Cervical cancer - serious, but treatable

We had the pleasure of having our friends Marit and Hans Olav visiting us earlier this month.  In addition to do the "vacation things", we wanted to utilize the expertise of Hans Olav as an experienced medical doctor.  We therefore scheduled a monitoring visit to one of the NCA supported projects with the headline "cervical cancer".

“Disease Relief through Excellent and Advanced Means” (DREAM) is a project of St Egidio community, supported by NCA.  DREAM has been deeply involved in HIV/AIDS work, but has also started important work to screen and offer early treatment of cervical cancer.  Malawi has the highest occurrence of cervical cancer in the world.  3,700 women are annually diagnosed, while more than 2,300 die every year.  Currently there are considerable gaps between the real occurrence of cervical cancer and the diagnosed cases.   Therefore much work needs to be done to carry out screening among women to detect cases.  If detected early, cervical cancer can be treated with simple methods.

The cervical cancer is mostly due to a virus infection.  The virus is spread through sexual activity, and linked with early sexual debut, multiple partners in combination of illnesses that weaken the immune system, including HIV/AIDS.

With this as background information we took off for Mangochi, just south of Lake Malawi.  DREAM had been conducted training for health workers in screening of cervical cancer and in counselling women with positive diagnosis.  We joined the thirteen participants as they entered into their last session with sharing their experiences and learning.  

Nurse Florence is sharing her experiences from the training

 The trainees came from three districts in the southern region of the country with the highest number of HIV/AIDS cases and cervical cancer diagnoses.  They work in health clinics, partly in hard to reach areas.  They are therefore well placed to reach out to remote communities and offer women the opportunity to come for screening.  

Plans for follow up of the training were shared at the close of the training

Screening is done by applying vinegar acid on cervical tissue.  Resulting colour changes and patterns are interpreted and informing the diagnosis.  The training is therefore much focused on how to interpret these changes and patterns. We met with an enthusiastic and committed group, both men and women.  Interestingly, we were told that it is not a problem in most communities that men carry out this type of screening.  The group was eager to go back and practice what they had learned, determined to contribute to bringing the number of cervical cancer cases in their respective communities considerably down.

 Early detection of cervical cancer can be treated through the Cryo-therapy, through freezing the infected tissues with liquid Nitrogen.  Only some district hospitals in Malawi have such equipment. Many women will have to travel long distances to reach the hospital, and travel and stay away from home represent financial constraints for poor families.  NCA has therefore provided one treatment equipment that can be mobile and brought to clinics in the more remote areas in the southern part of the country. Many more units are needed, but one is at least a start!  

We did not have time to visit any remote clinic, but we visited Mangochi Hospital to see the equipment available in that facility.  The Matron for the Mother and Child department took us around and showed us the screening and Cryo-therapy equipment.  

When women are coming for screening, the hospital is utilizing this opportunity to introduce the women to family planning information and other basic health issues.

 An illustration of family planning methods

The canister with liquid Nitrogen is the main
component of the Cryo-therapy equipment

A week of mourning

Last Friday I visited our NCA colleague Wellington who had been admitted at Kamuzu Central Hospital.  He was in fair spirit, surrounded by family and friends - as is the tradition.  The room was packed.  I left him, hoping to see him back in the office very soon.

Birgit and I left for safari in South Luangwa Natural Park in Zambia with visiting friends over the weekend.  On our way back Tuesday I received a call from my colleague Esther.  On a broken line I asked her to repeat her message, which I did not comprehend.  Her repeating the message left me still without comprehending, but not due to a difficult phone line.  Nevertheless, the reality sunk in: "We lost Wellington!" He had died some minutes earlier on that Tuesday.

The entire NCA team was in shock.  Wellington had been an important colleague for one year, challenging us with his academic strength, advising us on how to be more professional, and encouraging us to put words to what we had achieved but not been good enough to report on.  His contagious laughter was no more to be heard.

As employer NCA was expected to take lead in the preparations for the funeral rites,and the whole team was immediately put to work: including buying coffin, and bringing the body from the mortuary to his home in area 25 in Lilongwe. Our team facilitated the practical arrangements for bringing the body to his home village in Dowa, about 1 1/2 hours north of Lilongwe, and securing transport for the closest family and friends.  Food for the expected crowd to attend the funeral should also be in place before the funeral on Thursday.

Paying the last respect in Wellington's home village

On Thursday, in Wellington's home village, people trickled in during morning hours.  They were invited to pay the last respect, while the diggers were working hard to dig the grave in the village graveyard in the outskirts of the village. While waiting, all hundreds of mourners were treated with food.  After some hours the diggers and their supervisors entered the village in a procession, singing.  Time had come to start the ceremony in the square around which people had waited under the trees and wherever they could find shade for the blistering sun.

The diggers have completed the grave

The coffin was brought, and the speeches, including the village chief, the local parliamentarian, me as his employer, and his local church pastor were delivered.

Mourners gathered around the coffin

Wellington's life, achievement and character were highlighted.  Interestingly, the head chief of the area warned Wellington's family not to claim anything that he left behind:" Let all what he left behind go to his widow and his children, allowing them to grow up and go through school!"  He was obviously referring to the local custom that the deceased's brothers inherit the widow and his assets.

The local chief appreciating the life of Wellington

A local health worker seized the moment when this big crowd was together to share some important health messages, and to announce the arrival of a mobile health team.  The local community police urged people to help them bring to an end an upsurge of crime in the area, that had been experienced as of late.

Time had come to bring Wellington's body to his last rest.  The crowd followed the coffin to the cluster of trees under which the grave had been dug.

The village graveyard under the trees

After having lowered the coffin into the grave, the pastor administered the last rites.  Almost 20 wreaths were laid down as a last greeting.  The long row of mourners slowly made their way back to the village, as the diggers reappeared on the scene to finalize what they had started in the morning.

Returning from the grave, women... and then men

A community had taken farewell with a husband, father, son, friend, colleague, neighbour, member of the church...  The father could not be given back to his three children, but they were comforted and given support in their time of grief and sorrow.  In the midst of being a week for mourning, I was encouraged to experience that African culture has dimensions of solidarity and empathy.  Those vulnerable members of the community are reminded that they still belong to the community, and are not as fragmented individuals left on their own.