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When cervical cancer kills 1,600 women, what next?

By Stevie Chauluka:

MWAKASUNGULA – A lot has been done

The Malawi National Cervical Cancer Programme 2018 Annual Report indicated that Malawi has the highest cervical cancer incidence and mortality rates in the world.

The report shows that cervical cancer accounts for 45.4 percent of all cancers in women.

Every year, over 2,300 women develop cervical cancer and aleast 1,600 of those cancer patients die from the disease.

The figures show the acuteness of cervical cancer in the country and how it is claiming lives of thousands of women.

“Cervical cancer strikes women in the prime of life, when they are raising children, caring for families and contributing to the social and economic fabric of their communities.

“As nine in 10 women who die from cervical cancer are in poor countries, this means the disease is affecting some of the poorest women in the world,” said Maud Mwakasungula, who is Executive Director of Women Coalition Against Cancer.

A thirty-six-year-old woman we will identify as Alile, who is from Salima District, has been living with cervical cancer for two years.

She is undergoing chemotherapy treatment at a clinic in Lilongwe which she will take for some time before she is fully treated.

On Friday, April 26, during commemorations marking World Intellectual Property Day, civil society organisations that fight cervical cancer, used Alile as an example of the struggles women suffering from the disease endure when accessing treatment for the non-communicable disease.

They called on the government to implement intellectual property laws as a means of ensuring affordable cervical cancer treatment.

It was understood that is it always impossible for the facility to maintain a consistent supply of cancer and supporting drugs that she needs due to lack of resources and poor funding to the facility. As such, there is always a change in her treatment regime.

Intellectual property expert, Chikosa Banda, said: “Barriers to accessing cancer diagnosis and treatment are manifold and complex, and are part of larger, systemic medical, political and legislative problems.

“In particular, the impact of intellectual property rights, policies and laws in facilitating access to medicines is often overlooked by both government and civil society. These regulations, however, are critical to ensuring that patients are able to source and afford the medicines they need.”

Mwakasungula, on the other hand noted that although human Papilloma Virus Vaccine Cervarix has been available in Malawi’s private hospitals since 2011, the challenge is that most Malawians cannot purchase it as it is expensive.

Centre for Human Rights Education, Advice and Assistance (Chreaa) said the country’s screening process is also problematic as it is hindered by challenges such as costs involved, poor communication and cultural misconceptions.

“Discrimination also plays a role, especially among sex workers. While we encourage sex workers to go for cervical cancer screening, it is not easy for them to acquire the medical help they need as they face a great deal of stigma in hospitals,” said Chreaa Executive Director ,Victor Mhango.

Already, Malawi regards cervical cancer as a public health problem as stated in the National Cervical Cancer Control Strategy 2016.

With this acknowledgement, the Malawi Ministry of Health, through the Sexual and Reproductive Health Directorate, implemented the prevention strategy on the HPV vaccination.

It was a school-based programme for nine-year-old girls and screen-and-treat programme using visual inspection with acetic acid and cryotherapy or thermal coagulation.

However, Mwakasungula feels there is more to be done if the country were to win the fight against cervical cancer and save women from going to their early graves.

“A lot has been done but there is still more that needs to be done. Civil society, community-based organisations, patient organisations and communities need resources to have an impact in the cervical cancer elimination campaign.

“Socio-economic barriers like poverty and illiteracy, among others, need to be addressed for demand creation for cervical cancer services. We are not doing badly as a country; what we need is to join hands and complement government efforts,” Mwakasungula said.

Prevention and treatment of cervical cancer is categorised into primary, secondary and tertiary levels.

Joshua Malango

Spokesperson in the Ministry of Health, Joshua Malango, says the country is doing well at primary and secondary prevention levels but lagging behind in tertiary prevention.

“For primary prevention, the country is raising public awareness through different channels and the First Lady [Gertrude Mutharika] is championing this. The newly introduced Human Papilloma Virus Vaccine is another notable primary intervention that we are undertaking.

“For secondary prevention, the country is screening and treating women for early cancer lesions. Cervical Cancer screening services are available in all central and district hospitals and some health centres including [Christian Health Association of Malawi] facilities,” Malango said.

Meanwhile, according to Malango there are over 170 health facilities that are offering cancer screening services across the country.

“In 2018, over 95,000 women were screened, of whom 2,350 were found with early lesions and were treated,” he said.

Malango added that the country was missing out on tertiary treatment for women with large lesions, a development that is claiming lives of atleast 1,600 women each year.

“Radiotherapy is the recommended treatment for large lesions and that is combined with surgery. Over 1,600 women die of cervical cancer every year because of lack of tertiary treatment,” he said.

The government is constructing a cancer centre in Lilongwe, a development the Ministry of Health hopes will provide radiotherapy to large cervical cancer lesions and reduce the number of women dying from the disease.

“The facility will add value to tertiary management and treatment of cervical cancer where specialised treatment is required,” Malango said.

In May 2018, Director General of the World Health Organisation (WHO), Tedros Adhanom Ghebreyesus, announced a global call to action towards the elimination of cervical cancer.

He called on stakeholders to unite behind the common goal.

In line with this, WHO, in consultation with member states and other stakeholders, has developed a global strategy to accelerate cervical cancer elimination, with clear targets for the period 2020- 2023.

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