Doctorita, tengo
mucho dolor.
On our recent humanitarian trip to the Andes region of Peru we were
constantly told by our patients of their pelvic pain. We explained
to them that the focus of work was the primary detection of cervical
cancer and forged ahead as the lines of women waiting to be screened
grew at sometimes exponential rates. The impact of so many women’s
complaint however, was not lost on this humanitarian.
In developed countries, chronic pelvic pain is a challenging clinical
scenario. While endometriosis, pelvic inflammatory disease and its
sequela, interstitial cystitis, irritable bowel syndrome and similar
conditions are entertained in the differential diagnosis, there
is also a link with history of abuse, particularly sexual in nature.
I cannot help but recall that when Hurricane Wilma came through
South Florida in 2005 I observed an increase in visits for pelvic
pain. The one common denominator that my patients at the Cleveland
Clinic Florida shared was having hauled heavy yard debris in the
clean up process.
Putting it all together, we have a region of the world where women
have limited access to medical care to explore the etiology of their
pelvic pain. ( no pelvic ultrasound, no CT scans or MRIs, no laparoscopy
or cystoscopy). Add to that a society where women are frequently
victims of incest and other forms of domestic violence. Consider
that in the region we visited, women are frequently exposed to sexually
transmitted diseases that go mainly untreated. Keep in mind that
most of the women we saw, particularly in the rural areas work extremely
hard at physical labors not common to women in our society. Also
note that in this region of the world, preventive medicine is not
well understood and that women feel they must have a complaint in
order to validate seeking medical care. Never underestimating the
power of fear, the heavy psychological burden associated with the
fear of cancer must also be considered in our patients’ complaints.
The picture grows clearer as the solution becomes somewhat more
difficult.
For now Senoras,
have patience with us. We offer the peace of mind of knowing you
are free of a killer disease that ravages and destroys so many of
your countrywomen. We hope that our smiles, our embraces and our
genuine concern help in some small way to make your dolor more tolerable.
We may not yet offer a cure for your pain, but by our presence we
hope to begin to heal you of it.
