I found out earlier today that it is the first ever World Ovarian Cancer Day. The purpose of the day is to get everyone to send a consistent message about ovarian cancer — for at least one day. Remembering my mom's struggle and our family's, I decided to post the following to Facebook:

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13 years ago my mom knew two things: that she had ovarian cancer and that it had been caught late, just like in 85% of cases, which meant that she had less than a 50% chance of seeing any of her kids enter high school. Not catching it early is ugly but she beat the statistics for a long time. 10 years. She was atypically strong and had support from so many great people — and our family could never thank you all enough.

Eventually though, it's not a matter of strength or support; not a matter chemo or promising new treatments. Eventually — if it's caught late — it's not a matter of recovery because ovarian cancer is exponentially more deadly after its been given a chance to make a footing.

3 1/2 years ago my mom was one of the 14,000 US women to die wounded from a too-late a fight with ovarian cancer.

Cancer is treatable. Even ovarian cancer. The 15% of women who get diagnosed early make it 5 years with 93% certainty. Today on the first World Ovarian Cancer Day we would do well to know two things:

1) These symptoms of ovarian cancer warrant a check-up:

• Increased abdominal size / persistent bloating (not bloating that comes and goes) 
• Difficulty eating/feeling full quickly 
• Abdominal or pelvic pain 
• Needing to pass urine more urgently or more frequently 

2) That detecting cancer — of any type — late is a waste; it can usually be caught early because we have the screenings and exams to do so. Caught early, it can be treated effectively.

And really, detecting most diseases at most stages is a waste. Living healthier and seeking preventative medicine, we can prevent a majority of the diseases that ruin our quality of life and lead to an empty seat at the table. The most advanced treatments in the world aren't nearly as ideal as never having to consider them.

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It's one of the most deadly cancers for a woman to get because of how late it's usually diagnosed. That was the case with my mom's cancer and, although she fought like hell, ovarian cancer added one more woman to its long victim list.

I'd urge anyone with those symptoms to go in and get them checked out. You can't lose; either you don't have cancer (but also a little lighter in the wallet) or you might be able to catch it early when the 5 year survival rate is better than 90% (instead of catching it late when it's worse than 50%).

My professor read this poem to us. It highlights a common mistake that we make: focusing more on ways to cure illness rather than prevent it.

"The Ambulance Down in the Valley"

'Twas a dangerous cliff, as they freely confessed,
Though to walk near its crest was so pleasant;
But over its terrible edge there had slipped
A duke, and full many a peasant.
The people said something would have to be done,
But their projects did not at all tally.
Some said "Put a fence 'round the edge of the cliff,"
Some, "An ambulance down in the valley."

The lament of the crowd was profound and was loud,
As their tears overflowed with their pity;
But the cry for the ambulance carried the day
As it spread through the neighboring city.
A collection was made, to accumulate aid,
And the dwellers in highway and alley
Gave dollars and cents--not to furnish a fence--
But an ambulance down in the valley.

"For the cliff is all right if you're careful," they said;
"And, if folks ever slip and are dropping,
It isn't the slipping that hurts them so much
As the shock down below--when they're stopping."
So for years (we have heard), as these mishaps occurred
Quick forth would the rescuers sally,
To pick up the victims who fell from the cliff,
With the ambulance down in the valley.

Said one, in a plea, "It's a marvel to me
That you'd give so much greater attention
To repairing results than to curing the cause;
You had much better aim at prevention.
For the mischief, of course, should be stopped at its source;
Come, neighbors and friends, let us rally.
It is far better sense to rely on a fence
Than an ambulance down in the valley."

"He is wrong in his head," the majority said,
"He would end all our earnest endeavor.
He's a man who would shirk this responsible work,
But we will support it forever.
Aren't we picking up all, jut as fast as they fall,
And giving them care liberally?
A superfluous fence is of no consequence
If the ambulance works in the valley."

But a sensible few, who are practical too,
Will not bear with such nonsense much longer;
They believe that prevention is better than cure,
And their party will soon be much stronger.
Encourage them then, with your purse, voice and pen,
And while other philanthropists dally,
They will scorn all pretense and put up a stout fence
On the cliff that hangs over the valley.

Better guide well the young, than reclaim them when old,
For the voice of true wisdom is calling,
"To rescue the fallen is good, but 'tis best
To prevent other people from falling."
Better close up the source of temptation and crime
Than deliver from dungeon or galley
Better put a strong fence 'round the top of the cliff
Than an ambulance down in the valley.

 (by Joseph Malins as posted here)

Sixty-three.

Today you'll learn how to say "feces sample" if you look again at the title of this post. A week ago Brandon and I spent our days at the clinic working in the laboratory. It's a very interesting place to work. It's also really fun because the people in the lab are hilarious and really relaxed.

Most days the lab has been my favorite place to work because the people are so great. However, one Monday about a week ago, the lab was a pretty crappy place. Let's take that literally. On a regular day there are about 10 sample of urine, 15 samples of feces, and plenty of blood samples.

On the Monday I'm talking about there were 63 poop samples! It was a day full of a gracious amount of smells and I don't care to repeat it. The poop never stopped showing up at the window. We'd finish making 10 slides and then 10 more would magically appear—one of the worst kinds of surprises indeed.

Since that Monday I've worked more in the lab again (after really psyching myself up) but we've never come close to 63 poop samples again. You have to be thankful for small miracles.

Looking in the front doors of the clinic I've been working at.

I have MADE gauze and cotton balls--yes, just like they might have in the 1920's. I betcha they also did that in the Civil War.

Things are different here in Peru. Just a little different. Some of it isn't so bad, because we're pretty wasteful in our healthcare system. But some of it really sketches me out: things like MAKING gauze and cotton balls. I'm not a machine. We have machines for this! There is also a hand towel, singular. There are not hand towels, plural, in the form of paper towels. What you will find is a towel labeled "manos." With this, dry your hands, as so many have before you.

Patient privacy is a thing of the future. As you're cleaning a huge gash or talking about an illness with a patient, another patient might just walk into the room. Or maybe they've been sitting there the whole time because they were there first. Maybe they're passing out after giving a blood sample. Who knows. You couldn't look long enough to find HIPPA.

Gloves. For the birds. There's not really much to say about them and there aren't really that many of them. You use them when you're about to be bled on and that's it. I suppose you also use them when you're preparing a feces sample to be checked out under the microscope.

The lab here is a real lab. You don't place a piece of blood in a spacemachine that tells you all about it. You actually have to spin the blood, take it to dinner, and then manually measure the hematocrit using a plastic instrument. This is actually really beneficial for learning because you are able to physically see what a low or a high hematocrit looks like, for example. You don't get that with a magic-lab-spacemachine in the US.

Also dogs just run in and out of this little clinic as they please. Sometimes kids play with them. Other times people say ch-ch-ch and chase them out. Still other times they just take a nap by the pharmacy window. I don't believe I've stressed that these are wild, street dogs. They don't have collars or houses or Purina. So they just do what they want all the time. All dogs go to heaven.

Some things are the same though. People need shots, people need wounds cleaned, people need nebulizer treatments, and some people need their feces tested for giardia. Those things don't change and the basic treatments and procedures are roughly what you'd expect. But it's what you'd expect if you weren't living in a culture of abundance and surplus. So there are fewer needles, vials, sutures, and you MAKE gauze. You begin to appreciate how much we really have to work with in our hospitals. You've really got to McGyver things here sometimes.

A lot is different but I can agree with some of the differences. Not on an evidence-based level for sure, but on a come-on level perhaps. Like the gloves. In the US, I go through 30 pairs of gloves while asking a patient their name and date of birth. Here I've used about 3 pairs a day. We could really tone down the gloves and for the most part it wouldn't kill us all. It's also refreshing not to have to worry if each patient wants to sue everyone. I'm all for patient privacy, and do my best to maintain it down here, but it's for the patient… not to protect myself from getting sued. That's the way it should be. Also, dogs in the hospital: sign me up.