I attended the Tuesday afternoon grand round at the School of Medicine and Health Sciences yesterday afternoon.
The presention was of a woman with acute lymphoblastic leukemia. She was first diagnosed on clinical findings which included marked pancytopenia and her bone marrow biopsy finding was suggestive of ALL class 2 on FAB classification.
She underwent initial chemotherapy and made some recovery and was sent home. In late 2014 she returned again with mark pancytopenia.
This time her blood was sent down to Australia for a special test call flow cytometry. This test identifies certain proteins on the surface of malignant cancer blood cells and is more accurate in diagnosing the specific type of cancer. The accurate diagnosis and correct classification of these blood cancers especially provides essential guide to the choice of treatment.
In the years gone by we have not had a flow cytometry analyser and we have been mainly relying on bone marrow for diagnosis and classification of leukaemias. While we can say someone has leakaemia from their bone marrow, classifying the type of leukaemias can be very difficult with just bone marrow biopsy.
To add to our hardship we only have a few pathologists who are confident in examining bone marrow slides and they are all based in Port Moresby and see specimens sent from all over the country. No doubt many unfortunate souls die from these blood cancers before receiving a diagnosis.
In terms of pathology services there is some light at the end of the tunnel. PMGH recently acquired a flow cytometry analyser which hopefully will soon be operating so we won’t have to send specimens overseas to do this important test.
Also a good news is that we currently have 6 trainee pathologist undergoing training at PMGH. For anyone interested in a challenging career in pathology, there are two service registrar positions in pathology at PMGH which will allow you to get into the UPNG MMed training in pathology after 1 year of service.
Back to our patient, her best option now would be a bone marrow transplant which don’t do here and which is estimated to cost about K400,000. She may be lucky to find the funds to get this lifesaving treatment. Many, in fact the vast majority of Papua New Guineans with leakaemia and needing a bone marrow transplant will never be able to afford it.
The outlook for most cancer patients in PNG is not very good. Many of my colleagues expressed dismay at the fact that despite much talk about the economy being the best it has ever been, on the ground, at the coal face we are ill resourced to help our sick.
A notable comment was from Sir professor Isi Kevau who was critical of the PNG cancer society and stated that there are many foundations in PNG that lack proper foundation.
Is there hope? There is always hope.