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PREVENTION VERSUS CURE

In the jungle we often see illness in a state that is much more advanced than we would usually see in the US. Sometimes this is due to a lack of money or education, but other times it is due to a lack of normal preventative care. Francisca came to visit us this past June, where she explained to us she was having abnormal vaginal bleeding and had been recently diagnosed with invasive cervical cancer. She was only 35 years old.

Usually in the US, women have access to routine pap smears that screen for this type of cancer and it is caught very early. However in Honduras, women aren’t frequently getting these screenings, or the results of the screenings are incorrect. Even our hospital had stopped completing many pap smears a few years ago because the local results were so unreliable, we didn’t trust any of the pathologist readings because every result came back negative- even exams that were visibly abnormal. Thankfully, however, through a partnership with world wide lab this year, we were given the ability to send pap smear testing back to the states for a very low cost while getting reliable results.

Sadly, Francesca didn’t have any reliable preventative screening done before her diagnosis of cervical cancer. After examining her and going over the results of her tests, I had to explain to this young mother that her cancer was too big and too advanced for our hospital to remove it. She needed chemotherapy and radiation, and needed to start it soon. We both shed some tears during this conversation, prayed for the Lord’s protection, and hugged before she left with a referral to an oncologist in a city five hours away. She expressed faith in the Lord, that he would provide for her and her family during this tumultuous time. When she left, I didn’t think that I would ever get the chance to see her again. Chemotherapy and radiation are expensive, I wasn’t sure if she was going to go through it it.

However much to my surprise about two months ago Francisca walked in our hospital doors again. She had completed 22 cycles of radiation, 4 cycles of chemotherapy, and her cancer had shrunk substantially! Praise the Lord, we were able to put her on the operative schedule to complete a hysterectomy (removal of her uterus and ovaries). After having this surgery her rate of cancer recurrence is much lower.

While developing programs and processes for practicing preventative medicine seems like it should be simple to do in the rural jungles of Honduras, it has proven to be much more difficult to enact than I had thought. Most days we are inundated with emergencies and acute problems such as fractures, hemorrhages, and infections, which always take the front seat in our priority list along with taking up our time and energy. However this past year I have been able to help one aspect of preventative medicine grow at our hospital by resuming cervical cancer screenings.

This past spring, a patient named Iris came to the hospital to have her cervical cancer screening completed. The initial results showed abnormal cells on the pap smear, and on a follow up biopsy – dangerous precancerous cells were seen. We were able to complete a procedure called a cone biopsy with a visiting gynecologist which removed all of the pre-cancerous areas on her cervix. Thankfully the results after the cone biopsy showed that the margins were clear (meaning all of the precancerous cells had been removed with the procedure). Iris narrowly escaped Francisca’s fate, and won’t have to have chemotherapy or a hysterectomy. We still have a long way to go, last month there were two young women at Loma that were receiving hysterectomies due to cervical cancer that was not caught early enough. But I have hope that with the women we are reaching we can continue to screen earlier and ultimately save lives.

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