Menstrual Health and Menstrual Solidarity Campaign MHSA

Lack of menstrual health, menstrual solidarity and menstrual poverty is unfortunately still present everywhere in the world. Lack of education about menstruation, limited access to hygienic products, such as in schools, poor sanitary infrastructure are all factors that negatively impact the health and hinder the educational opportunities of young girls and women all over the world.

In June 2022 during the WHO 50th session of the Human Rights Council Panel, discussion on menstrual hygiene management, human rights and gender equality and menstrual health have been placed on the global health, education, human rights, and gender equality/equity agendas by grass-roots workers and activists from the global South.

These activists draw attention to reports of women and girls’ experiences of shame and embarassment, and the barriers they face in managing their period because they do not have the means to do so, with consequences for their life opportunities including their rights to education, work, water and sanitation, non-discrimination and gender equality - and ultimately to health.

WHO salutes the grass-roots workers and activists, who have doggedly championed menstrual health, and welcomes the inclusion of Menstrual Health in the Human RIghts Council agenda. WHO calls for menstrual health to be recognised, framed and addressed as a health and human rights issue, not a hygiene issue. WHO calls for three actions:

1. Firstly, to recognise and frame menstruatino as a health issue, not a hygiene issue - a health issue with physical, psychological and social dimensions, and one that needs to be addressed in the perspective of a life course - from before menarche to after menopause.

2. Secondly, to recognise that menstrual health means that women and girls and other people who menstruate, have access to information and education about it; to the menstrual products they need; water, sanitation and disposal facilities; to competent and empathic care when needed for example in conditions such as endometriosis, to live, study and work in an environment in which menstruation is seen as positive and healthy not something to be ashamed of; and to fully participate in work and social activities.

3. Thirdly, to ensure that these activities are included in the relevant sectoral work plans and budgets, and their performance is measured.

WHO recognises that several sectors have equally important roles to play in promoting and safeguarding menstrual health, and is committed to stepping up its efforts to encourage health policymakers and programme managers to engage with these sectors to promote the rights of women, girls and other people who menstruate and meet their comprehensive menstrual health needs, especially in humanitarian contexts. WHO is also committed to breaking the silence and stigma associated with menstruation and to make schools, health facilities and another workplaces menstruation responsive.

Governments are beginnning to act, but they need to do much more. Activists - including young people - and nongovernmental organisations have done much to place menstrual health on the agenda. A growing number of governments are acting. Some governments have removed taxes on menstrual products. Others have focused on the challenges faced by school-going adolescents in obtaining menstrual products. Still others have put in place strategies to provide menstrual products to populations in difficult circumstances eg. those who are homeless or those who cannot afford to buy them.

A handful of countries have put in place laws and policies for medical leave when one is experiencing pain, discomfort and other symptoms and signs related to menstruation. These are useful steps, but governments could and should do more than improve access to menstrual products. They should make schools, workplaces and public institutions supportive of managing menstruation with comfort and dignity. More importantly, they should normalise menstruation and break the silence around it.

Menstrual poverty is no longer acceptable. Access to healthy sanitary products and being able to go to school/work every day of the month is a fundamental right for women. We therefore cannot be thankful enough to companies who have supported this important initial step in securing menstrual solidarity. Let’s keep on working in collaboration with all government, policymakers, managers and companies to sustain and put gender solidarity, equality and equity on our agendas.

WHO (2022) The 50th session of the Human Rights Council Panel. Geneva Centre.

By Dr. Josephine Attard PhD

E: josephine.attard@um.edu.mt

Head of Midwifery Department

Faculty of Health Sciences

HIV in Malta

Malta was declared as the country with the highest rate of HIV diagnoses within the EU/EEA. An overwhelming rate of 15.9 per 100,000 has been reported in the 2021 HIV/AIDS surveillance in Europe, published by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organisation Regional Office for Europe. Since 2011, rates of HIV diagnoses have more than doubled locally.  

HIV is a viral infection caused by Human Immunodeficiency Virus. Once inside the body it attacks the immune system cells and replicates by gradually impairing the typical immune cell functioning. When left untreated, HIV can weaken the immune response over time and develops into AIDS ( Acquired Immune Deficiency Syndrome). At this stage, the body becomes vulnerable to what is called opportunistic infections; infections that occur more frequently when the immune system is damaged. These include various skin and lung infections, as well as different types of tumours and cancers. These infections can cause long term health problems or even be life threatening. With the current available treatment options, the development of AIDS can be prevented.

Despite the current situation in Malta with regards to the HIV pandemic, changes made to improve our local sexual health policy, free access to pre-exposure prophylaxis and adequate access to HIV testing have not been observed, explained Dr Mark Josef Rapa, a Lecturer in Bioethics at the University of Manchester, and the Founder of PrEPingMalta and member of the European AIDS Treatment Group (EATG). Dr Rapa was interviewed  about HIV in Malta.

What are the main reasons for the high rate of HIV diagnoses in Malta?

Dr Rapa explained that the most obvious reason for the high rate of diagnoses in Malta is due to the poor access to effective prevention tools. “Condoms are not the most effective HIV prevention method; PrEP is, and PrEP is not easily accessible” they remarked. PrEP refers to Pre-Exposure Prophylaxis; a combination of two drugs in a single pill that is used to prevent HIV negative individuals from acquiring the virus. 

“Nevertheless, this is not sufficient an explanation. One must dig deeper and look at the level of awareness around HIV and HIV prevention and sexual health at large.” Furthermore, Dr Rapa shed light on “the poor sexual health education we have received, and the non-existent sexual health policy” and argues that these are two factors that contribute largely to the high rate of diagnoses. 

“We also need to be asking ourselves how we talk about sex. Are we sex-positive or do we still see having sex as something dirty and shameful? It is evident that there is an element of shame that people experience when considering going for a test; some even experience shame when having sex. Of course, this is not made any better by the lack of sexual health campaigns.” 

Misconceptions about HIV.

HIV is heavily stigmatised, which contributes to the misconceptions that many have concerning the consequences of infection and it’s acquisition. Unfortunately, HIV stigma may also result in discrimination of individuals with HIV. Dr Rapa emphasised that “these misconceptions are not only stigmatising people living with HIV, but are also preventing people from getting tested out of fear, and/or lead some to think that they could not be at risk of acquiring HIV.”

While there are several dangerous beliefs about HIV, they explicitly listed the following as ones which are most prevalent locally:

1. HIV is a death sentence. 

“While there is no cure for HIV, those on treatment go on to live a long and healthy life.” 

2. Engaging sexually with someone living with HIV automatically means that you are going to acquire HIV.

“People living with HIV can get the virus to an undetectable level by taking Anti-retroviral therapy. An undetectable level means that the virus is untransmittable (U=U). In other words, you cannot acquire HIV if you have sex with a person living with HIV who is on treatment with undetectable viral load.”

3. HIV is only prevalent in men who have sex with men (MSM).

“There is an inherently dangerous misconception that only MSM who engage in high-risk activities or have multiple partners can acquire HIV. This is not the case. HIV is not Santa. It does not care if you have been naughty or nice. It’s a virus. It is transmitted through the exchange of bodily fluids during anal or vaginal sex, sharing of needles, during pregnancy and breastfeeding. It’s worth mentioning that, globally, over 50% of the people living with HIV are women.”

How to reduce the risk of becoming infected with HIV.

To reduce the risk of acquiring HIV, Dr Rapa recommended the use of condoms, taking PrEP, or both. They stated that “PrEP reduces the risk of acquiring HIV by over 99%. Condoms are also highly effective and also prevent other Sexually Transmitted Infections.”

PrEP may be taken daily or on demand as necessary by men, women, transgender people and injecting drug users. It’s use is dependent on how frequently the individual engages in sexual activity.

Further information about PrEP and how to access it in Malta can be obtained from: www.hivmalta.com / www.prepingmalta.com / www.sexualhealth.gov.mt

Getting tested for HIV.

Dr Rapa advocated for testing once a year as a “good sexual health practice for anyone sexually active. A person who has more than one sexual partner may consider getting tested more often.” They continued with the suggestion of testing every three months in the case that one is “having sex without condoms with new or casual partners.”

There are a variety of options to choose from for HIV testing in Malta. Dr Rapa listed the GU clinic, where a full sexual health screening is provided free of charge and certain private clinics in which similar testing services are offered. Additionally, they mentioned that HIV self-testing kits may also be purchased from pharmacies. 

“Those who are worried that they have been recently exposed to HIV (within the last 72 hours) should immediately call the GU clinic or go to the Emergency on the weekend. For anyone possibly exposed to HIV, within the first 72 hours from exposure access, there is the possibility of taking Post-Exposure Prophylaxis (PEP); a one month treatment that can stop the virus from taking hold”, they stated.

If you do not know your HIV status, or wish to get tested for HIV in Malta, an appointment for testing may be booked at the GU clinic by contacting 25457494. 

HIV positive individuals.

Dr Rapa recommended that anyone who is HIV positive to talk to HIV/Infectious disease consultants to discuss treatment options. “With the current treatment options, people living with HIV have the same life expectancy and quality of life of people who are HIV negative. Adhering to treatment prevents one’s health from deteriorating while eliminating sexual and mother to child transmission by lowering the amount of virus in the body. When the amount of virus in the blood becomes undetectable transmitting HIV through sex is not possible”, they advised.

For those who are undergoing treatment for HIV currently, it is heavily encouraged that any dissatisfaction with the current treatment should be brought up at their next appointment. “Together with the clinician, navigate other treatment regiments”, Dr Rapa suggested.

Treatment options for HIV in Malta.

As of the beginning of 2021, Malta has been offering what is referred to as ‘gold standard treatment’ for HIV. Dr Rapa described these treatments as consisting of “a single pill a day rather than a combination of pills”. They emphasised that “patients who are still receiving older treatment regimens should get in touch with their HIV clinician and ask about what other treatments they can get on”

What efforts can be made to reduce the rate of infections locally? 

Dr Rapa is an advocate for an updated sexual health policy, stating that “we have been promised an updated sexual health policy for a long time now”; this will have a great impact on the reduction of the rate of HIV spread. In the interim, they suggested that “measures are introduced that can be fully incorporated in the policy once published. One of these measures would be making PrEP available for free. We know that where PrEP has been introduced and made free, the number of new HIV cases dropped dramatically.” Although PrEP is offered in Malta, Dr Rapa protested that “is sold against a prescription for 57 Euros; a price tag too high for the many who may benefit from taking PrEP to reduce the risk of acquiring HIV.”

Other measures that may be introduced, they continued, are to “include provision of free condoms to people at high risk, including young adults of 16 and older.” Dr Rapa insisted that it is of paramount importance that, along with this, there is the provision of “comprehensive sexual health education that is inclusive of the diverse population it is targeting. Anything other than that would not get us far.”

Written by Bettina Zammit

Men’s Health Movember – Breast Cancer

What are Breasts?

• The breasts are medically known as the mammary glands.

• They are located in front of the pectoral muscles.

• In females they produce milk, while in males they are inert. 

What is Breast Cancer?

The development of malignancy in either of the breasts, is known as breast cancer. 

Breast cancer effects women far more than men, and in fact in males it is considered as a rare cancer. It has been found to be associated with obesity, and the corresponding elevated estrogen levels.

Local Statistics

In 2020 there were 403 new breast cancer cases in females, in contrast to 0 in males. 

Symptoms of Breast Cancer

• Lump in the breast

• Nipple turning inward

• Nipple discharge

• Sore and/or rash around the nipple

• Hardness, redness, and/or swelling at the nipple or the surrounding skin 

• Small bumps in the armpit

Getting Tested

It is important to attend check-ups as instructed by your medical doctor, particularly if you have been identified to have a higher risk of breast cancer. It is also possible to perform a self-breast examination at home by following the below steps:

1. Inspect the breast in front of a mirror in three main positions: arms at side, arms over head, and with hands placed on hips while leaning forward. Look out for changes in, nipples, texture, shape, contour, direction, and swelling at the breast.

2. Examine the breast by using the first few finger pads. Press on the entire breast, starting from the armpit, to the cleavage, and then to under the breast in a spiral motion. A deep pressure should be used to identify any lumps or hardness.

3. Squeeze the nipple between the thumb and the index finger and look out for any discharge. 

Written by: Miguel Sammut & Malcolm Camilleri

Men’s Health Movember – Suicide

Suicide Related Definitions

Suicide is death caused by injuring oneself with the intent to die.

Suicide attempt is when one harms oneself with the intent to end his life, but does not die as a result of their actions.

Suicidal ideation or more commonly known as suicidal thoughts, is when one is thinking about or considering suicide. It is then further classified depending on if one has a plan or not. 

Parasuicide is commonly known as self-harm. It includes actions where one seeks to physically damage the self, without death.

Local Statistics

80% of completed suicides between 1995 and 2018 were attributed to men.

Warning Signs of Suicide

• Past suicide attempts

• Threatening to hurt or kill themselves 

• Looking for ways to kill themselves 

• Talking or writing about death, dying, or suicide 

• Negative moods, including rage, anger, anxiety, agitation

• Sudden changes between extreme positive and negative moods

• Acting recklessly or engaging in risky activities

• No reason for living, no sense of purpose in life

• Increasing alcohol or drug 

• Withdrawing from friends, family or society 

• Inability to sleep or sleeping all the time 

What to do if you think someone might attempt suicide?

Ask them directly if they are considering suicide through questions such as: “Are you having thoughts of suicide?” or “Are you thinking about killing yourself?”.

• Ideally do so in an environment which is comfortable to individual and which is free from distractions

• Be patient and calm while the suicidal person is talking about his feelings

• Listen to the suicidal person without expressing judgment, accepting what they are saying without agreeing or disagreeing with their behaviour or point of view

• Ask open-ended questions to find out more about the suicidal thoughts and feelings 

• Call the 179 national support line for further guidance

• Call 112 if there any danger, and treat it as an emergency

Written by: Miguel Sammut & Malcolm Camilleri

What is Suicide Baiting?

In response to last Friday's news, MHSA is deeply shocked and disappointed at how the situation unfolded, as a crowd of onlookers flocked to the Valletta bastions, where an individual was pacing and contemplating suicide (as quoted by several news sources). Shocking footage shows bystanders encouraging the agitated man to jump off the Valletta bastions, as many took out their phones to record his act. 

Defining Suicide Baiting

Suicide baiting is when a group of individuals take action against someone who is actively threatening or contemplating suicide.

Stories like this are unusual, but as social media becomes a bigger part of our lives, we're hearing more and more stories about people being tormented with hateful comments, with others feeling as if suicide is their only option.

The man was cruelly taunted by comments such as, “Hurry up and do it so we can get back to work”

Crowd Behaviour and Suicide Baiting

Leon Mann conducted a study in 1981 that looked at newspaper descriptions of 21 situations in which a person threatened to jump off a building, bridge, or tower while a crowd was present. 

Mann discovered that the audience teased or jeered the person on ten of these occasions. Mann's research revealed that numerous elements were present in baiting incidents that may have contributed to a phenomenon called as 'deindividuation.' The prevalence of a sense of deindividuation in the persons who baited the victims, according to Mann, was the cause of the crowd's behavior (Phillips & Mann, 2019).

The experience of being part of a very large group, the emphasis on the dramatic event happening in front of them, and the behavior of the other members of the group could have all led to the individuals in the group losing their sense of self. A lack of self-awareness and a diminished sense of moral culpability would have resulted from this loss of self. Simply put, being a part of this particular group, in this particular set of circumstances, could have resulted in the observed behaviors, which most individuals who aren't a part of the group find difficult to digest and comprehend.

Identifying and Dealing with Suicidal Thoughts

Suicidal thoughts are vague ideas about ending one's life or the belief that others would be better off without you. Individuals experience sensations of agitation and anxiety as a result of such ideas, which fluctuate from moment to moment or even build up over time.

Before assuming that suicide is a ploy for attention, one must understand the bigger picture and the culture people belong to, as suicidal thoughts have both biological and social determinants, such as;

• History of violence and/or exposure to trauma

• Bullying/ toxic environments/ harassment 

• Social exclusion/ discrimination

• Predisposed mental illness such as major depression and bipolar disorder

How to approach a person experiencing suicidal thoughts:

• Be sensitive yet ask direct questions about how the person is coping. Asking about suicidal thoughts does not encourage the act, but rather allows the individual to speak up about his/her feelings. 

• Look for warning signs, such as withdrawal from social contact or talking about suicide. 

• Seek immediate help from a trusted source, call for local professional help right away if need be.

• Encourage the person to speak up and seek professional help, rather than bottle up feelings. There is no need for the person to feel ashamed. 

• Never be patronizing or judgmental towards the situation, offer reassurance

Some Sobering Conclusions

Reading about these theories may help us better understand crowd behavior, but it does little to alleviate the tragedy of suicide baiting stories. The concept that simply being in the presence of a group might radically shift our moral compass is alarming.

Many of us are unlikely to ever comprehend suicide baiting, and we certainly don't want to. More awareness of this, on the other hand, could be a positive force. By acknowledging the misery of suicide baiting stories, we might potentially take a closer look at our own actions and encourage others to do the same.

The MHSA applauds the brave bystanders who spoke up for the rest of the crowd, as well as the police force and other authorities who calmly and professionally defused the situation, saving the man's life. As future health-care professionals, MHSA encourages all students to speak out against these heinous acts and to provide all those in need of a voice.

National Suicide Helpline:

• Appogg support line - 179

• Richmond Foundation - 1770 

References

Mc Elroy, J.Suicide baiting – what is it & why does it happen? : Suicide Baiting - What is it & why does it happen? - (thegreenrooms.net)

Phillips, J. G., & Mann, L. (2019). Suicide baiting in the internet era. Computers in Human Behavior, 92, 29-36. doi:https://doi.org/10.1016/j.chb.2018.10.027

Written by Angele Gauci

Nursing Students Following A Degree On Part Time Basis Discriminated

Earlier on this week, MUMN chief Paul Pace claimed that an average of 3 nurses are quitting

their jobs at Mater Dei Hospital every week. Burnout, stress, and lack of new recruits seem to be

contributing towards the problem. Meanwhile, nursing students following a degree on part time

basis have been discriminated for the past 4 years. I write this with a heavy heart in the name of

all part time students whose desperate pleas have been ignored for the past 3 years by parliament

ministers, committees and organisations.

Four years ago the possibility of following a Nursing Degree on Part Time Day basis was

introduced. This opportunity was a blessing, especially for mature students who couldn’t follow

their lifelong dream of becoming registered nurses due to personal commitments. The Full Time

Nursing Degree course takes 3 years to be completed. The Part Time Day Degree Course

includes the exact same amount of study in theory and the exact same amount of placement

hours, in which we are required to practice nursing skills alongside clinical mentors or registered

nurses. The difference between the Full Time Course and Part Time Course is solely an

extension of 2 years – we graduate in 5 years and not 3. Other than that, we learn and practice in

the exact same way.

How are Part Time Nursing Students being discriminated?

Both Full Time and Part Time students are required to complete 300 hours of nursing practice in

two consecutive summers (apart from other placements during the year – us part timers complete

more than two summers in practice placements...but let’s leave that aside). Two summers ago,

Full Time students were granted approximately Eur1024 for their hours on placement. Last

summer, Full Time students were granted approximately Eur1857 for their 300 hours on

placement. Remunerations are issued by the Ministry of Education.

In total, Full Time students were granted Eur2881 for two summer placements.

What did us Part Time students get for the exact same amount of hours on

practice placements? Nothing. Why? Just because the course is on Part Time

basis.

And let us not forget the issue of stipends and grants...

The University of Malta website states the following, which is applicable to the Full Time

Nursing Degree Course:

Students registered on ‘Prescribed’ courses receive a stipend of €160.55 every 4 weeks.

Students following “Prescribed” courses receive the sum of €798.81 per academic year.

Students following ‘Prescribed’ courses receive the sum of €698.81 at the beginning of the first

academic year.

Some of the amounts mentioned are set to increase as per the latest announced Budget measures.

Among the criteria for these allowances are the following:

A student must be attending a full-time day course; in case of full-time postgraduate courses,

only those courses which lead to a professional warrant are eligible.

Not be in a full-time employment

If in part-time employment, one must not exceed the 20 hours of work per week during the

academic year

What does all this mean? It means that as Part Time Nursing Students, not only are we

completing our practice placements for zero monetary support – we are automatically

disqualified for an average of Eur4,816 in stipends, an average of Eur2,396 in maintenance

grants, as well as the initial one-time grant of Eur698.

In total...

Full Time Nursing Students throughout their 3 year course of studies receive at

least Eur10,791c

Part Time Nursing Students throughout their 5 year course of studies receive

NOTHING!

Have we attempted to bring attention to this? Of course! Throughout the course of the last 3

years we have been in contact with the offices of (at the time) Minister Evarist Bartolo, (at the

time) Minister Owen Bonnici, Minister Chris Fearne, and lately the office of Minister Clyde

Caruana who we are still awaiting a call from at the time of this article’s publication, as well as

the office of Minister Justyne Caruana, who we haven’t even received any communication from

as of yet.

Are we really recognising the seriousness of the nursing staffing crisis in Malta? If yes, then

shouldn’t an investment be made in favour of the Part Time Degree Nursing Course? After all,

such an investment would encourage individuals with side commitments, who otherwise

wouldn’t be able to follow a Full Time course, to enroll for a Nursing Degree, increasing not

only their personal prospects, but also the amount of future registered nurses in our country. This

would counteract the current lack of new recruits.

As nursing students we practice nursing skills and assist patients with their requests and needs,

providing direct contribution to the clinical tasks performed by qualified nurses. Similarly, just a

few months ago when our country needed us, we set aside concerns about our own safety and

vulnerability, and came together to contribute to the COVID-19 vaccination programme. We are

actually being recalled to be of service right now to help with the booster vaccination

programme. Through our contributions within the clinical setting, we can help alleviate some of

the stress experienced by qualified nurses, whilst reducing burnout and the amount of qualified

nurses’ resignations.

Unfortunately, to date, me and my part time nursing colleagues are struggling to keep up with

our studies, our families and children needs, our loans, along with student expenses... we end up

taking unpaid leave to make sure we miss no lectures, and to make time for our scheduled

clinical placements. And after a day of lectures or a day on placement, most of us have to go

straight to work for a 12 hour night shift in the healthcare setting. We are exhausted. We have

strained our existing commitments to give our utmost attention to a profession we want to serve

in. We want to be there for our patients. But we also want to feel appreciated, to be treated as

equal to our other fellow nursing students. We are not asking for more other than what we feel

we deserve.

Help us whilst we commit ourselves to be of service to our country in the very near future. If it

was ever uncertain, this pandemic has taught us how valuable healthcare workers are to our

society. Our country needs us and we are willing and want to serve. Do not keep on ignoring us.

We call upon the authorities to show us, not with words, but action, that we are indeed valued as

Malta’s future registered nurses.

by: Clare Galea

Men’s Health Movember – Testicular Cancer

What are Testicles?

• Testicles are the 2 oval shapes male sex organs.

• They are located inside a loose pouch of skin, called the scrotum.

• The testicles produce the male sex hormone called testosterone, together with the reproductive sperm cells.

What is Testicular Cancer?

The development of malignancy in either of the testicles, is known as testicular cancer. It is a common cancer in men, particularly in those aged under 50.

This type of cancer is highly treatable, even when it spreads.

Local Statistics

In 2020 there were 14 new cases and 0 deaths related to testicular cancer in Malta.

Symptoms 

A small lump, hardness, and/or enlargement of the testicle are usually the first signs of testicular cancer. Other symptoms often appear once the cancer has spread to other parts of the body.

• Lump or enlargement in either testicle

• Feeling of heaviness in the scrotum

• Dull ache in the abdomen and/or groin

• Sudden collection of fluid in the scrotum

• Pain or discomfort in  the testicle

• Lower back pain

• Swelling in one or both legs

Getting Tested

It is important to attend regular check-ups as instructed by your medical doctor, particularly when younger than 50. 

Self-testicular examinations, although they do not replace medical examinations, are also possible through following the below steps. 

1. Select one testicle

2. Hold the testicle between you thumbs and fingers

3. Roll it gently, while being cautious of any lumps, hardness, or enlargements

4. Repeat for the other testicle

Written by: Miguel Sammut & Malcolm Camilleri

Men’s Health Movember – Prostate Cancer

What is the Prostate?

• The prostate is a small gland in the pelvis, found

  only in men. 

• It is located in front of the rectum, under the   

  urinary bladder, and it surrounds the urethra.

• It produces prostatic fluid which is an important 

  component of semen.

What is Prostate Cancer?

The development of malignancy in the prostate, is known as prostate cancer. It is a common cancer in men, particularly in those aged over 50. 

Local Statistics

In 2020 there were 336 new cases and 53 deaths related to prostate cancer in Malta.

Symptoms
Symptoms may not occur in its early stages, but they tend to show when the prostate cancer is large enough to affect the urethra, which transports urine from the bladder out of the body.

Some of the most noticeable symptoms include:

• Increased need to urinate

• Difficulty urinating

• Blood in the urine and/or semen 

Getting Tested

It is important to attend regular check-ups as instructed by your medical doctor, particularly when older than 50. 

A digital rectal examination is often performed to assess the presence of prostate cancer. During this examination the doctor inserts a lubricated, gloved finger into the rectum to feel for lumps, enlargements, or areas of hardness. This brief and mildly uncomfortable procedure could potentially allow for the cancer’s early identification.

Written by: Miguel Sammut & Malcolm Camilleri

Pink October - Breast Cancer Awareness Month

The 1st of October marks the beginning of Breast Cancer Awareness Month, which is also commonly referred to as Pink October. 

It has been predicted that by the end of this year, 268,600 women and 2,600 men would have been diagnosed with breast cancer. Approximately 42,260 of these individuals will unfortunately die due to the disease.

What is cancer?

Cancer is a common disease which arises due to the uncontrollable growth of cells within the body. The disorderly growth occurs when the process of cell division breaks down, resulting in the unsignaled formation and unmanageable multiplication of abnormal or damaged cells. When these tumours are cancerous and dangerous, they are referred to as malignant tumours. The malignant tumours typically spread to other parts of the body, and cause further tumor growth. This process is referred to as metastasis.

Breast cancer is the most common malignancy in women. In the early stages of breast cancer, when the cancer has been found to be contained to the breast alone or the axillary lymph nodes, there is a high chance that via multimodal therapy the cancer will be cured. If the cancer is found in the advanced metastatic phase, treatments which are currently available aim to control the symptoms, prolong survival, and provide the individual with the best quality of life possible while living with breast cancer. 

Risk Factors:

• Smoking.

• Obesity or being overweight.

• Lack of exercise. 

• Alcohol use.

• A positive family history of breast cancer, as roughly 10% of breast cancers are associated with genetic predisposition. 

• A positive family history of colorectal or ovarian cancer.

• A past history of ovarian cancer.

• A past history of radiation therapy.

• Being a woman who began menstruating prior to age 12, or began menopause after age 55.

• The long term use of the oral contraceptive pill.

• The use of HRT for over 10 years with oestrogen and progesterone hormones.

• Not ever having children, or having the first child after 30 years of age.

• Mutations of the BRCA-1, BRCA-2 or PALB-2 genes.

Symptoms:

It is highly important that screening for breast cancer is carried out regularly, and prior to experiencing symptoms, in order to catch the disease in the early stages. According to guidelines, a mammogram should be done once every two years.

• A lump, or hard, thickened area in the breast.

• A lump situated under the arm. 

• Changes in the size and/or shape of the breast.

• Pain, tenderness, discharge, and/or bleeding coming from the nipples.

• Itchiness, rashes, and/or soreness on the nipples.

• An inverted nipple.

• Dimpling of the skin on the breast (having a texture that is comparable to that of an orange peel).

• Redness.

• Warmness or swelling in the breast.

Self-examination:

Breast self-examination should be done approximately once a month in combination with bi-yearly mammograms to increase the chances of early detection. Below, you can find a step-by-step guide on how to carry out a breast self-examination. 

1.Look at your breasts in the mirror with your back straight and your hands on your hips.

• Can you see any differences in size, shape, and colour?

• Is there an inverted nipple?

2. Raise your arms.

• Can you see any differences in size, shape, and colour?

• Is there fluid or blood leaking out of one or both nipples?

3. Lie down and feel your breasts, using the right hand to feel the left breast, and vice versa.

• Firmly press the breast using the pads of your fingers. Keep your fingers flat and together.

• Make circular motions around the whole breast; you should cover the area from your collarbone down to the top of the abdomen, and your armpit to your breastbone. 

4. Stand up and feel your breasts, using the same procedure as when you were lying down.

If you notice differences in your breasts, or think that you have found a lump during your self-exam, do not panic; there are a number of causes for breast lumps that are not cancer, such as typical hormonal changes. Call a doctor or gynecologist to make an appointment for an evaluation. 

NGOs: 

Below you can find two locally based NGOs which raise awareness about breast cancer, fund and provide support to those affected by breast cancer.

The Action for Breast Cancer Foundation is “a Voluntary Organisation that is campaigning for a quality assured service in order to diagnose and treat breast cancer in Malta and Gozo.” “[They] work towards strengthening everyone’s awareness on the danger of cancer and its repercussions on themselves and their loved ones.”

Europa Donna, The European Breast Cancer Coalition, “works to raise awareness of breast cancer and to mobilise the support of European women in pressing for improved breast cancer education, appropriate screening, optimal treatment and increased funding for research.”

Check out their websites here to learn more, gain support, and contribute to the cause: 

The Action for Breast Cancer Foundation: https://www.actionforbreastcancer.com 

Europa Donna: https://www.europadonna.org/

Written by: Bettina Zammit

World Heart Day - 29th September

World Heart Day is celebrated on the 29th of September 2021. 

During the COVID-19 pandemic, we have all become increasingly aware of the immense importance that keeping ourselves healthy has. In light of this, it is necessary to become informed about diseases that are regarded as the top killers worldwide: Cardiovascular diseases. Below, you can read about the risk factors that may lead to heart disease,  symptoms of a heart attack to look out for, and a step-by-step guide on how you may save a life through the proper use of an AED.

Risk factors for heart disease

Pertinent risk factors for cardiovascular disease include the use of tobacco, high amounts of alcohol intake, air pollution, a high BMI index, and little exercise. Studies have shown that an unhealthy diet, which is one which consists of a high intake of processed foods, trans and saturated fats, food items with high amounts of salt and sugar, and drinks with high sugar levels,

is a primary cause for the development of heart disease. High serum cholesterol and high blood pressure levels are regarded as another two of the leading causes for the development of ischaemic heart disease. 

A large number of the risk factors that lead to heart disease are modifiable. Nowadays, easily accessible tools, such as exercise and nutrition apps, are ideal to keep you motivated to maintain healthy habits that reduce the risk of heart disease development.

Hypertension 

Although risk may be decreased through lifestyle changes, there are a few risk factors that must be continually monitored for, despite having a healthy lifestyle. For instance, hypertension (high blood pressure), may not present with symptoms despite it being present. Hypertension which goes unnoticed has the potential to be seriously damaging to the heart, and thus, may result in  chest pain, heart attacks, heart failure, and even sudden death. Hypertension can be monitored by measuring blood pressure regularly.

Atherosclerosis

Atherosclerosis is a condition in which arteries become clogged due to a buildup of plaques, which are fatty substances. Consequently, arteries become hardened and narrowed, resulting in a decrease in the amount of blood flow to vital organs, and an increase in the risk of blood clot formation. Blood clots may result in heart attacks or strokes. 

This condition typically does not present with any symptoms, and therefore, oftentimes goes unnoticed. However, if atherosclerosis remains untreated, cardiovascular diseases, such as coronary heart disease, heart attacks, and strokes may develop. 

Myocardial infarction.

A myocardial infarction, more commonly known as a heart attack, occurs when there is a sudden blockage of blood flow to the heart, which typically arises due to the presence of a blood clot. 

The symptoms of myocardial infarction include: chest pain which may radiate to the jaw, neck, arms and back, shortness of breath, experiencing lightheadedness and/or weakness, and experiencing feelings of extreme anxiety. 

Heart attacks pose life threatening danger, and cause extreme damage to the heart muscle; it is of utmost importance that if you feel symptoms of a heart attack, you seek medical treatment immediately. 

The importance of AEDs and how to use them.

Sudden cardiac arrest is treated using an AED (Automated External Defibrillator). This is a device which is used to determine heart rhythm, and will provide an electrical shock which will aid in reobtaining a regular heart rhythm. 

AEDs in Malta may also be found in public spaces and buildings. In Valletta, AEDs may be found at: - Chemimart in Republic Street

- Chemimart at the City Gate

- Empire Pharmacy in Old Theatre Street

- Castille Hotel in Castille Square

- Marsamxetto Harbour

- Bus Terminus - Near Tal-Linja Kiosk

Every minute is crucial in the case of sudden cardiac arrest; each minute that defibrillation is not provided reduces the chance of survival by 10%. Therefore, since there is a certain amount of time that it takes for medical assistance to arrive at the scene, it is vital that everybody is aware of how to use AEDs, so as to potentially save a life.

Steps to take when using an AED:

Retrieve the AED and switch it on.

1. Expose the person’s chest and ensure that it is dry.

2. Open and apply the AED pads.

• One pad must be applied on the upper right chest above the breast.

• The other must be applied on the lower left chest below the armpit.

• If the individual has a device such as a pacemaker, position the pads in such a way that they do not make contact with the device.

1. Ensure that the wires are attached to the AED box as necessary.

2. Stop CPR and stand clear of the person. Ensure that neither you, nor any other bystanders, are touching the individual.

3. Let the AED analyse the rhythm.

4. Read the AED message provided. This message may read:

   • “Check electrodes”: in this case, ensure that the electrodes are attached to the skin properly.

   • “Shock”: in this case, ensure that the individual is clear, and press and hold the “shock” button until the AED delivers the shock

5. Resume giving CPR.

6. Repeat these steps.

The Dangers of Cotton Bud Usage

Cleaning the ears using cotton buds is a routine practice for many individuals. It is commonly believed that cotton bud usage is beneficial, as it maintains ear hygiene, and that visible wax from the ear canal must be removed using cotton buds as it may be deemed as a cosmetic nuisance. However, cotton bud usage may adversely affect ear health in a variety of ways.

The Importance of Ear Wax

Ear wax is vital for protecting, cleansing, and lubricating the ear canal. Self-ear cleaning by means of cotton bud usage is a procedure that has the potential to cause infection, irritation, and injury to the ear, and may result in impaired functioning of the hearing mechanism. The earwax that many seek to extract contains substances which prevent bacterial growth and infection in the ear canal. Self-ear cleaning is unnecessary as the ear itself has a self- cleaning mechanism through which excess earwax migrates out of and exits the ear canal. This cleansing process is aided by jaw movements. Throughout this process, materials such as dust stick to the earwax, and are therefore prevented from entering the ear canal and causing damage. Attempting to remove wax by blindly inserting a cotton bud into the ear disrupts the natural cleaning process, and might cause earaches, bleeding, infection, and tearing of the ear drum.

Dangers associated with the use of Cotton Buds

Cotton bud use has been linked to the development of otitis externa: an infection of the outer part of the ear canal. The use of cotton swabs causes breakage to the skin within the outer ear canal, making it more susceptible to becoming an area for bacterial growth. This results in pain, swelling, and discomfort within the infected area. Hearing may also be negatively impacted by otitis externa.

Disruption of the natural ear cleaning procedure may result in cerumen (earwax) impaction, where earwax accumulates within the ear canal, resulting in itchiness, pain, feelings of fullness within the ear, and hearing loss. The individual with cerumen impaction may feel more inclined to self-clean using cotton buds and may consequently worsen symptoms. Cotton buds that are inserted too deeply into the ear canal may puncture the delicate ear drum, resulting in tympanic membrane (ear drum) perforation. Complications resulting from tympanic membrane perforation include conductive hearing loss, in which sound is blocked from entering the ear, infection, bleeding, and fluid leakage from the ear. In more severe cases, a perilymphatic fistula may result, causing sensorineural hearing loss, which is a more serious type of hearing loss, loss of balance, feelings of fullness and ringing in the ears.

Since self-ear cleaning using cotton buds may lead to a host of complications, cleaning should only occur when there is ear wax impaction, or when there is obstruction of tympanic membrane. It is recommended that in such cases, ear cleaning is performed on the patient by an experienced otorhinolaryngologist.

Written by: Bettina Zammit

Every Second Counts - The Importance of Resuscitation

After the football tournament was postponed from last summer due to the pandemic, every football fan is currently enjoying the luxury of everyday football with the Euros 2020 officially kicked off on Friday, June 11th. However, on Saturday, June 12th, everyone was in disbelief and shocked when Christian Eriksen, a 29-year-old Danish footballer, collapsed on the pitch shortly before half time.

The cause of the incident has yet to be determined; however, it is certainly not the first time this had occurred in football. Fabrice Muamba, a former Bolton player, experienced a cardiac arrest during an FA Cup quarter-final in 2012. Both of these young football stars, have been reported to be in good physical shape with no signs or symptoms indicated for such an episode to happen. Other football players such as the former West Ham United midfielder Marc-Vivien Foe and the former Tottenham Hotspur defender Ugo Ehiogu died after suffering a cardiac arrest.

What is Cardiac Arrest?

Cardiac arrest is the sudden interruption of the pumping action of the heart. During a cardiac arrest, the heart stops beating effectively, blood flow around the body stops, oxygen supply to the organs depletes, and the heart and brain suffer irreversible damage as a result. It is the leading cause of death in the United Kingdom, affecting over 100,000 individuals yearly.  During such an episode, time is critical, and a without prompt treatment, the casualty is likely to die.

What are the signs of Cardiac Arrest?

Cardiac arrest is usually spontaneous and occurs with no warning. It is characterised by sudden collapse, loss of a pulse and breathing and loss of consciousness. Other signs and symptoms characteristic of sudden cardiac arrest could include shortness of breath, chest pain, weakness and fast-beathing or palpitations.

What are the causes and risk factors of Cardiac Arrest?

An abnormal heart rhythm (arrythmia) such as ventricular tachycardia (fast heart rate) or ventricular fibrillation (causes the lower heart chambers to twitch instead of contract) are usually the cause of such a life-threatening episode. Bradycardia, the slowing down of the heart rate, is also another arrythmia that may cause cardiac arrests.

Factors that could increase the likelihood for a sudden cardiac arrest are smoking, an inactive lifestyle, a family history of coronary artery disease, stress, high blood pressure or high blood cholesterol and/or obesity and diabetes.  Using illegal drugs, having a nutritional imbalance, previous episode of cardiac arrest/heart attack, chronic kidney disease, old age and males are amongst other factors that might also increase the risk for sudden cardiac arrest to occur.

Every Second Counts

Now that you know what sudden cardiac arrest is, it is time to prepare yourself on what to do in case you witness a person suffering from a cardiac arrest. Early use of CPR (cardiopulmonary resuscitation) and early AED (automated external defibrillation) are both techniques that are found to improve survival rates. Every minute that is delayed, reduces the chance of survival by 10%, thus, every second counts.

1.      Before approaching the area, assess whether the area is safe.

2.    Once the area is safe for you to enter, approach the individual and check for 2 things - level of consciousness and breathing.
Level of consciousness can be checked by tapping the casualty’s shoulder and asking if he or she is okay. If unconscious, ask for help to call 112.
(If you are alone and a phone is nearby, call 112 yourself).

3.     After, place the individual face up and check for normal breathing. Open the airway by tilting the head back and lifting the chin. This is done so to prevent the tongue from obstructing the airway. While doing this, check for breathing by looking, listening and feeling for not more than 10s.

4.     With heel of one hand in the centre of the chest, and your other hand on top and fingers interlocked, start CPR. The depth of compression should be 5-6cm, at a rate of 100-120 times/min. The role of CPR is to temporary replace the pumping action of the heart by compressing the whole chest and pushing blood around the body to the organs.

5.      For every 30 compressions, give 2 Rescue Breaths. Rescue breaths can be given by pinching the nose of the casualty and make a tight seal over his/her mouth with your mouth. It only takes 1 seconds for every rescue breath.

• If the casualty is a child over 1 years old, give 5 rescue breaths and 30 chest compressions using the heel of 1 hand at a depth of 1/3 of the chest.

• If the casualty is an infant under 1 years old, give 5 rescue breaths and 30 chest compressions using 2 fingers on the breastbone at a depth of 1/3 of the chest.
  

6.      Steps 4 and 5 should be given until an AED is available, area becomes dangerous, the casualty gains consciousness, or the paramedics take over.

If available, AED should be started immediately after step 3. This is a simple tool that can be used by everyone, with instructions being very clear to follow since prompts starts to be instructed once opened. AED will advise you to attach the 2 electrodes: 1 on the upper right of the chest and the other one the left side of the chest just below the rib cage.

7.      As soon as electrodes are attached, follow the prompts;

•  If shock is advised: shout “stand clear, shocking now” and press the flashing button to deliver shock.

• After shock is delivered or if shock is not advised: follow steps 4 and 5, and perform CPR immediately.
  
  

What can authorities do to Increase the Chance of Survival?

• Enforce first aid and CPR training in schools and workplaces.
  Learning CPR is an important skill to have, and learning the proper technique, increases the chance of survival. Having more people educated and confident upon performing resuscitation allows the individuals to be empowered and provide the necessary first aid in case of an emergency situations
  
  

•  Encourage the public to sign up for free first aid and CPR training programmes.
  

• Launch campaigns that create awareness to sudden cardiac arrest and what can a bystander do
  

• Have AEDs easily accessible.
  Not only it increases the chance of survival of the casualty, but it can be used by anyone.
  
   

Written by,
Miguel Sammut
2nd Year BSc (Hons) Nursing

Coming to Terms

MHSA is seeking to raise awareness on cancer during the month of January through the “Catch it Early” campaign. This article is the second of a two part series, and it gives an overview of the 5 stages of cancer diagnosis acceptance, following the Kubler-Ross Model. It is important to note that these stages are not fixed, but rather they blend into one another. Further, one may be in different stages at the same time due to varying acceptance levels in different facets of life.

Stage 1 - Denial

Receiving a cancer diagnosis is not an easy pill to swallow.  It is very common that one speculates about extrospective potential errors which may have led to the diagnosis. It is common to question whether the news received is correct and ruminate about the possibility of an error when scanning or inputting data.

One often experiences shock, where a high volume of emotions which are hard to process are perceived. The most common response in such a scenario is numbness, as it allows for functioning and a slow transition towards processing said emotions.

Stage 2 - Anger

Once the denial and shock start to fade, the healing process may start. During this stage the suppressed feelings begin to surface as one transitions from living in the preferred or hypothesised reality to the actual reality. This gives rise to the age old question “Why me?”, which in itself demonstrates progress towards the acceptance stage as the individual acknowledges having cancer.

The outlet for said emotions and frustration is most commonly anger. Often this is redirected towards friends and family, among higher beings and health professionals, as these are the entities with whom the individual is most comfortable with. Nonetheless, this dissipation of emotion will facilitate the transition to the next stage.

Stage 3 - Bargaining

In this stage the individual explores ways to manipulate their fate. Negotiations with a higher power are frequently attempted here; “If I make it through this, I will stop smoking”. Such attempts provide false hope to those diagnosed with cancer as unfortunately such bargaining does not change the diagnosis.

Introspective blame is also commonly seen  through “What if ?” queries. These may provide a positive source of self reflection as there are always lessons to learn from previous errors. If in excess, they cause an oversaturation of thoughts, guilt, and worry. This may influence mood and mental health negatively, and ultimately lead to depression in the following stage.

Stage 4 - Depression

The switch from living in a hypothetical world of ifs and buts to living in the current reality of being diagnosed often presents poor mood. Decreased motivation levels, social withdrawal, hopelessness, and not wanting to get out of bed are often seen, as is feeling that the world is too overwhelming to face. 

After processing the initial shock, expressing the suppressed emotions via anger, bargaining fate, and processing the depressive feelings and emotions one would be ready to progress to the final stage of acceptance.

Stage 5 - Acceptance

Acceptance is far more than accepting the fact one has cancer. Rather it is more about coming to terms with the fact that having cancer is the person’s new reality, further to being in a stable emotional state where one is at peace with the self, friends and family, and higher being, if any.

Good days and bad days are expected as they form part of the cycle of life, but the poor mood in the depressive stage subsides significantly. Motivation levels increase, social reintegration occurs, and most importantly hope is rekindled.

If you know someone who has cancer, whether a friend or family member you can help out! Although it is unlikely that said contribution cures the individual, providing support is key for optimal treatment.  You can:

1. Provide a source of normality  by keeping up fun activities you used to do, within health limitations.

2. Lend and ear when in need. Being equipped with the above information one should expect varying levels of frustration and hopelessness, sometimes listening to what the person has to say is all they need.

3. Communicate that you are available to listen and help, keeping in mind your own limitations.

4. Avoid pressuring as acceptance is a process and it takes time.

5. Encourage seeking professional help if needed.

6. Be present.

Written by: Malcolm Camilleri

Cancer: An Overview

MHSA is seeking to raise awareness on cancer during the month of January through the “Catch it Early” campaign. This article is the first of a two part series and will give a brief overview of cancers which may develop in various body systems.

Tumours are masses of abnormal growth which continuously divide. Malignant tumours, also known as cancers, may spread to other tissues or body systems, while benign tumours in contrast are less harmful as they are restricted to the site of origin.

Skeletal System

The skeletal system is composed of 206 bones, which together form the skeleton. Benign bone tumours are far more common than cancerous ones and in fact bone cancer only makes up 1% of all cancers.

Osteosarcoma is the most common form of bone cancer. The tumour usually develops at long bones; at the humerus (bone at the arm), femur (bone at the thigh), and tibia (one of the bones at the leg). Tumours are more common at the lower limbs than in upper limbs, and they usually present in children, teenagers, and young adults. Furthermore, if the osteosarcoma tumours are cancerous they may metastasise to various body parts, including the brain and other bones, but they most often spread to the lungs. 

Nervous System

The nervous system is a collection of cells called neurons, which transmit signals to different body parts. It is composed of the central nervous system which includes the brain and spinal cord, and the peripheral nervous system which is composed of numerous interconnected nerves all around the body.

The brain is composed of various types of cells, therefore this means that several brain tumours exist. Secondary tumours which metastasise from the breast, colon, kidney, lung, and skin are also quite common. Brain tumours whether primary or secondary are particularly of note as if a mass compresses a part of the brain it may cause malfunction, and hence negatively impact respective body systems. 

Circulatory System

The cardiovascular system is composed of the heart which pumps blood along blood vessels, providing oxygen and nutrients to the body. 

Primary heart tumours are very rare and according to the European Society of Cardiology they occur in less than 1 out of 2000 autopsies. Most of said tumours are benign, as only 25% are cancerous. These heart tumours tend to grow on the heart wall, rapidly disrupting the heart’s structure and function. Tumours which develop in the heart chambers restrict blood flow and increase the risk of blood backflow. Furthermore, if they develop in the muscular wall of the heart, it can become stiff and will be unable to pump blood efficiently.

Echocardiograms or electrocardiograms are used to distinguish cancer from other heart conditions.

Respiratory System

The respiratory system is a system which transports air into and out of the body. The lungs are one of the most commonly known structures in this system, and as expected they are not excluded from the risk of cancer. The main types of lung cancer are small cell lung cancer and non-small cell lung cancer. 

Small cell lung cancer is almost exclusively diagnosed in heavy smokers and is less common than non-small cell lung cancer. It is more aggressive than non-small cell lung cancer as it develops and metastasises easily. In fact by the time that a patient develops symptoms, such as coughing up blood, dyspnoea, wheezing and chest pain, the cancer would have already spread to other parts of the and developed significantly.

Digestive System

The digestive system is primarily responsible for digesting and absorbing food and drinks and it is composed of the oesophagus, stomach, and the large and small intestines, among others.

Colorectal cancer occurs at the large intestine, also known as the colon, and the rectum; the chamber which stores faeces before being passed. It presents with diarrhoea or constipation, blood in faeces, and pain and bloating in the abdomen. This specific cancer has a high recurrence rate, therefore if one had colorectal cancer s/he would be at a higher risk for its redevelopment. Furthermore, in 2017 it had the highest cause of cancer deaths in Malta.

Written by: Malcolm Camilleri

Taking action and becoming a climate citizen

As we approach the end of our campaign, we’re sharing with you the ultimate ways of how to be the change.

1.Calculate your carbon footprint

Carbon dioxide is a common byproduct of human everyday activity. The release of carbons in the environment may come from the burning of fossil fuels in power stations as well as from the cars we use to get about. All these factors affect our carbon footprint, however not many realise it. There are many online footprint calculators, once you find out where you stand make a commitment to reduce your emissions. You can choose different modes of transportation and take a bus instead of your car, reduce your waste or upgrade your appliances to be more energy saving.

2.Take political action

Politicians are the ones that implement policies in our society. Communicate to them your concern about climate change because after all, they are there to work for you. Vote for politicians who believe in the science of climate change and are committed to addressing it. Attend events or support NGOs which raise visibility towards climate change action or pressure officials to address issues. 

3.Be a critical thinker 

We are constantly being bombarded with information and because of this, it’s important to learn to judge and critically analyse the information before us. This means not taking the information at face value, seeking second opinions, questioning biases and understanding the context of the information. Being informed about the subject is key to form a strong and decisive opinion. 

4.Talk about climate change 

Share your concerns about climate change and your stories this helps motivate collective action. Share your story on why climate action is important to you, or how climate change is affecting you, this can be a very powerful way to inspire action and concern in others. 

All these acts can help our environment, and help safeguard it for future generations. Remember, that small things can make a big difference. Use these tips and tricks to not only help change but be at the forefront of it.  

Recycling during this festive season

Recycling can be considered as the formation of new products out of old ones! Quite a simple explanation, and a very straightforward process if you know how to do it right. However, not everyone can. 

To start with, let's think of common household items. Plastic bottles (which we should start reducing), papers (something we should also start reducing) and metal cans. These all have something in common - they can be recycled. Materials such as these, instead of being thrown away with the general waste, can be carefully separated from the normal household waste and put aside. 

Single-stream and Multi-Stream recycling are the two ways in which you can recycle. Single-stream is when households put all their recycling in one bag and this then gets sorted at a recycling plant whilst Multi-stream is when the material is sorted out beforehand. In Malta, single-stream is widely used, however multi-stream is done when people opt to go to recycling bins, and manually do the recycling there separating the paper, glass and metal. Malta also introduced new initiatives, such as introducing the plastic recycling bins to help multi-stream recycling slowly work its way into our home and to be more conscious of what we recycle. 

Recycling also has many benefits. From being highly beneficial to the environment by reducing the amount of waste in current landfills, and preventing new ones from forming up, it can also create a number of jobs across the entire process, which will also help the country economically. Basically a win-win, for everyone! 

Recycling also makes part of the famous three Rs - reduce, reuse, recycle. These are considered to be the fundamentals of waste management, and are key to help live life in a sustainable way. They are also easy to implement. For example, clothes can either be rehomed or repurposed for a more fashionable look, and glass jars can be reused to store new foods or turn it into a small DIY project by making it into a pencil holder, or a festive candle holder. 

Recycling is fairly straightforward. It’s as simple as separating the recyclables from the general waste. Most materials such as paper or plastic are easily and widely recycled but not everything can be. If you are wondering if the plastic wrapper is recyclable, services such as “GreenPak” will definitely help you out. Recycling something you shouldn't have can have disastrous effects on the whole recycling process. Machinery which costs a lot of money can be severely damaged affecting the whole process. Oftentimes, the right thing to do is to toss it out. 

So this time, think about how you can reduce waste this holiday season. Technology is bringing about major improvements and giving us new ways how to recycle, but it all starts from us. And remember, a small change can mean a big difference to help make the world a greener space. 

Written by: Nicholas Aquilina

A Sustainable Gift Guide

We’re making a list we’re checking it twice, so whether you’ve been naughty or nice this year, here’s a little inspo for finding the perfect sustainable gift this Christmas. 

Gift an Experience 

Rather than giving a gift that will wear out or be thrown away consider giving them an experience that they will cherish for a very long time. This can come in the form of tickets to concerts, the theatre, cinema, or even a session at the spa. Moreover, this could be something you can enjoy together. 

Buy Less 

Instead of buying gifts for every member of your family, try Secret Santa. Not only will this be more budget friendly to you, but it can also be an opportunity to create new traditions that can be enjoyed by all. Secret Santa can be fun, spontaneous and a little exciting as you do not know who will be gifting you a present and also everyone will still have a present under the tree. 

No gifts 

Shopping, going from store to store finding something to get your loved one can be very exciting for some but not for all. Trying to find something to give to someone may be stressful especially if invited to their home. So, put them out of their misery and instil the holiday cheer by giving them the option to opt out of gift giving. Instead ask members coming over for Christmas to bring wine, cheese or delicious chocolates. 

For the Animal Lover:

Consider adopting an animal such as an elephant or polar bear via WWF, they even give you a soft toy of the animal adopted as well as a welcome pack, regular updates and even an adoption certificate. Besides, this is a great way to do our part against the extinction of these beautiful animals and help conservation efforts worldwide. 

Adopt an elephant , Adopt a Polar bear, Adopt a Tiger 

For the Beauty Guru:

If you know where to look, Malta has quite a few hidden gems that can make your shopping experience unique and your gift one of a kind. Across the island you can find shops filled with hidden treasures for that special someone who likes to feel one individual and distinctive. We all have that friend, the beauty guru who would appreciate some handmade soap, or beautiful antique jewellery. 

This way we can help support local shops and local talent. Checkout this awesome Maltese brand that makes handmade soap, candles and ceramics amongst others.

For a child:

Consider some second hand wooden toys, a wooden puzzle, a Christmas jumper made from sustainable materials or a preloved teddy bear. 

For the tech lover:

A plastic free phone case would be perfect. There are also many organisations that sell items made out of recycled material and help save the environment when doing so. 

For the Frequent Flyer:

Consider a stainless-steel reusable bottle or a bamboo cutlery set to use no matter where they are. Let’s help the environment in any way we can. 

For the Houseproud:

Maybe a handmade candle or some sustainable wine, better yet a ceramic handmade mug or even a recycled wool rug. 

For the University Student

How about a stainless steal lunchbox, or an organic cotton towel for wiping off that sweat at the gym? A sustainably made blanket or a reusable sandwich wrap is also a great idea. 

Choose Sustainable this Christmas and the earth will thank you! 

Written by: Sarah Zerafa