NCCC Online - NCCC National Cervical Cancer Coalition

Posted On : Thu, Dec 12 , 2002

Stopping a Silent Killer in Sub-Saharan Africa

Geoffrey D. White, Ph.D.

It was almost by chance that I became involved in the fight against cervical cancer. It was 1995, and I had just returned to Los Angeles after working in Bosnia setting up psychosocial programs for war-traumatized Balkan refugees. In the process of looking for funds to send to Bosnian physicians, I became acquainted with several American gynecologists who told me of the pervasive horrors of cervical cancer in the developing world. They gave me facts like these:

? Each year over 200,000 women worldwide die from this preventable disease.
? It is the second most common cancer among the world's women and, in developing countries, by far, the most common.
? While cervical cancer is easily detectable and highly treatable in its early stages, detection and treatment in developing countries are virtually nonexistent.
? End-stage cervical cancer is one of the most painful deaths imaginable, and in developing countries, one that oten is endured without hospitalization.

These fact came as quite a surprise. Why, I wondered, didn't we hear more about cervical cancer in America? The reason, as it was explained to me, is this: American women rarely die of cervical cancer. Women in America can rely upon annual Pap tests to detect the cervical cell changes that precede cervical cancer, so dying from the disease in our country is almost unheard of. Since women in sub-Saharan Africa have no access to Pap testing, dying from the disease is commonplace.

How does a woman contract cervical cancer? Over 90% of cervcal cancer cases are caused by a sexually-transmitted organism: human papilloma virus (HPV). For most women, infection begins before they are 30; particularly at risk are those women who have used tobacco or had more than one sexual partner. The cells multiply slowly, undetected, and women do not generally exhibit painful symptoms until it is too late - when full-blown cervical cancer has become a death sentence.

These were the facts of cervical cancer; facts that I turned over and over in my mind. I thought about how, working in Bosnia, I had never become used to the external dangers of war: the street noise, the shouting, the concussion artillery, the maimed but living bodies. I thought the worst thing would be to hear death coming. In the case of cervical cancer, in sub-Saharan Africa, death comes silently, undetected, cruelly. Which I worse? What was te point of asking that question, when the result was the same?

Here was a sexually-transmitted, preventable cancer which could be detected and treated for, by Western standards, next to nothing. In a country like Malawi, however, where the primary transportation is by foot and it can take days to reach the most basic health care facility, it woul not be easy. How could one set up a cytology-based (Pap smear) system? And even if it were possible to set up such testing centers, who would read the tests> Malawi has not a single practicing pathologist or cytologist.

How, in short, could cervical cancer be detected early enough to save lives in a country in which less than $2 per person annually is spent by the government on health care, and where the annual income of citizens is about $200?

The answer is called visual inspection of the cervix. This involves wiping the cervix with acetic acid (simple household vinegar) and then examining the cervix to see if there are any abnormalities. Abnormalities can be safely treated by trained health care providers using cryotherapy, which administers medical-grade carbon dioxide to the suspicious cells, freezing and thus killing them. The cells can be detected and removed on the same day, meaning that the patient would have to make a single trip to the center, rather than return repeatedly.

I wondered how could I help establish such a program. I knew I couldn't do it by myself. So, in 1997, I approached Project HOPE, a nonprofit international health organization committed to creating sustainable and replicable programs around the world. I suggested that they consider implementing an early detection and treatment pilot program for cervical cancer-one that, f it showed the impressive results I thought it would, could be replicated in other developing countries to save women's lives. We agreed to pursue the project, pending an assessment visit to Malawi.

Malawi is a beautiful yet deeply impoverished country. Its 25 million people fall prey to countless health problems. The three weeks I spent in the field there wasn't easy. In Malawi, a walk along the riverbank can lead to schistosomiasis (a worm infestation that settles in the human brain); to sleep without a bed-net almost certainly means malaria. There were times during those three weeks that I though of inventing reasons to go home to Los Angeles, believing I'd take on more than I could handle.

Nonetheless, if I had doubts before going to the field that this project was needed, by the time I left, I had none. In Malawi, I visited the cancer wards of many hospitals-wards that were so full that most patients had no beds-and witnessed heart-wrenching scenes of whole families sitting and praying for women in the end stages of the disease. In addition, most of these women are still caring for, or trying to care for, their children. The evidence was everywhere I looked: women were dying terrible deaths from cervical cancer for lack of basic health education and a simple test using household vinegar. I could not look away from those facts.

I took the volunteer lead in an attempt to raise the funds needed for a two-year cervical cancer demonstration project in Malawi. I hoped the methodology could be implemented where it was needed in the developing world. I optimistically believed that we could see a dramatic reduction in cervical deaths within the next decade.

I was joined in my fundraising efforts by Alan Kaye, owner of a medical laboratory and the executive director of the National Cervical Cancer Coalition. The result of our combined efforts was a concert whose proceeds were donated to Project HOPE's Malawi cervical cancer program. At the center of the fundraiser was an internationally-known musician, David Benoit, who did the concert at no cost. Working together, we raised start-up money.

The tireless and efficient efforts of Project HOPE staff in the U.S. and Malawi have moved the program ahead, one step at a time, over the last five years. We have been near success and near failure many times. We have had to work hard to raise the money for the project and to oversee its implementation. We have had to overcome cultural and sexual barriers to success-always a problem where you are working with people whose lives are so different from your own. We have learned that it is hard to raise money for a medical issue that doesn't affect Americans significantly and is, therefore, easy enough to ignore.

After three years of start-up and implementation, however, the results have been impressive. Thousands of women in Malawi have been screened and hundreds treated for cervical cancer. The need is indisputable: nearly 10 of the Malawian women screened have had cervical cell changes requiring treatment.

The need will be ongoing. We are proud of the fact that Malawian Ministry of Health employees, trained by Project HOPE staff, re now overseeing screening and treatment. We are also poud that the Malawian Ministry of Health has agreed to take on the administration of the program. We view this as an acknowledgment that the program has value and that they are committed to continuing it in a country beseiged by famine, epidemic, and poverty.

This is the ultimate victory for an organization like Project HOPE that is based on the principle "sustainability", a notion aptly expressed in the Chinese saying, "Give a man a fish, feed him for a day; teach a man to fish, feed him for a lifetime." The project has proven that it works. The task, now, is to take the model to other resource-scarce developing countries and replicate the education, testing and treatment model that has saved so many women's lives in Malawi.

I remain committed to seeing that happen. If a lifesaving project like the cervical cancer screening and treatment initiative can be successful in Malawi, it can work in countless other places. If I can make a difference in the world, so can you.

For further information on this project and how to get involved, please contact Geoffry D. White, Ph.D. 2566 Overland Ave., Suite 780, Los Angeles, CA 9064; 310-202-7445; e-mail GeoffryW@aol.com; or contact Project HOPE, Millwood, Virginia 22646.

(Side Bars)

"Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it is the only thing that ever has." ~ Margaret Mead

How do you make a difference-even a small one-in a world in which hardship is the rule and relief is scarce?

There are only two choices: You do nothing. Or you do something.

LACPA member, Geoffry White, Ph.D., a recipient of Humanitarian Awards from both LACPA and the California Psychological Association, has chosen to do something on behalf of thousands of women in the desperately poor sub-Saharan country of Malawi. Women in Malawi are dying needlessly from cervical cancer, an easily detectable and, if caught early, fully treatable disease. Dr. White's first-person account demonstrates how one Los Angeles psychologist is making a difference in the world.

Are you involved in work that is making a difference locally or globally? Know a psychologist who is? The Editorial Board of The Los Angeles Psychologist would like to celebrate these achievements in future issues. Please contact us via the LACPA office