Every year 1,600 women die of cervical cancer in Malawi. The country has the highest rate of cervical cancer worldwide. JOSEPHINE CHINELE looks at why Malawian women continue to silently die of cervical cancer.
THE vaginal discharges became too much to bear and Maria went to a nearby health facility to seek medical assistance. She had experienced these discharges for a long time but she thought they were normal. “I felt no pain so I thought everything was okay. I was not feeling any pain at the time I was going to the health facility but was just irritated with the discharges,” she says.
But the medical assistant at the health centre told her that she had a Sexually Transmitted Infection (STI), was given treatment, and advised to call her husband to also get the treatment. “This happened about four times but nothing changed. The discharge persisted.
Later on, I had prolonged menses. I had different types of contraceptives as treatment to stop the menses but it was temporal. There was no change,” recalls Maria who was later referred to Queen Elizabeth Central Hospital for further diagnosis and treatment.
“That’s where I was told that I had cervical cancer. I was glad to be told of the problem I had but the bad news was that it had already spread and therefore, needed both surgery and radiotherapy. Radiotherapy treatment is not available in the country, the patient has to source own money for treatment abroad or be on the government’s waiting list to go to India,” she says.
But Maria’s only source of income is farming which she can no longer manage in her condition. Her only option was to be on the government’s waiting list. Maria is one of the 3,000 women that are diagnosed with cervical cancer in Malawi every year. Cervical cancer is caused by Human Papiloma Virus (HPV) and is one of the major public health problems in Malawi; yet, it gets little attention.
Queen Elizabeth Central Hospital’s Oncologist Leo Masamba says 1,600 of the women die annually because most of them go to the hospital with the cancer in its advanced stage.
“The 3,000 women are those who get screened but there are a lot of women out there [not diagnosed]. They have the disease but they don’t know because they haven’t gone for screening,” he notes. Masamba acknowledges that most women, like Maria, have wasted time at primary health facilities getting treated for STIs. “This just brings lack of trust between husband and wife when the woman has been faithful but the cancer is her only problem,” he says.
A policy brief report titled ‘Reducing Cervical Cancer Prevalence in Malawi’ by Beatrice Chikaphonya Phiri says cervical cancer is the third most common cancer worldwide and the leading cause of cancer death among women.
It says Malawi has the highest rate of cervical cancer worldwide. Cervical cancer is the most common cancer among women in Malawi. Despite the fact that cervical cancer is preventable and curable in the early stages, Malawian women are silently dying. Chikaponya Phiri’s policy brief report also notes that cervical cancer is a major public health problem, which kills approximately 250,000 women globally.
It says high rates of cervical cancer are linked with high prevalence of HPV and non performing screening programme. The policy brief, which was done as part of the Strengthening Capacity to Use Evidence in Health Policy programme (Secure) with funding from DfID and implemented by a consortium led by African Institute for Development Policy (Afidep), 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 providers, equipment and supplies; and communities not being aware of the services or its benefits.
Silvia Singo, a Blantyre resident who has survived cervical cancer, recently told Times TV that so many women are dying because they are ignorant of the disease let alone that they are supposed to go for screening. Dr Petani Mtonga of Oncology Department at Queens says some women waste time using native or herbal medicine when they experience early signs of cancer.
“They try several types of herbs which mostly don’t work as the cancer continues to advance. Some even believe that they have been bewitched, [and] they end up presenting advanced stages of the disease,” he observes.
Oncologist Masamba says the burden of cervical cancer would have been managed better if screening uptake was up to 70 per cent. “Cervical cancer is easy to destroy if it’s just started. It can easily be treated with liquid nitrogen, a special gas which is used to freeze the cells. This becomes difficult to do if the cancer has advanced,” he elaborates.
Masamba says it’s better for women to get tested and see whether they have the disease or not because Malawi does not have the capacity to treat advanced cancer as it does not have Radiotherapy treatment. The majority of women have indicated that they do not have much information about cervical cancer, let alone the benefits of screening. There are lots of messages for other diseases such as HIV and Aids but not much about cervical cancer.
“There is also lack of staff at primary health facilities. One may be overwhelmed to treat other diseases than to attend to women who are not sick but just want a cervical cancer screening,” Masamba says adding that there is need for deliberate policy to screen women. In Malawi, Visual Inspection with Acetic Acid (VIA) is the major screening method used.
The method involves examination of the cervix with the naked eye, using a bright light source, after one minute of 3-5 percent dilute acetic acid application. The equipment for VIQA is the least expensive among all screening techniques, reads part of Chikaphonya Phiri’s policy brief.
According to the brief, a study on health systems challenges in cervical cancer prevention programme in Malawi in 2015 found out that only seven out of 21 surveyed health facilities were providing both cervical cancer screening and treatment.
These facilities were secondary level facilities and women were travelling long distances to access the services. “Slightly above 52 percent of the facilities reported stock outs of medical supplies with some facilities reporting that women contributed money to buy acetic acid,” reads the report in part.
It says on average, 10 women undergo cervical cancer screening per clinic day, and most clinics are operated once a week. The health facilities have very few service providers and they have poor knowledge of the national therapeutic guidelines for cervical cancer. Deputy Programmes Manager for Non-Communicable Diseases in the Ministry of Health, Dr Kaponda Masiye, admits that government is failing to deal with cases of late cancer presentation partly because the country does not provide radiotherapy treatment. It has been sending patients to Tanzania, South Africa and India among other countries for treatment. Some patients die whilst on the waiting list.
Early this month, President Peter Mutharika launched the construction of Cancer Treatment Centre in Lilongwe.
This is a cancer care milestone in the history of Malawi. Recently, the first lady Madame Gertrude Mutharika joined the campaign against cervical cancer deaths by encouraging women (in solidarity) to go for cancer screening and get early treatment campaign. She says different stakeholders need to join hands to fight cervical cancer.