Challenges to treatment

A patient comes into my room complaining of swelling of her neck for about a year.  On exam I am concerned for Tuberculosis or Lymphoma.  A chest x-ray increasee my concern for lymphoma and so I talked to her and her brother about our treatment options.  Treatment for lymphoma in PNG is chemotherapy, given about one time a month for a number of months.  This brings with it many challenges: the challenge of getting to the hospital each month, the challenge of having the money to come to the hospital, the challenge of feeling sick with the medicine and not wanting to continue, the challenge of having the cancer respond to the chemo and actually help her, and more. For this patient and her brother, the challenges were just too much.  They live in a remote part of Southern Highlands Province where they have to walk a day from their village, and then spend the night to get to a road to catch a car the following day and come into Kudjip.  They also don’t have the money for this expensive PMV ride.  They have a health center near them, but they aren’t able to treat cancer, and the hospital in their province, is also a day’s walk and PMV ride away. As we talked about the options for treatment and they explained why coming to Kudjip wouldn’t work, my heart dropped, I wouldn’t be able to give them chemo and she would likely die of her Lymphoma sooner rather…
Source: Challenges to treatment from Erin Meier – Asia Pacific