By Rebecca Harshbarger
Monday, April 20, 2009
In Uganda, a fast, cheap diagnostic test based on vinegar is invigorating the battle against cervical cancer. Health activists are raising money to put it in a mobile clinic and health officials are eyeing a national rollout. First of two stories.
KAMPALA, Uganda (WOMENSENEWS)--Claire Judith Achieng remembers how long it used to take to receive the results of a Pap smear, which can help detect cervical cancer.
Women such as herself, who live outside the capital of Kampala in eastern Uganda, would need to travel significant distances to a few referral hospitals for the screening test. From there, all Pap smears were transported to the capital for analysis at Mulago Hospital, after which the results were sent back to the original hospital or clinic.
The process could take six months.
In Uganda, cervical cancer is the leading cause of cancer deaths among women, although the cancer typically takes between 10 and 20 years to reach an advanced state and is very treatable if it's caught early.
The disease's slow development should give women ample time to have the condition's telltale lesions detected and treated. However, the vast majority of women in Uganda have never had a Pap smear. Other factors, like early marriage and HIV, make women more susceptible.
In 2006 a group of doctors and public health activists began searching for ways to boost screenings. They belonged to the Uganda Women's Health Initiative, collaboration between Makerere University, a public university based in Kampala, and the University College London's Institute for Women's Health.
They started a pilot project in Kampala to demonstrate that cervical cancer screening was possible in small health centers.
As part of that project, two clinics began screening women with a fast, innovative test that used acetic acid--or vinegar--as the primary active ingredient.
The test, called visual inspection with acetic acid, or "VIA," doesn't require a pathologist, refrigeration of samples or a microscope.
A nurse, midwife, or gynecologist swipes a patient's cervix with acetic acid and then inspects the tissue visually. If the cervix has lesions, the tissue turns white.
Currently, public clinics and hospitals continue to screen women using both techniques, but many gynecologists have begun using a positive visual test as a basis to start treatment on the spot. The treatment, called cryotherapy, freezes the lesions and treats the disease in its early stages, before the cancer becomes advanced. It does this by destroying abnormal cells in the cervix that may lead to cancer. The swift move from diagnosis to treatment saves patients' time and transportation costs.
"This service has prevented a lot of disease," said Dr. Dan Murokora, a gynecologist at the Kampala Dispensary who works for the Uganda Women's Health Initiative. "We screen an average of 15 women a day. We know that the Pap smear has been the standard of screening in the West, but the VIA test has considerably high accuracy rates."
Currently, five hospitals and clinics in Kampala, as well as three regional hospitals in other parts of the country, offer Pap smears, the visual test and cryotherapy.
The Ugandan Ministry of Health is watching research by the Uganda Women's Health Initiative to gauge patients' reaction to the technology, and to estimate the costs of rolling out screenings and cryotherapy to women in smaller clinics throughout the country who have less access to medical services.
The visual inspection screening provide midwives and nurses with a more active role in conducting and encouraging screenings within local communities, instead of referring women to distant hospitals.
Richard Ndhuhura, the state minister for the health department, said the Kampala clinics have been drawing plenty of women. "People are now flooding the clinics, which is very good, and it's a challenge to handle the flood. But I am happy to hear that people are flooding the clinics to be screened."
As a community health activist, Achieng is also pushing to get the new screenings rolled out to other parts of the country.
In 2006 she and a college classmate, Patience Grace Kyuomugisha, founded the Save a Woman Initiative, after losing a friend to cervical cancer.
The organization of health activists and doctors has been giving presentations on the importance of screenings in churches, marketplaces and clinics in Luweero, a rural town in central Uganda.
The group is currently raising funds for a mobile clinic--a truck equipped with medical equipment, a refrigerator, and literature--to bring screening tests and awareness to rural communities with minimal gynecological services.
They hope to launch the clinic later this year, or in 2010. Achieng estimates the mobile clinic will cost $150,000. She can't begin to predict how many women's lives it might save.
"You are doing this for a fellow woman, to save them from a gruesome disease," she said. "It gives you a passion to go on, even if you save just one woman."
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Rebecca Harshbarger is a journalist based in Kampala, Uganda.