Script and Scalpel

After quite a long hiatus from providing patient care (and no, I’m not counting all the doctoring I do at home), for the last few months I’ve returned on just a short-term basis to help in our cervical cancer screening clinic here at Kudjip while two of our other physicians are away. The White House, as we call it, serves not just our female

population, but also a growing group of patients with HIV/AIDS. I will say that after being absent from the doctor-patient relationship for a couple of years I was a little nervous about what the return to medicine might look like for me. I suppose that practicing medicine, in some ways, is a bit like riding a bicycle. There are aspects of being a physician that (for me, at least) require little to no practice. The building of a relationship and creating a space where a patient can be vulnerable are things the Lord has helped me to do with ease, much of the time. However, a doctor also needs to know things! Ha! And I feel so out-of-practice when it comes to creating differential diagnoses and choosing appropriate medication regimens. But, fortunately, I know that those things will all come back with time once I’ve returned to the hospital on a more regular basis (even though at this point I don’t know exactly when that will be).

But in the meantime, I am absolutely loving the chance to care for these precious women in our cervical cancer screening clinic. During the week, my dear friend and gifted nurse, Pauline, sees women from all over our area who have been referred to the White House for the initial screening for cervical cancer. We don’t use Pap smears here at Kudjip because they

require a sample to be taken, stored, transported, viewed by a pathologist and then results reported back to us. We’ve found that this method of screening presents a lot of challenges, including follow up for these ladies who often don’t have cell phones or who may have made a full day’s journey to get to us in the first place. So, believe it or not, we have an equally effective method to screen for cervical cancer and it utilizes something found in most kitchens—vinegar! A dilute vinegar solution causes abnormal cells on the cervix to turn white and also allows us to directly visualize (with a colposcope) other changes that are indicative of all stages of early cancer cells.

Each week Pauline sees ladies from all over our area who have been referred to the

White House for one reason or another. She does an initial evaluation on these women and then refers the more concerning cases for me to see on Wednesday mornings. Often I’ll find pre-cancerous lesions that can easily be treated with cryotherapy (liquid nitrogen that freezes abnormal cells). This is an incredibly simple and cost-effective procedure that can be done at the time of initial evaluation and it absolutely save lives. Occasionally we find pre-cancerous lesions that are more progressed and in these cases we can schedule the patient for a LEEP (Loop Electrosurgical Excision Procedure) to be done at the hospital procedure room. And, as is sometimes the case, we discover more advanced disease. If the cancer seems localized to the cervix still, we are fortunate to have surgeons (I happen to know a good one) who can do a hysterectomy to save the woman’s life. And the

saddest cases are those that we see too late. Unfortunately, it is one of the stark realities of practicing medicine in a remote, underdeveloped place like Papua New Guinea. Some of the more advanced cancers that we see might be helped with radiation, but there’s currently not a hospital in this country that provides this service. I’m grateful that, even though we cannot always provide a life-saving measure, we CAN provide the hope of Jesus. Its really easy to feel overwhelmed by the sadness for the ones we cannot physically save and forget that there is One who provides healing of another variety that is far greater than the limited measures we can provide. And when I have the opportunity to share this very truth to the broken woman sitting before me, I realize that all of a physician’s book knowledge becomes a little less important, both for that moment and for eternity.