Long journeys to the nearest clinic, local myths and fears, and poor health services can prevent women from being screened for cervical cancer.
As usual, Pratibha’s morning in Maharashtra State, India, began early. After she lit the fire, she went out to get fresh water from the village tap and found a group of women talking anxiously.
As she approached the group, she listened to what they were saying. “They had come to my house,” her neighbor said. “They were telling me about cervical cancer and that I should get myself tested.” Pratibha, 37, said to herself, “Well, this is not for me, I am perfectly well.” She would have liked to linger and listen to what the women had to say, but she had to hurry back since her mother-in-law was waiting for her.
An initial meeting
When Pratibha arrived at her house, two women were talking to her husband. She learned that they were workers from the cancer hospital. Pratibha felt frightened, although she was not sure why. She wondered why they were there.
The health workers approached Pratibha and asked to talk to her. Together, they sat down in the only room in the house. In the corner, Pratibha’s two-year-old son was still sleeping. The health workers asked Pratibha many questions, such as how old she was, when she married, and how many children she had. Then they told her about cervical cancer—that it is common in women in her region, and that it is a preventable disease. They also told her about an opportunity to be screened in the village.
Pratibha asked why she was selected for this interview. She was relieved to learn that they were visiting every house in the village. She still didn’t understand why she should go for the test, but when the health workers invited her to the schoolteacher’s house for a talk on cervical cancer prevention, she was curious about what the other women would say.
A spirited gathering
When Pratibha arrived at the teacher’s house, it was already full of women and their children. Everybody was talking. As soon as the health worker began speaking, however, the room fell into silence. The health worker explained that testing women for precancerous lesions—even if they feel well and have no abnormal symptoms—can prevent cervical cancer and death.
“I found it difficult to understand all the things that were being said, as, unfortunately, being a girl child my parents educated me only up to primary level,” said Pratibha. “I was happy to hear that a video show would be organized in the evening. I would understand better by seeing the pictures. In the end, the health worker said if a woman is healthy, then the family will be healthy. When I heard that, I remembered how difficult it had been for me to look after my son during the last monsoon season when I got seriously ill with typhoid. When the meeting was over, I thought I should attend the clinic if my neighbor who is more educated than me also attends.”
That evening, Pratibha and her husband attended the function organized by the cancer hospital, and they heard senior hospital staff speak about cervical cancer screening. After hearing this and viewing the video, Pratibha thought that the procedure seemed simple and noted with relief that female health care providers perform the exams. As she spoke with other women, she found their concerns were also alleviated and that they felt good about participating in the screening.
Pratibha was still worried about talking to her husband about going to the clinic, however. “I wondered whether he would allow me to have a gynecological test since I have no complaints,” she said. “One of the advantages of participating in the program was the testing and treatment were all for free. There was no financial burden. If any expense was involved, I would never have thought of participating or discussing it with my husband.
“Now as there was no such problem, I asked my husband if he would allow me to go to the clinic. My husband informed me that Mr. Shinde had said that all women from this village should go and avoid getting cervical cancer. Mr. Shinde is the political leader of the village—a well-respected man. His mother had died of cervical cancer when he was 10 years old. I was pleased to hear my husband approving my being screened, and I realized that Mr. Shinde had done a good deed by talking to husbands in the village. My husband was also able to convince my mother-in-law about the benefit of my getting tested.”
Taking the next steps
Pratibha said that almost all of the women in the village attended the clinic and found that the test was fast and painless, as the health worker had said. Although the women had to wait in a long line, Pratibha said they were happy with how the clinic was organized.
As Pratibha explained, “After examination, the [health] worker said that they would inform me about the report. Then, after some days I got my report. It was positive. I thought, ‘I am not suffering from any symptoms. How then is my report positive?’ I was very upset. My neighbor, a woman I respect, consoled me. She told me, ‘Don’t worry, my report is also positive. We will take treatment. There is no need to worry.’
“Then I attended the cancer hospital. The doctor examined me and advised LEEP [loop electrosurgical excision procedure] treatment. I thought that this would be sufficient treatment, but, unfortunately, again the report of LEEP was positive [for cancer] and the doctor advised hysterectomy. It was very shocking; it disturbed me a lot.
“My husband and I decided that I should take the treatment but I had a problem. There was nobody to look after my son, who is just two years old. But happily, I solved it with the help of my neighbors and attended the hospital for hysterectomy. The doctor has done my operation successfully and now I don’t have any problems.
“Previously, I thought that I am a very unlucky woman because there was a positive report. But now I feel how lucky I am! My disease was detected in the earlier stage. And I got treatment for free. These people saved my life. They have not only saved the woman but they have saved the mother of a small child.”
Reflecting on her experience
Pratibha recalls talking to another woman with advanced cancer in the hospital. The woman was very upset, worried about what would happen to her children if anything happened to her. “Listening to her, I thought how lucky I was to get the opportunity to attend the program. I was saved. If I did not attend the clinic, what would have happened to me? This thought frightens me even now. I am lucky that I live in the village of Osmanabad District, which has been selected for this program. I am thankful to these people, who put in so much effort to convince me to get tested and prevent cancer. They saved my life and my family.”
This story is an excerpt from Women’s Stories, Women’s Lives: Experiences with Cervical Cancer Screening and Treatment, a publication of the Alliance for Cervical Cancer Prevention. The story is based on the work of the International Agency for Research on Cancer.
Photo: Anne Boyd.