The Rock and the Hard Place

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Kung-fu Hillbilly
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The Rock and the Hard Place

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People wait at MSF's Hepatitis C clinic in Preah Kossamak Hospital, Phnom Penh, Cambodia. Photo: Dean Irvine/MSF

By Dr Theresa Chan
18 May 2017

His abdomen was the size of a 36-week pregnancy and felt dull and tight to my touch.

Midway through my first week in the hepatitis C clinic, a patient was urgently triaged for an MD evaluation. He arrived on foot, but only with the support of his son and his daughter.

“How long has he been sick?” I asked his daughter, because he couldn’t answer me himself. He just blinked at me and nodded, with his eyes averted as if he were listening intently to his own, opaque thoughts.

I thought about sending him home with medicines to improve his symptoms, but he could barely walk, and when his son told me they lived in a province five hours from Phnom Penh, (He arrived on foot) decided he was too ill to travel, ....

He was entering the stage of illness I call the Rock and the Hard Place, when every attempt to improve his liver symptoms would worsen his kidney function. Furthermore, the likelihood that hepatitis C had caused liver cancer meant that he could not be treated with the direct-acting anti-viral (DAA) medicines he was hoping to receive at our clinic.

It’s important to tell this man’s story, because it illustrates how much is at stake in the treatment of hepatitis C in Cambodia. Up to a third of hepatitis C patients will develop cirrhosis and one or more of its complications: ascites, GI bleeding, encephalopathy, jaundice, and hepatocellular carcinoma.

full. ... hard-place
The idea that seeing the world is going from place to place to look at obvious things is an illusion natural to dull minds.
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