Imagine that you started to bleed unexpectedly from your genitals. How long would it take you to visit a doctor?
Many persons might respond with “immediately” or even “a few hours” and scoff at the idea of waiting longer than these periods to visit a doctor if they exhibited such a symptom. However, how many of the previous answers would remain the same when factors such as finances, access to doctors, and the invasiveness of some checkups come into the equation?
Has “immediately” become a day? A day a week? Or longer?
In theory, the answer to the initial question should be a frantic “right away!”But in reality, more and more Guyanese are visiting a doctor less and less despite showing alarming symptoms. Though many persons understand that the right thing to do is to have regular check-ups and exams, it is not as simple as it appears.
In an interview with Stabroek News, a 21-year-old-woman, who asked to remain anonymous, said that she had experienced unexplained bleeding from her vagina for months before she decided to visit a doctor. According to the woman, she visited the same doctor several times earlier this year before she subsequently stopped because there had been no resolution of her bleeding despite the visits. The bleeding, she said, eventually stopped a few months ago and she has not followed it up elsewhere since.
When asked why she had waited months before taking the step to see a doctor, the woman explained that she had been both deterred by the thought of an invasive procedure and dwindling finances. She noted that the visits had been expensive and the prescribed medication even more so, though it proved to be ineffective. “I just got put off after all of that and never bothered to see what was it after I stopped bleeding,” she said.
The young woman was one of 20 Guyanese—10 male and 10 female—approached by Stabroek News with questions about their medical histories. These persons were asked whether they had ever undergone a prostate, breast or cervical examinations. They were also questioned on whether they had gone for a medical check-up within the past five years without first being ill. The respondents were as young as 19 and as old as 55.
Shockingly, none of the respondents had undergone any prostate, cervical or breast examination in their lives; none of them had visited a doctor within the last five years without being seriously unwell.
These figures are just a microcosm of the larger Guyanese society and are concerning in a country where cancer is the third leading cause of death, according to a 2004 to 2011 report from the Ministry of Health.
Most respondents voiced the belief that doing regular checkups was “not a Guyanese norm.”
“I haven’t done a medical checkup in the last 10 years; in the last 20 years in fact,” one male respondent said, before adding that the process could be invasive. Another respondent said that he had thought about having a prostate exam but never “pursued or followed up the issue.”
‘They’re not seeking any help’
Dr Narendra Bhalla, radiation oncologist with the Cancer Institute of Guyana, explained that not enough Guyanese are taking their health seriously despite statistics, which show that hundreds of Guyanese each year are diagnosed with some form of cancer. Breast, prostate and cervical cancers were noted as having the highest rates of incidence and according to a December 2008 report from the Cancer Registry of Guyana, there were 998 cases of the three cancers within the country.
These figures are disturbing when one thinks of the numerous persons throughout Guyana who are yet to be diagnosed with the deadly disease.
According to Bhalla, education could play an integral role in the reduction of cancer incidence within the country. “Sometimes people don’t recognise the alarming signs,” Bhalla noted.
He related one case when a team of doctors went into an interior location and found patients with far-gone stages of cancer.
“During that time, we found these stage three and stage four patients; they’re not seeking any help and they many times don’t know where to go, what to do. So this is the problem; people are not being properly educated,” Bhalla said.
He further said that persons are discouraged from visiting a doctor when these visits could rack up big medical bills. Persons who cannot afford to visit a private hospital always have the option of public ones such as the George-town Public Hospital (GPH), Bhalla said. How-ever, he noted, the public hospital is often packed with people and the waiting time can drag on for hours. In addition, he noted, many persons do not even know that the Cancer Institute exists.
According to the oncologist, the Cancer Institute works closely with the GPH and receives referred patients from the public hospital. These patients, he said, are oftentimes already in the late stages of cancer.
“So they come to the Cancer Institute at stage three and stage four; I’m not seeing stage one; very rarely,” Bhalla said. He continued, “Some of them come when they are already at stage four, when they realise that there’s nothing they can do.”
Bhalla recalled one patient, a 15-year-old girl, who had developed a thick mass by the time he saw her. Another patient had a tumour on her skull for years and he only saw her a few months ago. “I can even see her brain as she is talking to me,” Bhalla shared.
He explained that when patients are referred to the institute with advanced stages of cancer, there is little that can be done due to the long process before surgery can be performed.
“Suppose somebody did biopsy and they’re at stage two… by time they get the pathology report they get to stage three,” Bhalla said. He added that these persons would then have to wait for official letters and other documentation before they can proceed with any surgery and must also factor in the availability of funds, which can exacerbate the waiting time before surgery. All the while, the cancer is progressing through the stages until it is too late.
In contrast, he said, if a patient is able to start the treatment soon after diagnosis, the cancer can be cured within one month.
Bhalla urged Guyanese to learn the signs and symptoms of diseases and not to procrastinate when they manifest. Signs and symptoms, he said, should not be overlooked.
He also noted the use of self-examination of the breasts for women, which can be performed in the comfort of one’s home.
He further said that examinations to detect cancer, such as the visual inspection with acetic acid (VIA) and mammograms, are available for free at most reproductive health facilities throughout the country and he emphasised the need for healthier lifestyle choices by Guyanese, including improved diet and physical activity along with the reduction of habits such as smoking.
He recommended that sexually active women get tested for cervical cancer because the examination could save their lives, while men, particularly older ones in their fifties and beyond, should undergo a prostate exam.
Bhalla reiterated that it is easier to prevent cancer than cure it. “Prevention is always better than cure,” he said.
