A practical approach to an old problemBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39293.614954.59 (Published 02 August 2007) Cite this as: BMJ 2007;335:260
- Ben Moore, retired NHS gynaecologist
A spell of gynaecological work in central Africa provided a reminder of major problems still existing in many parts of the world, including the morbidity and mortality from neglected cervical cancer. By chance the African experience was followed almost immediately by a medical attachment in southern India that gave insight into how this problem might be tackled.
The first move was to a general hospital in eastern Zambia, a job involving three surgical and two outpatient sessions per week. At the clinics some complaints were ever present, including infertility (always the largest group) and pelvic and abdominal masses, plus two smaller groups: young women with urinary incontinence (mostly from obstructed labour) and older women with pelvic pain and foul vaginal discharge—a combination almost invariably heralding a cervical neoplasm. Of the last two groups the latter was more to be pitied. Fistula surgery was available but for advanced cervical …