ABSTRACT
Maimuna, a 54-year-old mother of 7 and grandmother of 12, enters the outpatient clinic with a certain hesitation. She has travelled to Farafenni hospital from Bambali, situated on the North Bank of the river Gambia, 35km from Farafenni. Maimuna is accompanied by her daughter, Isatou, who speaks some English. Maimuna has complaints of weight loss, dizziness, increasing breathlessness even for the slightest physical activity, pains in the lower abdomen, and vaginal blood loss, although she is postmenopausal. She is not looking well, is cachectic, and is clinically severely anaemic. On internal pelvic examination I find a large inoperable tumour of the cervix that has invaded the surrounding tissues. The haemoglobin result confirms severe aneamia, and I admit Maimuna for blood transfusions, a biopsy from the tumour, and to begin pain medication, but I fear that her prognosis is bad and that we will not be able to do much for her.
