HPV VACCINE

 It breaks my heart when I come across patients who have negative misconceptions about vaccination. We have come a long way in medicine when we used to have various infectious diseases wipe out a whole population, or leave thousands with multiple disabilities. The discovery of the Human Papillomavirus by Harold Zur Hausen as the causative agent for various cancers, such as the cervix, anus, and oropharyngeal, was a major scientific breakthrough. He won a Nobel Prize for this. Later on, we had the HPV vaccine coming around 2006, to prevent our youth from being infected with the virus, and decrease the rate of precancerous cervical lesions and other HPV related cancers. 

The HPV vaccine has been available in South Africa since 2009. There have been numerous international studies showing that the vaccine works. The number of women diagnosed with precancerous lesions has declined after the introduction of the HPV vaccines. What we need to do as health care providers is to educate young women, to get vaccinated before they become sexually active, around the age of 9. HPV is a sexually transmitted disease, and boys also need to be vaccinated. Due to financial constraints, the governments are funding women to be vaccinated. 

The rise of vaccine misinformation in conventional and social media has contributed to growing distrust in vaccines in general, including the HPV vaccine. All related health care workers, such as paediatricians, Obstetricians and gynaecologists, and public health experts must respond with evidence-based messaging that emphasizes cancer prevention. Social media sends controversial messages that the HPV vaccine causes infertility, autoimmune disorders, or promotes early sexual activity.   

PALLIATIVE CARE

 When we are in medical school, we have a totally different mindset, we enjoy learning the science and the pathophysiology of diseases, and we are eager to save the world. Later, during our clinical rotations and patient interactions, we eagerly await hearing the cardiac murmur, lung sounds, and crackles, among other findings. Then we grow up a little more, and we learn the various blood investigations and imaging. As time goes by, we probably touch the patients less and spend more time figuring things out through the investigations. 

There are certain clinical situations when a diagnosis has been made, and the patient’s prognosis is poor. We feel like we have done our part, and perhaps not much can be done from our side. There is still so much that the team looking after a patient with end-of-life issues can do. It is important to be straightforward with the patient from the day the diagnosis of cancer, or organ failure such as cardiac failure, liver failure, or dementia, has been made. We are not God, and we might not know how much time they have, and they may end up being very sick at some point. They need to have those important conversations with their loved ones while they are relatively better, to be able to make plans for the future. 

If they need additional support, the social worker and the palliative care team can come to play. We need to ensure that we have a support structure for our patient and make sure the family member or caregiver who is looking after them is coping. We need to guide them in terms of hospice placement. Make sure they are not in pain and make their end-of-life journey as easy as possible. I am an OBGYN and I often bring babies to the world, but I also have a special interest in the oncology field. Perhaps one day, when I retire, I will volunteer to help these patients and provide support. I was so touched when I saw our palliative care team had brought Art therapy to our ward, and the patients are creating crafts and feeling busy and happy.