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.
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.
As you may have already heard, Guatemala was the first Central American nation to adopt new World Health Organization (WHO) guidelines in late 2014 for cervical cancer which for WINGS and the thousands of women we screen and treat on a yearly basis using visual inspection with acetic acid and cryotherapy, is welcome support. The WHO guidelines recommend cryotherapy over more invasive preventative treatments and also take into account the role the human papilloma virus (HPV) plays in cervical cancer incidence. While vaccinations and tests for HPV remain cost prohibitive in Guatemala, our team of educators and nurses are making every effort possible to encourage women to get screened and get screened early, until we can incorporate HPV testing into our services.
Unfortunately, we recognize how difficult it can be for many women to ask for a screening, let alone visit a clinic or health center. That is why, throughout 2015, we will be increasing the number and geographic reach of our cervical cancer prevention clinics to ensure that Guatemalan women in indigenous, low-income, and rural communities can access information, screening, and treatment to prevent cervical cancer. In fact, we already have 7 clinics lined up for this month.
Flor dropped by one of our mobile clinics last month in Chahal, a Q’eqchi’ Maya community at the crossroads of three Guatemalan provinces. The 29 year old mother of four had been suffering from vaginal pain and wanted to undergo screening to figure out what was going on. Nurse and Project Coordinator Aury found precancerous cells and quickly provided her with cryotherapy treatment to prevent those cells from advancing into a devastating cancer. This month while we were providing follow-up support to clinic attendees, Flor told us, “I feel so much better now. The pain is gone and so is my fear of not knowing. I’ve told my sisters and neighbors that they must get screened, because I cannot imagine what would have happened to me if Aury had not been there to treat me. What would my children do?”
Flor and many women in her community have a higher risk for developing cervical cancer due in part to early child bearing – before age 17, multiple full-term pregnancies, and poverty. Flor, who first became pregnant at 15 and miscarried during her first two pregnancies due to domestic violence and injuries from a bus accident, says “Things were difficult in the past but I left him [her abusive boyfriend]. Now, I just want to be there for my children and help my husband provide them with everything they deserve.”
23 year old Ligia actually attended one of our day clinics in Chimaltenango but instead came for an IUD rather than cervical cancer screening. However, as our nurse Claudia was inserting the IUD, she noticed something abnormal and asked Ligia if she was interested in undergoing our rapid screening. Ligia, who has a one year old daughter, consented but was shocked: "I have a pap smear every year and each time, the results are normal...so I almost could not believe it when Claudia detected precancerous cells."
As worried as she was, Ligia received immediate cryotherapy treatment for those cells and could not be more relieved, “even today, Claudia and the WINGS team have checked up to make sure I am feeling fine, not just after the treatment but daily so that I can live without fear of cancer. I am so grateful that they were able to treat something that would have stopped me from watching my daughter grow up and being there for her along the way.”
We know how dedicated mothers like Ligia and Flor are to their children which is why WINGS is all the more dedicated to these women and their reproductive health. We want women throughout Guatemala to be able to lead healthy and productive futures for themselves and for their children and we believe guaranteeing them quick and quality cervical cancer prevention services is one important step towards those futures. And to make these life-saving cervical cancer screenings and preventative treatments even more accessible, we are in the process of creating a second mobile unit to travel throughout the Guatemalan highlands and southern Coast to offer daily clinics. Stay tune for our next major update in June when we have officially launched the second mobile unit!
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.
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