Uganda Embraces Low-Tech Test for Cervical Cancer

Sustainable Health Care For Women

For regular readers of ‘Inconvenient Woman’, this will seem like an oft repeated refrain, but there are better, safer, more sustainable ways to prevent and treat cervical cancer both at home and in developing countries.  Safety, and ethical issues aside, , many countries (in my opinion the Us is one of them) simply cannot afford the Merck solution. There are too many other critical demands for public and private health dollars.

In early 2006, when I first started writing about Gardasil, I questioned the necessity of a very expensive, possibility unsafe vaccine for a disease that was easily detected through the use of regular PAP screens and was the most treatable and curable of all cancers. The “500,000-Cervical Cancer Deaths” Merck touted in their marketing blitzkrieg as their HPV vaccine’s justiHPV vaccine,fication, referred to women in developing countries who died due to inadequate access to existing medical technologies, like the PAP Test

Convinced that the pricey and dangerous Gardasil, was simply not appropriate technology for the existing threat, I have reported on the Alliance for Cervical Cancer Prevention (ACCP) work with ‘Visual Inspection with Acetic Acid (VIA) as a low cost, easily deployable, alternative to the PAP Smear. Visual inspection with acetic acid (VIA) can be used to screen women. It can be done by nurses or midwives with appropriate training. Research results show that VIA is simple, accurate, cost-effective, and acceptable to most women.

The following story is an example of how VIA is being deployed.

By Rebecca Harshbarger – WeNews correspondent

KAMPALA, Uganda (WOMENSENEWS)–Claire Judith Achieng remembers how long it used to take to receive the results of a Pap smear, which can help detect cervical cancer.

Women such as herself, who live outside the capital of Kampala in eastern Uganda, would need to travel significant distances to a few referral hospitals for the screening test. From there, all Pap smears were transported to the capital for analysis at Mulago Hospital, after which the results were sent back to the original hospital or clinic. The process could take six months.

In Uganda, cervical cancer is the leading cause of cancer deaths among women, although the cancer typically takes between 10 and 20 years to reach an advanced state and is very treatable if it’s caught early.

The disease’s slow development should give women ample time to have the condition’s telltale lesions detected and treated. However, the vast majority of women in Uganda have never had a Pap smear. Other factors, like early marriage and HIV, make women more susceptible.

In 2006 a group of doctors and public health activists began searching for ways to boost screenings. They belonged to the Uganda Women’s Health Initiative, collaboration between Makerere University, a public university based in Kampala, and the University College London’s Institute for Women’s Health.

Screenings in Small Centers

They started a pilot project in Kampala to demonstrate that cervical cancer screening was possible in small health centers.

As part of that project, two clinics began screening women with a fast, innovative test that used acetic acid–or vinegar–as the primary active ingredient.

The test, called visual inspection with acetic acid, or “VIA,” doesn’t require a pathologist, refrigeration of samples or a microscope.

A nurse, midwife, or gynecologist swipes a patient’s cervix with acetic acid and then inspects the tissue visually. If the cervix has lesions, the tissue turns white.

Currently, public clinics and hospitals continue to screen women using both techniques, but many gynecologists have begun using a positive visual test as a basis to start treatment on the spot. The treatment, called cryotherapy, freezes the lesions and treats the disease in its early stages, before the cancer becomes advanced. It does this by destroying abnormal cells in the cervix that may lead to cancer. The swift move from diagnosis to treatment saves patients’ time and transportation costs.

‘High Accuracy Rates’

“This service has prevented a lot of disease,” said Dr. Dan Murokora, a gynecologist at the Kampala Dispensary who works for the Uganda Women’s Health Initiative. “We screen an average of 15 women a day. We know that the Pap smear has been the standard of screening in the West, but the VIA test has considerably high accuracy rates.”

Currently, five hospitals and clinics in Kampala, as well as three regional hospitals in other parts of the country, offer Pap smears, the visual test and cryotherapy.

The Ugandan Ministry of Health is watching research by the Uganda Women’s Health Initiative to gauge patients’ reaction to the technology, and to estimate the costs of rolling out screenings and cryotherapy to women in smaller clinics throughout the country who have less access to medical services.

The visual inspection screening provide midwives and nurses with a more active role in conducting and encouraging screenings within local communities, instead of referring women to distant hospitals.

Richard Ndhuhura, the state minister for the health department, said the Kampala clinics have been drawing plenty of women. “People are now flooding the clinics, which is very good, and it’s a challenge to handle the flood. But I am happy to hear that people are flooding the clinics to be screened.”

As a community health activist, Achieng is also pushing to get the new screenings rolled out to other parts of the country.

In 2006 she and a college classmate, Patience Grace Kyuomugisha, founded the Save a Woman Initiative, after losing a friend to cervical cancer.

The organization of health activists and doctors has been giving presentations on the importance of screenings in churches, marketplaces and clinics in Luweero, a rural town in central Uganda.

The group is currently raising funds for a mobile clinic–a truck equipped with medical equipment, a refrigerator, and literature–to bring screening tests and awareness to rural communities with minimal gynecological services.

They hope to launch the clinic later this year, or in 2010. Achieng estimates the mobile clinic will cost $150,000. She can’t begin to predict how many women’s lives it might save.

“You are doing this for a fellow woman, to save them from a gruesome disease,” she said. “It gives you a passion to go on, even if you save just one woman.”

Rebecca Harshbarger is a journalist based in Kampala, Uganda.

Peprinted with permission from Women’s eNews

Related Stories HPV Vaccine Flags Need for More Pap Tests http://www.womensenews.org/article.cfm?aid=3303 Vaccine Holds Special Promise for Women of Color http://www.womensenews.org/article.cfm?aid=2712 HPV Vaccine Mandates Face Public Hesitation http://www.womensenews.org/article.cfm?aid=3252

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Author: H. Sandra Chevalier-Batik

I started the Inconvenient Woman Blog in 2007, and am the product of a long line of inconvenient women. The matriarchal line is French-Canadian, Roman Catholic, with a very feisty Irish great-grandmother thrown in for sheer bloody mindedness. I am a research analyst and author who has made her living studying technical data, and developing articles, training materials, books and web content. Tracking through statistical data, and oblique cross-references to find the relevant connections that identifies a problem, or explains a path of action, is my passion. I love clearly delineating the magic questions of knowledge: Who, What, Why, When, Where and for How Much, Paid to Whom. My life lessons: listen carefully, question with boldness, and personally verify the answers. I look at America through the appreciative eyes of an immigrant, and an amateur historian; the popular and political culture is a ceaseless fascination. I have no impressive initials after my name. I’m merely an observer and a chronicler, an inconvenient woman who asks questions, and sometimes encourages others to look at things differently.