Poverty and cervical cancer

By Allan Olingo

Margaret Nguvi, a mother of seven from Makuyu, was admitted at Kenyatta National Hospital with fistula complications. She was, however, diagnosed with cervical cancer at the hospital.

To cover her medical expenses and radiotherapy costs, Margaret required about Sh1 million. She could not raise a dime. She died days later at the cancer wards. She was only 32.

This is one case among many poor women dying from cervical cancer complications.

Majority of Kenyans live below the poverty line, and majority of women are vulnerable to cervical cancer.

Cervical cancer is the second deadliest cancer, affecting women: It strikes 500,000 every year, and more than half die. About 85 per cent of these deaths are in poor countries.

David Makumi, vice-chairman of the Kenya Cancer Association, says women in urban areas are four times less likely to die of cervical cancer because they get regular Pap tests where cells from the cervix are examined under a microscope so any cancer can be detected early and treated before it spreads.

Reproductive health

Dr Makumi notes that certain risk factors are believed to contribute to the high cervical cancer prevalence among poor women. He notes that the poor women’s medical history and lifestyle, especially sexual habits plays a major role in their chances of developing cervical cancer.

Margaret’s case is a perfect example of how poverty-related factors, including lack of formal education, unemployment, low socio-economic level, rural residence and insufficient access to reproductive health information led to her untimely demise at a young age.

Makumi points out that when such women develop cervical cancer, the disease usually remains undiagnosed and untreated until it has spread to other parts of the body.

Poor women are often undernourished, and poor nutrition can also increase cervical cancer risk.

"Taking diet that doesn’t include ample amounts of fruits and vegetables can increase a woman’s risk of developing cervical cancer," he adds.

Tabitha Njoroge, the Executive Director of Women in Law and Development in Africa, who together with friends came to the assistance of the late Margaret’s family, say the situation at Margaret’s home in Makuyu was heart breaking.

"We found a family that had lost all hope. They lacked all the basic necessities from food, clothing and shelter," says Tabitha.

She says Margaret’s demise was a painful reminder of the need for more reproductive health education among women, especially those in the rural areas.

"We plan to launch a vigorous reproductive health programmes, with the late Margaret as the face of campaign, to coincide with the International Women’s Day," says Tabitha.

Mukami says only increased cervical cancer education and awareness can save lives of many women.

The Government, through the Ministry of Education and in partnership with the Kenya Cancer Association, should incorporate awareness lessons especially in girl’s secondary schools.

"Every woman who has reached the age of 18 or who is or has been sexually active should have regular Pap tests. The only way we can do that is to increase the awareness of Pap smear screening and lobby for its affordability," he claims.

Cervical cancer if detected through routine screening, popularly known as Pap smear, is 100 per cent curable.

But the hindrance is access to information. The Government even lacks a national cancer policy making it difficult to help cancer patients.

"The most common forms of cervical cancer begin with changes in cervical cells and if these changes are detected early enough, treatment can be commenced immediately to prevent cervical cancer from developing," explains Makumi.

Cancer policy

There are also cheaper ways, which the rural women can use to check if they have any cervical cancer symptoms. Visual inspection of the cervix using acetic acid (VIA) is effective as a method of cervical cancer screening.

"The technique involves applying four per cent acetic acid (vinegar) to the uterine cervix and examining it with the naked eye under bright light.

"If a well-defined white area on the cervix is observed after one minute, the test is positive", says Makumi.

For Tabitha, Margaret’s suffering and her death should be a wake up call to the Government to adopt a National Cancer Policy already presented to the Parliamentary Health Committee for debate in Parliament.