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].”
Berta, 29, suffered a terrible loss when one of her four children died as an infant. Now, her two-year-old son is also sick. Berta and her husband, Juan, have spent a lot of money trying to keep him well, but on the combined salary of about $150 per month that they earn as bus drivers, they simply cannot afford to buy all of the medicines that might help him.
This harsh reality motivated them to seek out a reliable family planning method at from WINGS. The couple wants to make sure that they do not bring another child into the world in such difficult circumstances. Berta has been getting a Depo-Provera injection every three months, but explained that sometime the government-run health center runs out, and she is forced to go for months without protection from unintended pregnancy.
“It seems that every day life gets more expensive. We are living with my in-laws to try to save money, but sometimes we still have problems making ends meet. We need time to figure out if we can support more children,” said Berta.
At the clinic, Berta received a Jadelle, a sub-dermal hormonal implant that will protect her from unplanned pregnancies for up to five years. WINGS offers the implant at a deeply subsidized price of approximately $3, and will waive the cost for families who truly cannot afford it, so it is accessible to couples like Berta and Juan. The couple is pleased that they can now focus their resources on their surviving children, without worrying about having to provide for another child in the future.