Cervical Cancer History

As we wind our way deeper into Kisenyi II past the pungent aroma of fermenting millet, down a steep alley, through a door that opens onto a dirt courtyard of children playing and women washing clothes, around the corner of a block of latrines you can see how a child could get washed away in a downpour. We edge along narrow ledges between houses, the drop-off off to deep open sewers inches from my toes. I duck my head to follow Veronica into a house, a sheer piece of cloth is the door. We are welcomed and a colouful woven mat is layed on the floor where I sit, legs bend beneath me next to Hadija, a wide-eyed 2-year old chewing on her breakfast chapatti. The morning sun glows through the curtain as Veronica explains what we're doing and asks if the woman would like to participate. She's keen to get tested only after she is reassured that she won't have to 'open her legs for an exam like they do at the hospital' unless the test is positive.

Although I am obviously deeply invested in the project and passionate about working towards preventing women dying of something so incredibly preventable it still boggles my mind that women are so open to collecting their own samples and being screened for HPV. On our first day of testing, one of the teachers at the primary school heard we were testing for cervical cancer and ran over to find us during recess so she could get tested. They take the swabs, go behind a curtain or to the latrine, and come back with the specimens for the research assistants to label then ferry to the lab for analysis. To be honest, if someone showed up at my door with a cooler full of swabs and asked if I wanted 'do-it-yourself' cervical cancer screening I might just shut the door. Although the logistics of a truly community-based screening program can seem intimidating, I can't help but be encouraged by how eager women are to be involved.

I remember an impassioned speech by Stephen Lewis at a huge HPV conference in Montreal last year. His usual topic is HIV but he spoke about cervical cancer that night, and the tragedy of something that is completely preventable, not only with screening, but with an effective and safe vaccine that is responsible for the death hundreds of thousands of women across the world. Over 85% of those deaths occur in the developing world where there is no infrastructure for effective screening programs.

I heard Stephen Lewis again more recently, on a CBC podcast interrupted by haltering internet when he spoke at the funeral of Jack Layton, previous leader of the opposition. The quote of Jack Layton's that stuck with me was 'Always have a dream that's longer than your lifetime'. Today, my dream is to make cervical cancer a historic disease, this disease that is often called a case study in health equity has no right to take the lives of young women, regardless of where they are on the planet. Check in with me in a decade to see how we're doing.

Blatantly Obvious

The sound of my feet pounding the path was the only rhythm I was aware of as I slowly climbed the incline of the Kololo hills in the rising early morning mist, past embassies and houses that would put the mansions of Shawnessey in Vancouver to shame. As I pass Kololo Heights and start my descent back home, the orange ball of the sun peaks out from behind Ntinda hill sending sunbeams shooting through the low lying clouds in a brilliant peachy fan. Running is good for the soul. A nearby mosque emanates sing-song prayers out into the waking world. Funny, I think to myself, normally their morning prayers are done by this time.

As I drink my coffee, the plan for the day goes through my head, meeting with PATH (an NGO with offices nearby at the WHO building). Then Michael (Doreen’s replacement) and I had a long to do list, check-out labs for processing cervical biopsies, buying a specimen carrier, editing and printing surveys and educational material, we had discussed it all just yesterday.

I show up at the gate of the WHO offices at the appointed time, but have an intriguing discussion with the guards at the gate. No, no one is in the office today. Why? They give me a strange look, a bit confused even. Well, its Eid.

Of course, Eid, silly me, oh well. Having not learnt my lesson I tromp down the hill to Mulago Hospital, get to the office to find the place a bit deserted. That’s funny, Mike and I had this work plan, oh well. When I call him (he’s a good Catholic boy by the way), he says: Sheona, it is Eid, we cannot work today!

I now recalled our scheduling challenges with the outreach workers in Kisenyi:

Does Monday work? No, Veronica’s church has to help distribute the World Food Program food.
Tuesday? Well, Esther is a Muslim, it could be Eid.
Wednesday? Well, it could be Eid.

Of course no one had thought to tell me, its obvious to the rest of the world, the date of the huge celebrations of Eid marking the end of Ramadan can’t be announced until the Imam sights the new moon.

It reminded my of a lovely family from Kerala, India who after recently moving to Calgary experienced their first Halloween. Of course, no one had thought to mention to them that children in their neighbourhood would be coming by, ringing the doorbell, yelling ‘trick or treat’ and asking for candy. Its so obvious, isn’t it?

So I spent the day immersed in epidemiology and statistics, catching up on courses instead. I have to say, I was grateful for Eid!