In The Nick Of Time - A story about cervical cancer in Kenya

IN THE NICK OF TIME
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Last week, I had an epiphany; one of those moments when reality assumes certain clarity and smacks you right in the face, leaving your wits ruffled. This was a surprise to me because I have never been one of those people with a profound outlook on life,  those people who are always scratching the surface looking for a deeper meaning of things or for a third dimension to life. I am contented with a surface view of most things and of life in general.  For a long time, this is the attitude I have carried to work every morning; an aloofness and emotional detachment towards my patients, until last week when I attended Karen’s wedding.
 
To go back a little, my meeting Karen was by chance, one of those occurrences that fate throws at you on a random Thursday afternoon and whose significance is never apparent until later. I had just completed a particularly tedious shift and was sitting at the hospital cafeteria, immersed in my own thoughts and absent-mindedly thumbing the remainder of what had been a rather untasty doughnut as I waited for the traffic to fizzle out before heading home.
 
She walked into the restaurant and took a seat not far from mine and ordered a diet coke. She took it with one of those vegetable salads and a hotdog.  In the course of her meal, the draught from one of the overhead fans picked up one of her paper napkins and it landed onto my feet.  I picked it up and pushed it back on her table. She offered a smile and said polite thanks and I nodded in acknowledgement.  I was done with my meal and I figured traffic must have lightened up so I stood up and left.
 
A couple of weeks later, I was walking along the hospital corridor when I bumped into her.  She recognized me first,  I stopped and we exchanged pleasantries.  She asked me what I was doing there, I told her I was one of the hospital psychiatrists, at which she was amused and told me she always pictured all psychiatrists were old, bearded and had a schizophrenic look. I laughed and told her jokingly that nowadays we had newer models that were young, hip and had swag, like me. I asked her what had brought her to hospital and she told me that she was coming for a routine visit at the Specialist clinic. She was diabetic, and had been since she was ten; she was on medication and checked her blood glucose every week. The doctor had recently added some new medication to her treatment - to protect her kidneys, as she had explained to me, and the medication was making her cough. She had come back today to get the medication changed.
We stood for a while on the corridor and talked and I found her quite charming. I learnt that she had just turned thirty-two and had worked as a banker.  At the moment, she was between jobs but was pursuing a couple of leads which she hoped would be successful. Her last job had been at an Israeli telecommunications company which had closed shop and relocated to Zambia.

After this encounter, we met several times afterwards; she made it a habit to pass by my cramped-up office on her way from her routine visits. She even made friends with one of my manic patients. It was during one such pop-in visit that she mentioned to me that she was experiencing some slight discomfort when having intercourse and had noticed some spotting on her pants thereafter. She was vaguely curious if this was anything serious and wanted my opinion on it, much as I was quite ignorant on the matter. I suggested that she sees a gynecologist. I also remember casually throwing in the idea of a pap smear although I didn’t expect much from it since she was a bit young and chances of cervical cancer were remote.
 
I didn’t see her for a while after that visit, until she called me on one Friday morning a couple of weeks later and asked if she could pass by. I agreed and she did. She had decided to go for the Pap smear out of curiosity and the results had not been good; a highly suspicious cervical abnormality. A follow up biopsy done had confirmed her fears - early stage cancer localized to the cervix.  She had received her results earlier in the day and had called me almost immediately. Our conversation was somber and devoid of the usual good humor, she was scared out of her wits at the prospects of dying young and was in need of assurance.
 
A few weeks later, and barely three weeks to her wedding, Karen underwent a total hysterectomy, a surgical procedure for removing the uterus and cervix.  I was impressed by how fast she had recovered as she walked down the aisle on her wedding day; they had decided to carry on with the nuptials in spite of her surgery. As I watched her that day, I felt happy for her,  despite the fact that I knew she would not be able to conceive. I was happy that her cancer had been diagnosed at an early stage when it was still amenable to surgery with a good chance of success. The odds are always high that most cancers in African women are discovered late and she had beaten the odds.
Cervical cancer is the second most common cancer in women and accounts for over 200,000 deaths worldwide every year, over eighty percent of which occur in developing countries. It is common among older women with a high number of births although a number of cases have been reported among younger women.  Early stage cervical cancer can be diagnosed by a pap smear, a fifteen-minute outpatient procedure and can be easily treated using a variety of surgical procedures. Advanced cancer of the cervix is difficult to treat and carries a high mortality rate.
 
Despite this increased risk of acquiring cervical cancer among African women, it is shocking to find out that as much ninety percent of women in Kenya have never had a pap smear or screening for any sexually transmitted infection. Compare this to western Europe where as much as eighty percent of the women have had at least one pelvic examination every year. In general, it is recommended that all women should have a pap smear done at least once in their lifetimes.  If the results of this first smear are normal, a follow up smear is recommended after another year after which they should be done every three years.  HIV infected women are advised to have a pap smear every year since they have a higher chance of developing cervical cancer.



See http://www.iafya.org/tip/03349 for more information

Contribution by Dr. Griffin Manguro - http://www.ustadhgriffin.wordpress.com

Dr. Griffin Manguro
Research Project Physician
Mombasa HIV/STI Research Clinic
Tel. 0721908504
email: mangurogriffin@yahoo.com