WINGS permanent clinic is in full swing here in Antigua! This past month we held back to back clinics offering cervical cancer screening and treatment of precancerous lesions to women from both nearby and remote communities. Despite the rain, over 60 women attended the clinics, many bringing their 1 or 2 children along!
Cervical cancer when detected early is treatable. There is absolutely no reason why any woman should die of cervical cancer today. However, because basic information about cervical cancer is non-existent in so many rural villages and services are equally limited in developing countries, cervical cancer remains a preventable tragedy. In Guatemala, cervical cancer is the leading cause of cancer-related death among women. And regionally, a woman in Latin America is 3x more likely to die from cervical cancer than her North American counterpart (PATH, 2014). This dark reality is what we are trying to change through outreach, mobile services, and now, an easy to reach stationary clinic.
Maria, 45 years old, and a mother of eight, came to WINGS looking for answers. During an informational talk about cervical cancer, the screening procedure, visual inspection with acetic acid (VIA), and cryotherapy treatment for precancerous lesions, Maria raised her hand to ask what the risk factors for cervical cancer are. She also wanted to know if heavy, continued bleeding is normal or indicates something is wrong. Based on Maria´s concerns, we knew she needed an immediate examination.
During the consultation prior to screening, Maria explain that 9 years ago she was diagnosed with a vaginal infection, but at the time could not afford the prescribed treatment. Since then, she never returned to see a doctor or receive treatment. WINGS examined Maria, referred her to a partner clinic to undergo a colposcopy, and when it resulted that she would require surgery, we accompanied her through the pre and post surgery process.
As is often the case, women in Guatemala seek medical care only when something is clearly wrong, as in Maria´s case. Preventative care, such as routine cervical cancer screenings, are deemed unnecessary, in part due to the costs and difficulties in accessing these services. Thankfully for Maria, treatment was still an option and with our team, affordable. We know Maria is lucky and unfortunately this is not the case for far too many women in Guatemala. Thus, we will continue to urge women to take a proactive role in their health and make it easier for them to do so.
Our dedicated team is out visiting different communities every week, talking with women about the real risk of cervical cancer and the importance of regular screenings, and following up with them so they feel comfortable attending our clinics. Thankfully, cervical cancer awareness is growing, as evidenced by high attendance at our clinics this year. Between January and June, WINGS staff performed 1,131 screenings, reaching 52% of our annual projection. And we couldn’t have done this without you.
Thank you for your support and for making reproductive rights a reality in Guatemala.
Since January 2015, WINGS is proud to offer voluntary surgical contraception (tubal ligations for women and vasectomies for men) as one of our valued reproductive health services. We have seen an overwhelming need for these services throughout Guatemala with many women and men having wanted a permanent procedure for some time, but unable to find affordable care. We are both surprised and encouraged by the number of men, 37 so far, who have chosen a vasectomy, as we anticipated performing 10 vasectomies throughout all of 2015. Our incredibly subsidized prices have allowed numerous men and women to access their contraceptive method of choice.
In spite of these initial successes, we know many barriers remain to acceptance and use of permanent contraception in Guatemala, especially for men. Besides cost, men confront misconceptions and stigmas about vasectomies such as they cause impotence and they are emasculating. It is a commonly held belief in Guatemala that the size of one's family reflects a man's worth, therefore, limiting the number of children a man could have undermines his worth. Secondly, male involvement in family planning is not only limited in Guatemala, but also a taboo. Family planning is believed to be a woman's issue and therefore, it is her responsibility to use a method.
Despite these barriers, 22 men came to our vasectomy clinic in Antigua this past month and underwent the quick procedure. Daniel was one of the first men to arrive, accompanied by his partner, Gaby. Daniel and Gaby live in Guatemala City, an hour away from our office, and had been interested in a vasectomy for a long time but unfortunately nearby services were always too expensive, over $150 in a country where 43.5% of the population survives on less than $450 per year. They planned to wait until they saved enough money for the procedure but luckily, Gaby heard about our clinic in Antigua, where we asked men for only a $ 6.50 donation for their procedure.
Gaby quickly let Daniel know so that he could take time off work and the couple arrived at our clinic grateful for the opportunity they were given. Daniel told us that he never had any children, but he and Gaby are parents to her 10-year-old daughter from a previous marriage.
Daniel and Gaby feel very happy with the family they now have and together made a decision not to have any more children. Daniel confessed that, although he considers himself an open-minded and progressive person who is not afraid to speak his mind, he decided not to share his plans about having a vasectomy with anyone until after the procedure.
“My family and friends think a man should have children. If they knew I was planning to do this, they would have tried to convince me to change my mind. But I feel that my parents and grandparents didn’t raise me to blindly follow society’s norms. I believe a man or a woman has a right to make their own decision about if and when they want to have children.”
Kevin, who arrived shortly after Daniel and Gaby, made the decision to have a vasectomy to make sure his wife Vivian can lead a long, healthy life.
Vivian had serious complications during her first pregnancy. For months her feet and face were severely swollen, she was extremely weak and was advised to rest. During labor Vivian lost consciousness twice and had to be revived by the attendings - she nearly died during delivery.
Luckily, Vivian made it through labor and she and the baby are now doing well. However, the attending doctor told the couple that if Vivian becomes pregnant again, she may face life-threatening complications during the pregnancy. Considering what his wife suffered while delivering their child, the couple wanted a real solution to preventing future pregnancies. Tubal ligation was out of the question due to the high risk of complications for Vivian. Kevin didn’t want his wife to have to take hormones for years, and since they were both sure they didn’t want to have anymore children, he offered to have a vasectomy. The couple struggled to find affordable services in their area, but, having heard of WINGS’ clinic, they decided to call one of our team members to reserve an appointment for the procedure.
Post surgery, Kevin and Vivian shared how happy they are now that they don't have to worry about future pregnancies putting Vivian´s life at risk.
Later in the day, 50 year old Roger came to the clinic. A veterinarian by trade, he works for a large dairy company and spends much of his time organizing clinics to care for animals. Roger and his wife who have 3 children between 10 and 14 years of age decided their family size was just right and started looking into their contraceptive options.
The day of the vasectomy clinic, Roger shared his thoughts about family planning with WINGS, “In Guatemala, the idea of men being involved in family planning is a huge taboo. The idea that ‘a man is no longer a man” after having a vasectomy is very common.” He believes that a lack of information is to blame for these misguided ideas.
Roger opposes the machismo culture in Guatemala which means women would undergo the operation, not the men. “Women are expected to do everything, men nothing...just lie on the sofa” he says.
Pleased with his decision to have a vasectomy, Roger believes he and his wife can provide for their children and offer them everything they need to have a head start in life.
We congratulate Daniel, Kevin, Roger, and all the men who have chosen to take an active role in the health and future of their families, setting an example for other men, and breaking down barriers to reproductive health in Guatemala.
Thank you for your support and for making reproductive rights a reality for all in Guatemala.
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.