We started down a muddy alley where several women ran a row of cooking stalls, little shacks made from old planks and recycled car parts. Huge pots on charcoal jikos with piles of plantains steaming covered in banana leaves, beans boiling and peanut sauce simmering. Once we started doing a few surveys word spread among women, cervical cancer is all too common yet women know little about it. Confidentiality turned out to be challenging as women and men endlessly sauntered close wanting to know what the muzungu was at, could they do it too? One woman was persistent, popping back to see if we were done so she could go next. She started reeling off questions, what if she had a lot of pain, what if things didn’t smell right, what if there was this chunky foul discharge? Her symptoms could mean a dozen different things, from benign to well, terminal I suppose. Had she been to a doctor? No, there was no time, she had to work to feed her kids. Her eyes were worried and sincere. We went through the survey and found she was HIV positive. She was 38 and had never had a pelvic examination, an incredibly common situation in most of the world.
There we stood, next to an old converted container that smelled faintly of urine, mud and broken glass at our feet, in an alleyway buzzing with people, the sweet smell of steamed plantains mixing with the human odours of sweat and engine oil. She looked into my eyes, asking for help. I stared back humbled. Completely helpless, overwhelmed by my knowledge and unable to convert my skills and training into the real help that she needed. Yes, the project we’re doing will eventually provide proper screening but we’re just getting started.
I urged her to see a doctor, told her where she could go, and gave her some names of medications she could try (for the benign options, obviously).
Last week at rounds we had discussed a woman who had cervical cancer and was HIV positive. Initially her cancer was treated successfully but it soon returned, metastasized and took her life last Thursday. A combination of underlying cancer allowed to rampage through her body in the setting of an immune system ravaged by AIDS.
This isn’t fair. But this is life, in all its grittiness, that’s what I asked for, wasn’t it?
It feels like such a privilege to be able to see people in their environment. Whether it was the chai/chapatti stall girl who took a break and sat in the alley with us, the mama lishe who sorted the rice for lunch which searching our faces inquisitively wondering about this ‘HPV’ thing we were talking about, or the 60year old woman who is currently having post-menopausal bleeding fumbling nervously and with fear as she asked questions about whether she had cancer…the tethered goat in the background gently chewing on her 2 year-old grandson’s shirt in the shade of a tree. The suvey is going well, it gives me hope in the midst of such raw human need.
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