By Esther Nakkazi
Twenty year old Tahiya Nakatudde, a housewife, walked for ten kilometres to Nsangi Health Centre III to screen for cervical cancer. She left her two young children in the custody of a neighbour as a care taker.
It was on 24th March, the first time that the health centre was offering this service in partnership with PREFA, a non government organisation that aims to keep mothers, families and children healthy.
“I want to know the status of my health. I have heard that cancer affects women badly,” she said after the screening. That was not the only reason.
Nakatudde had seen spots of blood in the bathroom even though she was through with her menstruation. The prompt response was also to double check that all was well.
After the cervical cancer screening that lasted just ten minutes and was ‘ticklish’ the young mother was happy she had walked the long journey from Nakitokolo, Namagoma Village.
She was pronounced cervical cancer free.
“Women are very interested in cervical cancer screening,” said Henry Namigugu, the in- charge of Nsangi Centre III. That coupled with the general public’s fear for cancer has created an upsurge in numbers of people seeking for cancer screening services.
Uganda’s Ministry of Health data shows the most common cancer among women is cervical cancer, which affects 48 of every 100,000 followed by breast cancer, which affects 28 per 100,000 people. These numbers, however, vary remarkably across different regions.
Survival rates are also low, despite registering about 4,000 new cases of the disease annually, survival rate is only 20 percent tagged to lack of access to treatment, late diagnosis of cancers such as cervical, breast and prostate, where early detection is key for survival.
As well Uganda has only 25 oncologists for its 36 million people. About 60 percent of all cancers in Uganda are caused by infections and 40 percent by life styles.
Dr. Jackson Orem, the director at the Uganda Cancer Institute (UCI) said Uganda is making strides to lower new infections and improve survival rates from 20 to 50 percent.
This is being done through prevention, early detection and improved care for patients. But more success can be achieved if people changed their lifestyle, reduced their tobacco and alcohol use and sexual unfaithfulness, said Orem.
Dr. Anthony Mbonye the acting director general at the Ministry of Health said government is committed to putting more interventions in place to address cancer, including scaling up immunization programs.
One such government initiative is the Human Papilloma virus (HPV) vaccination drive against cancer of the cervix, which has been rolled out across the country and targets young girls aged 10-14 years.
At Nsangi health centre III females aged 9-14 years receive the HPV vaccine for free under the government initiative. It also uniquely tests HIV for all their clients.
Namigugu says it is what is called Provider Initiated Testing and Counselling (PITC) and is sure that it is ethical as it saves the government of resource wastage. In February 2017, through this system, 70 new clients who didn’t know their status were netted.
“It saves government resources by not meandering into tests like malaria, bacterial infections yet treatment of HIV avoids its spread,” said Namigugu, which seems to be his personal stand on the matter.
PREFA also supports other services at Nsangi like antenatal to about 60-100 women per month and Tuberculosis treatment. Namigungu said they were trained to do contact tracing for any TB index case, which requires a home visit and if the client is found negative they do preventive therapy.
For Prevention of Mother to Child Transmission of HIV (PMTCT), which is PREFA’s flagship service, the health facility is also supported and they reimburse transport to midwives and vulnerable mothers.
“PREFA started off with PMTCT but as we go along you find that there are other services needed by the communities that we have to provide or integrate,” said Dr. Bernadette Ssebadduka the PREFA executive director.
To improve on maternal health outcomes, PREFA gives all mothers ‘health passports’ to help health workers track mothers’ birth preparedness plan, said Edmund Mbabazi, a community officer with PREFA. The passports are certified by the Ministry of Health.
PREFA also has an innovation that has since been adopted and formalised by the Ministry of Health. HIV positive mothers form facility based groups, where they share experiences and encourage each other.
The intention is to improve adherence and reduce stigma, said Mbabazi. PREFA also supports youth who come to health facilities to get youth-friendly-services from youth corners in a peer-to-peer style.
Cervical Cancer Screening;
At the Nsangi, although cervical cancer screening was on high demand the health facility had only offered sensitisation but the service was not available until PREFA made it possible.
On the Friday, when PREFA started to offer screening services, about 35 women turned up. “I got the news on wednesday and I started mobilisation,” said Joseph Mubiru a Village Health Team (VHT) worker who works with about 100 VHTs at the Nsangi, Gombolola level.
Mubiru said cervical cancer screening should also be offered to school going children and he has already approached schools like Olympio and Nsangi secondary schools that agreed to the move.
“It is the first time I have done this at this health facility,” said Sister Damalie Kibirige, a senior Nursing officer who was screening. During the screening she had challenges, one of them, no a consultant to compare notes with – which also confirms the need for further training for health workers. She screened 14 women and referred 3.
The cervical cancer screening is a simple test. A clean swab is soaked in 3% to 5% acetic acid and applied to the cervix liberally for at least 1 minute for the acetic acid to be absorbed. Depending on the color change, the results may be VIA-negative, VIA-positive, or suspicious for cancer.
But the bigger challenge was yet to come. As she was carrying out the exercise, women in the waiting area were discussing how the procedure was done. A rumour was circulated that the machine (speculum) is inserted inside the woman’s reproductive parts and it brings out the uterus, which the health worker checks and returns, sort of pulling a drawer peep inside and close.
The rumour was also that the screening was so painful although Nakutudde’s experience was the reverse, ‘ticklish, fast and with no pain at all’.
“Someone preached and the women run away. We made a mistake because we should have sensitised them this morning and explained exactly how the procedure is done,” said Kibirige.
“I urge all parents to bring their children for the HPV vaccine and urge men to allow their wives to come and be screened for cervical cancer. Women should not listen to rumours because this is such a simple, painless procedure,” said Nakatudde as she rushed home to meet with her children and relieve her temporary baby sitter.