Scaling up our service provision throughout Guatemala this year has already made an important impact on our team’s ability to prevent tragic cases of cervical cancer in the lives of women, mothers, sisters, and friends. In June alone, our two mobile units hosted 8 clinics in the Northern and South-western regions of the country, offering preventative services to over 100 women. For 39 year old Olivia from Chivencorral, a farming village in Alta Verapaz, the availability of these services could not have been timelier. Olivia was one of many women survivors of domestic violence in Alta Verapaz who sought integral support from our local partner Ak Yu’Am and attended our cervical cancer clinic at the center. The single mother of three had left an abusive relationship to ensure the safety of her 11, 16, and 19 year old children and herself at Ak Yu’Am’s center.
Using visual inspection with acetic acid (VIA), a technique ideal for low resource settings in that results are instant, to perform the screening, WINGS Nurse Rosa detected precancerous cells. Olivia was terrified, telling Nurse Rosa, “I’m going to die…what will happen to my children?”
Olivia was confused as she visits her local health center each year to undergo a pap smear and never received any negative results in the past. Unfortunately in low resource settings like Guatemala where laboratory facilities are often underequipped, we find that pap smears do not necessarily detect cell abnormalities as effectively as VIA. Nurse Rosa quickly calmed Olivia, explaining that the cells had not yet led to cancer and we would provide cryotherapy immediately to treat the abnormal cells and thus prevent cervical cancer from developing.
Although relieved to know that treatment was available, Olivia was worried about paying for treatment. As a domestic worker, she earns $65 per month which just provides for her family. WINGS was more than happy to forgive the cost of screening and treatment so that Olivia could lead a healthy future and be there for her children.
On the other side of Guatemala, 47 Maria-Filomena returned to WINGS’ mobile clinic in San Pablo La Laguna to undergo VIA. She visited WINGS three years ago for screening and as her results were normal, Maria-Filomena was able to wait three years until her next VIA. However, at our June clinic hosted in collaboration with the Organization for the Development of the Indigenous Maya (ODIM) at one of their two wonderful fixed clinics on Lake Atitlan, Nurse Flori, who conducted the screening three years ago, detected abnormal cells on her cervix and provided Maria-Filomena with immediate cryotherapy treatment. Both Maria-Filomena and Olivia have said that they are recovering (emotionally) from their brief scares and were fortunate to have undergone timely cervical cancer screenings.
Not only do we emphasize the importance of timely detection and prevention, but we also believe in the importance of collaborating with other local NGOs to bring reproductive health services to the most vulnerable individuals. By working together, organizations can share the load, rather than try to take on every issue that arises. Our relationships with Ak Yu’Am and ODIM allow women we meet to receive high quality care for a range of sexual and reproductive health issues, including gender-based violence. We are grateful to these local organizations for their support and look forward to strengthening our collaboration in the future to make sure that women like Olivia and Maria-Filomena get the treatment they need to prevent cervical cancer.
Stay tune for more updates from our cervical cancer program – this month we’re off to Totonicapán in the Western Highlands to offer clinics to women’s weaving cooperatives and local development organizations.
Thank you for your continued interest and support, and for making WINGS' work to spread awareness of and prevent cervical cancer possible.
It is widely acknowledged in the world of sexual and reproductive health that young people require a separate, unique approach when it comes to delivering education and services. There are many barriers young people face concerning access, such as judgement from their communities, families, and/or health care providers, limited or incorrect knowledge, and cost of services/transportation. Some of their key concerns are privacy and confidentiality, followed by quick in and out service. So how do we provide youth friendly services?
First we look at the context. In Guatemala the statistics relating to youth vary from region to region and amongst different populations, such as indigenous versus non indigenous groups. Petén has the highest teenage pregnancy rate in all of Guatemala. Alta Verapaz faces the highest number of maternal deaths in adolescents, with 44% of adolescents giving birth before age 20, and 29% of those births unplanned. More astounding, nearly 50% of Guatemalan women give birth before age 20. And even though 83% of sexually active women between ages 15 to 19 have stated they do not intend on having children within 2 years, only 18% are using effective contraception. These different local situations within the same country necessitate strategies that are aware of the structural barriers and easily adaptable.
For WINGS, the strategy to ensuring adolescents have access to youth friendly services has been peer outreach with strong community support. In many rural, indigenous, and low-income communities throughout the country, few young women and men continue studying past middle school. Take the north for example, nearly 85% of adolescent girls do not complete junior high school which means their access to vital information regarding their health and their rights is extremely limited. Our Youth Leader projects in Alta Verapaz and Petén recognize the limited access to social and educational spaces and trains young women and men to be leaders in their communities who share knowledge about reproductive risk, rights and advocacy, gender inequality, and sexual identity with their peers. Youth leaders develop and offer informal talks to vulnerable peers in their communities, creating safe spaces for adolescents to address stigmatized topics, including sexual violence and ‘machista’ norms, in addition to helping their peers access our youth-friendly health promoters and mobile clinics for their specific sexual and reproductive health needs. These leaders become trusted and reliable sources of information who simultaneously build their self-esteem and become advocates for reproductive rights at the community level.
Using peer outreach this year we can reach 3,600 marginalized youth through informal talks and provide services to a minimum of 450 marginalized youth.
Early this year, WINGS hired its youngest staff members, a 17 year old and an 18 year old who are working as Assistants in the Sierra del Lacandón Park in Petén. Together Dalila and Hector support 20 youth leaders from 10 communities, promote family planning clinics, and seek new ways to engage young men and women to think about their health and their futures: “We see these young mothers and have to remember that they are still girls. Instead of toy dolls, they are now taking care of real dolls. They’re kids taking care of kids. That’s why our work is so important.”
For Dalila, this is more than just a job, it’s about her community’s wellbeing. As one of five siblings and one of the few to have stayed in her small community along the Mexican border, Daly as she’s known, has different plans. “I just started studying social work this year in Santa Elena [the provincial capital]. I want to understand the problems we face, at the root, and fix them.” Daly makes the arduous 8 hour journey to study every Saturday morning and travels daily on dirt roads between communities providing both informal and formal workshops, counselling, and support to youth leaders.
Our youth leaders and young staff members continue to awe us with their commitment to their communities and we are fortunate to have the opportunity to train more youth throughout the country. In June, we were invited by a local NGO Education for the Children Foundation to work with their high school and college scholarship students. Our team organized and led a dynamic activity during the Foundation’s Annual Sexual Education Congress on the topic of 'Responsible Parenthood'. It was a fantastic opportunity to work with a group of young men and women who all have overcome many difficulties to continue their education and break from the cycle of poverty.
WINGS is working hard to ensure young people in Guatemala have access to information and services about sexual and reproductive health that understand their needs and meet them. Moreover, we are increasingly moving towards linking sexual and reproductive health to livelihoods, in order to create long term sustainable change. We encourage our youth leaders and their peers to identify what they want for themselves, what is available within their communities, and what tools they need to fulfill their plans.
As you may have already heard, Guatemala was the first Central American nation to adopt new World Health Organization (WHO) guidelines in late 2014 for cervical cancer which for WINGS and the thousands of women we screen and treat on a yearly basis using visual inspection with acetic acid and cryotherapy, is welcome support. The WHO guidelines recommend cryotherapy over more invasive preventative treatments and also take into account the role the human papilloma virus (HPV) plays in cervical cancer incidence. While vaccinations and tests for HPV remain cost prohibitive in Guatemala, our team of educators and nurses are making every effort possible to encourage women to get screened and get screened early, until we can incorporate HPV testing into our services.
Unfortunately, we recognize how difficult it can be for many women to ask for a screening, let alone visit a clinic or health center. That is why, throughout 2015, we will be increasing the number and geographic reach of our cervical cancer prevention clinics to ensure that Guatemalan women in indigenous, low-income, and rural communities can access information, screening, and treatment to prevent cervical cancer. In fact, we already have 7 clinics lined up for this month.
Flor dropped by one of our mobile clinics last month in Chahal, a Q’eqchi’ Maya community at the crossroads of three Guatemalan provinces. The 29 year old mother of four had been suffering from vaginal pain and wanted to undergo screening to figure out what was going on. Nurse and Project Coordinator Aury found precancerous cells and quickly provided her with cryotherapy treatment to prevent those cells from advancing into a devastating cancer. This month while we were providing follow-up support to clinic attendees, Flor told us, “I feel so much better now. The pain is gone and so is my fear of not knowing. I’ve told my sisters and neighbors that they must get screened, because I cannot imagine what would have happened to me if Aury had not been there to treat me. What would my children do?”
Flor and many women in her community have a higher risk for developing cervical cancer due in part to early child bearing – before age 17, multiple full-term pregnancies, and poverty. Flor, who first became pregnant at 15 and miscarried during her first two pregnancies due to domestic violence and injuries from a bus accident, says “Things were difficult in the past but I left him [her abusive boyfriend]. Now, I just want to be there for my children and help my husband provide them with everything they deserve.”
23 year old Ligia actually attended one of our day clinics in Chimaltenango but instead came for an IUD rather than cervical cancer screening. However, as our nurse Claudia was inserting the IUD, she noticed something abnormal and asked Ligia if she was interested in undergoing our rapid screening. Ligia, who has a one year old daughter, consented but was shocked: "I have a pap smear every year and each time, the results are normal...so I almost could not believe it when Claudia detected precancerous cells."
As worried as she was, Ligia received immediate cryotherapy treatment for those cells and could not be more relieved, “even today, Claudia and the WINGS team have checked up to make sure I am feeling fine, not just after the treatment but daily so that I can live without fear of cancer. I am so grateful that they were able to treat something that would have stopped me from watching my daughter grow up and being there for her along the way.”
We know how dedicated mothers like Ligia and Flor are to their children which is why WINGS is all the more dedicated to these women and their reproductive health. We want women throughout Guatemala to be able to lead healthy and productive futures for themselves and for their children and we believe guaranteeing them quick and quality cervical cancer prevention services is one important step towards those futures. And to make these life-saving cervical cancer screenings and preventative treatments even more accessible, we are in the process of creating a second mobile unit to travel throughout the Guatemalan highlands and southern Coast to offer daily clinics. Stay tune for our next major update in June when we have officially launched the second mobile unit!