Melvin Ouyo is the Hospital Matron at Family Health Options Kenya (FHOK) –Nairobi West clinic. The facility has been implementing the Cervical Cancer Screening and Preventative Therapy (CCSPT) –supported by the International Planned Parenthood Federation (IPPFAR) Africa Region.
Melvin shares her experiences with regard to the cervical cancer awareness, mobilization and provision of services during outreach activities.
How do you Create Awareness around Cervical Cancer?
Melvin: We conduct community outreach activities. We announce our intended ‘cervical cancer camp’ for about three weeks before the activity. We mobilize women through door-door campaigns, distribution of leaflets, announcements in churches, in women’s groups, and in chiefs’ baraza’s. Most of these activities are undertaken by our peer educators and community health volunteers, all of whom have received basic training on cervical cancer.
How do you Conduct the Outreach Camps?
We station tents in selected areas within the camp venue. Locations for the camps include strategic open fields, churches and classrooms. During the outreaches, we give information on cervical cancer and also provide screening services. Screening helps detect the presence of precancerous lesions in the woman’s cervix. We use the Visual Inspection with Acetic Acid / Lugol’s Iodine tests (VIA/VILI) method for screening.
If any precancerous lesions are detected, we then offer the woman cryotherapy treatment, which involves the freezing of abnormal tissues. However, if the woman is found to have advanced precancerous lesions, we refer her to a higher level health facility for further management.
Do Women Readily Accept to be Screened for Cervical Cancer?
Melvin: Not really. Most women in the community are hesitant about it and ask many questions before they agree to it. Some of the questions asked are:
- Will I be able to have sex after screening?
- Will I be able to walk after screening?
- If the results are positive, does it mean that I have cancer? How long will I have to live?
We however offer the woman adequate counselling before she undertakes the test, ensuring she understands the testing procedure and the implications of a negative or positive test result.
Why are Some Women Reluctant to Undergo Screening?
Melvin: Many fear to test because of the fear of positive results. I have had many women tell me they would rather live in ignorance, rather than find out they have precancerous cells. We however encourage them to test, letting them know that cervical cancer is highly preventable, especially if diagnosed in the early stages.
We also notice that women, especially those who have never had children gasp as we explain to them the testing procedure, which includes widening the vagina with a speculum. Because of this fear, some refuse to undertake the test.
Interestingly, women who have had children, more so those who had traumatic vaginal births cringe at the thought of a medical instrument being inserted in their vagina. Because of a prior negative birth experience, some refuse to take the test.
Unfortunately, we also see cases of women who present with chronic abdominal pain and bleeding. Their cervical cancers are usually at an advanced stage. Many seek hospital treatment late, having held on to the belief that the constant bleeding and ‘chronic stomach ache’ is as a result of bewitching by a jealous neighbour. They spend months taking herbs and local concoctions before eventually coming to us as a last resort. We refer them to higher-level facilities.
Do Women ask about Cervical Cancer Treatment?
Melvin: Yes they do. They are curious to know if the treatment is 100 per cent effective and if it will cure them of cancer should screening results turn positive.
Women also ask about the mode of treatment –whether it will be in the form of pills, injections or if it will require hospital admission and for how long.
We however inform them of our cryotherapy treatment procedure which is quick and painless. We also let them know that the treatment method is dependent on the extent of the precancerous lesions spread, and the need to refer them for advanced treatment if need be.
Do you Involve Men in your Activities?
Melvin: Yes we do! Even though our main target population is women, we include men as they are critical determinants to the health and well-being of women. We invite them to listen to the information shared during outreaches, as they too can pass on this information to other women.
Whenever couples come together for family planning services or HIV testing in our clinic, we give them information on cervical cancer and the need for the woman to get tested. More often than not, it is actually the men then encourage their wives to undertake a cervical cancer screening test. With the support of their partners, you find many women accepting to get tested, their fears having been allayed.
About the Cervical Cancer Screening and Preventative Therapy (CCSPT) Initiative
Cervical cancer is the fourth most common cancer in women worldwide. The vast majority of women who suffer cervical cancer in Sub-Saharan Africa seek care when the disease has already advanced and is far beyond the capacity of surgery or other treatment modalities to offer cure. IPPFAR's response to Africa's cancer burden is through the Cervical Cancer Screening and Preventative Therapy initiative, which is aimed at maximizing the number of cancer services offered to women through a validated, low-cost screening and preventative therapy approach. Screening is carried out using Visual Inspection with Acetic Acid (VIA), an evidence-based and affordable alternative approach for cervical cancer screening in low-resource settings.