Cervical Cancer Screening Campaign

Cervical Cancer Screening Campaign – Bougaribaya Commune
Dina Carlin, Peace Corps Mali Health Education Volunteer
August 23-28, 2010

Six days, six villages, and 299 women later, Founeba and I returned from our cervical cancer campaign. We were exhausted, run down, but proud. Using visual inspection with acetic acid (VIA) and Lugol’s iodine (VILI), we screened an average of almost 50 women in each village, and had found that 48 women had at least the first signs of infections that can lead to cervical cancer.

This campaign was designed as a follow up to a workshop in May, where doctors and matrones from each of the 35 health centers (CSCOMs) in the the Kita Cercle were trained in visual inspection, a preventative screening method for cervical cancer. VIA and VILI is carried out by applying an acetic acid solution (for VIA) or Lugol’s iodine (for VILI) directly to the cervix. Pre-cancerous cells, known as cervical intraepithelial neoplasia (CIN), are cervical cells that have been exposed to persistent infections from one or more high-risk strains of the Human Papilloma Virus (HPV), which often lead to high-grade lesions. In almost 50% of cases, these lesions develop into cervical cancer. In VIA, precancerous cells form white areas (acetowhite) while in VILI pre-cancerous cells turn yellow (iodine non-uptake) when exposed to the solution. These results occur within a minute, and are easily seen using a strong light source. Along with Dr. Oussman Sangare, Chef de Poste at the Bougaribaya CSCOM, Mme. Founeba Dansira, the CSCOM’s head matron, the health center’s governing board (Bougaribaya ASACO), and community health workers (Relais), and myself, the campaign focused on expanding the accessibility of VIA and VILI to communities without health centers, as well as promoting the importance of women’s reproductive health care and the CSCOM’s activities.

After informing all the villages of our campaign schedule the previous week, the doctor went to Kita to attain some final materials needed for the screenings. The morning of the campaign, the matrone and I found ourselves alone, as the doctor had had to stay in Kita indefinitely due to domestic difficulties. While this left only Founeba to perform the screenings, we decided to go ahead as the villages were awaiting our arrival. Armed with my backpack full of supplies – speculums, placental probes, cotton, gloves, acetic acid and Lugol’s iodine - we set off for Karo, our first village. We arrived late in the morning, and set up in the hut of the Relais. Founeba did the screening in the dark hut, using a flashlight as the women laid on a bamboo bench. I sat outside the door, taking down the information of the women who crowded around me. Founeba explained the procedure, and performed the screening. At the end of each screening, I would run in to confer with her results and record them. From time to time Founeba paused to breastfeed Omou, her 8 month old baby, while I tried my best to trudge through the questions, helping them gauge their age despite their lack of birthdates, and talking to them about family planning and STI prevention. When we finally finished after 5pm, we had seen 43 women, had found 9 of them were infected or had high-grade lesions, and had seen two cases of suspected cancer. With the women’s approval, we gave the list of the positive women to the Relais and spoke individually to her and her husband, if available, trying to convey the importance of a follow-up appointment at the health center. We urged the Relais to follow up on these women to ensure treatment was sought.

The second day we gathered the women at the school of the next village, Bagnakafata, where we designated one of the classrooms as the screening/consultation room. By midday the sky had darkened and the rainstorm raged as we performed the screening. Many of the determined women waited, soaking under the hangar as we called each name, while the rest of the women went home. We ended the day with headaches, colds and 10 new positive cases or infections. The next few screenings went much more smoothly as we became used to the system and had additional help. Some we did in classrooms, others in dimly lit huts. After the six days, we had seen 299 women, and found 48 of them had infections or pre-cancerous cells. We urged many of the positive screenings come into our health center, where the test would be repeated by Dr. Sangare. However, several screenings showed high grade lesions or invasive cancer, which we referred directly to the health center in Kita. The Relais were encouraged to talk to the women in their individual village about the importance of following up with their screenings, and to organize transportation and fundraising.

There are still missing links, however. It is difficult for rural women to find funds to travel to Kita, but, due to lack of equipment, the health center is unable to provide adequate treatment. In an ideal case, immediate treatment would be available, like cryotherapy and loop electrosurgical excision procedure (LEEP). Linking screening to treatment is critical in providing comprehensive prevention in rural areas, as the probability of follow-up treatment decreases with multiple visits. Both are simple and minimally invasive treatment options, but are currently unavailable at the village level. A follow up to this screening campaign would include investigation into the accessibility of such treatment methods at the village level. For now, however, there is infrastructure in place to support these women, at the cercle, regional and national levels. With the support of their communities and annual preventative screenings, and with further investigation on increasing the availability of appropriate treatment techonologies, we can start to makes moves towards reducing cervical cancer here in Kita, and in Mali at large.