|
February 2001
Dear Friends
Doctors have been accused of possessing a bizarre sense of humor.
This is undoubtedly true, but perhaps it is our defense against
despair and discouragement. Here I present some events in my working
life that culminated recently with a sense of pure joy while I
was looking at a frozen cervix here in Malawi.
The cervix is the mouth of the womb, the part of the uterus that
dilates so a baby can be born. Cancer of the cervix is the number
one cancer of woman in developing countries. The incidence of
cervical cancer in developed countries has decreased dramatically
over the last fifty years due to the introduction of the pap smear.
This is a simple test that involves gently scraping the cervix
with a wooden spatula to obtain some cells from the surface and
then examining the smear under a microscope after applying a special
stain. This test is readily available to most women in developed
countries, but is not available at all in many African countries.
Why is this test not available to women in developing countries?
There are many tests and therapies that are readily available
in the West that am not available in Africa. This is just one
of them. Health problems peculiar to women are often not priority
issues when funds are allocated by parliaments and legislatures
in the capitals of African countries. Also, to implement a national
plan to offer pap smear screening in even a small African country
would cost millions and millions of dollars. These dollars are
simply not available.
We who are working at Mulanje Mission Hospital in southern Malawi
have been blessed to be able to participate in a totally new approach
to preventing cervical cancer. Realizing that it would be light
years before pap smears could be implemented in many countries,
a group of doctors and medical researchers have developed another
method of screening for cervical cancer. This method is called
visual inspection of the cervix. It involves looking at the cervix
with the naked eye, applying vinegar to it and looking for small
white lesions. These small white lesions could be the beginning
of cervical cancer. If these small white lesions could be destroyed
right at this stage, many cases of cervical cancer could be prevented.
We have been working on starting this program for 18 months.
There have been numerous meetings and training sessions, equipment
has been purchased, and many preparations have been made. The
method to be used to destroy the pre-cancerous cells on the surface
of the cervix is called cryotherapy. Cryotherapy is simply freezing
the cervix with a probe connected to carbon dioxide gas. On a
Monday afternoon a week ago, all was in readiness for our first
cryotherapy to be performed in Mulanje, the town where I live
and work as an obstetrician/gynecologist.
I had been on call at the hospital all weekend. We are in the
midst of malaria season here and dozens and dozens of children
were desperately sick in the hospital with malaria. Five had died.
The rest of the hospital was quite busy as well, plus we were
understaffed, as usual. Monday morning was a regular work day
with about thirty outpatients to be seen. Monday afternoon I dragged
myself to our local government hospital to assist and supervise
the first cryotherapy session I had seen in Malawi.
We were four individuals with the patient in the small room.
It was four o’clock in the afternoon. The carbon dioxide
gas was connected and the probe applied to the cervix. The gas
flowed and then we could see a ball of ice forming on the cervix.
The procedure is painless to the patient. I did, I did feel real
joy in seeing this frozen cervix because it means we have started
on the road to preventing a disease which is a serious problem
for women in Africa.
Sue Makin
Mulanje Mission Hospital
PO Box 45
Mulanje
Malawi
The 2001 Mission yearbook for Prayer & Study, p. 41
|
