Getting a 'good pap'

Getting a 'good pap'


Updated 10:54pm (Mla time) Jan 10, 2005
By Rina Jimenez-David
Inquirer News Service



Editor's Note: Published on page A11 of the January 11, 2005 issue of the Philippine Daily Inquirer.


HERE'S what the "V Book" says about "getting a good Pap": "An optimal Pap test depends on several different elements: a good sample, proper interpretation of that sample, a good screening lab, and an accurate reading. Each aspect along the way holds opportunities for error."

While there is little the average woman can do to ensure the quality of the lab work and interpretation of her sample, there are some things she can do to ensure that her doctor or clinic gets a good sample. Here are the "V Book"'s recommendations:

• Don't use intravaginal medication or douches for 24 hours before the sample is taken.

• Don't have intercourse or use contraceptive jelly or cream for 24 hours before your Pap.

• Don't schedule a Pap when your period is due. Small amounts of blood will not interfere with evaluation of the cells, but large amounts during the menses are likely to make the smear impossible to interpret.

• Don't wait until after your Pap is finished at an annual exam to tell your clinician about other V symptoms you're having (for example: bleeding, itching, secretions -- RJD). Talk about your problems first and let her/him decide whether to go ahead with the Pap.

• Dr. Elizabeth Stewart, primary author of the "V Book," says women shouldn't try to "sanitize" their V areas before they come for a consultation. Odor and appearance of the vagina and vulva are some of the factors doctors use to diagnose an ailment, if any.

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HERE'S more on the ongoing "Patricia" trial on a vaccine to protect young women from the two types of HPV (human papilloma virus) that have been linked to 70 percent of all cervical cancer cases.

Dr. Wen del Rosario Raymundo, one of the investigators in the trial based at the San Pablo Colleges Medical Center (her husband John, also an Ob-Gyn, is a co-investigator) says that aside from the present centers where volunteers may sign up (aside from San Pablo, these are Makati Medical Center, De La Salle University Medical Center in Cavite and Calamba Medical Center), new centers will soon be set up. These are at UP-PGH, University of Perpetual Help and Healthserv in Los Baños.

To repeat, women volunteers need to be from 15 to 25 years old, in good health and not pregnant or breastfeeding (and not planning to get pregnant within the next eight months). Dr. Raymundo stresses that the vaccines, Pap smears and gynecologic exams are all free of charge, though volunteers need to commit to 10 scheduled visits over the four years of the research trial. "The specimens for Pap smears are sent to the US since we have a centralized lab to standardize results," adds Wen.

In contrast to the complaint of investigators based at Makati Med that volunteers have been difficult to attract, Wen says the response of women from San Pablo, chosen to represent a rural setting, has been "very encouraging." "Women in a rural setting do not give as much priority to their reproductive health care. Majority of the women I see have never had a Pap smear or even have an idea of what it is! They do not even know what or where the cervix is!" And right there is the reason cervical cancer, despite its manageable nature, continues to kill so many Filipino women.

By the way, National Cancer Consciousness Week will be observed from Jan. 16-21. On Jan. 16, Sunday, National Cancer Survivors' Day will be observed with a Mass and get-together at 11 a.m. at the Our Lady of Miraculous Medal Church in Project 4. Cancer survivors, their families, caregivers, friends and supporters are all invited to join them in their celebration of life.

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AMID THE MANY problems that survivors of the South and Southeast Asian tsunami tragedy confront, from starvation to disease, homelessness to violence, the "same old problems" continue to haunt them. If the tsunami devastated parts of the world already reeling from hardship, the flood of relief and aid, already in the billions of dollars, can only address the more immediate needs of survivors. Structural problems, like hunger and poverty, will continue to blight their lives. Long-standing concerns, such as reproductive health and violence against women, on the other hand, not only will continue to exist, but have even been exacerbated by the crisis.

The United Nations Fund for Population (UNFPA) estimates that there are at least 150,000 pregnant women in tsunami-affected areas, and of these, 50,000 will be giving birth within the next three months.

How these women could give birth safely, and how they are expected to care for their newborns amid the devastation, is a question that seems to have escaped the attention of much of the world. Even under normal circumstances, notes the UNFPA, 15 percent of births will be attended by complications. The percentage of women dying from childbirth, or of infants dying soon after birth, can be expected to rise in these countries where, to quote an observer, "the health infrastructure has been largely destroyed, and traditional midwives have been sidelined."

To prevent unnecessary deaths, the UNFPA has begun distributing "safe birth kits" among pregnant women in the evacuation centers. The contents of each kit are eloquent testament to how little it takes to ensure the survival of both mother and child at delivery: a sterile plastic sheet, a bar of soap, a razor blade to cut the umbilical cord, and a string to tie off the cord. A simple step to ensure a child survives the first hours after birth is to keep him or her warm, wrapped in a clean blanket or piece of cloth.

Whether both mother and child survive the other challenges of their post-tsunami existence, though, is another question altogether.