Cervical Cancer Hits The Hardest At Zimbabwe's Rural Women

By Jeffrey Moyo

Mwenezi-For 39-year-old Tambudzai Gumbo from Mwenezi rural district in Masvingo Province, cervical cancer gradually eats her away without consistent medical attention from the only available hospital in the district.

“I visited the hospital once, which is too far for me to visit regularly as I have no money for transport to keep going there for check-ups. It’s a painful situation,” Gumbo said.

Gumbo’s homestead is 54kms from the local hospital, a situation experts here say discourages rural women from going for cervical cancer check-ups.

“Neshuro Hospital is several kilometers away from many women here, who are silently suffering from cervical cancer in their homes,” said a senior medical doctor in Mwenezi district, who spoke on condition of anonymity.

But for many other Zimbabwean women in the countryside, it is ignorance about cervical cancer that is putting them at risk, say health experts.

“Women in rural areas are often not exposed to information about cervical cancer and thousands in remote villages die every year as a result of the disease before they find out what is ailing them,” Eunice Nyamapere, a private oncologist in Masvingo, said.

And many rural cervical cancer patients like Gumbo apparently confirm Nyamapere’s assertion.

“For over a year I suffered silently from this disease while I visited faith healers and traditional healers, with most of them telling me that I was being bewitched by my mother-in-law. But all this didn’t treat the disease I didn’t know I already had at the time,” Gumbo said.

Even experts fighting cervical cancer in this Southern African nation agree the disease has caused widespread suffering for rural women.

Says Dr Lowell Schnipper, who works with the international private voluntary health care organization, Better Health for Africa: “Treatment for women with advanced cervical cancer remains a difficult problem, especially in rural areas. Zimbabwe’s rural women, along with many women in the region, are at risk of developing cervical cancer.”

According to Better Health for Africa, cervical cancer accounts for one-third of all cancer cases in Zimbabwe and is the leading cause of cancer deaths among Zimbabwean women. And, according to national statistics, rural women are the worst affected.

In 2013 the Ministry of Health recorded that 3,900 women in the countryside succumbed to cervical cancer.

And compounding these stark circumstances, a 2014 study conducted by Better Health for Africa, reports that cervical cancer in Zimbabwe has been heavily influenced by the HIV/AIDS epidemic.

The study also found that when women finally arrived seeking help at rural hospitals they are diagnosed to be already suffering from invasive late-stage cervical cancer.

This is despite government last year launching the Human Papilloma Virus (HPV) vaccine for prevention of cervical cancer among women and girls.

About the HPV, Dr Portia Manangazira, director for epidemiology and disease control in the Ministry of Health and Child Care, said: “We are planning to avail the vaccinations free of charge to women and girls to ensure universal access in all parts of the country.

“Massive health education campaigns are also going to be carried out around the country to familiarise people with the vaccine, which has since been scientifically proven to reduce chances of contracting the disease,” said Dr Manangazira.

HPV, which is carried by both men and women, often without any symptoms, is known to be the initiating cause of cervical cancer in 90% of patients.

But the vaccines are costly and it is unlikely that the ministry will have the funds to conduct a nationwide vaccination campaign that will protect all the adolescent girls and  and young, sexually active women against this little-known but deadly virus.

However, the key to treating cervical cancer (like all cancers) is to catch it in its early development, and there is a simple, low cost test using household vinegar that immediately provides results identifying whether or not a woman has pre-cancerous cells that are likely to develop into cervical cancer. This Visual Inspection with Acetic Acid and Cervicography test, known as VIAC, is a simple test and has been introduced as a pilot project in some of the country’s major hospitals.  But although it is intended to expand this service nationally over time, rural women will remain marginalized until the ministry has the funds to do this.

“Due to lack of funding, VIAC is only available at major hospitals in the country, while rural women living far from these hospitals are not even aware of this service and are, anyway, hardly able to access it, thereby endangering their lives,” a top government official in the Ministry of Health and Child Care, said on condition of anonymity for professional reasons.

However, cancer activists have remained critical of the government’s vaccination initiative, which they say rarely caters for girls and women in remote areas.

“Yes, government launched its cervical cancer vaccination programme, but to tell you the truth, it is only in the urban centers that this vaccination is being enjoyed. Villagers deep in Mwenezi, in Dotito and Chiyendambuya, just to mention a few, are still succumbing to cervical cancer without accessing the vaccination,” Marry Chiito, a cervical cancer survivor, and now ardent cancer activist, said.

But the vaccination does not come on a silver platter, activists say.

There are also no laboratories in the vicinity of cervical cancer patients in remote areas to conduct tests on them, according to experts.

According to Mike Chirenje, a cancer specialist based at the University of Zimbabwe, it costs between US$80 to US$120 to get a dose of the Human Papilloma Virus (HPV) vaccine for cervical cancer from private doctors in Zimbabwe, which experts have said certainly goes beyond the reach of many cancer patients in the country’s remote areas.

But in other countries in the Southern Africa region, prices for the cervical cancer vaccine range from around US$18.

Chiito said even screening village women for cervical cancer comes at a cost.

In Zimbabwe, it costs US$20 for every single cervical cancer sample taken on every woman.

With few or no pharmacies in remote areas in Zimbabwe, most cervical cancer patients like 43-year-old Linda Zizhou from Mwenezi district, hope of survival seems to be fast fading away.

“For a terminally ill person like me, even if I receive money from my son based in South Africa for treatment, deep in the villages here there are no pharmacies and this means I am faced with certain death,” said Zizhou.

According to a recent report released by the Midlands Aids Support Organisation (MASO), only three out of the province’s eight districts offer cervical cancer services, putting the lives of many rural women in danger.

Data released by MASO last year showed that Shurugwi District alone has more than 400 women, 60 percent of these from remote areas, on the waiting list for cervical cancer screenings.

The Cancer Survivors Association, a Zimbabwean lobby group with a branch in Mwenezi district, last year said there were 1,200 cervical cancer cases in the district, which the group claimed was a quarter of the total cervical cancer cases across remote areas in Masvingo Province.

The Cancer Research UK in 2012 said annual statistics of cervical cancer globally stood above 527,000, with three percent of these cases from Zimbabwe, according to this country’s Ministry of Health and Child Care back then.

And according to the Cancer Association of Zimbabwe (CAZ), cervical cancer is the most common in the country, followed by breast cancer.

The Zimbabwe National Cancer Registry report for 2009 said cervical cancer accounted for about 360 annual deaths out of an annual total of 1,029 of all cancer deaths nationwide then, with 234 of these cervical cancer deaths occurring in remote areas.

With the Zimbabwean government accused by activists of just concentrating on combating cervical cancer in urban centers, many rural victims of the disease, like Gumbo, say they are most likely headed for an early grave.

“We know for sure our government here thinks it is successfully combating cervical cancer nationwide, but it is unfortunate that the effort is focusing on the towns and cities, leaving rural cervical cancer patients with little or no attention,” Gumbo said.