In the crowning year of my campus life, I once came across a huge attractive placard inscribed on it: Upcoming Medical Camp Organized by the Consortium of College of Health Sciences students, Marie Stopes Kenya and Texas Cancer Center to be held in Migori County. The word consortium was a vocabulary at the time insinuating an association of like-minded people. It was my resolve to be part of that Medical Camp. And part of it I was.
Migori County borders Uganda via the Migingo Island in Lake Victoria. The county has one of the most pleasant climates as I can recall. This is because of the high altitude that modifies the climate alongside the cool breeze from Lake Victoria that was named after the then Queen of England by explorer John Hanning Speke in the 19th century. Two centuries later, the name stands. Are we that powerless such that we are unable to name the Lake after Raila or Lupita or Okot p’Bitek? Modern colonialism still binds us.
The sites for our medical camp included Muhuru Bay on the banks of Lake Victoria close to the border of Tanzania, Macalder Mines area where gold is occasionally mined, Wath Onger and Karungu. The thrill I had when I was assigned to Macalder Mines, the half has never been told. I had anticipated getting back to Nairobi and beginning a gold business. To cut the story short, I have never seen gold to this day.
The Public Health County vehicles on the morning of 4th April drove us to the serene area of Macalder Mines. Six of us, students of the consortium of health sciences, were in full medical gear ready to conduct community service in terms of health well-being. Our arrival at the village’s dispensary was messianic. Women and children were lined up with longing desire to be attended to. It was quite a moment when we were told by the Clinical Officer in charge, “Karibu Madaktari!” I have never felt so boisterous.
The diagnosis began. Recommendations made. Therapies and remedies offered. Lab tests conducted. Nutrition prescribed.
One child was next in line with utmost agonizing pain. She was carried by her frail mother. Our hearts were moved with compassion. She was immediately attended to by our supervising lecturer Dr. Tibery. Dominating symptoms of the child included flared up rash and fever, pain in the chest during breathing, loss of scalp hair, Raynaud’s (where some areas of the body feel numb and cool in certain circumstances), and blood in urine. The mother pitifully sought for help from us, ‘Doctors from Nairobi’. The child suffered from systemic lupus erythematosus, a disease where the body’s immune system attacks its own tissues. It is categorized as an autoimmune disorder. The disease is mostly genetic and can be triggered by a few environmental factors. As blood was being drawn from the girl’s arm, her body suddenly turned pale and passed on.
Unable to surmount the sorrow at that moment, we had to finalize the day by carrying out cervical cancer screening to a group of about 20 women that had waited all day long.
I did not know how cervical cancer screening was done. Neither did three other colleagues of mine. Our supervising lecturer impressed upon us that we shouldn’t in any way portray signs of amateurism. The women trusted that our diagnosis that day was the gold standard. Dr. Tibery, therefore, had a quick side theoretical lecture to us as to how the screening is done. It wasn’t hard after all. Or so we thought until we were in the screening room.
Pap smear is the common means of cervical cancer screening where cells from the surface of the cervix and vagina are collected and then viewed under the microscope to find out whether they indicate any abnormalities. That is not the procedure we carried out since the microscope of the dispensary was faulty. We did Visual Inspection with Lugol’s Iodine (VILI) and Visual Inspection with Acetic acid (VIA).
Like how we used to do it back in primary school, my colleagues made me lurch to the front by pushing me to be the first person to enter the screening room and perform the screening to the first woman.
I found her patiently waiting. I’m glad she didn’t notice my shaky hands and sweaty brow. The attending nurse sternly reminded me in a whisper to keep calm. In Luo, the nurse told her to lay supine and bend her knees in the manner that delivering women pose. I was ashamed. The woman was way older than my mother. She confidently positioned herself naked.
Her legs wide apart, the nurse handed me the vaginal speculum after sterilizing it. The speculum is an instrument that is usually inserted into the vagina to dilate it for the examination of the vagina and the cervix.
I gently inserted it and it did not seem to go through. The nurse, in English, almost retorted that I should push it in with some more force. The woman uncomfortably moved her legs but I was already done with. The two hinged blades are usually closed to facilitate entry and then opened by a screw mechanism to enable the direct vision to the cervix area. And so in a clockwise manner, I moved the screw to open the speculum. The sight that met my eyes was not one I am used to. I squinted as I paused. The nurse stepped heavily on my foot. It was a wakeup call to proceed. First, I dipped the cotton swab on an applicator stick into acetic acid and applied it on the surface of the cervix. The woman immediately began cursing in Luo loudly. I was reminded that I was handling an internal organ hence I ought to be gentle.
Checking on the chart directly above and opposite my face, Visual inspection with acetic acid (VIA) was negative for cervical cancer. I then dipped another cotton swab on an applicator stick into Lugol’s iodine and repeated the same procedure. This time I was gentle. I almost jumped from my seat as I asked the nurse to come and see the yellow color indicating positive for cervical cancer. She visualized and truly, the color change was yellow but it was attributed to the fact that the lady was just from her monthly periods.
That was it! I had done it despite a few medical ethic malpractices. I rectified them in the second, third and fourth lady. I walked out of the screening room the Arnold Schwarzenegger way after conquering a war in Hollywood. I was met by the shuddering frames of my colleagues who were yet to do their bit.
Out of the 20 screened women that day, four were found to be with cancer of the cervix. It was the saddest thing that day too to break the news to them.
Cervical cancer is characterized by a malignant tumor at the cervix, in the lowermost part of the uterus. It is prevented by screening and more recently, the Human Papilloma Virus vaccine that is quite costly. Most cervical cancers are caused by longstanding infection with one of the human papillomaviruses. Abstinence for the unmarried, regular screening for the married and acquisition of the HPV vaccine are the core ways to tackle the issue.
- Pain during sexual intercourse or in the pelvis
- Abnormal menstruation, heavy menstruation, irregular menstruation or spotting.
- Abnormal vaginal bleeding or abnormal discharge
- Also common are fatigue, nausea, and weight loss
Cervical cancer is the feministic foe that ought not to take away the ladies in our lives or the ladies we associate with.
“Cancer happens. It is always pink. For many women, it is teal and white. No one likes talking about their cervix. Boobies are much more fun. However, the more we share, the more we become aware of it. Cervical cancer is not a stigma. It is real and it kills. I will gladly discuss my cervix to save a life.” – The Teal Ladies.