The numbers of women screened and referred for cervical cancer treatment to Nkhatabay district hospital and FPAM mobile clinics in hard-to-reach areas of Nkhatabay district have been on the increase if we are to compare the period 2020 Jan–March during which 421 women were screened and for 2021 April–June during which 548 women screened, NKhatabay district hospital Cervical Cancer Prevention and Control Programme coordinator has confirmed.

 “More women and youth are coming for screening and we are glad that every month we are able to screen up to 25 women. We screen on Monday and Friday at Mzenga Health Center but the turn-up is usually low because most women find no reason to walk 20–30km up and down the mountains just to get screened when they are not sick regardless of the benefits of early screening in the long run. This is where our partner FPAM has helped a lot to get to where these women live through mobile clinics.

Since 2020, we have referred almost 4 women to NKhatabay district hospital and we lost only one woman from Kavuzi who came to seek help when cervical cancer was at an advanced stage and was referred to Nkhatabay main hospital where she passed on. Out of 25 women, young women aged 26–29 years constitute around 16%, so older women are leading in screening for cervical cancer,” said Gomezghani Mapala, Nurse and Midwife Technician and Cervical Cancer service provider at Mzenga health center.

Mapala: Mobile outreach clinics are greatly supporting the reach of women in mountainous areas

Giving testimony to dispel myths and misconceptions regarding screening for cervical cancer at Chitheka – Chakupompha FPAM mobile clinic, Elita Nyirenda, 34, a mother to four children, explained that “I’m happy to have screened results negative and I have been informed about benefits of regular cervical cancer screening. I have been educated on the signs of this cancer where I remember that a woman feels abdominal pains, bleeds in the course or after having sex, and mostly a woman experiences back pains.”

 Dyless Kaunda, 39, a mother to seven children came for a five–year implant as agreed with her husband and accepted the nurse’s request to screen for cervical cancer through a successful health education session. “I screened for cervical cancer and results have come out negative,” Kaunda said.

 “It’s true that most women in my area have not yet screened for cervical cancer because some do not know it’s a health problem, some do not know where to get the services and some threaten their colleagues that the screening process causes cancer itself. I will carry sensitization news that women and young ladies who screen late, may face fatal results,” Kaunda added.

Concurring with Kaunda, Nyirenda added that “there are many women who fear that nurses insert heavy metals that injure vaginal walls during screening. But this is not true because I have gone through a very smart and modest screening process.”

Nyirenda: Receiving counseling before accessing cervical cancer services at Chakupompha FPAM outreach clinic

Nkhatabay district hospital Cervical Cancer Prevention and Control Programme coordinator, Rosemary Msukwa, confirmed that “In 2020 FPAM supported Usisya and Chintheche cervical cancer screening mobile clinics. In November 45 women were screened in Usisya, and in December 50 women were screened in Chitheche.”

“From January to October 2021, 100 women in Nkhatabay district have been screened with the month of September leading on screening chart with 49 women. One woman tested positive and accessed cryotherapy the same day,” added FPAM Mzuzu district manager, Alinafe Chasowa.

Although the NKhatabay district has started very well to save many women from cervical cancer, there are still some challenges that are affecting service delivery efforts. The challenges reported so far include the culture of people, the frequency of mobile clinics conducted, and the number of people engaged to create awareness and demand for cervical cancer screening.

“Most boys and men in Nkhatabay do not have a culture of getting circumcised although we do not have facilities to handle Voluntary Medical Male Circumcision in deep rural areas. So it’s like a vicious circle where we are dealing with one part and leaving the other unattended which is a typical source of infection. However, it was in 2018 when the last Voluntary Medical Male Circumcision (VMMC) clinic came to Mzenga and most men and some boys got circumcised which indicates that people would be willing to take the foreskin off,” Mapala said. He added that “Out of 14 boys and men that come to seek Sexually Transmitted Infection (STIs) services, almost none of them has penile foreskin removed and this gives a picture that 99% of men of reproductive health in Mzenga health area are not circumcised.”

“My husband is not circumcised, and I know in my area most women have their spouses uncircumcised.  And I will find a way to convince him to understand how to protect me from the disease. I’m now free to continue with the farming and the fish selling businesses. I will motivate my colleagues to come for screening. I’m also told to get back for a second screening after three years because I do not have HIV,” Nyirenda said.

Mapala also observed that the community health workers like Community Based Distribution Agents (CBDAs) and Health Surveillance Assistants (HSAs) that communities rely on accessing health information, supporting successful referrals to static and mobile clinics, and championing all health demand creation efforts, were never oriented or trained about cervical cancer. “Community health workers are found with little or no accurate information about cervical cancer and because they do not provide counseling or any lead about cervical cancer services in mountainous hard to reach areas, communities would neither trust visiting health workers nor be encouraged to come out for screening. CBDAs and HSAs need to be trained and charged with cervical cancer awareness and demand creation duties to mobilize more women of reproductive age to access screening and treatment services,” Mapala suggested.

Responding to the gaps, Msukwa said “We have not yet included Community Health Workers to sensitize and educate communities about cervical cancer. However, at Nkhatabay district hospital, 10 HSAs have been engaged to support the demand creation for cervical cancer screening and treatment referrals and we are still partnering with other organizations to intensify cervical cancer awareness campaigns to girls, women, and men of reproductive age.

So far 11 out of 22 health centers in Nkhatabay provide cervical cancer screening and treatment services and more outreaches are required because most places in Nkhatabay are mountainous and are hard to reach. And Voluntary Medical Male Circumcision services are only provided at Chintheche health center and at the district hospital. There are plans to scale up to some health centers in the future to reduce risk factors that affect women to contract cervical cancer.”

Msukwa: VMMC is currently provided at Nkhatabay district hospital only

Traditional and religious leaders of Chakupompha under Chitheka health area expressed concern that they do not have proper information about cervical cancer. “We sensitize our community about malaria, HIV and AIDS, family planning but we can’t just explain cervical cancer in detail to inform our subjects about signs and symptoms, how it is caused, and how it can be prevented. We link all mysterious deaths to cervical cancer or breast cancer even if it’s not so,” Group Village Headman Chibalaka and Pastor Dabson Nyirenda of Chakupompha and Zion Church from Traditional Authority Kabunduli respectively, shared the concern.

Apart from all 74 clients that accessed integrated SRHR/HIV/GBV services at Chakupompha mobile clinic organized by FPAM through Chitheka health center on 17th September 2021, six women were screened for cervical cancer and were all found negative. A total of 580 male condoms were also distributed during the mobile clinic.

FPAM is implementing a UNFPA-funded SRHR Integration project in Nkhatabay, responding to a need to reduce teenage pregnancies currently at 29% according to MDHS 2015-2016, and ensure men and women of reproductive age have access to quality health services by 2030 to contribute to the attainment of the  Sustainable Development Goals 3 Good health and wellbeing and 1 No poverty, and the  Malawi Vision 2063.