Hepatoma

Working in a low-resource setting definitely teaches doctors to be better physicians.  Labs are basic.  There are no fancy tests.  X-ray may or may not be helpful.  There are no ultrasonogrophers or radiologists or super specialists.  A doctor must rely on observation, physical exam, and the power of his or her brain.

I have noticed some definite improvements in my observation and physical exam skills over the last year and a half.  For example, before doing a spinal tap you must first check the patients eyes.  The absence of papilledema, or swelling of the optic nerve, makes significantly increased intracranial pressure unlikely.  This is important because doing an LP in the presence of increased ICP could kill the patient.  Once upon a time, I had difficulty doing fundoscopic exam.  Now I can easily find the optic nerve!  Liver edges and spleen tips are palpable.  Heart murmurs and lung sounds are more clear.  I still have a lot to learn (that is the power of the brain part of the equation), but I am on my way!

There are certain illnesses that you can diagnoses even from across the room, if you just pay attention.  Patients with COPD are easy to pick out of the line.  They are usually older, quite thin, breathing rapidly with the use of accessory muscles.  Someone with swelling of the abdomen and legs probably has chronic liver disease.  Paining body parts are usually tied with some sort of cloth.  Patients with head ache turn a scarf around their head like a turban.  Knees and other extremities are wrapped in a bandage.

Abraham is 15 years old.  He comes from the Jimi Valley, a remote part of PNG with very little health care.  He has been sick for about 8 months.  He and his father recently traveled to Madang, but left the hospital without understanding what was wrong.  Abraham's father had heard about a Christian hospital at Kudjip, so they traveled many more hours by PMV to come see us.

When Abraham walked into my clinic room, I had a sinking feeling about his diagnosis.  His eyes were slightly jaundice and he had a very large epigastric swelling.  I hoped that there was another reason for the swelling of his stomach.  Maybe tuberculosis or heart failure?  Yep, pretty sad when you are hoping for TB or heart failure.  But these diseases could be cured or at least treated with medications.  Abraham laid on the exam table and I palpated a hard, irregular mass growing in place of his liver.  Ultrasound confirmed my feared diagnosis... hepatoma, or liver cancer.

There are very few cancers that we can treat here, and liver cancer is not one of them.  There isn't a medicine, chemotherapy drug, or surgery that will help Abraham.  He probably won't live for very long.  No, we can't help his illness.  But there is something that the Christian hospital at Kudjip, such a long way from Jimi or Madang, can offer... the good news of the Gospel and hope for eternal life.  Abraham's family goes to church, but he was not a Christian.  We were able to pray together at the end of the visit.  Now I have a new brother in the family of God!  And Abraham will soon have a new pain-free, cancer-free body.

In Mark chapter 8, Jesus is talking to the disciples about the cost of following him.  He says, "What good is it for a man to gain the whole world, yet forfeit his soul?"  Or what good is it if we spend our time and resources and lives to bring health to patients if we don't take the opportunity to share about Jesus?  That is why we do what we do.

We see an unfortunate number of patients with liver cancer.  With a national prevalence rate of 20%, hepatitis B is the likely culprit.  The virus causes some bad problems such as chronic hepatitis, cirrhosis, and liver cancer.  Abraham is the youngest patient I have seen with hepatoma.  Dr. Erin once diagnosed an 8 year old with the same disease.  Thankfully the hepatitis B vaccine is available and is being given to children.  Hopefully with time this vaccine will help to decrease the incidence of hepatitis B and its complications.