Why women aren't lining up for life-saving screening, vaccine

Screening uptake is very low in Kenya. [Courtesy] Mary Mukulu, a 35-year-old mother of three in Kitui County is not afraid or ashamed of taking the cervical cancer test. She has been getting screened every five years since her early 20s thanks to a habit that was nurtured through the guidance of her mother, a retired nurse. "My mother began explaining the dangers of cervical cancer to my siblings and me from an early age. By then, it was not a well-known threat like it is today. She would show us how the samples are collected, and always assured us that if we took the tests, we would be saving ourselves and our families." For many women, the method of sample collection is intrusive, but to Mukulu, the fear of not getting screened on time would always override it. She constantly reminds herself that prevention is better than cure. Cervical cancer is the leading cause of cancer mortality in Kenya with an estimated 3,200 deaths in 2020 according to the National Institutes of Health. According to the World Health Organization, the highest rates of cervical cancer incidence and mortality in the world are in low- and middle-income countries. This, according to them, reflects major inequities driven by lack of access to national HPV vaccination, cervical screening and treatment services and social and economic determinants. Dr Alfred Mokomba, a gynaecologist and gynaecological oncologist at Kenyatta National Hospital says that screening uptake is very low, with less than 10 per cent of women in the entire population having been screened at least once in their lifetime. "The implication of that is we get patients in very advanced stages because these tests are meant to get even those who have changes that can lead to cancer even before it becomes cancerous," he says. He adds that the introduction of the HPV vaccine also has low uptake for young girls and eligible women yet it is an effective vaccine. The oncologist explains that the low screening uptake is perhaps because the screening services are only available in hospitals or clinics in urban areas. "Some women might feel that the test is intrusive since it entails the examination of their private parts, which has been solved through self-testing HPV kits," he says. "These kits are expensive and many people may not afford, hence poverty is another reason for the low uptake of screening." According to him, the low uptake of the vaccine could be because people have paraded the vaccine as harmful, with some saying that it contains components of family planning or toxins that could kill them later on in life while others say that their religion does not allow them to take the vaccine. The Matibabu Foundation founder and CEO Dan Ogola believes that cervical cancer is caused by structural inequalities. "For instance, the women in my community in Ugenya must travel long distances sometimes up to Nairobi to access the testing and treatment options and because of poverty, they cannot afford it." He also says the myths in his community act as a barrier towards testing and HPV vaccine uptake and, therefore, he believes that it is the role of the entire community to create awareness by eliminating the misinformation and disinformation. He has been working in conjunction with the Lake Region Economic Bloc leadership including the County First Ladies towards eliminating cervical cancer in the region. This has seen many women being screened, those diagnosed with cancer begin treatment while young girls get vaccinated against HPV. Further, the foundation has trained bodaboda women to go for their fellow women in the community and bring them to the hospitals, bridging the geographical accessibility gap. Ogola says that through this, several women are now accessing the opportunity to get screened unlike before. Dr Richard Godfrey, a surgical oncologist suggests that one of the main ways of combating the spread of cervical cancer is through education within the communities. "This can be done through various platforms such as the churches, chiefs' barazas and through the media to give confidence to the women that screening can make a difference and that it should not cause fear, because why would one be afraid of something that could save their life?' he poses. According to him, the government needs to increase its support to organizations working towards the elimination of cervical cancer in the country to help more women afford the testing; "it is far much cheaper to spend money on screening for cancer than on treating it.

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