Thursday, March 22, 2012

102. San Lucas: the Logistics of Care

Dr Tun had five San Lucas patients screened for possible gyn surgery:

Valeria, 67 has apparent cervical cancer with zero chance of getting the type of radiation, chemo and/or surgical treatment that would be standard in first world countries.  Would a "debunking" (i.e. removing as much of the cancer as possible, knowing that microscopic remnants would probably remain?) hysterectomy help?

But malignancy makes surgery more risky: life-threatening bleeding, pulmonary embolism, and injury to the urinary system, and so on. So I said I could not offer surgery, though the government hospital about 2 hours away by public transportation, might help her.  That would require multiple trips and blood donors.

Surgical patients at the government hospital are supposed to bring two blood donors (of the same blood type) in case they need a blood transfusion. Even if the surgery is unlikely to be associated with heavy blood loss--therefore the blood not needed--these donors will help replenish the hospital's blood bank. Apparently there are local biases against blood donation, such that many prospective surgical patients have to pay donors.

Chances are that the logistics of care away from San Lucas will prevent Valeria finding any care, unless symptoms such as bleeding increase, at which point any therapy would be less likely to help.


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