This past December, Guatemala became the first country in the region to adjust its guidelines for the screening and treatment of cervical cancer in alignment with new recommendations from the World Health Organization. This is a huge step in the right direction. While in much of the developed world death as a result of cervical cancer is uncommon, it is still a real issue in Guatemala and other developing countries. Cervical cancer is the leading cause of cancer-related deaths among Guatemalan women of reproductive age.
WINGS will follow the Ministry of Health’s lead and implement the new guidelines into our own work with cervical cancer. The new guidelines take into consideration the limited resources many developing countries face, and recommend VIA-visual inspection with acidic acid- as a highly effective tool in detecting the presence of cancerous lesions. While WINGS has been using VIA to detect cervical cancer since 2006, we are excited to see this form of screening adopted by national health institutions and other NGOs. Results with VIA are immediate, which eliminates the need for women to wait or return the next day for their results and/or treatment.
The primary cause of cervical cancer is the human papilloma virus, or HPV. There is a serious gap in HPV related data for women in Guatemala, particularly indigenous women. WINGS Board member and retired OB/GYN Roger Duvivier recently participated in a study to obtain current data on the prevalence and strains of HPV in the underserved indigenous population of highlands Guatemala. And based on this study, roughly 50% of indigenous women harbor some form of the virus. While no nationwide plan is in place to distribute the HPV vaccination, further studies such as this one, will set the stage for such a campaign.
With vaccination, regular screening, and treatment, no women should die of cervical cancer. In 2014, WINGS held 82 medical clinics, in which over 2,000 women were screened using VIA for cervical cancer. 51 cases required treatment for lesions using cryotherapy. WINGS is determined to continue spreading awareness of cervical cancer among the underserved, indigenous population in so that no more women die unnecessarily from this treatable disease.
During September WINGS held our biannual family planning and cervical cancer prevention clinics in El Tejar, Chimaltenango and Antigua. Each clinic lasted two days and offered both long term family planning methods, specifically the Jadelle sub dermal implant and the copper IUD, and screenings for cervical cancer at extremely subsidized costs.
Generally, WINGS offers such clinics in Alta Verapaz where the population is mainly rural indigenous, as the more urban departments in Guatemala typically have more options available when it comes to reproductive health. However, as seen by the large turnout of women that attend our clinics in Chimaltenango and Antigua, there is still great need for WINGS services in semi-urban areas.
At our Antigua clinic, we received a group of 50 women from Escuintla, who first walked over an hour to reach the nearest bus stop, many with a baby strapped to their back or a toddler in tow, and then traveled an additional 2 hours by bus to attend. Another group of 25 women came from a local nonprofit, Camino Seguro, in Guatemala City, and were so pleased with WINGS care that future collaboration is being discussed.
To begin each clinic, WINGS nurses give a short talk about the methods being offered and the importance of getting screened for cervical cancer. Women are given the opportunity to voice any concerns or questions they may have about any of the services before deciding which they would like to use. It is very common that a woman comes to the clinic looking only to use a family planning method, and decides to do the cervical cancer exam as well, or vice versa.
In total, WINGS attended to 233 women throughout the 4 clinic days.
We performed 173 rapid cancer screenings, and implanted 76 Jadelles and 10 copper IUDs.
Thankfully treatment for precancerous lesions was only necessary in 2 cases.
We are encouraged that 20% of women in attendance were under 25 years of age, demonstrating interest from younger women in taking action concerning their reproductive health.
*For more photographs from our recent clinics, visit WINGS´ Facebook page.
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.
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