By Cat Normile, Project Manager, NCDs, PSI
In India, nearly one woman dies from cervical cancer every seven minutes, and yet the disease is highly preventable if women are screened and treated early. Community mobilizers like Soni play a critical role in educating their peers about screening and treatment options. Through their personal commitment to this work, they are saving lives, one woman at a time.
It’s 10am on a balmy morning in Uttar Pradesh, India. Soni rocks quietly on an unbalanced stool as she watches Mamta plea with her mother-in-law. Soni has been counseling Mamta on cervical cancer treatment. Mamta wants permission to be screened for cervical cancer, but her mother-in-law, whose family lost its money to her own cervical cancer treatment, is not supportive: A positive diagnosis of cancer would be an additional burden on the family, and Mamta has no symptoms anyway.
Soni understands the burden of treatment. Only three years ago, Soni’s own mother passed away from cervical cancer. Though grief-stricken, Soni felt inspired to motivate other women to seek early screening and treatment for the disease. Today Soni is a community mobilizer with PSI’s cervical cancer project in Uttar Pradesh, where she counsels women on the benefits of both cervical screening and family planning. For cervical cancer screening, she centers on women 30 years and older, the target age group. “When a woman turns 30,” she explains, “she has so many problems. Why not bring these services together?”
Soni and two other community mobilizers ride each morning to the day’s targeted area in a colorfully branded van. They divide the area among them and begin knocking on doors, receiving congenial welcomes from the women inside. Soni teaches women about cervical cancer and related services. She shows women a small, plastic model of a uterus to explain where the cervix is and what screening and treatment will entail. Two days after these home visits, Soni and others organize a local mobile screening camp to screen women for cervical cancer. For anyone who is screens positive and needs additional care, the program offers treatment at a nearby medical facility.
Providers are often confronted by incorrect perceptions of cervical cancer and screen-and-treat services. “They think [we] will remove some part of their body [during treatment, and] interfere with their fertility,” she describes. Women face pressures of misconception from their peers, their husbands, their mothers-in-law; they are terrified of a positive screening and the idea of having cancer and the burden this will place on their families.
This is where Soni comes in. At Mamta’s home, Soni pulls out a deck of ten cardboard cutouts of identical women and lays each card on the floor. “All of these women look healthy”, she explains. “But one will screen positive for early signs of cancer or pre-cancer”.
Soni explained to Mamta that although she may not show any symptoms, there is no way to know with certainty unless Soni undergoes screening by a health provider. If pre-cancerous lesions are caught early, they can be removed by ‘cryotherapy’, a safe, simple procedure which uses highly compressed carbon dioxide or nitrous oxide gas to freeze away the affected areas.
After seeing these cards and hearing Soni’s explanation, Mamta’s mother-in-law gives her reluctant approval. Soni provides information on an upcoming screening opportunity and continues to the next house. In a typical day, Soni will visit 30 houses and speak with 55 women about cervical cancer.
Among women who do agree be screened and who test positive, roughly 7 out of 10 will follow through with treatment. One of those seven women is Mamta. Upon being told she had pre-cancerous lesions, she boarded the community mobilizers’ van and traveled to a clinic where the affected areas were removed using cryotherapy.
In only two years, Soni has persuaded 8,000 women to be screened for cervical cancer and helped more than 300 with precancerous lesions seek treatment. Since 2013, the program has treated over 3,500 women throughout Uttar Pradesh. However, certain challenges threatened the success of the project. Notably, women’s lack of knowledge of cervical cancer, fear of being screened positive, and misconceptions regarding cervical cancer treatment can diminish uptake of screening and treatment services on offer.
“The Early Detection and Treatment of Cervical Cancer in Uttar Pradesh” project was piloted in 2013-2016 by PSI/India and founding Maverick Collective member, Kathy Vizas. Because of its success, the Government of Uttar Pradesh is now funding cervical cancer screening in the public sector, as part of a package to promote women’s health and screening for common non-communicable diseases (NCDs). As part of this effort, the government of UP is training and incentivizing providers to use a screen-and-treat approach to cervical cancer.
Banner photo: © Population Services International / Banner Photo by: Manprit Shergill