Taking cancer screening to rural communities

It is Saturday morning at Ndamera Health Centre in Nsanje District.

Senior community health nursing technician Evelyn Zambasa is standing in front of almost 30 women educating them about cervical cancer—the commonest cancer among women in Malawi.

Clad in her green uniform, the community health worker is using a poster that shows the different stages the cervix goes through once it is infected.

Says Zambasa: “The photos that you see in the first two rows show a normal cervix. If you look closely at the photos in the third row, the cervix is changing colour, indicating that something is amiss.

“Sometimes this change of colour happens to signify a sexually transmitted infection and sometimes this change is cancerous.

“This is something you cannot ascertain while at home; hence, you need to get screened for cervical cancer at least once every three years.”

The women consider this their lucky day as, after getting this information, they will have the opportunity to get screened, courtesy of Queen Elizabeth Central Hospital’s Chatinkha Maternity Care Support (Chamaca).

Chamaca chairperson Frank Taulo, a renowned gynaecologist and obstetrician, says the screening exercise is one way of ensuring that women in rural communities don’t develop cervical cancer.

For those women who will be identified as having cervical cancer, he says they will be assisted to get medical attention promptly because the disease is curable when detected in its early stages.

As Zambasa and her colleagues get down to work, one of the women they see is Brenda James, 26, from Kangaecha Village, Traditional Authority Ndamera. The mother of three has walked for an hour or so to get to the health centre to get screened.

She says: “I have been experiencing stomach pains and vaginal itching for the past three months. Every time I come to the health centre, they give me meds and the pain only disappears for a week before recurring.

“So, when I heard that there will be cervical cancer screening today, I decided to come because a thought or two has ever crossed my mind that the pain and itching might be a big problem.”

Fortunately for James, the screening cleared her doubts. It came out negative. However, she was advised that next time she comes to the health centre, her husband should come with her.

Unlike James, Fatima Nyahoda, 47, hasn’t been experiencing any signs and symptoms of cervical cancer such as abnormal vaginal bleeding, lower abdominal and back pain, or painful sexual intercourse.

Actually, the mother of five only knows a few things about the cancer caused by persistent infection with certain types of human papilloma viruses which are common and spread easily by skin-to-skin contact during sexual activity.

“Despite not knowing much about this disease, I decided to come when I heard about the screening opportunity because I believe that it is important for a person to know how they are doing inside their body for them to be able to plan about life properly,” says Nyahoda.

As more women are getting screened at Ndamera, the team of health workers spot a cervical cancer case. Taulo is the one who attends to the woman who is probably in her early 70s.

While he has collected her specimen for processing in Blantyre to find out what kind of further medical attention will be needed, the gynaecologist is saddened when he goes through the woman’s health passport.

The passport shows that she had previously been going to several health facilities in the district for the past three years presenting signs and symptoms of cervical cancer.

However, she was only getting painkillers and antibiotics.

Taulo says: “If this woman had the opportunity to get screened all that time she was previously turning up at health facilities, I don’t think she would have developed cancer.

“But now she has cancer which is at an advanced stage despite that she had been presenting herself to the hospital.”

He calls the case devastating considering the cost of cervical cancer treatment for poor women like her and the emotional and physical turmoil that she will have to undergo while she waits to get treated.

“At her age, she was supposed to be home having a nice time with her grandchildren, not being sick from a disease that could have been dealt with had it been detected early,” says Taulo.

Visibly in pain, the old woman’s face briefly brightens up when Taulo tells her that she should not worry about her treatment as that is the main reason Chamaca is at Ndamera today, to ensure that all cervical cancer cases detected get medical attention.

“This is the beauty of the generosity we received from Malawians who supported us during our fundraising events and some who are still sending their support until now.

“Part of their money is the one that will be used to help you and many other women from rural areas across the country who would otherwise not afford to get cancer treatment,” he tells the woman.

Before coming to Ndamera, Chamaca had conducted two fundraiser events to raise at least K200 million to be used towards preventing cervical cancer among women in rural areas.

As the team leaves Ndamera, to return the next day and the following weekend, women surrounding Ngabu Rural Hospital in Chikwawa have started receiving messages that Chamaca will have a date with them next month for two consecutive weekends.