Q. Could you tell us about yourself, your education journey and what inspired you to specialise in obstetrics and gynaecology?

Thank you for having me. I am Dr Disket Dolker from Skurbuchan village. To briefly summarise my educational journey, I completed my primary schooling in Skurbuchan village and studied in Mahabodhi School, Leh, till 10th standard. I then pursued my higher secondary education in Bangalore through a sponsored programme by the Mahabodhi Institute. I completed my MBBS at Government Medical College, Srinagar, and my postgraduate degree at the prestigious AIIMS, Delhi. During my MBBS, I was always interested in how women’s health could be improved and uplifted. This interest drew me towards Obstetrics and Gynaecology, and that’s why I decided to specialise in this field. I completed my senior residency at Dr RML Hospital, Delhi, and my fellowship in minimal access surgery. Professionally, I have been working at La Femme, Bangalore, a leading corporate healthcare institution. I have also worked in the remote peripheral region of Ladakh, at the Primary Health Centre, Tangste, for two years during the COVID-19 period, and currently I’m working in SNM Hospital.

Q. You and your team performed the first minimally invasive laparoscopic ovarian and salpingectomy in Ladakh. Could you explain the significance of this milestone and what this means for the healthcare sector in Ladakh?

This is a significant milestone in Ladakh because laparoscopic surgeries have not been performed in Leh until now. This minimally invasive surgery uses small incisions to insert a camera and surgical instruments instead of a large cut that leaves a scar. It is beneficial for patients because it is less painful, allows faster recovery, requires a minimal hospital stay, and leaves minimal scarring. This achievement is particularly important in Ladakh because patients often travel outside Ladakh for such procedures, often at a cost of ₹3-4 lakh in corporate hospitals. Many people in Ladakh cannot afford that. Now, this advanced surgical procedure is also available in Leh, free of cost.

The Ovarian Cystectomy we performed was especially challenging, because it leans towards the more technically demanding procedure in gynaecology. In this case, we successfully removed a large dermoid cyst intact, without any spillage. To explain it, a dermoid cyst can contain various components such as hair and other tissues. In many cases that I’ve observed , the cyst is ruptured firsthand before the cyst wall is extracted. However, in this case, we were able to remove the whole cyst intact.

The procedure was performed through laparoscopic keyhole surgery, where three to four small incisions are made, and the cyst is removed under camera guidance and with the help of surgical instruments inserted through those small incisions. This is the first time such a procedure has been introduced and successfully performed in Leh, in the Gynaecology sector. For example, a patient who wants minimal scarring and yet has to get this surgery done, would’ve required to travel outside of Ladakh, whereas it is now available locally as well.

Q. What were some of the challenges involved in introducing laparoscopic surgery in Ladakh?

The main challenges were procuring the equipment required for the procedure. Especially since it’s a government sector, procurement is done through the GeM portal, and the lowest bidding results in low-quality equipment. As a result, securing high-quality equipment and instruments was our biggest concern. For laparoscopic surgery, the quality of the camera and other instruments is extremely important. We wanted to ensure that there were no gaps or limitations caused by the equipment and that it met all the required standards for the procedure.

We received immense support from the UT Administration, the Medical Superintendent, and the Directorate of Health Services. They understood our concerns and the importance of the project, and its requirement for high-end instruments, and ensured that the procurement process was carried out smoothly. With their support, we were able to obtain high-quality equipment that met our requirements. The camera we used was a 4k camera from Olympus, which is a reputed brand. Although it was challenging at first, the cooperation and support from the start helped us successfully establish the laparoscopic surgery in Leh.

Q. There have been concerns about rising breast and cervical cancer cases in Ladakh. What are the trends you’re observing as a practising gynaecologist, and what should the public know about these diseases?

One consistent trend I’m noticing in Ladakh is that many patients with cervical cancer are diagnosed at their very end stage. By the time they seek medical help, the cancer has already spread. This pattern is also seen in cervical cancer, endometrial cancer, ovarian cancer and breast cancer. A major reason for late diagnosis is the lack of regular screening, early diagnosis, and regular health check-ups. Many women either do not undergo screening or they tend to neglect the early symptoms of cervical cancer, which delays detection and treatment.

Cervical cancer is commonly caused by the Human Papillomavirus (HPV), which is a sexually transmitted virus. One important thing the public should know is that the incubation periods of this virus can be very long. A person may contact the virus and yet develop cervical cancer about ten years later as well. That’s why regular screening and checkups for it are very important. Most cervical cancer patients I see in the OPD are elderly women in their 60s or 70s. Although the overall percentage of cervical cancer amongst the population is less that 1%, according to the population, even that number is significantly high because the patients usually diagnosed are often at an advanced stage.

Among the gynaecological cancers I’ve encountered, cervical cancer remains a major concern and the most common one to spread among patients. Followed by ovarian cancer, then endometrial cancer, while breast cancer is also being increasingly observed. More awareness, early diagnosis and regular screening can help detect the virus early on before it becomes fatal, and mandatory cautions are essential for improving outcomes and reducing the adverse damage of these diseases.

Q. What are the early symptoms women should watch for, and what are the preventive steps to reduce risk?

The primary cause of cervical cancer is infection with the Human Papillomavirus (HPV), which is a sexually transmitted virus. Factors such as multiple sexual partners, early sexual activity, and poor genital hygiene can increase the risk of HPV infection. The public should be aware of the common warning signs of cervical cancer, which include irregular bleeding, foul-smelling, excessive vaginal discharged, and post-coital bleeding. If these symptoms persist, it is important to seek medical attention without delay and get themselves checked.

For ovarian cancer, symptoms may include abdominal bloating, pressure in the abdomen, lack of appetite, and unexplained weight loss. In such cases, an ultrasound examination is important for further evaluation. Breast cancer commonly presents as a lump in the breast, which is often painless, and this gets ignored by the public for a long period of time. Endometrial cancer may present its symptoms as irregular bleeding or post-menopausal bleeding. In many cases, a long history of untreated PCOD or prolonged metrogen exposure can increase the risk of developing endometrial cancer. Early diagnosis is very crucial. The government of India recommends cervical cancer screening for all women above the age of 30 every 5 years. At SNM hospital, cervical cancer screening is available free of cost every Tuesday, which everyone must be aware of. This includes a Pap smear test of the cervix, which helps detect abnormal changes in the cervix early on.

In addition to that, there are facilities such as an ultrasound, MRI, mammography, which is like an ultrasound or an X-eat for the breast, and other diagnostic services are available free of cost at the hospital. These investigations can be very expensive outside Ladakh, but women here can access them without any financial burden. For ovarian cancer, tumour marker tests such as CA-125, which is a blood test used for screening and ultrasound examinations are available. For endometrial cancer, evaluation may include an ultrasound and endometrial biopsy, where a sample is taken out of the lining of the uterus, which is used for screening.

When it comes to the prevention of the HPV virus, the vaccine for the HPV virus is one of the most effective tools we have against cervical cancer. The vaccine is said to work best when introduced before any sexual exposure, as girls of the younger age group can benefit the most from the vaccine, which is why it is recommended for girls between the ages of 9 and 15 years old. After that, any woman up to the age of 45 can also receive the vaccine.

There are many myths and rumours surrounding the HPV vaccine, which I’d like to debunk, including claims that it causes infertility. I would like to strongly deny dispersing these myths. This vaccine has been used globally for many years and has an excellent safety record with no major recorded side effects. When given before sexual exposure or exposure to the virus, it provides the highest efficacy against cervical cancer. There are two commonly used vaccines: Gardasil 4 and Gardasil 9. Gardasil 4 protects against four high-risk HPV viruses responsible for the majority of cervical cancer cases, while Gardasil 9 protects against nine HPV viruses. The government of India had also rolled out free HPV vaccination for eligible girls who are 14 years of age through public health facilities.

For cervical cancer, prevention through vaccination remains the strongest pursuit. For ovarian and endometrial cancer, the key lies in early detection, awareness, timely  screening and early medication. Women should not ignore symptoms and should seek medical attention at the earliest.

Message to the Readers

“Awareness is the key to preventing many gynaecological diseases and cancers. Ensure girls aged 9–15 years receive the HPV vaccine and encourage women to undergo regular cancer screening. Women with gynaecological symptoms should seek timely medical care. Free screening for cervical, breast, ovarian, and endometrial cancers is available every Tuesday at SNM Hospital. Early detection saves lives.”