Cervical Cancer: A manageable threat

Josephine Chinele, CNS Correspondent, Malawi
The vaginal discharges became too much to bear and Maria (name changed) went to a nearby health facility to seek medical assistance. She has had these discharges for a long time but thought they were normal as they were not painful, and she was simply irritated by them. The medical assistant said that she had a sexually transmitted infection (STI). Maria was given treatment, and advised to ask her husband to also receive treatment.

But even prolonged treatment did not help her. The discharge persisted. Later on she had prolonged menstrual cycles. She took different types of contraceptives to regularise them, but the relief was only temporary. She was then referred to Queen Elizabeth Central Hospital in Blantyre.

“That is where I was diagnosed with cervical cancer. I was glad that the problem was finally found but the bad news was that the cancer had already spread and therefore needed both an operation and radiotherapy treatment. Radiotherapy treatment is not easily available in the country and one needs to either have lots of money to get treated abroad or be on the government's waiting list,” she said.

But Maria’s only source of income was farming, and now her physical condition did not permit her to do even that. So the only option left for her was to be on the government list. She is still waiting in vain for her turn to begin treatment.

Maria had no knowledge whatsoever about cancer in general, let alone cervical cancer, and no means to decide upon the kind of diagnosis she needed. Even when the diagnosis was finally made, she could not access any treatment.

Her case is totally different from the likes of Dr Rita Banik of India, the Founder President of Race to Rein in Cancer. After Dr Banik was diagnosed and treated for breast cancer in 2006, she lived a cancer free life for 7 years before she got a relapse in 2013.

Dr Banik shared her personal battle with cancer, during a webinar organised by Citizen News Service (CNS) for health journalists. In 2006, she felt a hard lump in her left breast and a biopsy confirmed breast cancer. She immediately underwent mastectomy, followed by reconstruction surgery two years later. But in 2013, she felt pain in the chest, mostly at night, while during the day she was okay. From her knowledge and information about cancer, Dr Banik inferred that her symptoms were indicative of bone cancer. Yet, she had to literally push her doctor to send her for a PET Scan, which confirmed cancer in the sternum bone. While being still under treatment, she spends her time spreading awareness about cancer and debunking the myths, as well as stigma, related with this dreaded disease.

Dr Banik notes that breast, cervical cancer and other types of cancers are best managed with early diagnosis and treatment. “Early detection saves lives. Cancer is curable; it is not contagious and there is life after cancer. Do not be scared of cancer, fight it,” she advised.

Despite the fact that cervical cancer is preventable and curable in the early stages, Malawian women are silently dying of it. Dr Leo Masamba, an oncologist working at Queen Elizabeth Central Hospital, says that one of the reasons for this is that most of them go to the hospital when the disease is in its advanced stages.

“Around 3,000 Malawi women are diagnosed with cervical cancer yearly. But there are many more out there who have the disease but do not know because they have not gone for screening,” he notes.

Masamba acknowledges that most women (like Maria) waste precious time at primary health facilities, getting wrongly treated for STIs. “This not only delays diagnosis (and hence treatment), but also creates lack of trust, as the husband thinks that his wife has been unfaithful, unaware of the fact that she is suffering from cancer and not an STI.

A policy brief report titled ‘Reducing Cervical cancer prevalence in Malawi’ done by Beatrice Chikaphonya Phiri notes that cervical cancer is a major public health problem, especially in Malawi, which has the highest rate of cervical cancer worldwide. The policy brief also reveals that cervical cancer screening programme is under performing, with the services being largely inaccessible to most women in the country due to long distance to facilities that provide these services, shortage of service providers and equipment, and communities not being aware of the benefits of services available.

At times, people use native or herbal medicines when they experience early signs of cancer. “They try several types of herbs, which do not work and the cancer continues to advance. Some even believe that they have been bewitched. All this leads to presenting themselves in advanced stages of the disease. Cancer is easy to destroy if it has just started, but becomes difficult to treat in its advanced stages,”  observes Dr Petani Mtonga of QECH, oncology department.

Masamba advices that it is better for people to get tested early on, more so because Malawi does not have the capacity to treat advanced stages of cancer as it does not have radiotherapy treatment. But then, most people do not have much information about cancer, and the benefits of early screening. There are lots of messages for other diseases such as HIV/AIDS, but not much about cervical cancer. Moreover, most of the health facilities are not equipped to deal with cancers.

Deputy Programmes Manager for Non-Communicable Diseases (NCDs) in Malawi’s Ministry of Health, Dr Kaponda Masiye admits that Malawi government is failing to deal with cases of late cancer presentation, partly because the country does not provide radiotherapy treatment. Malawi sends its patients to countries like Tanzania, South Africa and India for treatment. Many patients have died whilst being on the waiting list.

He however said that, “The ministry is very much committed to both prevention and management. We are training health workers to manage NCDs and also to bring awareness to the communities through health education units.”

In early April, President Peter Mutharika launched the construction of a Cancer treatment centre in Lilongwe. This is a cancer care milestone in the history of Malawi.

Also speaking at the CNS webinar, Dr Cristina Parsons Perez, Capacity Development Director of NCD Alliance said that limited progress in engaging non health sectors, lack of access to adequate financing for national programmes and interventions, and weak health systems are some of the challenges hindering the progress on control and care for NCDs.

The 2030 Agenda for Sustainable Development adopted at the United Nations Summit in September 2015 recognises non-communicable diseases (NCDs) as a major challenge for sustainable development. Governments are now committed to develop national responses to the overall implementation of this agenda, including reducing by one third premature mortality from NCDs like cardio vascular diseases, chronic respiratory diseases, cancers, and diabetes.

Josephine Chinele, Citizen News Service - CNS
July 6, 2017

No comments:

Post a Comment