Trip Reflection 2009 – Maria Lina Diaz M.D.
Maria Lina Diaz M.D., FACOG, The Cleveland Clinic
“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.