“You white people, do you have these problems in your country?”
A 23-year old woman was lying down on the examination table, legs splayed with a pillow propped under her bottom to help with visualization. Adah, one of the Tabitha Clinic nurses and my teacher for the day, was sitting on a chair between the woman’s legs, a Black Diamond headlamp mounted on her head as she examined the patient’s cervix.
This woman was asking about cervical cancer, for which she was presently being treated. Cervical cancer is a large problem in developing countries that unfortunately doesn’t get much attention, due to the public’s general aversion to talking about lady bits. It is the third most common female cancer in the world, with over 90% of cases reported in developing nations. Kenya has an alarmingly high incidence rate of 22% in females age 15-40, but many cases go undiagnosed, or aren’t discovered until the cancer has metastasized.
“Oh yeah, we’re at risk for cervical cancer, too,” I said, explaining the Canadian government’s HPV vaccination program and the controversy surrounding it. “All bodies are the same on the inside, they can all get sick with the same things.”
Adah nodded in agreement, the light on her headlamp momentarily bouncing around the room. “It’s only the colour that’s different.”
The cervical cancer screening process is astonishingly simple and low-tech, taking only a few minutes for the women to receive their results. First, a cotton swab covered in acetic acid (yes, just your typical grocery store variety vinegar) is wiped on the cervix, which makes abnormalities turn white. Then, iodine delineates the borders of the lesion, making it stand out in yellow against the otherwise brown solution. The clinician can then say with certainty whether pre-cancerous lesions are present, giving the results in less than 10 minutes.
If there are no signs of lesions, the woman is instructed to come back in three to five years for another screening – unless, as I found out later, you are HIV-positive. Women infected with the HIV virus are immunocompromised, and as a result have a reduced capacity to fight off an HPV infection. Cancer can develop rapidly in these women, necessitating more frequent screening.
If the hallmarks of cervical cancer are found, the woman undergoes cryotherapy. In this procedure, an extremely cold, highly pressurized gas is applied to the lesion, effectively freezing all the abnormal cells to death and leaving a mark on the otherwise pink cervix that looks like a large cigarette burn. Within six months, this mark is completely gone, and the cervix is as good as new.
Of the ten women who came in for screening that morning, more than half of them showed precancerous lesions. Others had some other sort of infection, including a particularly brutal yeast infection that covered the entire cervix in a white goop. Despite this being a relatively small sample size, I was astonished at the prevalence of cervical cancer in the Kibera community. It just wasn’t an issue that I had thought much about before coming to Kenya. HIV and malaria, yes. Cancer, not so much.
This goes to show that when thinking about health issues in the developing world, cancer and similar chronic illnesses are often neglected. Infectious diseases, most recently ebola, often take centre stage in the media, dominating the western world’s view of health in developing nations. However, there are many chronic illnesses lying beneath the surface, some of which can be equally deadly. Cervical cancer is one of the most treatable cancers in existence, but due to a lack of services and education, many women often do not receive the help that they need, and even when they do it is often too late. It is important to recognize that cancer and similar illnesses are not unique to the developed world – after all, bodies are all the same on the inside.
