasts. It is a small airport, but several flights arrive daily, and families of workers often wait for their loved ones in the lobby behind the glass door partitions in fear because they have no information whether the family members are returning alive or dead. Corpses of deceased workers arrive at the airport from abroad every day along with westerners with backpacks, who want to hike in the Himalayas or simply seek spirituality. I think this was the most shocking thing to watch the simultaneous exit through the small airport doors of the happy and satisfied tourists and caskets with dead Nepali migrant workers. Each conversation also left a lasting impression and brought new knowledge, especially with migrants, who have returned because each story is special and difficult.

How are people reacting to the film?

I am glad to say that the film has a very good reception–it was already screened at around 15 film festivals across the world and the audience really resonates with and is interested in the topic. The film has received three awards so far–Audience Award for the best international short documentary film at Chania Film Festival, Special Jury Award for short documentary at Workers’ Unite Film Festival in New York and the Award for Best Human Rights Film at Hummingbird International Film Festival in India. I really hope that this documentary reaches as many people as possible, starts conversations and helps bring about positive changes.