Penny was in Pakistan from 20.2.16 until 28.2.16. Pakistan has an increasing incidence of breast cancer, which affects a younger population than in the UK. Despite recent local awareness campaigns, there remains widespread ignorance about the disease and the importance of reporting breast symptoms. There are social and cultural barriers which dissuade many women from presenting to a doctor, and most breast cancers are diagnosed at stage 3 or 4 when treatment is difficult and survival poor. Government hospitals are poorly funded and specialist services are rare outside the major centres. Penny is working in collaboration with local healthcare workers to try and improve awareness, early presentation and standards of treatment.

This year Penny gave lectures in breast surgery and breast reconstruction to medical students and doctors in Jinnah Hospital Lahore, Sialkot Medical College, Gujranwala Medical College and Cleft Hospital Pakistan in Gujrat and lectured on breast cancer symptoms and signs. She spent a day operating at Gujranwala District General Hospital where she performed the lumpectomy and also a mastectomy and immediate reconstruction. Conditions in theatres and on the wards were very basic in this government hospital; equipment was dated and poor quality and cleanliness was tough to maintain, but Penny was impressed by the enthusiasm of the local surgeons and students, and the resilience of their patients. She undertook a full ward round the following day before giving further lectures.

Penny has been visiting the city of Gujrat for four years. This year she was delighted to inaugurate the first one-stop breast clinic which is housed in the newly built Cleft hospital of Pakistan, funded by charitable organisations. The clinic is being sponsored by a local business family and is free for patients to access. It has the only mammogram machine for 100 miles radius, as well as an ultrasound machine and consulting rooms. There are also operating theatres available for treating diagnosed cases. The clinic will be run on an ongoing basis by Mr Arif Khawaja; the UK trained breast surgeon based in Lahore, and his wife Dr Hamda Khawaja, a breast radiologist who have very kindly agreed to provide this service on alternate Saturdays.

This is a significant step forward for Gujrat and the surrounding area. The new hospital is an excellent facility and Penny is confident that the team will be able to provide world class care there to even the poorest patients. In future years, she hopes to run course and worships for nurses, students and doctors during her visits and to try to develop a centre of excellence for breast surgery in Pakistan from which to spread good practice.