by Scott Wittet, PATH


IT'S-PERSONAL-AS-WE-SEE-IT-SCOTT-WITTET2Here at PATH we have been working on cervical cancer prevention in the developing world for over two decades. But it’s only in the past five or six years that our work has come to fruition.
I’m particularly thinking of the relatively recent global acceptance of using visual inspection with acetic acid to screen adult women for pre-cancer (Pap smears are too complicated for low-resource settings) and, of course, the advent of a vaccine against human papillomavirus (HPV), the virus that causes cervical cancer. The vaccine has only been available since 2006.

As part of a recent project, we made a film for BBC World on cervical cancer in Uganda, Africa. The focus of the film was a woman named Sarah Nyombi. Sarah is a midwife by profession, at the time she was a Member of the Ugandan Parliament, and will always be a motivated advocate for cervical cancer prevention. Her auntie died of the disease some years ago and Sarah has been vocal about it ever since.

Part of the film focused on our project looking at how best to deliver the HPV vaccine to girls in Uganda. The vaccine had already been licensed in the country, so that wasn’t the question. Rather, we were investigating whether it would be most cost-effective for the Ministry of Health to send teams to schools to vaccinate (more expensive, but maybe with a higher payoff in terms of reaching more girls and preventing more disease), or if they asked families to bring their daughters to clinics and health posts for vaccination (much less expensive for the Ministry).
The film crew and I took Sarah to a school in a rural part of the country where the project had been rolling out for about a year. The village is several hours from the capital, Kampala. There Sarah met the girl who would be our “local star.”

Little Aisha was selected for the film by the school headmaster before our team arrived. He chose Aisha because she was articulate, cute, and not too shy. My director and cameraman loved her and enthusiastically filmed Aisha getting her third (and last) dose of vaccine along with her female schoolmates.

Later, there was some time to relax, and Aisha and Sarah shared a bench.

I wasn’t listening, so I didn’t know it at the time, but Aisha began asking Sarah very specific questions about the terrible symptoms and pain associated with advanced cervical cancer. After two or three of those, Sarah the Parliamentarian asked “How do you know about that? Have you seen someone with those symptoms?”

With a tear rolling down her cheek, Aisha replied, “Yes, my mother.”

The film crew happened to be filming the interaction, but without knowing what was going on (the conversation was in the local language). When they saw Aisha begin to cry, they called me over. Sarah explained everything.

From then on our plans for filming changed. It was incredible that one of “our girls” had suffered the loss of her mom to the disease. We made arrangements to visit her home and interview her father. All of that can be seen in the 25 minute version of the film at www.rho.org/multimedia.htm. There’s a shorter, 12 minute version too, and you’ll see Aisha in that one, but not her dad.

This experience helped everyone involved to become even more emotionally attached to the work. Here, right in front of us, was a concrete example of the positive value of vaccination—a ten year old girl now had protection that never was available to her mother.