Interview with Dr. Hawa Sangarè Mamary, National Manager for the Prevention and Treatment of Cervical Cancer in the DREAM centers of the Community of Sant’Egidio in Malawi.
Between 20 and 27 April a campaign for the prevention and treatment of cervical cancer took place in the district of Blantyre, Malawi. The event received widespread support by the media and the local population.
We met with Dr. Hawa so as to learn how the initiative unfolded and ask her to explain its results and the coming challenges for the future.
Cervical cancer is very common in Africa, particularly amongst HIV-positive women. It can be prevented through vaccinations (routine in western countries, but not yet implemented in developing countries due to associated costs) and is easily cured if diagnosed in time through a simple screening process.
Q: Good morning, could you briefly introduce yourself and tell us about your role in the Dream Program of the Community of Sant’Egidio?
A: My name is Sangarè Hawa Mamary, I am a doctor and have been working with the DREAM program in Malawi since 2010 at the Elard Alumando Center in Blantyre.
My work at DREAM consists of various activities: I visit and treat the HIV-positive patients and in particular I manage the vertical prevention program to impede the mother to child transmission of the HIV virus (PMTCT). I dedicate myself to pregnant women and their children born in the program, which are all essentially HIV-negative, but whom we follow until their second year of age.
Furthermore I monitor and supervise the district’s healthcare facilities where DREAM supports and collaborates with the Ministry of Health on matters such as HIV and early child diagnostics.
Another aspect of my job is training the activists (Expert Clients). They are patients we select and train in order to follow the newly arrived women who enter the program through Home Care and a detailed health and food education program.
I am also DREAM’s National Manager of the health programs for women and particularly for the prevention and treatment of female cancer. In our center we carry out cervical cancer screenings through a visual inspection of the cervix, using acetic acid (VIA).
Q: How widespread is cervical cancer in Malawi and what are the possibilities of treatment and prevention?
A: Cervical cancer in Malawi represents 45% of all types present. In 2010 the HPV Center of the World Health Organization estimated that every year in Malawi 3684 women develop cervical cancer and, due to the lack of efficient programs, many die. Unfortunately the diagnostic and treatment centers are scarce and present only in the main cities.
Q: What are DREAM’s efforts in fighting cervical cancer in Malawi?
A: Our program is mainly based around prevention and treatment. We work together with partners such as the Ministry of Health and use the SVA – single visit approach through the VIA (visual inspection of the cervix) and immediate cryotherapy when needed. This is an efficient and practical method approved by Malawi’s Ministry of Health and many African countries. Furthermore DREAM, in collaboration with Norwegian Church Aids, supports the National Health Service by training medical personnel, supervising and supplying materials and devices required by cryotherapy in the districts of Mangochi and Balaka.
Q: When and why did you begin working on the prevention and treatment of female cancer?
A: We started the program in February 2016. This idea came to be together with the new approach of the DREAM program which in 2016 became DREAM 2.0.
The idea is to consider the global health of our patients. We immediately noticed the high prevalence of cervical cancer amongst HIV-positive women and realized that the existing services were not able to reach every woman.
Q: How did the idea of dedicating a special week to this campaign come to be?
A: The idea of the Campaign is the result of having participated in a meeting discussing the implementation of screening tests in the district of Blantyre. During the encounter it turned out that most of the rural health centers were not able to carry out screenings. For this reason we asked various partners to work with us in the district of Blantyre and we organized mobile clinics to carry out screenings in the rural areas.
Q: Who collaborated in planning the week?
A: The list is very long. First of all we met several times with the District Health Officer (DHO) of Blantyre, the various managers of the different health sectors, the village chiefs and the Traditional Authorities of the local area, as well as the personnel of the rural health centers. Their agreement and cooperation was necessary for the success of the event.
Q: What was the week’s schedule?
A: The opening ceremony took place on 19 April at the Health Center of Chileka. The next day we began the screening activities which lasted up until 27 April. The intervention was always preceded by health education lessons in order to explain the importance of periodically undergoing prevention and favor the spread of this message.
After the lessons the screening was carried out.
We operated at 9 sites: Chikowa, Dziwe, Chileka, Chimembe, South Lunzu Machinjiri, Lirangwe, Makhata, Lundu and Ndeka. All HIV-positive women found were directed to the two reference sites for treatment, the Queen Elizabeth hospital and the DREAM Center Elard Alumando.
Q: What was the fixed goal and how many women were examined?
A: Our goal was to reach 1500 women over the course of the campaign. Actually during this week 2731 women underwent screening tests (182% more than our initial predictions), with 52 resulting positive to the VIA test (2%) and treated with cryotherapy, while 10 women showed signs of stage 2 or 3 cancer and were directed to surgical treatment (0,3%).
Q: Why do you think that health education and this campaign are important?
A: Health education and the campaign we carried out are important because they raise awareness in the community to the health risks. They allow, thanks to an early diagnosis, to intervene on the disease before it manifests through its symptoms and becomes hard to treat. This is particularly important in countries with limited resources such as Malawi.
Furthermore it helps the people change their lifestyle and avoid a risky behavior. Over the course of the campaign we realized that many people never underwent a screening test due to the lack of information on how this type of cancer develops and how it can be treated.
Q: What were the people’s reactions and comments?
A: The women were happy and grateful for the occasion. Due to the high demand we raised, we decided to offer two more days of screening at the DREAM Center Elard Alumando. On the last day of the campaign every site was full of women. We received requests to repeat the event and many women will come over the next few weeks to our center to benefit from the prevention routine that we offer twice a week.
Q: How did the health institutions and the donors react?
A: The District Health Officer welcomed the campaign with enthusiasm and a few news outlets publicized the event free of charge. The red cross offered its tents for the duration of the activity. Total Malawi supported us on the purchase of a few materials required for screening.
Q: What are your plans for the future and how do you intend on moving forward with the project?
A: This year we managed to cover 9 areas and reach many women, and many more will continue to visit us over the next few months.
Next February (as is known, 4 February is World Cancer Day) we plan to repeat the mass screening process in more rural areas. Furthermore we would like the next campaign to last 4 weeks.
It is also fundamental to build other centers that are able to autonomously carry out the VIA. It is useful to equip mobile clinics in order to reach the most remote rural areas and it is important to provide the population with quality health services. One of our dreams is also to administer the HPV vaccine to teenagers. To fulfill our plans we must trust in an increased support on behalf of companies, non-governmental organizations and provate donors. Naturally we will continue, as always, to carry out routine screenings to whoever visits our centers.
Q: What were the main challenges in realizing this activity?
A: I would say that the first challenge was to raise awareness amongst women, especially in the rural areas. It was a success anyways, and in some cases we carried on with the activities until late due to the high number of patients present.
Another problem was the short duration of the campaign. It attracted many women that wanted to undergo screening, and with adeguate resources we could have extended its duration.
Notwithstanding this we demonstrated how it is possible to achieve much more. In just seven days we visited 52% of the total number of women visited in Blantyre over the course of 2016.
Q: Thank you, would you like to add anything else to this interview?
A: Yes, I would. In particular on behalf of all the women who live in rural areas I would like to thank the Community of Sant’Egidio for having made this campaign possible and having amplified DREAM’s coverage also to the prevention of cancer in women. I would like to thank as well the various news outlets for their role in encouraging and mobilizing the women. I am also grateful to the public health institutions and all the donors and operators that supported our activities. And also thank you for this interview.