Monday, 1 February 2010

My least favorite

It must be pretty bad if a disease makes it to a doc's least favorite list.  And I have a couple:  measles, SSPE, heart disease in kids, incurable cancer.  But this one is the least of all my least favorites.

I first developed an interest in cervical cancer when I came to PNG as a medical student.  Dr. Bill asked me to help with writing a grant to fund cervical cancer screening.  I did some background research for the project and was surprised to learn that this disease is one of the leading causes of cancer death in women in the developing world.  It is an illness that is so easily preventable and/or treatable after detection with a simple pap smear, yet it is killing hundreds of thousands of women every year.  And as I dug into the hospital records, the info confirmed that there were many women in PNG who were also dying from cervical cancer.

Here are some of the stats (from Comprehensive Cervical Cancer Control, WHO 2006):
~ 95% of women in developing countries have never been screened for cervical cancer.
~ In 2005 there were more than 500,000 new cases of cervical cancer, more than 90% were in the developing world.
~ It is estimated that more than 1,000,000 women worldwide have cervical cancer.  Most have not been diagnosed or do not have access to treatment.
~ In 2005, almost 260,000 women died of cervical cancer, almost 95% were in developing countries.

Well, that grant that Dr. Bill and I worked on way back when was actually funded.  Nazarene Health Ministries used the grant money to begin a cervical cancer screening program.  A building called the "White House" was constructed to house the clinic as well as offices for STI and HIV treatment.  
Pauline is a CHW or community health worker, the PNG equivalent of a medical assistant.  She has been trained to do pap smears and follow up.  The slides are sent to Meripath, a non-profit organization in Australia that provides necessary supplies and reads pap smear slides.  The only cost to our patients is a few kina (less than $2) for shipping expense.  Special thanks to Meripath for this wonderful ministry!

A few months ago, Dr. Susan asked me to help with the cervical cancer screening program.  Dr. Susan, who is a pediatrician by training, had been supervising the program for several years.  ("Flexible" is the middle name of every missionary.)  Last year she added "Director of Medical Services" to her job description.  Despite her love for the program and patients, she decided to share some of the responsibilities.  

So Dr. Becky 2 and I are now the dynamic duo of Kudip Hospital, working together to fight cervical cancer!  Our weapons are a bit unusual:  speculums, cytobrushes, biopsy forceps, and liquid nitrogen.  On Tuesdays and Thursdays, Pauline refers patients who have abnormal pap smears to see us in clinic.  Tuesday is my day and Thursday is Becky's day to do a procedure called "colposcopy."  This gives us a closer look at the potential abnormality.  If we see something abnormal, we take a biopsy which goes to Meripath for diagnosis.  Patients with evidence of cervical pre-cancer or early cancer are treated with cyrotherapy, LEEP, or a hysterectomy.  It is so satisfying to be able to prevent a future cancer with such simple procedures!

Sometimes we see women who already have cancer, and at a stage that is too far advanced for treatment at Kudjip.  Actually since I have started working with the program, I have seen more women with advanced cancer than the pre-cancers that we can take care of.  It used to be that there was no hope for these women.  They were destined to die, slowly bleeding to death.  They also suffer from a bad smelling discharge, urinary incontinence, and severe pain.  As you probably can tell, I have seen one too many of these cases and one too many women die.  

However, today there is a hope of treatment.  In May of last year, the PNG Cancer Treatment Centre was re-opened in Lae after a 10 year hiatus.  A very big thanks to Dr. Niblett and all the folks at Angau Hospital for your service to the women of PNG!  Patients who qualify and are able to travel can receive free radiation therapy that is potentially curative.  Sometimes the logistics are a bit challenging to work out.  Patients must pay their own transportation costs, which amounts to about $35 per person (usually one patient and one or two watchmen will travel).  This cost may be prohibitive to some.  They must also be away from home for up to 8 weeks, as the standard course of treatment is at least 5 weeks.  And it is preferred that the patient has family or "wantoks" in Lae in case there is no room to stay at the hospital.  But every challenge is worth it for one patient who is cured from her disease.

I want to share about three patients I have cared for over the past year.

I first met Wendy last fall.  I can't remember her exact story.  Maybe she was a follow up of an abnormal pap smear, or maybe someone found something abnormal on a pelvic exam.  She was referred to me and I diagnosed her with cervical cancer.  She was the first patient I was able to refer to Lae for radiation therapy.  Just after the new year, she returned for a check-up.  Dr. Becky saw her and brought her to my room for a visit.  I could barely contain my tears for the joy of seeing how well she looked.  Thanks to the Lord for working this healing miracle!

Kuni is a pastor's wife from a nearby town.  I saw her in clinic last October and also diagnosed her with cervical cancer.  I was particularly burdened for her as she is a mother of 4, with the youngest being only 2 years old.  She disappeared for a few months, and I later learned she had gone to see a traditional healer of some sort.  She came back to see me a few weeks ago, asking me to check and see if the sickness was still there.  Unfortunately it was, and it had grown larger and was now blocking one of her kidneys.  After considering the news, she and her husband decided to find a way to go to Lae.  She is there now, being evaluated at the Cancer Centre.  Please pray for Kuni and her healing, for the wisdom of the doctors and the nurses who care for Kuni and many more like here.

Christina is the last patient I want to write about.  I took care of her in December when she was admitted to D-ward (maternity).  She was nine months pregnant with her 4th child.  She also had cervical cancer.  The cancer would have prevented her from delivering normally, so Dr. Jim did a c-section.  My plan was to see her a few weeks after discharge and refer her for treatment, but unfortunately she has been lost to follow-up.  It is because of patients like Christina that cervical cancer is my least favorite disease.  My prayer is that someday she will make it back to the hospital so that we can help her get the care that she needs.

These are only a few of the many many stories, and three in particular that have touched my heart.  Will you pray for Dr. Becky and me as we continue work with the cervical cancer screening program?  For the Meripath team in Australia?  For the doctors and nurses at the Cancer Centre?  And for our patients and their families?  Thank you for prayer partnering with us in this ministry.


  1. Stephanie, My sister is a survivor of cervical cancer that was in advanced stages. Back in 1989, she was diagnosed, after having 3 mis-read biopsies and / or pap smears. She is a miracle today, as she continues to fight to live. She had significant radiation damage. They had to do chemo, radiation, and a radium implant. Dr's. did not expect her to live; they gave her no hope. Yet, she lives. Dr's. still do not approach her medical needs with any hope; she has had to have intestinal surgery, re-routing of the bowel, temporary colostomy; her kidneys have suffered and she has one that has ceased to function. She is constantly seeking to eat the right things to get enough nutrients, but she is thriving compared to what the Dr's. ever expected. We know she is a miracle. Since you believe in miracles, I wanted to share this with you to encourage you as you are working with these women. Wish I could have my sis come work with you, as she is also a nurse. (0: God bless you as you serve Him there. Love reading your stories!!! Tara West (in snowy Mount Vernon....)

  2. I would like to thank you beautiful people who are making a difference in somebody's life. I spent 15 years in Lae. My daughter was born at Angau hospital in 1984. I knew Dr Nibblet and his family. I am survivor of breast cancer and now I live in Winnipeg, Canada!!!!!!. Dianne Manchur