Health
 Guatemala
Project #2501

Prevent and Detect Cervical Cancer in Guatemala

by WINGS
Vetted
Ana Isabel and her son
Ana Isabel and her son

Ana Isabel is a 31-year-old mother of three from the rural community Pueblo Viejo. She spends her days caring for her home and children, while her husband works in the fields. Ana Isabel had her first child, a baby girl, at the age of 20. It was an unplanned pregnancy, as she knew almost nothing about family planning methods at that time. “Back then, this wasn’t talked about. I don’t know why; but even our parents didn’t talk to us about it. And on the occasions when our parents did talk about these topics, they would ask us to leave the room or they would send us somewhere else where we couldn’t hear anything. We were told that it was adult stuff, so they refused to talk about it.”

After her first pregnancy, Ana Isabel started to hear a bit more about contraceptives from other people in her community. But all the information made her believe contraceptives were dangerous. “I heard about birth control, but I was afraid to use it because people told me that it caused diseases. I was also told that it would dry up my cervix and that I wouldn’t be able to have kids after, so I got scared.” Eventually, after her third child Ana Isabel began using the 3-month injection to plan her family and continued using that method until recently, when she decided she wanted to have another child.

A woman in Ana Isabel’s community told her that WINGS’ mobile medical team would be offering a family planning and cervical cancer prevention mobile clinic in their community. Ana Isabel decided to attend and undergo a cervical cancer screening. She shared, “…the reason I wanted to get a cervical cancer screening was that I can’t manage to get pregnant, and I would love to have another baby.” Ana Isabel admitted that before the mobile clinic, she didn’t actually know what cervical cancer was, but thought she might have some illness and maybe WINGS could help. “Sometimes, because of ignorance, we don’t know what goes on inside us, and we can’t afford getting a checkup. So, when a mobile clinic comes here, we have to take advantage of it because it helps us. We can’t go to hospitals because it would be too expensive, and here, we don’t have the means to afford those services.”

Thankfully, the results of Ana Isabel’s cervical cancer screening were negative. WINGS’ nurses did detect a common sexually transmitted infection during the exam, and gave Ana Isabel counseling and treatment for herself and her husband. WINGS’ mobile team is happy to have provided reproductive health services for Ana Isabel, which she could not afford elsewhere. Ana Isabel left well-informed about her personal health and with the reassurance that she did not have cervical cancer.

Cervical cancer is the number one cause of cancer related deaths in Guatemala and there are still many women in need a screening. As a solution, WINGS' Mobile Units travel to many remote, rural communities each month to provide long-acting reversible contraception and cervical cancer prevention services. It is thanks to you that we can reach out to so many people in need; your support is crucial in helping us save lives from cervical cancer.

Nurses set up mobile clinic in Tecpan
Nurses set up mobile clinic in Tecpan
Ana Isabel during mobile clinic talk
Ana Isabel during mobile clinic talk
Ladies waiting for a cervical cancer screening
Ladies waiting for a cervical cancer screening

Despite it being treatable if caught on time, cervical cancer is the number one cause of cancer-related deaths in Guatemala. This tells us that the majority of women in Guatemala do not get screened in time to save them from an early death. WINGS works daily to change this reality. In both our stationary and mobile clinics, our nurses provide cervical cancer screenings for women throughout rural Guatemala. If we detect cancerous cells during the screening, we provide immediate cryotherapy treatment. If the cancer is more developed, we follow up with the patient and provide resources so she can go to the hospital and get further treatment. We also have volunteer family planning promoters in communities, and they are crucial in saving women from cervical cancer.

Etelvina has been a volunteer family planning promoter at WINGS for 8 years. She started working with WINGS because she is passionate about supporting her community, Santo Tomás Milpas Altas, especially women who need guidance. When women have reproductive health concerns, Etelvina encourages them to take action and seek help, and counsels them so they feel less nervous about this very taboo topic.

Etelvina told us that the public health center in her community is in very poor condition; it lacks resources and trained staff to provide accurate counseling. When women seek reproductive health services, the staff at the health center does not provide accurate or sufficient information. That is why Etelvina takes matters into her own hands and helps her community as much as she can.

As a volunteer promoter, Etelvina focuses on family planning services, specifically preventing unintended pregnancies and helping women space their pregnancies. As part of her role with WINGS, Etelvina also coordinates several mobile clinics for her community each month. She encourages women to undergo cervical cancer screenings. Many women have shown positive results in their screenings. Fortunately, these pre-cancerous cells have been detected in time and are treated on the spot with cryotherapy.

 Etelvina shared with us the story of Ines, a 26-year-old woman who came for a screening and needed treatment beyond cryotherapy. Thanks to Etelvina’s follow up with this woman, we were able to coordinate chemotherapy sessions and cervix removal through another institution. To this day, Etelvina visits Ines to make sure she has fully recovered and is in good health. When asked why she thinks cervical cancer is the number one cause of cancer-related death in Guatemala, Etelvina knew the answer immediately; “Women in Guatemala are scared of going to the doctor for a check-up. These are conservative women, and they feel that the procedure is very invasive. They are also afraid that the result of a cervical cancer screening will be positive, so they would rather not know. I always tell them that if they get tested on time, there’s a solution and treatment for them.”

Etelvina is one of sixty volunteer family planning promoters that support WINGS in providing reproductive health services to those who could otherwise not access them. It is thanks to these great women that people in the most rural, remote areas get access to reproductive health services. Furthermore, it is thanks to you that our family planning promoters get a chance to make such a huge impact in their communities. Thank you for helping us save lives in Guatemala. 

Family planning promoter Etelvina
Family planning promoter Etelvina
Etelvina babysitting while a patient gets screened
Etelvina babysitting while a patient gets screened
Nurse Rosy during a talk about contraceptives
Nurse Rosy during a talk about contraceptives

In Guatemala, cervical cancer is the number one cause of cancer-related deaths among Guatemalan women. While the disease is preventable and highly treatable if detected early, in countries like Guatemala where healthcare is largely inaccessible, it’s a grim story. Inadequate health centers, lack of knowledge, and geographic barriers make it difficult for women to get screened for cervical cancer in Guatemala.

Ten years ago, WINGS developed its Cervical Cancer Prevention Program to overcome these challenges by providing visual inspection with acetic acid and immediate cryotherapy treatment for pre-cancerous cells. We continue to offer these life-saving services in stationary clinics in Sololá, Cobán and Antigua, and through our mobile clinics, which travel to the most remote areas of the country to reach underserved women. We have provided lifesaving services to improve the lives of thousands of women in Guatemala, even within our own team! 

41 year old WINGS’ Nurse Rosy was born in a rural community in San Cristobal, located in northern Guatemala. Rosy travels every month with our mobile team to provide family planning information and contraceptives to the most remote areas of the country. Like many of the girls and women we serve, Rosy has faced many challenges in her life. When she was only 15 years old, her family forced her to marry a man who turned out to be abusive. Sadly, in Guatemala it is very common for young girls to be married off without their consent. Rosy suffered through her marriage because, similar to many women in her situation, she didn’t have a say in any decisions. Although Rosy was finally able to separate from her husband, the difficulties persisted. As a single mother, Rosy had to figure out how to make ends meet so she could feed her four children and send them to school. Luckily, her former father-in-law was very supportive and encouraged her to go back to school.

Rosy and her family had never received any information about reproductive health and prior to resuming her studies, she knew very little about her own health in general. As a child, she lost her mom and aunt to cervical cancer. Neither had ever been screened and Rosy was terrified that the she would face the same health burden. However, as an assistant nurse providing these important services throughout Northern Guatemala, Rosy decided to undergo a screening with our team. Unfortunately, our staff discovered abnormal cell growth which could lead to cancer, but our team treated Rosy immediately.

As Rosy shared with our team that day, “I am truly grateful to WINGS for supporting me and allowing me to keep being a mother to my children. I now have my nursing diploma and I am so proud to be able to help people who need it. I am thankful for the opportunity to work with WINGS; I love every part of my job. I give educational talks to different communities in my native Mayan language; I provide different birth control methods; and I screen women to help prevent cervical cancer. This work is so important and I hope that I can keep doing it forever.”

Like Rosy’s aunt and mother, there are thousands of women in Guatemala who do not know about the causes of cervical cancer and how to prevent it. WINGS has worked endlessly to change this and provide information and reproductive health services to Guatemalan women in need. In 2015, we surpassed our cervical cancer screening projection by 141%, ensuring that 3,062 women were able to undergo preventive screenings.  And in the first three months of 2016 alone, we have already provided 496 cervical cancer screenings.

It is because of supporters like yourself that we are able to provide these imperative services, saving thousands of women from cervical cancer in Guatemala. Thank you for believing in the work WINGS does!

Rosy giving a talk about cervical cancer
Rosy giving a talk about cervical cancer
Rosy explaining cervical cancer at a mobile clinic
Rosy explaining cervical cancer at a mobile clinic
Educational talk before cervical cancer screening
Educational talk before cervical cancer screening

If caught early, cervical cancer is highly treatable. However, it is the number one cause of cancer-related death among Guatemalan women.

There are many reasons why fighting cervical cancer is so difficult in Guatemala. For one, there is an obvious lack of access to health centers, especially in rural areas, where people are predominantly poorer than in the rest of Guatemala. In fact, more than half of Guatemala’s population lives in rural areas, and the rural poor account for more than 70% of the country’s poor population. Additionally, transportation to a place where women could potentially get a cervical cancer screening is also very unlikely. Not only do rural areas lack proper roads, but there are many villages where public transportation simply does not exist.

Education is also lacking; especially in rural areas. Indigenous girls attend school, on average, for only three years of their lives. Even for those who do attend school; it is most likely that they will not receive education about reproductive health in general, let alone information about cervical cancer. With Guatemala being such a conservative country, reproductive health education and family planning have never been a priority. This results in many women not knowing about the risk factors for cervical cancer, or the importance of getting screened. To make matters worse, those who do need treatment for cervical cancer can rarely afford it. The poorest people in Guatemala live on approximately $2 per day, which simply does not permit paying for treatment, when there is a family to feed and other basic needs to meet.

Take Gabina Sajbin. She is 25 years old and she has three children. She’s from Ximaxox, a very remote village in Quiché. Gabina wanted to get a contraceptive method and a cervical cancer screening, but she thought she did not have enough money to afford both, so she chose to get a contraceptive method first. Gabina had been in constant pain and discomfort for the past few years. She got a pap smear two years ago, but never received the results. Her mother, the local midwife in their town wanted to help Gabina, but there was no medical facility within reach. Thankfully, WINGS held a mobile clinic in Gabina’s town, and once we found out about her financial concerns, we covered the costs of her services.

Gabina’s cervical cancer screening came out positive, but WINGS’ mobile clinics are prepared to provide immediate treatment of pre-cancerous cells using cryotherapy, so Gabina received treatment on the spot. We noticed that it was challenging for Gabina to understand certain words because Spanish is not her first language, but thankfully one of our staff members speaks Gabina’s native tongue, Quiche. This gave Gabina the opportunity to fully understand the importance of screening, the disease progression, and the treatment. To this day, we are still in contact with Gabina, making sure that she gets the attention and treatment she needs.

There are so many women in need of screening and treatment in Guatemala, but lack of resources and other challenging life circumstances create significant barriers to access. WINGS breaks down these barriers in many ways. We provide talks and training that explain the risk factors of cervical cancer, the disease progression, treatment, and the importance of screening. We also reduce our patients’ financial burden by providing low-cost, high quality services made possible through generous donations to WINGS. Last but not least, our mobile clinics are key; if a patient cannot come to us, we will go to them. Through our mobile clinics, we are able to reach people in the most remote, rural areas of the country, in the hope that more Guatemalans can get the medical attention and services they need. In 2015, WINGS surpassed its cervical cancer screening projection by 141%, screening 3,062 women. And just in the first three months of 2016, we have already done 496 cervical cancer screenings.

 Thank you for standing with WINGS and bringing vital cervical cancer education and screening to vulnerable women in Guatemala.

WINGS doing outreach in rural Guatemala
WINGS doing outreach in rural Guatemala
WINGS nurse and a patient during our mobile clinic
WINGS nurse and a patient during our mobile clinic
Raising awareness for women
Raising awareness for women's group

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. 

Healthy mothers, healthy children
Healthy mothers, healthy children
Educational talk about cervical cancer
Educational talk about cervical cancer
 

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Organization Information

WINGS

Location: Antigua, N/A - Guatemala
Website: http:/​/​www.wingsguate.org
Project Leader:
Sally Parmelee
Development Coordinator
Antigua, Sacatapequez Guatemala

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