This past week I attended dysplasia clinic which mainly screens women for cervical cancer. Unfortunately in a country where routine Pap smears are essentially nonexistent and AIDs rates are high, cervical cancer is a major problem (but of course it's only one among many major problems). Gardasil, the vaccine against the Human Papilloma Virus which causes most cervical cancer, just came out in the U.S. a few years ago and has gradually gained more wide spread use there (and hopefully soon it will have even more use after this study showing that it protects men too...and dammit they are definitely also a factor in spreading it to women). However, Gardasil's effect on mortality related to cervical cancer in a developed country that already has good screening is small compared to the effect it could have in a developing country. While vaccination is no replacement for having good access to health care it is certainly a step that could save many lives. Unfortunately it all becomes a matter of cost...and a few donated vaccines just aren't going to cover it. Fortunately there are organizations such as Universities Allied for Essential Medicines that might actually make a difference.
For at least one of the women I saw last week the vaccine wasn't available soon enough and we had to break the news that she had invasive cervical cancer. Since I'm interested in a career as a pediatric oncologist I'm always curious to observe how people break bad news. The realistic optimist in me believes that it's essential to strike the right balance between acknowledging the severity of the situation but also focusing on the positive aspects and what can be done to help. Especially in a country where women have so little access to health care it truly is a blessing that our patient received screening so that her cancer could be caught at an early stage when a cure is possible instead of at a much later stage when she really would be beyond hope.
This weekend a bunch of use went white water rafting down the Nile in Uganda which was AMAZING!!! Okay, I was terrified before going, but after going through a bunch of grade 5 rapids and not dying, I actually started to enjoy the trip. And swimming in the water as the current carries you downstream was idyllic (as long as I didn't pick up schistosomiasis...Africa can kill you in so many different ways). I was lucky to have a great guide and be in a boat of like minded people who didn't necessarily want to steer directly into the biggest rapids. Those are always key things to have with you as you get swept down the river of life. You can also attempt to divert the Arno--give some chemotherapy, perform a total hysterectomy, build a dam, etc--and hope you survive with all your limbs intact.
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