Sometimes my job takes me by surprise. Like the time we were delivering twins and found
triplets. How those three triplets all weighing less than 3 lbs in the harsh African conditions
survived, and how just last week their mother and grandma “agogo” visited us at our house
looking very healthy and fat at 13 months of age. I really liked that surprise, and look forward to
surprises like that.
Unfortunately, not all surprises in my job are good. The other day I was called to see a little
18 month old baby who was struggling to breathe. His bed looked extra large next to his
small body with his mother snuggled next to him. Mom was quiet and sweet as almost every
Malawian mother I have met watching over their precious charge. The baby while not wasted
appeared chronically ill. It was not very surprising to find out that this child had HIV, and was
likely struggling with pulmonary tuberculosis. I wish it were surprising; it's not.
Another surprise is that in Malawi, there is a medical record system that is much more efficient
than in most developed countries like the United States where I come from. Patients carry with
them a health passport. It is a small book -- about the size of a real passport -- and serves as
a repository of all pertinent medical information. In one or two minutes you can review the sum
total of an individual’s interface with the health care system. I asked to see the mother’s health
passport book, knowing it would have more information. That is where I found what I did not
expect.
It seemed she had been diagnosed with HIV after she had delivered her child, and therefore
had not been put on treatment to prevent transmission to her child. In Malawi, there has been
a lot of effort to prevent congenital transmission of HIV from mothers to children by universal
HIV testing and treatment during pregnancy. Through national efforts, the rate of perinatal
transmission has dropped from 25-30% to less than 5%. Consistent with the African trend of
improved outcomes for people living with HIV/AIDS, these statistics give me hope that one day
this scourge will abate.
Unfortunately, my little patient and his mother missed out on all this. I continued reading the
story -- six months ago this quiet sweet 28 year-old mother of three had been diagnosed with
stage 4 inoperable cervical cancer. She would not have long to raise her children.
I have become a little bit “tough” after working in an environment where bad outcomes are more
common than we would like, but that caught me off guard. How in a short time this nursing
mother would be taken from her family by the sadistic synergism of two preventable diseases.
How her last to be born son was also suffering from a deadly combination of preventable
infectious disease. How if he were to survive this illness, for the rest of his life he will deal with
the stigma and consequences of having congenital HIV, and to face it all without that comfort
God has graciously given to little boys who deal with injustice...
I don’t think about all this when I see patients -- it would incapacitate me from a healthcare
professional to what I am right now -- emotions and tears. But the fact that I don’t think about it
doesn’t mean that it is not everyday life for these dear people. They are mothers and children
first, and patients last. I take off my white coat at the end of the day, they suffer. This story has
been repeated time and again in our villages.
Cervical cancer is the leading cause of cancer related death in Malawi. It is a sinister disease
that attacks women in their prime of motherhood. The pathogenicity and course of HPV (the
cervical cancer causing virus) in HIV is accelerated, and a cancer that would ordinarily take
decades to progress to a life-threatening disease, only take a few years or less. It is because
of this that our hospital has targeted cervical cancer as a top priority for prevention. Through a
simple screening technique called a pap smear, the rates of cervical cancer have been cut by
over 80% in developed countries. Malamulo Hospital is one of the only places in Malawi where
a pap smear program has been developed. With the help of Loma Linda University, the PAPS
International Team, the Coto Family, and the leadership of our previous Medical Director, Dr.
Cristy Shank, and our dedicated Malamulo staff we have to date screened almost 3000 women.
We have treated over 100 early cancers with minimally--invasive surgical procedures, and over
30 women have had a life-saving hysterectomy provided free-of-charge by our Surgeon Ryan
Hayton. Through what has been done in the last two years at our Women’s Health Center we
have saved over 125 mothers’ lives. How surprising is that?
The reality is that Malawi is a country of over 16 million with no fewer women than men. What
we have done is only little, and we would like to do more. We need to increase our capacity for
screening and treating women with early cancers. We need to train more cytotechnologists to
read the pap smears, and we need more supplies and equipment.
If you would like to partner with us, please pray for our work. We have given our work into
God’s hands, and we are dependent upon Him as He leads us forward. He knows no haste nor
delay or surprises, and we have seen His hand moving us forward.
“For we are God’s handiwork, created in Christ Jesus to do good works, which God prepared in
advance for us to do.” Ephesians 2:10.
If you would like to partner with us by giving, we request you do so by making your contribution through Adventist Health International with a note that you would like it to go to the “MALAMULO CERVICAL CANCER” project. Their website can be accessed at the following address: http://www.ahiglobal.org/main/main/
