Recently, Zimbabwe joined the rest the world to commemorate World Cancer Day. For me, each year we celebrate this day brings very painful memories.
In 2009 I lost a close colleague to cervical cancer. The diagnosis was made after the disease had progressed and she could not be saved. Attempts were made to find treatment for the dreadful condition but it was too late. She was a young mother who had a bright future in the development sector. She was always a happy person and whenever I was in her company I did not notice anything that made me suspect that she had cervical cancer.
The majority (80%) of women will acquire the virus in their life time but will not have any symptoms or signs. It can take between 10 to 20 years before one develops cancer or even less if one has HIV. This could have been the case with my colleague as my naked eye would have not picked the problem except through screening.
After this experience I made a commitment to play my part to encourage other women to go for early screening of cervical cancer. As fate would have it, I am now one of the programme officers leading the implementation of the National Cervical Cancer Programme. I am nurse by profession. For so many years I worked as a midwife, an experience which taught me to value human life. At work my colleagues know me as “amai” (mother) because of my passion for women’s health. I am constantly reminding women in the office to get screened for cervical cancer and get regular check-ups to prevent other cancers such as breast cancer. Prevention is very important and this is the heart of our work at United Nations Population Fund (UNFPA).
Why should we worry about cervical cancer? The glaring statistics.
Every woman of reproductive health age is at risk of cervical cancer. Cervical cancer is the second most frequent cancer among women aged 15 to 49 years in Zimbabwe. According to the Human Papillomavirus (HPV) and Related Cancers in Zimbabwe report (ICO/WHO 2013), all women 15 years and older (accounting for approximately 4.37 million women) are at risk of developing cervical cancer. Risk factors include early age of sexual intercourse, multiple sexual partners, HIV infection, Sexually Transmitted Infections and smoking. Current estimates indicate that every year 2,270 women are diagnosed with cervical cancer and 1,451 die from the disease. These glaring statistics should worry every woman of reproductive age.
The disease burden for cervical cancer has been greatly influenced by the high prevalence of HIV and Human Papilloma Virus. About 24.7% of women in the general population are estimated to be HPV-positive and 17.7% women are estimated to be HIV positive. Lack of information and access to screening and treatment services contributes to the high mortality. Cervical cancer screening coverage is extremely low at 7.2% (ICO/WHO 2013), with coverage much lower in rural areas (5.2%), as compared to the urban areas (10.8%).
What are the efforts under way to prevent and treat cervical cancer?
In 2010 and 2011, UNFPA supported the Ministry of Health and Child Care (MoHCC) to set up pilot cervical cancer screening sites using Visual Inspection with Acetic Acid and Cervicography (VIAC) at United Bulawayo Hospitals (UBH) and Masvingo District Hospital. VIAC is a see and treat method that is cost effective and minimises delays and the number of visits between screening and treatment. The programme aims to increase the population coverage of cervical cancer screening in the public health sector. Using lessons learned and experience from the two pilot sites, the programme has since expanded and to date, 88 screening sites have been established and 164,103 women screened for cervical cancer.
UNFPA has supported the MoHCC to set up these screening and treatment centres through the procurement of equipment, medical supplies and training of health workers. To date about 294 workers have been trained. Other support has also included supporting the MoHCC to develop guidelines and training tools on screening and treating cervical cancer, development of a nationwide cancer register, among many other things.
The good news is that cervical cancer can be prevented through screening. Our desire as UNFPA is therefore to see the national cervical cancer programme grow to ensure as many women as possible are reached with life-saving screening and treatment services. The VIAC programme is potentially sustainable due to the low operational costs once set up. It also facilitates taking up of other SRH services such as HIV counselling and testing, STI treatment and family planning, making it a worthy investment. I therefore urge all women to visit their nearest health facility and get screened for cervical cancer.
While the increase in cervical cancer screening sites has been very commendable there is still a lot more that needs to be done to increase coverage of cervical cancer screening services in Zimbabwe. Among many other things, is the need to prioritise the availability of treatment services in the public sector for women with advanced cases of cervical cancer. Generally availability of treatment services (surgery, chemotherapy, radiotherapy) for advanced cervical cancer cases is very poor. Where services are available, the cost is a deterrent factor for women to access treatment. Additionally the referral system is weak making it difficult for women to access services at higher level of care.
There are opportunities to reach more women with cervical cancer screening and treatment services. As already highlighted, every woman is at risk of developing cervical cancer so make some time to get screened. These are some of the VIAC sites in each province in Zimbabwe:
Harare-Parirenyatwa and Harare Central hospital
Bulawayo-United Bulawayo Hospitals
Matabeleland South, Maphisa District Hospital and Gwanda Provincial Hospital
Matabeleland North, Victoria Falls Hospital and Tsholotsho District Hospital
Mashonaland Central-Bindura Provincial Hospital and Mt Darwin District Hospital
Mashonaland West-Chinhoyi Provincial Hospital and Karoi District Hospital
Mashonaland East- Murehwa and Mutoko District hospitals
Midlands-Gweru Provincial and Kwekwe District Hospitals
Manicaland- Mutare Provincial Hospital and Chipinge District Hospital
Masvingo- Masvingo Provincial Hospital and Silveira Mission Hospital
Remember, women, your health is your responsibility. Get tested for cervical cancer and other cancers that affect women.
About the author
Agnes Makoni is a midwife specialist by profession and Programme Analyst for Maternal Health for the United Nations Population Fund (UNFPA) here in Zimbabwe. UNFPA supports the Government of Zimbabwe to implement a number of programmes on reproductive health. She can be reached at makoni@unfpa.org
