Medical Error

I was participating in a training course in cervical cancer screening with the Visual Inspection with Acetic Acid technique. We had had three full days of classroom instruction, and had finally progressed to the clinical practicum stage. I was excited to be back at Mulago for the first time since I had left Kampala. I had passed through the ID ward to say hi to Dr. Etolu. I had missed him greatly during my time away.

When I got back to Ward 5B (GYN Oncology), the screening had finally started. I tried to seek out the English-speaking patients so that I could clerk them. Under the guidance of the nurses and our trainer, we started doing speculum exams and conducting screening using the VIA technique in earnest.

Towards the end of the day, we ran out of acetic acid. I asked Gina, one of the other course participants, where we could get more. She saw a bottle of acetic acid underneath the counter, and asked Stew, one of our colleagues, to pour some more acetic acid into our tray. Since I was assisting in this case, I soaked a cotton swab in the acid, and handed it to Deo, who was the one conducting the screening on this patient. The smell of acetic acid permeated the whole room. A funny feeling started brewing in the bottom of my stomach. Something about the whole situation just wasn’t quite right. Deo applied the acid to the patient’s cervix, and immediately, the patient started shouting in pain. Gina held onto the patient’s hand and talked to her gently, trying to calm her down. The patient’s pain increased, and so did her yelling. Suddenly, Gina said, “Remove the cotton swab, now! Get another swab soaked with distilled water!!” We did as told. Deo quickly wiped the acid off the patient, and continually applied cotton swabs soaked through with distilled water onto the patient’s cervix, changing the swabs as quickly as I could prepare new swabs and hand them to him. Finally, the patient started to calm down. I was still confused as to what had happened.

“I don’t understand. Why was the patient in so much pain?” I asked. “The acid we put on the patient was too strong. It hadn’t been diluted,” Gina whispered to me. Everything suddenly clicked into place. Everything made perfect sense. I almost started to cry. “I’m so sorry,” I told the patient. Someone pushed me roughly from behind. I turned around. Gina was shaking her head at me. The others quickly escorted the patient out of the room.

“We need to tell the patient what happened.”

“It’s ok. We’ll just tell her to come back in 6 months for the re-screening.”

“But it is our responsibility to tell her the truth. And if we don’t, she’ll think that cervical cancer screening is the most painful process ever, and she won’t ever come back. That lady is going to die of cervical cancer, and it’ll be our fault!”

“Don’t worry. She’ll definitely be back. She’s HIV-positive, and those people take their health seriously. She’ll come back when we tell her to.”

“It’s not right. If nobody wants to tell her the truth, I will.”

I walk out the room to find the patient. But she had already left.