Cancer fight in Papua New Guinea: A Case of Horse before the Cart?

Recently there has been so much coverage in mainstream news outlets and social media regarding cancer treatment or rather the lack of it (treatment options) in PNG.

Much of these increase in media coverage has been spear-headed by the PNG cancer foundation. Numerous medical symposiums and conferences have been held regarding this very issue in PNG over the last 20 years.

Women Doctors Association of PNG has also been in the news regarding this agenda as well.

A recently held workshop in Port Moresby on cancer treatment spear-headed by PNG NDOH (I stand to be corrected on this) with attendance by various development partners where discussions were held on what treatment options are available for cancer patients in PNG. Particularly I am told via the grapevine that much of the discussions were on radiotherapy! (BTW PNG does not have laws to import radioactive substances I am informed).

But what blows my mind away is here are the major stakeholders in PNG involved in the fight against cancer talking about treatment but not an utter on DIAGNOSIS! Aren’t you suppose to diagnose cancer first, characterize it and know its biological behavior THEN look at treatment options to obtain a much more favorable outcome?

How can you treat if you do not know what you are treating? Shotgun treatment? And hope for the best?

Cancer diagnostic infrastructure and technical know-how has to be improved first or hand-in-hand with development of treatment options! Currently there are 7 specialist pathologists involved in cancer diagnosis for PNG – current estimate is 8 million people? And all of whom are working in Port Moresby and thousands of tissue/organ specimens are received each year from around the country for histopathological diagnosis (diagnosis by examining tissues obtained by biopsy or surgery).

People in PNG seem to think that you just do a biopsy or collect some blood in a tube and send it to the “Lab” and somehow the sample is put into a machine that automatically tells you what kind of cancer you have. And they wonder why results take so long so they go on the social media to vent their frustrations. The PNG public need to be informed how cancer prevention and treatment occurs. You need specialist doctors to make the correct diagnosis using the tissue from a biopsy or blood (in the case of leukemia) to report back the specific diagnosis. THEN you can treat correctly.

How can you expect a quick result from the lab (for cancer diagnosis) when a team of 10 people are trying to process specimens coming from a country of 8 million people. Do the maths! By simple logic, it will dawn even to the high school student that you need more people and other similar laboratories to share the workload so results are given out faster to patients/surgeons/gynaecologists.

Surgeons and gynecologists in PNG also give public the perception that by examining someone (looking, hearing the story and physically checking) they can make the diagnosis of cancer right away!  PNG public need to be informed that there are many different types of cancer and treatment is not the same. Not all mouth cancer or cervical cancers are the same. Not all leukaemia are the same. Treatment is tailored to the specific cancer. Surgeons and gynaeocologists in PNG please do not fool the PNG public. Inform them that the sample you obtain is sent to the laboratory and a specialist doctor called a PATHOLOGIST will examine it make the confirmatory diagnosis.

PNG NDOH including development partners and other stakeholders involved in cancer work in PNG really need to look at cancer diagnostics before talking treatment. This means looking at PNG’s pathology services including specialist pathologists, medical laboratory scientists and necessary laboratory equipment and infrastructure to diagnose the different types of cancers accurately before talking about how to treat.

The PNG cancer treatment (radiotherapy unit) is in Lae (treatment is ancient in terms of current practice) and the main cancer diagnostic services (Histopathology services) are in Port Moresby (PMGH) and these two cities are not linked by road. What a financial and social nightmare for cancer patients. By this very fact, cancer patients in PNG are already disadvantaged! So in PNG you get diagnosed in one city and fly to another city (where there is no social support) to get treatment. What plans are in place to change this status?

I have not heard or read anything about plans to establish histopathology services for cancer diagnosis in Lae. What is the PNG NDOH plan to establish cancer diagnostic services? Including development of specialists and scientists to make accurate diagnosis? Treatment involves giving radiotherapy and cancer drugs. How can you give the correct cancer drugs if you have no clue as to what type of cancer you are dealing with?

I am convinced (as a trainee pathologist) that stakeholders involved in cancer fight in PNG have put the horse before the cart.

We need to develop and build the capacity to diagnose cancer accurately before treating.

 

 

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About rodney itaki

I am a medical doctor from Papua New Guinea. My posts focuses on current and emerging health issues in PNG.
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