60% of Zimbabwe's women risk dying from cervical cancer

Posted October 12, 2011 from Zimbabwe

The slow pace in cancer solutions is detrimental to Zimbabwe’s women, girls. With only 2 radiotherapy machines nationwide and no human papilloma virus vaccinations, 60% of Zimbabwe's women face certain death from cervical cancer.

Young Grace recently visited her gynaecologist in Zimbabwe’s capital, Harare because she had been trying and failing to conceive for five years. The doctor orders a series of tests, among which were a pap smear; a first for Grace. Upon collecting her results, she is informed that she has a sexually transmitted infection called human papilloma virus (HPV), and pre-cancer cells had been detected on her cervix. Confused and barely grasping what this meant for her, the doctor informs her that there is no treatment for either the HPV or the pre-cancer, but he recommends that she goes for another check up in exactly six months after which he would determine whether or not there would be need for surgery. Essentially, Grace had just been informed that she had the first signs of cancer and an untreatable STI, but there was nothing the doctor could do for her. Meanwhile, before the next check up, she would wait it out while the pre-cancer cells had good chances of morphing into cervical cancer.

Grace’s case is a classic example of the big threat being faced by at least 80% of Zimbabwe’s women. Being diagnosed with cervical cancer has become a death sentence in Zimbabwe. The disease affects 1800 women annually, and of those, an estimated 1200 certainly die. Cervical and breast cancers are the leading causes of death among women in Zimbabwe and many developing countries. Treatment is often unavailable and expensive; or for those who get a small chance – they have month long waiting lists to deal with before getting their turn on either of the only two radio-therapy machines available in the country. Cancer is undisputedly a rising epidemic in Zimbabwe and there is an urgent need for investment in its screening and treatment. The disease has certainly but quietly become more fatal than HIV. Being diagnosed with the latter, you know there are ARVs and civil society providing all kinds of assistance.

Cervical cancer awareness month came and went in September, and many a Zimbabwean woman neither knew nor cared; and a myriad of reasons explain this.

A notorious virus called Human Papilloma or HPV in short is the established cause of 70% of all cervical cancers worldwide. It is a very common (residing in over 60% of the sexually active age group) and most commonly transmitted sexual infection that cannot be treated. Some countries now have vaccines available for the prevention of that HPV where three shots of the vaccine are administered to girls before their sexual debut. This vaccine is currently not available in Zimbabwe because - if recent media reports are to be believed – Health and Child Welfare Minister Dr Henry Madzorera said that currently the government cannot afford the vaccine. Costs aside, apparently the vaccine must be constantly refrigerated, a small but hopefully not permanent difficulty currently in Zimbabwe with the frequent power cuts. But women are however encouraged to go and get regular check-ups, through for instance pap smear tests every six months. These are free in most public health institutions, but cost $50 or so in private ones. Half the time public hospitals lack reagents and other necessary things needed to conduct the pap smears. Treatment for advanced cancer including doctors’ fees, surgery costs and treatment cycle cost anything between $4000 – 5000. This means in short, majority of Zimbabwean women will not even try and will simply die.

Another problem is, 80% of Zimbabwe’s women lack awareness of the fact that they must be screened and cannot begin to decipher the gravity of the risk they face. Most cancers, including cervical, can be treated if people recognized the signs and sought treatment timeously. Education, early detection and early treatment can improve the quality of life for women and reduce unnecessary deaths from these diseases. However fewer options are currently available for treating early or advanced disease in Zimbabwe.

There are currently very little or no cervical-cancer screening programmes in Zimbabwe. This has seen fewer opportunities present to diagnose precancerous disease and consequently, most women only visit their doctor with the disease at an advanced stage.

A number of non-profit organizations operate in Zimbabwe in the health sector. They are constantly engaged in ‘consolidated appeal processes’ to access funds for humanitarian assistance which have never included procurement of cancer equipment. Perhaps there will be a time yet when donor organizations would look past the desire for ‘visible’ and immediate short term results to invest more in this long term need. There is a hesitancy to commit perhaps because the equipment is not only very expensive, but there is also a huge responsibility in maintaining it. Outreach programs that involve local physicians and hospitals, ministries of health, NGOs, and even traditional healers are needed urgently for education, screening, and early detection which can significantly extend and improve the quality of life of women. Another big factor is that African women generally do not want to talk about gynecological cancers and other such-like problems; understandable - given the intensely personal nature of gynecologic cancer. But sharing experiences in this problem confronting women and creating platforms that provide knowledge can go a long way in saving the lives of other women. Recently, Zimbabwean Deputy Prime Minister Thokozani Khupe came out and announced that she was receiving breast cancer treatment in South Africa. Not only was this big of her, but it should serve as an example for other women in public office and high places to start to demystify this disease, and cultivate local solutions to this problem so that we can in earnest start moving forward on this issue as a nation. How can we make cervical cancer month for instance bring hope and real meaning to many of our women who cannot afford to fly to South Africa or Malaysia for treatment?

Zimbabwe’s President, Robert Mugabe has been discussed in recent media reports as currently undergoing treatment for prostate cancer. He reportedly flies out to Malaysia regularly for checkups and other things. One would think he would – in the situation – be foound championing for better cancer health care in his own country.

The Cancer Association of Zimbabwe has however said that the government has approved HPV vaccines being used elsewhere to also be used here in Zimbabwe. It is refreshing to know that guidelines for adoption of this critical service are currently being developed. Hopefully, young girls will be getting the HPV vaccines some time in the very near future, so that a lot of their lives can be preserved. Even then, it is a sincere hope that like with HIV - the government will also subsidize HPV vaccines which at normal rates are beyond the reach of the majority. We wait with bated breath to see if for once this very grave issue will be treated with the seriousness it deserves.

Comments 5

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  • Rumbidzai Dube
    Oct 12, 2011
    Oct 12, 2011

    Great post Stash. I am reposting this on my facebook wall because as you rightly said people (including myself before I read your post) are unaware of how deep the problem is and how much of a threat to human life cancer is in Zimbabwe. I lost a colleague form University 2 months ago to Cancer. We were all shocked by it but no one took the time to investigate how widespread the problem is among young women in Zimbabwe, so really thank you for this :-)

  • Usha K.C.
    Oct 12, 2011
    Oct 12, 2011

    Stash, thank you for writting on this mery essential issues. We all should be aware about it.

  • ikirimat
    Oct 12, 2011
    Oct 12, 2011

    Indeed this is a silent killer among women. In Uganda too cervical cancer is a number 2 killer I am told according to statistics. Cervical cancer kills more than half a million women worldwide every year, and is the leading cause of female cancer deaths in the developing world. New low-tech screening programs have begun to reduce cancer deaths .Just 2 week ago I buried my uncle's wife who succumbed to this disease. This rural woman started having symptoms of the disease about 2 years ago and attributed her long heavy bleeding as normal but also attributed it to her age (over 49 years). She thought it was normal. Nor body had ever given her the information on the symptoms of cervical cancer to watch out for. A bout 3 months a go she was refered to the national referral hospital in the capital Kampala where she was diagnosed with advanced stage 3 of cervical cancer. Of course not much could be done to save the poor lady. She was just taken back home to wait for her fate.

    This is what happens everyday to us women.The main limitation to cervical cancer screening is the lack of awareness of cervical cancer as a significant health threat to women in the general public and in the healthcare sector. The women are being encouraged to screen for cervival cancer, though even this information is still not reaching a wider community. But the challenge that still looms is the question " what if one tests positive for cervical cancer, how can she afford the treatment which is still very expensive? another question that is still not answered is the expensive vaccine not affordable to the ordinary woman.

    There have been subsidized drives in Kampala (city) mobilizing women and girls from age 12 years to go for the vaccination but a cost of about 200 $ for all the shots is still expensive for the ordinary woman.

    The more common Pap smear test requires more highly trained health providers, access to equipment and supplies, a cytology laboratory, arrangements for communicating results to screened women and a facility for confirming diagnosis.

    Otherwise governments and partners need to provide the tests and treatment as part of the minimum health care package to be provided to all women for free. This includes information and awareness creation.

  • Stash
    Oct 12, 2011
    Oct 12, 2011

    Thanks for these points, Ikirimat. I should tell you, once I had all these details about cancer, I have been feeling really emotional and sort of angry at the same time. I really hate how governmnets are not taking this thing seriously, and currently, all eyes on HIV, none on Cancer, which in my opinion, is worse than. I feel helpless as an individual, and day and night, I keep thinking, what could I do, not only to grow a strong movement that will advocate for more seriousness, but for necessary treatment and vaccines to be made available. I have for once, started really scrutinizing the role that civil society and donor support is actually doing in my country.

  • NEWCourse_Colleen
    Oct 13, 2011
    Oct 13, 2011

    Stash, We too have encountered cervical cancer - in rural Tanzania- and, as you rightly point out, it is difficult to build long term programs/ raise the money for expensive clinics, etc. But, I am encouraged by us ngos such as Livestrong- that has done groundbreaking work in de-stigmatizing testicular cancer, here in the US - and has partner organizations around the world. Also, PATH (located here, in Seattle WA) - is making so many advances toward simplified medical screening, medical education/ prevention and other complex things - in cultures around the world. I am heartened. Thank you for bringing up this topic- and I will be sharing your article via Twitter to both Path and Livestrong. Keep writing about these important issues, please! ~ thanks again, Colleen