Sunday, October 9, 2011

Cervical Cancer Screening

I’ve seen so many cervices in the last week!!!  I helped lead a 5-day cervical cancer screening training for midwives and nurses in the Kedougou region.  There were 9 students, and they were required to pass a written and photo test before they could be certified to do cervical cancer screening on their own.  I went into the training not knowing much about cervices, but along with the trainees, I can now distinguish between negative, positive, and invasive cancer results.  We looked at a lot of example photos of each type, and the trainees would go up to the projected image and explain what the result was and their reasoning for their conclusion.  They also got to practice inserting the speculum into a plastic vagina and spraying vinegar in.  After 4 days of intensive all-day training, they were ready to go out and test real women at a health post.

Testing a woman for cervical cancer is easy and doesn’t require a lot of supplies.  You insert the speculum into the vagina to examine the cervix.  Next you put a cotton swab of vinegar on the cervix and wait for 3 minutes.  After the time is up, you can look inside the vagina with a flashlight and know by looking at the cervix whether or not it is positive or negative for precancerous cells, or if the woman already has an invasive cancer.  Women in villages do not go to the doctor for an annual checkup or pap smear, and early detection of cervical cancer is extremely important.  Having cervical cancer screening in a village can help women find any problems early and seek treatment.

We divided the trainees into two groups, and each group went to a different village to do the cervical cancer screening.  I went with one group to a village not far from Kedougou and was surprised at how much I was able to participate.  Initially I helped the trainees get demographic and health information in Malinke from the women being tested, but soon I moved into the screening room to help with the test.  I held the flashlight to help the trainee examine each cervix, and I was asked for my opinion to verify the cervical status.  A trained nurse was also there to verify results as well.  Being in this medical room and looking at women’s cervices felt so surreal.  We got a great turnout at the health post, and I realized how many women are interested in their health.  A woman from their village had died of breast cancer, so the village was very cognizant of what cancer can lead to.  Before the testing began, we explained what cervical cancer is and why it is important to detect it early.  It was an amazing experience to be part of this training and see women being tested first-hand.  Looking at real cervices, I learned so much more than just looking at the pictures of them during training.

Nafadji just got a new midwife, and she participated in this training.  I plan to work with her and organize a cervical cancer screening in my village and possibly Ian’s village as well.  Nafadji has never had a cervical cancer screening before, so it would be great for the women here to be able to find out their cervical cancer status.  I’m excited to work with the new midwife, Madame Diop, on maternal health issues in the village. 

After a week in Kedougou, I’m back in Nafadji for a while.  It’s nice to have a slower pace here after being in training from 9-5 every day last week.  The kids on my compound love drawing every day, and each morning I am greeted with “Aissata, dessin, dessin!!!”  “Dessiner” is “to draw” in French and they use “dessin” in Malinke as well.  Thank you to everyone who has sent me art supplies, because the kids have gone nuts over all of it!  A couple months ago, I gave them blank paper and pens and told them to draw.  They had no idea how to draw or what they should be drawing.  Since children in the US start drawing at a young age, I assumed children here knew how to draw as well, but I found that they need a little guidance.  They started off trying to copy whatever I was drawing, and then they asked me to tell them what they should draw.  Now, they’re finally getting creative with it!  Although they do ask me every few minutes “Aissata, regarde” to get my approval.  Art projects have been a fun activity on days where not much is going on, and the kids really look forward to it. 

We have a seasonal river that runs just below Nafadji, and women have been using it to bathe and wash clothing and dishes.  Fily invited me to go down to the river to bathe with her and Diabou one evening.  I felt uncomfortable bathing in the river when people are frequently walking along the road right next to it, but I agreed to go in a bathing suit and swim around for a bit.  Right before sunset, I walked to the river with my sisters, and they bathed in the river as I swam around with a bunch of kids.  It was funny being in the situation, because I think I pictured this scenario of women bathing in a river when I came to Africa, but now it didn’t really feel as foreign since I know all the people involved.  I also had just gone running right before we headed to the river, so it felt amazing to be in cool waters.  It was a fun evening activity! 

Right now, Ian and I are working on a project to get matrons (midwives) trained for 5 villages that don’t have anyone trained in birthing babies.  A couple weeks ago we biked out to a remote village to talk with the village about electing a woman to participate in the 6-month matron training.  It was great to be able to meet the woman they chose and to see the village’s enthusiasm for getting a trained midwife.  Women in villages with no health post give birth at home, and oftentimes there is no trained individual to help with the birth.  I’m planning to meet with another village this week to have them elect a woman for the training as well.  It’s a project that I think will have a big impact on maternal health in the villages that do not have easy access to a health post.

I’m at a point where I’m beginning to do work and have so many ideas for projects that I don’t know where I should start.  This week I’ll be writing up an action plan that will cover the projects I’m interested in doing in the next year.  It’s exciting!


  1. So So So So So...
    That you are working virtually free to help these people you never knew before and potentially saving lives. I wish our government expanded the peace corp. I would guess every dollar spent on work like you are doing is worth a thousand dollars spent putting a plane in the air to bomb buildings.

  2. haha welcome to my future life! What do you do if you find precancerious lesions or cancer? Do you have a place to refer them to for LEEP or cone biopsy or is the only option hysterectomy? I'm sure you are doing awesome work, you should think about combining that screening with a breast exam, since they probably never have one, you might not find everything but you could catch the big stuff that really needs to be worked up and teach the women how to do a self exam at home and when to come to the hospital. Keep on fighting the good fight!

  3. Thanks Dad! I miss you!

    Hannah, a team of doctors is coming in January to teach cryotherapy, and we'll begin to train health workers all around the region in that technique for precancerous cells. At the health post level, that's as much as they'd be able to do, and if women need treatment for cancer, they'd be referred to a hospital. Thanks for the advice about the breast exam. That's a great idea! I hope med school is going well!

  4. That sounds awesome! I just had my first interview at University of New Mexico and the program director there is interested in cervical cancer screening in 3rd world countries, so it was cool to talk to her about it! I'm glad you are doing so much good work, hopefully I'll get to see you this winter!