Deepa will be 42 this January. Her husband, Ramesh had returned to Nepal from his third visit to Qatar, just before the expiry of his working Visa. He immediately took a bus to Dhunche and walked hurriedly in excitement to reach his family, in the remote hill of Nepal- Cholangpati. His wife and five children were equally excited. The eldest daughter was born when she was 17 years old. The youngest was the only son-born three years back, after repeated attempts to continue the generation for the family.

With the sunset and an early dinner, all the children quickly fell asleep. A reunion of the departed husband and wife turned into intimacy where Ramesh discovered that Deepa was wincing in agony during sexual intercourse. A little later after the moment, Ramesh went to the bathroom to pee where he noticed some blood stains on his genitals. 

Deepa had her first day of menstruation 20 days back and was told the same by her husband. She even mentioned that there had been some blood spotting between her menstruation for the last eight months. Ramesh thought it was a normal response to women’s bodies. The following night, she requested her husband to avoid sexual intercourse as she was feeling tired with backache, pelvic pain, and foul-smelling discharge. Ramesh’s stay for two months before his return wasn’t a pleasurable sexual experience for both of them-with Deepa’s denial, pelvic pain, tiredness, and vaginal discharge.

Deepa was in agony from this dreadful experience and cursed herself, however, she never visited a doctor for the painful sexual experience. She didn’t feel like eating and was subsequently losing weight. She increased her frequency of smoking, a habit she learned from her mother in childhood- while lighting cigarettes for her in the firewood. Eight months after Ramesh’s return, on her birthday, on the 5th of January, she noticed her left leg swollen while taking a shower in the cold morning.

This, now, alarmed her. She visited the nearby health post, which referred her to a doctor’s clinic in Dhunche. The doctor then referred her to Kathmandu, for further management.

With detailed history taking, examination and investigations, the doctors found out that she had Metastatic Cervical Cancer- Stage 4B.

Metastatic cervical cancer is an advanced-stage cancer of the mouth of the uterus(cervix) where the cancer cells have spread to other parts of the body such as the lungs, liver, bone, or lymph nodes.

Deepa’s story could have ended differently if:

• She was aware that it wasn’t normal to have spotting, foul-smelling vaginal discharge, painful sexual intercourse, pelvic pain, backache, etc., and visited a doctor earlier.

• Her husband had known about Cervical Cancer being the reason for his refusal of sex.

• She had known the risks for Cervical Cancer such as smoking, early pregnancy, giving birth to many children, etc.

• She had screened herself for cervical cancer beginning at 30 years of age and repeated every 5 years.

• She was vaccinated against Human Papilloma Virus (HPV) with the appropriate dosage at the appropriate age.

January is celebrated as Cervical Cancer Awareness Month.

Hyuna Sung et.al estimated 604,000 new cases and 342,000 deaths in 2020 due to cervical cancer globally. About 90% of the new cases and deaths worldwide in 2020 occurred in low- and middle-income countries. Due to vigorous screening and effective vaccination against HPV, cervical cancers have decreased significantly in developed nations. The contrary is true for developing nations.

Bruni L. et.al recently stated cervical cancer is one of the leading cancers in women in Nepal with 2,244 new cases and 1,493 deaths every year.

Every year, thousands of Deepa suffer in the world and Nepal.

Has Nepal thought of anything for our women to prevent the situation that Deepa is currently facing? A question to think about!

 

Dr. Yagya Prasad Timalsina

Danphe Care