By Dr Gunzee Gawin, MBBS (UPNG) – PNG Doctors Group.

I agree that it is expensive to set up a  radiotherapy unit and run it. As always, money had been the issue, is and will always be until our leaders forget self. I thought I’d throw in my thoughts and it is up to you to embrace it or disregard. Your comments (positive and negative) are most welcome.
 
Getting a radiotherapy machine alone is not a problem if the country can be mobilized through some kind of awareness. I had raised this point with several professional women in their various capacities in PNG in 2003 – 2004 and here in Melbourne in 2005 and they thought it was a good idea except for one thing – “Who will collect the money?”  This is the idea. PNG’s population is almost 6 million. More than two thirds are women. If everyone (both sexes) contributes 1 kina we can raise 6 million kina. At least we can get a second-hand cobalt machine (approx. $US 2 million).

The government’s contribution will be to employ specialists in this area who can train locals and at the same time maintain the equipment. Now, don’t give me the shit that people can not afford K1.00. If they can spend money on betel nut and smoke without pausing to think, this is no exception. You can not just write-off having such a form of treatment, it is genocide. People should not die in pain and agony. Besides, wouldn’t you want having a loved one around for another year at least? It is not that this can not be achieved, it can be done. The problem though is who can be trusted to collect and manage this mammoth sum of money? People will give only if they know that someone is trustworthy. And keep the politicians out of this. What do you think?
 
Next is equally important – Public Health. I always slept during the ‘Community Medicine (it was called then) Classes’ and now it is haunting me. Never in Medicine will one get away from Public Health. Public Health equals Preventive medicine. No plus/minus nor if/buts. Running a Pappanicolau smear (pap smear) testing exercise, for instance, is a daunting task, expensive and a waste of resources.Victoria alone in Australia budgets $AUD 18 million dollars annually to run its Pap Smear Testing program alone. That, as you can see, is no way near the PNG National Department of Health’s annual budget allocation. It is a very expensive exercise. We do not have the money and the resources to start off with. Secondly, patient follow-up, which is a very important part of this exercise, is almost impossible in PNG. No telephone contact and mailing addresses for more than 95% of the population makes it a nightmare and extremely hopeless to follow-up with patients who have abnormal results. Our post and telecommunication is below par and besides 80% of the population are in the rural areas. I hope you see the picture.  

The limited resources available can be used in other ways to bring the desired outcome in the interim until we have the capacity to start dealing with this. Public Health awareness, I’m afraid, is the only means of keeping cervical cancer (and of course others as well) under control. Starting the awareness in primary schools and other learning institutions, church gatherings, and into the villages, etc, is a next best way to start. And the message? Do not have sex until you are married. If you can not hold it that long than use a condom.

Cancer of the cervix is a sexually transimitted diseasse and therefore preventable. The other option for those who have already completed their family size would be to have  a prophylactic hysterectomy if they have high risk factors (e.g. family member with cervical cancer). Boys – circumcise. There is evidence associated with uncircumcision and high risk of carcinoma of cervix. Until such a time, I do not see it any other way.

We can not sit back, lumped up in a corner and howl about no money!