Two years ago, I travelled to Maputo, Mozambique, to help the team with cervical cancer screening activities, and to address difficult cases and other challenges.
In Maputo, MSF is focused on screening HIV positive women because they are most at risk of developing cervical cancer.
The HIV epidemic is rampant here and although one in eight women lives with the virus, lifesaving antiretroviral treatment has become far more accessible in recent years.
By vaccinating young girls and by providing on the spot screening and treatment, we give more than just hope – we prevent cervical cancer from developing.
Together with the friendly nurses, I’d been following the sexual and reproductive health consultations the entire morning. The nurses and patients laughed at my limited Portuguese but, somehow, they managed to understand me.
Women came to the clinic for various reasons; I saw around 20 women and girls come in for HIV testing, family planning, their first antenatal care visit and cervical cancer screening.
Sometimes patients consulted for HIV testing, family planning and cervical cancer screening all in the one visit.
Forty-year-old Maura* was our last patient of the morning. I immediately noticed how thin she was and the swollen lymph nodes in her neck.
“Benvindo Maura,” I say, “Sou doctora Séverine do MSF.” I get a warm smile in return.
The nurse asks Maura why she has come into the clinic today. “I have belly pain,” she says, “and there is something dirty coming out of my vagina.”
I instantly hope that this is ‘just’ a sexually transmitted disease, something treatable. But during the examination, the nurse and I see a large mass coming from the cervix, protruding into the vagina.
Further examination reveals that the mass extends to the pelvic wall.
After she is dressed again, we counsel Maura for HIV testing. She agrees and, as we suspected, she tests positive.
The nurse sits down with Maura and explains very gently that she has two serious conditions – cervical cancer and HIV.
The nurse reassures her that we will do everything we can and that she will be referred to the HIV clinic and can start treatment as early as today.
The treatment for her cervical cancer, however, is complicated. It’s inoperable and she needs radiotherapy to have any chance of survival.
There is no radiotherapy unit in Mozambique, so patients are referred to hospitals in South Africa. But in reality, this system is not functioning because it is too far, too expensive and too complicated.
Two years ago, I hugged Maura, wished her all the best and went home with a sick feeling in my stomach.
Maura’s serious health issues were largely preventable. If only she could have come for screening, if only she had had her HIV test sooner. If only…
A silent killer
Worldwide, more women die of cervical cancer today than of pregnancy and delivery complications.
In 2018, 311,000 women died of cervical cancer. These were mainly women living in low-income settings with limited financial, cultural or geographical access to quality medical care.
The figure is projected to increase in the coming years, yet the world is largely silent about these deaths.
The worst part is that preventive tools, including human papillomavirus (HPV) vaccination and treatment like cryotherapy (freezing of the cervix), are available and, in the case of the latter, affordable.
Last July, I travelled to Zimbabwe where MSF is managing a cervical cancer screen-and-treat programme in collaboration with the Ministry of Health and Child Care. The screening is integrated into six clinics where women also receive family planning, HIV testing and treatment if needed.
The team screened 5,751 women in Gutu district last year and we’ve now reached 75 percent of the women in the catchment area.
We do health promotion in the clinic and we invested in Loop Electrosurgical Excision Procedure to be able to better treat precancerous lesions that we detect using VIA (visual inspection of the cervix with acetic acid).
All this has brought good results. Year after year, more women come for screening and we detect fewer abnormalities.
Perhaps this is due to a combination of more women being screened earlier, our teams doing outreach and staff being better trained to recognise abnormalities. We also know that long-term effective HIV treatment helps to spontaneously clear precancerous lesions.
More than just hope
Last year in Gutu MSF also carried out an HPV school vaccination campaign for 9- to 10-year-old girls, and supplied vaccines for 1,000 HIV-positive girls and young women aged 15-26.
This vulnerable patient population now has a very good chance of life-long protection against this deadly disease.
So, by vaccinating young girls and by providing on the spot screening and treatment, we give more than just hope – we prevent cervical cancer from developing – so more women like Maura have a chance to survive.
But so much more needs to be done.
* Patient's name has been changed to protect confidentiality.
Editor's note: The woman pictured in the top image, Shuvai Munyaradzi, was screened for cervical cancer at the MSF-supported hospital in Gutu, Zimbabwe. After undergoing cryotherapy to treat abnormalities on her cervix, Shuvai found out she was pregnant with her third child. She named her "Chidochashe", which means "Will of God", in honour of her successful cervical cancer screening.