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In pursuit of Excellence in Journalism
2008-08-02 09:53:29
By BAMUTURAKI MUSINGUZI
Cervical cancer is caused by the human papilloma virus (HPV), which is sexually transmitted. Persistent infection with HPV is responsible for 99 percent of all cervical cancers.
``IT\'s a painless disease - so you can`t easily tell that you are infected with cervical cancer,`` says Peace Amanyire, ``Many women have it, but they don`t know.``
In her case, Ms Amanyire only discovered that she had the disease when she noticed a discharge, which she mistook for urine, four years ago.
But even a gynaecologist for a biopsy test and his conclusion was that I was in my menstruation periods. I told him that I had not had menstruation for two years, but he insisted he knew these things better because he was a doctor,`` says Ms Amanyire.
``I later developed a constant flow of discharge which made my life uncomfortable,`` she says, adding that, ``I thought my gall bladder had a problem. It is only after I visited another doctor in August 2005 and another biopsy test was done that I learnt that I had cervical cancer. I then underwent a major operation to remove the tumour the following month.``
The disease primarily strikes women aged 35-50.
This has catastrophic consequences on families and communities, especially in developing countries where women are the backbone of society.
It exacerbates the already damaging effects that HIV/Aids has on communities where women are often burdened with the responsibilities of catering for extended families, the sick or orphaned children.
HPV is the most common sexually transmitted infection in the world. There are more than 100 strains of the virus, but only a handful cause cancer. Women are usually infected in their 20s or early 30s, but they don\'t show symptoms until much later, so they are not aware.
Without screening, there are no warning signs until the cancer has become life threatening.
After her operation, Amanyire, 50, went public about her condition and formed the Women Awareness Against Cervical Cancer (WAACC).
She is the country director of WAACC, which has 26 members in Uganda. Its major objective is to create awareness among young women about the disease and to sensitise them about the need to go for regular check-ups.
WAACC wants the government to develop a policy that will compel women who seek other services at health units to test for cervical cancer as well. Men should also be sensitized to stand by their wives when they are found to be suffering from the disease.
According to Ms Amanyire, lack of knowledge by health providers about the disease has meant that women only learn that they are victims late in life. ``Health providers lack information on cervical cancer to sensitise women on its symptoms and dangers.
If for example, I had known about my status much earlier, I wouldn`t have reached the point of being operated on,`` she said.
Ms Amanyire says there are no facilities in Uganda to detect the disease, especially in upcountry hospitals, patients are always referred to Mulago National Referral Hospital in Kampala and some can\'t afford the costs.
``It is saddening that cervical cancer is one of the leading killer diseases in Uganda and nothing is being done to save the lives of women,`` she says.
``We shouldn\'t be dying of cervical, breast and prostate cancer, which are preventable in this modern age.``
Ms Amanyire, married and a mother of six, notes that the disease is stigmatizing at its fourth and fifth stages (fully blown) when both urine and faeces flow out easily and uncontrollably, attracting flies around the victim.
``If you don``t have somebody to attend to you, no one will want to be around you. Even your husband will abandon you and most men have done this,`` she says.
The disease effects more than 500,000 women worldwide each year, killing more than 250,000, eighty percent of the fatalities occur in developing countries where prevention and treatment are not available, making it the most common cause of cancer-related deaths for women in these countries.
Health experts warn that if the current trends continue, by the year 2050 there will be over one million new cases annually.
In Uganda, statistics show that the median age of a person diagnosed with breast cancer is 45, while for cervical cancer it is at 43 and the prognosis for most Ugandans with cancer is poor.
Only 45 percent of breast cancer patients and 18 percent of cervical cancer patients survive five years after diagnosis, in part, researchers believe, because the cancer is diagnosed at a late stage.
However, plans are underway for systematic screening programmes based on visual inspection, as pap smear screening is not easily available. Effectiveness of population screening programmes requires high uptake and for cervical cancer, minimal loss to follow up.
Uganda has a poor reproductive health services uptake; 10 percent post-natal care attendance, 23 percent contraceptive prevalence and 38 percent skilled attendance at delivery.
Barriers identified after analysis by the Department of Obstetrics and Gynaecology at Makerere University Medical School include ignorance about cervical cancer, cultural beliefs, economic factors, domestic gender power relations, alternative sources of reproductive health knowledge and unfriendly healthcare services.
The findings of the study released in June, last year show that knowledge about cervical cancer among Ugandan women is low.
``For an effective cervical cancer-screening programme, awareness about cervical cancer needs to be increased,`` it says, and adds: ``Health planners need to note the power of the various authoritative sources of reproductive health knowledge and involve them in the awareness campaign.``
Cultural and economic issues explain the perceived reluctance by men to participate in women`s reproductive health issues. Men are potentially willing partners, if appropriately informed.
Health planners need to address the apparent loss of confidence in the health care delivery system, as well as considering use of other cervical cancer screening such as mobile clinics or camps, the researchers say.
In January and February, 2006, WAACC interviewed women and health-care providers in Uganda and discovered various factors.
Women in polygamous unions attributed the cause of the disease to witchcraft by their co-wives; some health providers claimed that it was due to unfavourable changes in body cells; while others said it was sexual transmitted.
Yet others claimed that when you have more than five children, you are likely to get the disease.
Besides, new vaccines which protect against the most dangerous strains of HPV are largely unavailable in developing countries.
Vaccines and innovations in HPV screening and treatment for women have the potential to end the threat of cervical cancer worldwide.
Effective screening programmes in rich countries catch the disease early and have cut death rates by more than 80 percent.
New, simple and cost effective screening techniques exist, but are scarcely used in the developing world.
At the beginning of 2008, young women in Uganda, India, Peru and Vietnam will become the first in the developing world to live without fear of cervical cancer as PATH International and its partners began the pilot introduction for new vaccines for the disease.
These four countries are laying the groundwork for vaccination throughout the developing world.
PATH is an international NGO that creates sustainable, culturally relevant solutions, enabling communities worldwide to break long standing cycles of poor health.
By collaborating with diverse public and private sector partners, it helps provide health technologies and vital strategies that change the way people think and act.
Working closely with its government partners, PATH is supporting HPV vaccine demonstration projects in the four countries.
All the countries have shown a commitment to preventing cervical cancer, have strong existing vaccination programmes and are likely to expand successful demonstration projects.
Results from pilot tests in the four country projects will be synthesized and widely disseminated to inform HPV vaccine policy, programming and funding decisions made by other countries and by regional and global agencies.
This advocacy and dissemination role will build on existing advocacy mechanisms developed by PATH and will be implemented in close collaboration with the World Health Organisation (WHO) and other global partners.
PATH says that since it is usually babies, who receive routine vaccinations, new delivery strategies will be needed to reach young people.
The NGO has signed a Memorandum of Understanding (MoU) with the government of Uganda to allow decision-making in introduction of cervical cancer vaccine.
Already, there are two vaccines on the global market - Cervarix by Glaxo Smith Klein and Gardasil by Merck Company.
Both have been proven effective and are licensed in over 50 countries, including Kenya.
``We expect Uganda to license these vaccines before the end of this year,`` said PATH Uganda Cervical Cancer Vaccine Project Country Manager, Emmanuel Mugisha.
Foreign Direct Investments (FDIs) was on average USD 10 per annum in 1999s and increased to USD 350m in 2004 when it was at its highest.
After 2005 the inflation rate started to rise for a variety of reasons and some of them are questionable.
Since then however, it is possible to trace rising government`s recurrent budget deficits, despite the cash budget management mechanism being in place.
Public over-spending naturally increases the amount of money in circulation in relation to goods especially food items, hence triggering inflation.
Food inflation has increased not because of low production as such, but because pitiable infrastructure makes it difficult to transport food from surplus regions to deficit areas, causing what is termed `structural inflation`.
Of course, a combination of expensive fuel, electricity tariffs and low food production and depleting reserves would be said by policy makers to have contributed to the current inflationary spiral.
It is difficult to believe that the high prices of food are caused by the rise of world food prices only.
There has been a laxity in managing the monetary policy through the adoption of an expansionist monetary policy, whose effect is to pump more cash into the thin economy.
Yet, it is possible to control fuel prices by allowing more players to import oil, like envisaged strategies to re-allow Tanzania Petroleum Development Corporation (TPDC) into oil business.
At the same time, the Energy, Water and Utilities Regulatory Authority, (EWURA) needs to be given more legal and operation clouts to prevail over possible actions of price collusion in oil marketing.
As the Deputy Secretary General of United Nations Asha -Rose Migiro recently told parliamentarians that current high food prices should be a ``challenge for farmers to increase food production``.
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