THE PAP SMEAR: SAVING LIFE WITH A BRUSH

Every gynaecologist, in the fight against cancer of the cervix, has a critical responsibility of offering the cervical cancer screening test to every woman of reproductive age group who walks into the consulting room.
In the early 2000s when the HIV scourge was at its peak, the stakeholders were grappling with the double responsibility of providing treatment while attempting to reduce the incidence. Running after the epidemic that was moving like a tornado, trying to stem the high rate of infection, especially in the third world, was no mean feat. The disease was heavily stigmatised, and considering the highest number of infection were acquired sexually, a mode that isn’t openly discussed as it is associated with negative connotation, the work was twice as hard.

Today, we enjoy a space where HIV testing is commonplace and we should never take it for granted. It took a lot of hard work, dedication, heavy investment in resources, deep commitment by government, external partners, health workers of every cadre and patients who agreed to advertently or inadvertently be the test subjects of drugs, policies and systems. As doctors, we are grateful that every patient who walks into a public hospital can be offered free HIV counselling and voluntary testing irrespective of what they sought treatment for.

While HIV care may be a story of success, we have not succeeded in several other, equally devastating epidemics in our midst. Cancer particularly comes to mind and cervical cancer even closer to my heart. Every time I meet a new patient diagnosed with cervical cancer, I am upset all over again. Our failure as a nation, as policy makers, as practitioners and as individuals is essentially paraded right before me one more time.

Cervical cancer (cancer of the cervix) is the only cancer that has capacity to be fully eliminated. Compared to the cost of treating it, the cost of prevention is a drop in the ocean. This entails health education, vaccination, timely screening and early treatment. Each one of us has a role to play in achieving this.

The government, through the Ministry of Health, may not have given this matter the attention it deserves. It is unfortunate that in the 21^st century in Kenya, there are women who have never heard of cervical cancer. That right there is the first sign that all is not well in the Health Ministry. The Ministry has engaged in various activities to do something about this scourge that kills over 8,000 women in this country annually but sometimes they come across as uncoordinated. There is a ‘Breast, prostate and cervical cancer prevention’ policy guideline and effort was put to train health workers on screening methods. Cheap screening options were availed at public facilities all the way to health centres in the counties to improve access to screening. The effectiveness of this has been hindered by lack of information to the women to utilize these facilities, inability to retain the trained nurses and midwives who are the backbone of this programme, frequent breakdown of equipment such as the cryotherapy machines due to poor servicing, lack of motivation to the staff and the absence of proper referral mechanisms in case of women found to have the disease. It is an exercise in futility to claim to treat cervical cancer without access to radiotherapy and the fact that we only have one such machine in the entire public sector is embarrassing.

Meanwhile, the Ministry from the year 2012, was involved in efforts to introduce the cervical cancer vaccine into the regular Kenya Expanded Programme of Immunisation (KEPI). Project piloting was done and we await the launch. While the Reproductive Health Division of the Ministry waits for implementation, the Paediatrics and Child Health Division has managed to get the Rotavirus and the Pneumococcal vaccines incorporated for better protection of our children. I commend this progress and in the same vein continue to agitate for the girl child who has survived childhood to be given a chance to survive adulthood by sidestepping cervical cancer. The government must put money where their mouth is.

At a professional level, all health care workers must never cease to offer cervical cancer screening to all eligible women they come into contact with. Doctors, especially gynaecologists, have the power to touch the life of a woman, and must display leadership in the various units they work in. The midwives, reproductive health nurses and clinical officer RCOs have been the foot soldiers despite not getting adequate recognition. These are the men and women who take care of women in Bondo, Kacheliba, Kinango and Mugumoini at dispensaries and health centres, who may never see a doctor in their adult life. We must not fail them in their efforts. They come into contact with the highest number of women and must be supported by providing them with adequate facilities and infrastructure, and robust referral systems that work. The system they have set in place must be exploited to ensure all our women get the message that screening saves lives.

At an individual level, if you are a woman who has access to health services and you keep coming up with excuses not to get your pap smear done, you are exactly what is wrong with the health system. For years, women complained that insurance will not pay for the service, yet even now when most will pay for your annual pap smear, most women will not even use the service. You owe it to yourself to avoid a preventable death, even if you must spend money to do so. This means that you will increase your chances of seeing your children graduate college. It will ensure that you will not burden your children who are trying to settle down into adulthood with having to take care of you in the end stage of the disease or fundraising to afford your chemotherapy.

The educated and more exposed woman holds a candle to the less exposed one. If you cannot pass on the message of screening to the other women you influence on a matter as important as cervical cancer screening, then you have not done much in empowering your fellow woman. Women must learn to form health clubs just like their chamas, and use these to encourage each other into healthy habits, including good nutrition, exercise and cancer screening. I encourage my younger college patients to come for screening and cervical cancer vaccinations in groups so that they exploit the sisterhood bond positively, and this has worked. They are less likely to forget their next appointment and will certainly complete their vaccination schedules. These are home-grown solutions we can adopt in spreading the screening message.

That pap smear is a five-minute procedure that could save you five years of utter misery. Remember, cervical cancer kills slowly, very slowly. You will live every day of it in pain. The life-saving treatment is expensive and uncomfortable. The complications of radiotherapy, the side-effects of chemotherapy, the feeling of violation as your doctor is forced to access the most private part of you to provide treatment, all these are not for the faint hearted.

In this respect, I take time to appreciate, commend and cheer on the strong women who have stared this disease in the face, taken it on and won. And not only that, they dedicate their lives to educating other women so as not to end up in the same situation. They have held hands of those going through treatment, wiped the brows of those sweating out the chemotherapy agents and even gotten wigs for the hairless to give them self confidence. Women like Sally Kwenda and Rose Chiedo are heroines in their own right and history will remember them well for bearing the cervical cancer advocacy banner with dedication!