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."
Like many of the women WINGS serves, Elena, 20, made a long journey to reach us. Guatemalan communities, especially in the isolated rural areas targeted by WINGS, are often very small and scattered throughout the countryside, making it logistically impracticable for WINGS’ mobile unit to reach them. While field educators do conduct educational outreach in these difficult to access areas, WINGS schedules mobile unit visits in slightly larger communities that both have necessary facilities for a temporary clinic and are accessible to those living in the outlying villages. Elena walked two-and-a-half hours with her son to reach her village’s nearest health center, where WINGS held a mobile medical clinic.
When she heard a radio announcement about WINGS nearby clinic, Elena decided to see what she could learn. She proudly reported that she now knew that “all women need to do this [cervical] exam to avoid getting cancer,” but was nervous because she did not have any money to pay for the service. WINGS charges women Q10, or about $1.25, for a cervical cancer prevention screening, but will not turn away a patient, like Elena, who is unable to pay. WINGS screened Elena and her results were negative for pre-cancerous cervical cell abnormalities.
“I am so happy and grateful that WINGS helped me get tested even though I do not have money. If I didn’t come to this mobile clinic, I would not have gotten screened at all. It is too difficult to go to San Cristobal [the nearest bigger town where they offer exams].”
The Tall Pines League is a group made up of the leaders in 12 communities formed a year ago to promote camaraderie between their villages and improve intrafamilial relationships.
Gavino, one of the leaders, explains, “We saw a lot of violence in the community, including domestic violence, and young people without recreational opportunities. We wanted to create opportunities to bring families together.”
The group decided that a soccer tournament would be a good start. The men, women, and children of the community enjoyed the experience playing and watching the matches, but when rainy season came along, the group looked for another activity to engage their communities and try to decrease the level of violence.
Although the majority of their group is made up by men, their conversations revealed that women’s health was an area that was being overlooked. By dedicating an activity specifically for women, the leaders hoped to emphasize a women’s worth in her family and her rights as a citizen. As a result, the leaders contacted WINGS and the organization came to give a talk about cervical cancer prevention.
At first, only the wives of the men in the League came to the talk to learn more about cervical cancer and to get tested for cervical abnormalities. To confront the taboo in the community that has prevented open discussion about sexual and reproductive health, the League had to intensify their actions to recruit women participants for the activity. Each League member committed to talking to at least five women before the next WINGS talk.
WINGS supported the group with information and materials and the League met with groups of women to explain a bit about cervical cancer. They purposefully used their native language, Kakchiquel, in their outreach to ensure that the women received the information in the language with which they are most comfortable.After vigorous recruiting work by the community leaders, the house was packed with women wanting cervical cancer screenings.As a result of their efforts, the WINGS’ team held an additional four cervical cancer prevention talks. At each talk, there were more than 50 women in attendance.
Roberto, another representative of the League, expressed his appreciation: “We feel very satisfied. We didn´t think that it would be like this because convincing people in this region can be difficult. We believe what we are doing is a service to the community because it has shown that the women deserve to be included and respected. We dared to worry about women’s health because no one else does, not even the government.”
We at WINGS are inspired by the Tall Pines League. The leaders of the League challenged taboos and traditional gender roles in their communities, all for the good of women’s health and cervical cancer prevention.Gavino, of the League, says, “I could say a thousand words to thank WINGS, but really I only need four: Thank you very much!”
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