2016 marks the 10 year anniversay of WINGS' development and implementation of a cervical cancer program using the screen and treat visual inspection with acetic acid and cryotherapy method (VIA-cryo). Prior to 2006, WINGS provided nearly 5,000 referrals a year to a national partner organization for pap smears. As high as the need was and remains for these services, what we realized early on is that in a low-resource setting like Guatemala, the traditional pap smear was not the best or most practical option for women from rural, indigenous, and low-income villages. Why not? Because first and foremost, there were and still are so few adequate facilities and competently trained lab technicians to read pap results. Second, unlike in the United States, there is quite a bit of lag time in preparing the results to share with each woman. And finally, because the results are ready up to a month after the initial pap, it was often difficult to communicate with each woman in question to provide her with a positive or negative result: many did not have cell phones, clear addresses, or even live near the facility in which they underwent the pap smear.
VIA-cryo is a wonderful alternative because it can be performed outside of a clinical facility, including in many of the remote jungle and mountain settings we work in, and provides immediate results. Same-day treatment is provided for pre-cancerous lesions while more advanced cases, including women suspected to have cancer, are referred to a partner gynecologist for further examination (biopsies, colposcopies) and treatment. Moreover, international guidelines recommend that women who have a normal result do not need to return for an examination for 3 years.
We provide VIA-cryo through two service components: daily mobile clinics in communities and stationary clinics in peri-urban areas. The ease and availability of this service means nearly 4,000 women visit our clinics on an annual basis for cervical cancer screenings. As pleased as we are to see women arriving daily at our clinics for screening, we know one major issue remains in our path to making preventative cervical cancer screenings a norm in Guatemala: a fatalistic view of cancer, and cervical cancer specifically, among many Guatemalan women. Fatalism tends to be more damaging after a woman has undergone screening and does in fact have a positive result or suspected case of cancer. In many communities, people believe that they do not have control over their future - that cancer is part of their destiny. Take 28 year old Carmena who we met in our mobile clinic in Zacualpa, Quiché. The mother of one had been struggling to conceive as she and her partner are ready for their second child, so she thought it best to undergo a screening and see if our team could detect anything. Unfortunately, we did.
The young mother has what our team refers to as a "suspected case of cancer" and was given emotional counselling by our team and immediately referred to a more advanced medical facility in her area so that the appropriate course of treatment could be determined. Carmena has been hesistant to actually visit the medical facility because she thinks it's her fate. This is an indication for our team that so much more needs to be done in addition to making services accessible: Guatemalan women need to know and understand that they can have a say in their health, their lives, and their futures, and in this case, following through with a screening or treatment is the first hurdle.
Both our medical team and our Reproductive Health Educators are working with Carmena to help her move beyond the idea that cancer is her fate so that she can go forward with a treatment plan and be there with her daughter. Learning from Carmena and other similar cases, our team is all the more dedicated to ensuring that women in Guatemala understand they have a right to health which does not stop at a positive diagnosis.
Thank you for standing with WINGS and bringing vital cervical cancer education and screening to vulnerable women in Guatemala.
In Guatemala, 58.1% of youth become pregnant for the first time before age 18, leading to one of the highest adolescent fertility rates in the region: 92.4 births per 1,000 girls between ages 15 and 19. All the more shocking is that over a quarter of young women between ages 15 and 24 express an unmet need for family planning. This means these young women do not want to have a child right now, but are not using contraception.
We ask ourselves why, if these girls and young women do not want to have a child right now, are they not taking preventative measures as simple as taking birth control? Unfortunately, the reality in Guatemala is not that simple. Stigmas, misconceptions, and administrative barriers often impede young women and even men from not only learning about their sexual health, but buying and properly using any form of birth control. In fact, one of the biggest issues we see is that one too many healthcare providers do not treat youth with the respect they deserve. Rather, questions and doubts are dismissed and young women and men are turned away because ‘they are too young’ or ‘they need permission’. While WINGS has worked throughout the years to ensure the availability of accessible information, most recently through our networks of youth leaders, making services ‘youth-friendly’ remains the bigger challenge.
But we are happy to report, that we are overcoming that challenge: between March and December of this year, our local family planning promoters and mobile units saw a 234% increase in the number of not-in-school youth deciding to use birth control. 131 more young women and men chose to protect themselves from early pregnancies (and in many cases, sexually transmitted infections) in the past nine months. Among those 131 youth, was Ana-Antoineta from Morelia, a mountainous village in the Western Highlands accessible only by a muddy dirty road. At 19 years old, the mother of two was unable to learn about birth control, let alone receive any kind of health services in her rural community. Fortunately, WINGS’ Family Planning Promoter Enma who lives in nearby Vista Hermosa decided to organize a mobile clinic with our medical team. Our two nurses and driver made the bumpy journey, crossing an overflowing river during the midst of Guatemala’s rainy season, to provide highly effective long-acting reversible birth control to 18 women, as young as 19 year old Ana-Antoineta and her neighbor Delfina, a 16 year old mother of one.
We know in many cases that we are helping women prevent their second pregnancy which is equally as important as enabling girls to postpone the first pregnancy until they are mentally, physically, and emotionally ready to be mothers. Girls and young women who give birth at an early age are more likely to become multiparous earlier than their counterparts who become pregnant for the first time later in life. Not only do pregnancies at an early age and multiparity increase reproductive risks for these young mothers, but also, are major risk factors for developing cervical cancer, the leading cause of cancer-related deaths among Guatemalan women.
Many young women like Ana-Antoineta do not have the opportunity to continue studying, earn a decent living, and perhaps build the future they once dreamed off, but instead are now making responsible decisions to invest in the futures of their children. Ana-Antoineta was so grateful for finally having access to family planning services that she has started talking to her family and friends about their options so that they have the freedom to plan their lives as they see fit.
So how do we make it easier for youth like Ana-Antoineta to learn about and decide on available family planning options? We make sure that everyone involved in the chain of services willingly creates a supportive environment for these often nervous young women and men. From your neighborhood promoter Enma and youth leader Alejandra who will offer you counselling and answer any of your questions in a kind receptive manner, to our mobile staff that will travel by whatever means necessary to make sure the service is available in your community, and to our entire team that has made the decision to provide all services to youth between ages 14 and 19 for free, we are committed to making sexual and reproductive health information as accessible and friendly as possible.
And it is only through the support of donors like yourself that we are able to carry out our work. So thank you for your continued support and for standing with WINGS in bringing sexual and reproductive health information and services to the most vulnerable in Guatemala.
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.