During this month of cervical cancer awareness I thought it would be befitting to hear from one of the leaders in cervical cancer prevention in Zambia, Dr. Sharon Kapambwe. She is one of the most hardworking people I have ever met yet welcoming and always ready to hear you out. When Dr. Sharon speaks with you she looks you in the eyes letting you know she is listening. Its no wonder many patients run to her for help. Lets read her story and what drives this force of nature to fight cervical cancer so aggressively.
‘As a medical student I remember learning about cervical cancer, clerking patients who had cervical cancer but that didn’t really have that personal story to it. I learned of the gravity of the disease during my internship in the gynaecology Department at The University Teaching Hospital. As a junior doctor I would prepare letters of recommendation for the consultant to the UTH Adhoc Committee to send women with cervical cancer for treatment abroad, mostly to Zimbabwe and South Africa. Majority of those recommended were rejected anyway. The government did not have enough resources to send cancer patients for treatment abroad. Now as I look back, those rejected are sadly just now memories in the minds of their loved ones. In 2003, there was no cancer treatment centre, no cervical cancer screening program and definitely no HPV vaccination program.
With high prevalence of HIV in our country then, the number of young women with cervical cancer was surely rising. Cervical cancer was an HIV defining illness. Cervical cancer screening using cytology (Pap Smear method) was more for symptomatic cases than as a screening method and limited to urban areas.
The Zambian Cervical Cancer Screening Program started in 2006 and when the Netherlands awarded me a scholarship to pursue a Master’s in Public Health in 2007, Professor Groesbeck Parham requested that I look at cervical cancer control in Zambia for my dissertation. I quickly agreed because it was uncharted waters, HIV being the buzzing field at the time.
I believe my love for cancer control truly started during my study in Amsterdam. There I read about cervical cancer every day of program. By the end of my stay I had done an assessment of the Zambia Cervical Cancer Prevention Program and made recommendations. I fully understood the burden of cervical cancer and what can be could be done to change the status quo.
Fortunately just as I was about to graduate I was offered a job as a program manager for the Zambian Cervical Cancer Prevention Program under the Centre for Infectious Disease Research in Zambia. My cancer warrior journey truly began and I was well equipped to travel it.
However, when I finally got onto the scene, my job was not as glamorous as working in HIV/AIDS but it was a challenge that tested my limits as an individual. I was the program manager, procurement officer, health promotion officer, etc. I was equally reviewing patients. Funding was limited and all doors for possible source of funding looked closed. Awareness levels in the population were low. Over 60% of the women we saw in the screening clinics came with advanced disease. Our services were limited to Lusaka district. Making matters worse these women would come from all over the country, wait in long queues only to be told they have advanced disease already. The fortunate fact was that treatment was now available in the country with the Cancer Diseases Hospital having opened its doors in 2006. Even though this was a great achievement for the country, the waiting lists for treatment and logistical nightmares for most patients were still unbearable.
Prevention strategies were still needed and we had the blue print. I started giving interviews to radio and TV stations on cervical cancer particularly cervical cancer screening.
I vividly remember three cases, which keep, break my heart to this day.
The first one a 28-year-old young woman with a six-month-old baby presented with advanced disease. The second an elderly woman from one of the remotest areas in Zambia was brought in by her son who was selling merchandise on the streets of Lusaka. Her only relative in the capital city with no fixed aboard. She had stage 4 disease and opted to go back to the village peace rest among her ancestors. With all the difficulty of openly talking about issues of sexual reproductive health in our society, I was left with no option but to explain to the young man what was wrong with his mother. The last patient was a woman from middle class with advanced disease.
Through these patients I learned that cervical cancer was affecting women from all backgrounds young and elderly women.
Cervical cancer is a highly preventable disease women need not die. That’s what pushes me daily. One death of a woman from cervical cancer is too much. Women are the cornerstones of every society. Loss of a woman is not just an economic loss but social loss. Women are the custodians of the moral fibre of any society. They are the soul of a society.
Looking at where we have come from with absolutely no interventions for cervical cancer, the Zambian government has invested heavily in cancer control. The investment has continued. A few years ago, with no in-patient facilities it was difficult to effectively monitor patient treatment.
Introduction of the HPV vaccination is another intervention, which will see reduction of cervical cancer cases over the coming decades.
Today we have screening clinics in over 70% of the districts. Traveling across the country has shown me that there is a still lot of work to do.
Cervical cancer screening services must be brought as close to the people as possible. It’s also imperative to adopt interventions which are adaptable to the Zambian setting yet scientifically sound. Some interventions fail because they are not suited to this environment.
My personal long-term vision is for my daughter’s generation and generations to come (she just turned seven years old) to have a cervical cancer free generation. Together we defeat cervical cancer in Zambia.
Zambia already has the foundation for the comprehensive control of cervical cancer. All the legs for eliminating cervical cancer are present.
Having lost close relatives, friends and workmates to cervical cancer I see cervical cancer through their lenses. I spend hours talking about cervical cancer because it is a cancer we can definitely prevent.
We must begin to work together from the community to the treatment center.
Some of key lessons I have learned in the fight against cervical cancer is that eliminating cervical cancer is possible even within resource constrained environment with high political will. Coordinated team work from community engagement to treatment has made a great difference in Zambia.
The use of existing sociocultural channels like traditional leaders, marriage counselors (traditional and religious), politicians, etc. raises awareness but also increase uptake of screening services. When choosing a method for screening always look at what is appropriate yet optimally accurate.’
Dr Sharon Kapambwe is the Deputy Director of Non-Communicable Diseases the Ministry of Health. She is a leading voice in cervical cancer prevention globally