Hello Friends and Family from the paradise of Western
Highlands, Papua New Guinea, the land of perpetual spring!
Sorry it has been such a long and cold winter for you. I am
glad to be missing out on all of that. I hope spring arrives soon for you too.
All is wellF here. Tyronza has been busy working in the
storeroom (sorting stuff) and other odd jobs. She has also been busy with bread
making and other “from scratch” cooking. Our current culinary project is making
sauerkraut. I tasted it yesterday and it is coming along nicely. We plan to
invite friends over this week for homemade sausage and sauerkraut.
I have been busy with the clinics, labor and delivery and
surgery. I am trying to bring some of the other new family doctors up to speed
on their surgical skills, and teaching what I can to the nurses and medical
students. We are supposed to have a new PNG resident doctor in the next few
weeks. That should be interesting and different.
I would like to spend a little time discussing the problem
of cervical cancer in PNG with you. I had reported on this subject three years
ago in this blog, but it merits another go. Cervical cancer is a major problem
in all the third world areas around the globe. This is a particularly nasty
problem in PNG. There is rampant human papilloma virus, multiple wives,
multiple partners, lack of basic health care, non-existing pap smear screening,
slow diagnosis, and poor treatment facilities. The patients scarcely stand a
chance!
Cervical cancer is the number one cancer among women in PNG.
It has the highest cancer mortality among women in PNG. It is slow to be
diagnosed and treated. As a result, it is often quite advanced when first
discovered.
There are precious few pap screening projects here, mostly
due to medical manpower shortages, limited funds, and poor follow up. A pap
smear must be sent off to Australia for interpretation. Eight or more weeks are
required to get results back, and when you do get results you are dependent on
the patients remembering to come back. Trying to track someone down who lives
in one of the hundreds of tiny jungle villages near the station is nearly
impossible.
From my perspective, I must rely on how the cervix looks and
feels on exam. I have a very limited number of speculums and even if I did do a
pap smear on every patient contact, I would probably have returned to the U.S.
by the time the results came back. When
I do diagnose cervical cancer, the primary complaint is usually bleeding or
pain. This means the lesions are almost always advanced (stage II or III) by
the time the patients enters the system. I can sometimes operate if not too
advanced, but usually the cancer is already in the nodes by this time. Surgery is
of some help, and will usually add a year or two before the patient hemorrhages
to death or dies of uremic poisoning, secondary to kidney obstruction.
Papua New Guinea does have a single irradiation treatment
facility. It is a ten hour drive over some of the worst roads I have ever seen.
Very few families can afford the trip. Because there are so many patients with
advanced disease, the oncologist screens pretty tight. If the kidneys are
already partially obstructed, the patient is often rejected for treatment. Most
of the time, all I can offer is prayer for comfort or a miracle.
One such patient crossed my threshold four weeks ago. She
had stage III/IV disease with tumor involving the cervix, vagina, base of the
bladder, the parametrium, and nearly eroding into the rectum. She was also 29
weeks pregnant with her fourth child. She was brought into the clinic by her
husband and the first wife. The patient is the second of four wives. My mission
was to get her to viability before she developed kidney obstruction or
hemorrhaged to death. I saw her weekly, gave her extra iron and monitored the
kidneys. Unfortunately, at 33 weeks she had a major hemorrhage and the baby
died in-utero. She obviously couldn’t
deliver through the vagina and I had to do a c/section. She now has significant
kidney obstruction on both sides. Barring a miracle, she likely has only a few
months left in her life.
Pray for us and please pray for my patients.
We miss you all,
Dr. P and Tyronza
p.s. I have requested the other three wives come in for
screening.
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