In the past month, WINGS held a family planning and cervical cancer screening clinic in the town La Libertad, in the department of Tucuru, Alta Verapaz. Two women from the community, Victoria, 36, and Gloria, 29, came to the clinic looking to undergo a VIAA exam, a cervical cancer test using visual inspection with acidic acid. For doña Victoria the results came back normal, however, for doña Gloria the results showed bleeding of the cervix.
The nurse at the community health center shared with WINGS staff that a month prior, four women were suspected of having cervical cancer after abnormal results from a Papanicolaou test, more commonly known as the Pap test. Each woman underwent biopsies and was given information about the importance of cryotherapy as treatment.
However, the women were frightened as they had no previous exposure to such an exam and treatment. Among their concerns were if the procedure would be painful or if it was similar to a surgery. There was also the issue of cost, and finding a health center that performed cryotherapy treatment.
WINGS feels it was truly a miracle to encounter these women when we did and be able to answer their questions, provide reassurance, and ultimately deliver the cryotherapy service.
With the help of the dedicated nurse, we were able to go and find each woman, bring them to the clinic, and provide them the necessary treatment to live without further complications.
Cervical cancer is the number one cause of cancer related death in Guatemala, and yet knowledge of cervical cancer, its causes and treatment, is still very limited. WINGS is committed to providing women with the resources to prevent cervical cancer and ensure healthy futures for themselves and their families.
On February 26, 2014, WINGS held a community leadership workshop in San Cristobal, Alta Verapaz. About 40 representatives learned about family planning methods and management practices to provide for men and women in their communities. Laura,* who had previously been a patient at a WINGS reproductive health mobile clinic, decided to become a promoter in her community:
“My sister got me into it. I had visited her last year and she was going around letting her community know about the WINGS clinic that was going on. She told me about being a promoter and encouraged me to participate, since I’m already a leader in my community and part of a women’s committee.
I decided to go to the clinic first as a patient, since I’d been feeling sick for a while. I’d gone to a few doctors but they weren’t able to tell me what was wrong, so I thought maybe WINGS would be able to help. I’m married with two kids, and my husband was really supportive of me going, since he was worried about what might be wrong with me.”
WINGS recommended that she be tested for cervical cancer, which resulted positive. “It scared me to hear that, but I was relieved at the same time since they told me right there, and told me they would go with me to the doctor.”
WINGS refers patients with positive results to partnering physicians, who perform colposcopies and treatments. However, Laura found out she was pregnant, and would have to wait until after she gave birth to receive treatment.
“Most of what I knew about birth control before the WINGS workshop was false—that they weren’t effective or that they made you sick. My husband and I used condoms, but had gotten careless, and now I’m pregnant! Since I’ve been in the leadership workshops I’m recognizing how important it is not to be afraid to know. I know that I need to talk to my kids about this so that they don’t have the same problems.”
Laura is now a WINGS promoter in her community and counsels men, women and teens about family planning. She says it is a challenge. “Being a leader can be difficult. I deal with women who suffer from domestic violence, who have heard all the wrong things about birth control and are afraid to use it. I try to explain to them what I could have prevented by having the right information, that it is better to know.”
WINGS offers continued support to promoters with monthly follow-up visits and method redistributions, where promoters can have questions answered and better their management skills.
* Name has been changed
Anastasia attended a WINGS clinic to receive a cervical screening, and advanced abnormal lesions were discovered. WINGS referred her to our partner organization APROFAM to receive a colposcopy, which will determine the kind of treatment she will need. WINGS paid for the colposcopy and will also cover the cost of any future treatment that Anastasia might need. This is her story.
In early May WINGS came to my village to do womb exams [cervical screenings]. The comadrona [traditional birth attendant] in our village told us about the clinic and I wanted to have the exam done because I have been feeling very ill – sometimes I have a lot of pain my womb. The WINGS nurses were very kind and patient, and they answered all my questions. I like how they treat us - they speak to us in our own language [Q’ekchi] and they don’t treat us badly or differently in the way that some health workers do.
When they finished the exam I felt very scared and sad, because the lady said I would have to go to APROFAM and have another examination because there is something wrong with my cervix. Today I travelled to the APROFAM clinic with my neighbor – we left our village at 7am and travelled in a minibus to get here. I am very grateful to WINGS for helping me. I was supposed to come to the APROFAM clinic a few days ago to be examined, but because I didn’t have any money I couldn’t attend. I went to the national hospital to try and get treatment but they said that they don’t offer the exam that I need.
WINGS called me to ask why I hadn’t gone to the APROFAM clinic, and said they would help me to get there and pay for the exam. You don’t know how grateful I am for this support. I didn’t know how much it would cost and when I saw the nurse from WINGS pay the fee I felt very grateful, but I also felt bad that I couldn’t pay for it myself – I would never have been able to save up Q200 [$25]. WINGS also helped me with the transport costs, and the nurse stayed with me while the doctor did the exam. On July 17th I will come back to get my results.
I was pregnant eight times, but only six children survived. I never used family planning although I would have really liked to – perhaps if I had had fewer children then two of them wouldn’t have died. However my husband wouldn’t let me use family planning. I am very worried because my husband doesn’t believe that I am ill. When I tell him that I don’t want to be with him [have sex] he gets angry and says that I have another man and that I only stay with him because he maintains me.
I am really grateful to WINGS – you are amazing and I hope that God blesses you and everything you do. I don’t know what to say because thank you isn’t enough. I will remember the kind staff forever, and to the donors who live far away I would like to welcome you into my humble home if you ever want to come to my country. I will greet you in my own Mayan language because I never went to school and I don’t speak Spanish very well. May God bless you and reward you for every woman that you help.
Mariana is the mother of three children and when she was pregnant with her first child her husband started to drink heavily. Also while pregnant, she discovered that both she and her husband had the human papilloma virus. Mariana recently took the decision to leave her husband due to his alcoholism and ongoing infidelity, and came to WINGS to receive a cervical screening. At the clinic we discovered abnormal lesions which we treated using cryotherapy as well as providing antibiotics for a secondary sexually transmitted infection. Because of Marina’s history of HPV we have referred her for a cervical colposcopy with one of our partner organizations. In situations like Marina’s, WINGS covers the cost of follow-up examinations, treatments and transport fees, and wherever possible we accompany the patient on medical visits.
Mariana told us:
“Because I had HPV before, I wanted to know how I am now, but I was ashamed and scared to get examined at the public clinic. I had been very shocked and frightened when the doctor told me how you get the illness [it is a sexually transmitted infection] but I was too shy to ask him any questions. I heard that WINGS would be coming and so I came today to get an exam. After hearing the talk that WINGS gave before the clinic I understood better what human papilloma virus is. The talk was very easy to understand and I felt comfortable because it was delivered by women and they spoke to us in our own language [Q’eqchi]. The doctor who first told me that I had HPV didn’t explain anything to me and I didn’t understand what it meant, but now I understand that it can cause cancer of the womb and that it is important to get tested often. Bringing clinics and family planning to communities is a great help for us.”
“The women who examined and treated us were very kind and gentle, and they can’t imagine how grateful I am. Finally I will be able to know whether I am healthy and move forward with my life.”
Sylvia Rodriguez sits on the foot of her white-linen clad bed at the Hilario Galindo Hospital in the Western Guatemalan state of Retalhuleu, seemingly at peace with her sterile surroundings. At only 24 years old, Sylvia has gone through more physical and emotional pain than most people experience in their entire lives, but she refuses to let the negative overshadow the positive, even only an hour prior to a hysterectomy ordered by her oncologist.
Sylvia’s hysterectomy is actually part of her treatment – she has a very advanced form of cervical precancer.
These recent events have been only part of a series of loops and corkscrews in the rollercoaster of Sylvia’s life. When she was eight years old, her mother died from a similar form of cervical cancer. Left with her father, she and her brothers were mentally and physically abused until they collectively decided to save themselves by leaving their father and moving in with their grandmother. And just four months ago, Sylvia lost her husband of eight years to his battle with rectal cancer, leaving her to care for her three children by herself.
Earlier this year, Sylvia attended a WINGS-organized screening in Cotzumalguapa after hearing a WINGS Educator, Flory, deliver an informal pre-educational seminar on cervical cancer. Sylvia recalls, “I was scared that I showed many of the risk factors that I was told about – for example, my mother had cervical cancer, and I started having unprotected sex at a young age with multiple men, because I was never exposed to responsible sexual health when I was growing up.”
Sylvia went through the screening, which includes visual inspection of the cervix with acetic acid and treatment of cellular abnormalities using cryotherapy (VIA/Cryo method), subsidized by WINGS. Unfortunately, the screening revealed a lesion on her cervix – far too advanced for the cryotherapy to be effective. Flory referred her to an oncologist in the area to continue testing and treatment.
An additional biopsy, colposcopy, and loop electrosurgical excision procedure (LEEP) gave Sylvia the prognosis she had been hoping to avoid: she had severe dysplasia (CIN III) on her cervix, prompting the oncologist to recommend relocation to better facilities and an emergency total hysterectomy. The lone bright spot was that preliminary tests concluded that the cancer was localized to the cervix, so a hysterectomy would theoretically leave Sylvia cancer free.
“When I found out, I felt desperately sad and alone. But if it wouldn’t have been for WINGS and their Cervical Cancer screening in Cotzumalguapa, I would have never known about my condition, and I wouldn’t have this opportunity to beat it,” she told Flory, the WINGS Educator that has stayed by her side. Flory came with Sylvia to give her the support she needed, in the absence of her late husband.
Sylvia, with her hands placed lightly in her lap and her chin held up, looked out the single window onto the adjacent wing of Hilario Galindo. “This procedure is a second chance at a healthy life with my kids."
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