Mi nombre es Silvia Fuentes y soy sobreviviente de Cáncer Cervicouterino; cuándo me diagnosticaron en Mayo del 2014 no estaba trabajando y por tanto, no tenía seguro médico. Ante esta situación mi familia y yo teníamos dos opciones: tramitar mi atención a través del Sistema Nacional de Salud o asumir todos los gastos de manera privada.
Optamos por la primera opción; recuerdo tenía mucho miedo. No sabía si tendría que esperar mucho tiempo para ser atendida...y por lo que había escuchado, en la lucha por el cáncer el tiempo vale oro.
Fui referida al Bertha Calderón, que es el hospital de referencia nacional para la mujer; allí conocí a muchas mujeres de diferentes zonas de mi país. Mujeres que al igual que yo, querían vivir. Con ellas, pasé varios días esperando la hora de nuestras respectivas consultas o exámenes; cada una tenía una historia diferente. A unas les habían detectado su cáncer a tiempo y otras ya avanzado; pero la mayoría teníamos en común, que no nos habíamos hecho el examen de Papanicolaou en mucho tiempo. Algunas por vergüenza, otras por que no nos gusta ir al ginecólogo al igual que no nos gusta ir al dentista, otras porque no lo creíamos necesario hacerlo anualmente y otras porque les quedaba muy lejos los lugares donde los realizan; con ésta última opción no me pude identificar, dado que vivo en la ciudad y tengo todas las facilidades para acudir a cualquier hospital público o privado y aún así no lo aprovecho. Eso me dolió en el alma, constatar lo difícil que es para muchas personas en mi país, el recibir atención médica.
De manera paralela a la gestión que hice en el servicio público de salud; solicité autorización ante el Instituto de Seguro Social de continuar pagando el seguro de manera personal y recibir atención a través del Programa Oncológico del Seguro. Esta solicitud fue aprobada y en Junio inicié mi tratamiento en otro hospital. Dios me dio una oportunidad a través de personas que me apoyaron incondicionalmente y yo me comprometí a retribuirle apoyando a otras mujeres que estén pasando por la dura situación de aceptar que tienen cáncer y motivarlas a que sean valientes para enfrentar su tratamiento.
En el 2015, sintiéndome sana, con fuerzas y con mucho ánimo; buscando como cumplir mi compromiso con Dios. Encontré por las redes sociales esta nueva iniciativa que trabaja en la prevención del Cáncer Cervicouterino en comunidades rurales de mi país. El equipo de Lily Project trabaja de manera coordinada con el Ministerio de Salud, liderezas y lideres comunitarios así como con organizaciones locales y se traslada a comunidades de difícil acceso. Aún me emociono al recordar como me puse en contacto....recuerdo que les escribí al correo, quería conocerlos.... tenía que ser parte de este proyecto.
Así fue como me sume a esta causa, mi causa!!!. Las veces que he acompañado al equipo a las comunidades, he disfrutado estar con las mujeres que acuden a realizarse su papanicolau; hablar con ellas, compartirles mi historia, escucharlas. Darles ánimo y decirles que todo pasa. Que hacen lo correcto de revisarse por amor a ellas y a sus familias.
En esos momentos o a través de las fotos que el equipo comparte en la página de The Lily Project, ver a madres que llegan con sus hijas o sus nueras, ver a niños que juegan mientras esperan a que sus mamas, hermanas o tías sean atendidas.....siento la vida, siento el amor y le doy gracias a Dios por regalarme una segunda oportunidad para vivir a plenitud.
Silvia Carolina Fuentes
By Silvia Fuentes, Board Member (Translated).
Hello - my name is Silvia Fuentes, and I'm a survivor of cervical cancer. When they diagnosed me with the disease in May 2014, I had not been working and I had no medical insurance. My family and I had two options: take the treatment that was offered through the national health system or pay for treatment privately.
We decided to go with the first option. I remember I was so afraid. I did not realize that I would have to wait so much time to be attended to when I arrived to start the treatment. I had heard that fighting cancer in the national health system was like trying to survive against all odds. I was referred to Bertha Calderon, the hospital in Managua that treats cancer in women. There I met many other women from around Nicaragua also fighting to stay alive. With these other women, I waited many days going through various exams and appointments with doctors. Every woman had a different story to tell. Some of the women were fortunate and had detected the cancer early, but others were in advanced stages. However, one thing we all had in common: we had not had a regular Pap exam. Some for shame of the exam process and others because they just didn't like visiting the gynecologist, others because they didn't think the exam was important, and others because they lived in rural communities where the exam was not available. It was hard to identify with the ladies in the rural communities that did not have access because I lived in the city where I had all the resources, public & private, and I still did not take advantage of them. This made me sad as I realized how I had an opportunity that many women in my country do not.
While waiting for treatment in Bertha Calderon, I submitted a request to be transferred to a better hospital based upon my previous job and the payments I was making to the social medicine at that time. The request was approved in June, and I started a better treatment program in a different hospital. God gave me an opportunity through this change as the treatment was much better, and I promised Him I would repay it by helping other women in similar situations. I was determined to encourage other ladies to be strong and courageous in light of the circumstances and fight the disease with the treatment available.
In 2015, I was declared free of the cancer, and I began looking for opportunities to fulfill my promise to God. Through social media, I found out about a new program focused on delivering health services to women in rural communities in Nicaragua called the Lily Project. The Lily Project Team was working with the health ministry, local leaders and established organizations to deliver their services to areas that were difficult to reach. I still remember how excited I was when I reached out to Lily, and I explained I wanted to be a part of the work and help the women in need.
This is how I came to The Lily Project; a cause I'm so passionate about, my cause! The times that I've participated with the Lily Team in the communities, I've truly enjoyed being with the women and helping them realize the value of having a regular Pap exam. I talk with them, share my story, and I listen to them. I emphasize that this is for their health and for the love of their family.
In these moments as I see the work of The Lily Project through the pictures on the website or via social media, I see moms and grandmothers arriving with their daughters and granddaughters, I see kids playing while their moms, aunts and sisters are examined, and I feel life. I feel love. I give God thanks for giving me a second chance at life, and I choose to live it to the fullest!
By Susan Cotton, Chair of The Lily Project
Despite the introduction of Pap Testing in the 1960s, regular Pap screening is available to less than 10% of women in Nicaragua. Cervical cancer remains the largest cancer killer of women in Nicaragua, which is burdened with the highest annual rate of death from cervical cancer of any country in the Americas. Cervical cancer in Nicaragua disproportionately affects rural communities where there is very limited access to preventive health care including Pap tests and a high incidence of sexually transmitted disease. Additionally when cancer is discovered, these communities do not have the resources to treat the woman and help manage her pain – contributing to a horrible death and compounding the tragedy of this preventable disease.
Given the lack of success in relying on Pap tests to prevent cervical cancer in low resource countries, alternative evidence-based preventive measures are being developed and promoted. Global health organizations and advocacy groups, including the WHO and PAHO are investing in new screening methods and a simple ‘screen and treat’ approach. During the last decade, a great deal of research has been conducted that proves the efficacy and cost-effectiveness of these newer approaches in slowing the incidence of cervical cancer in developing countries, primarily in Africa and Latin America.
Visual Inspection with Acetic Acid (VIA). This screening test identifies pre-cancerous areas of the cervix by washing with simple distilled vinegar (acetic acid). When swabbed, abnormal lesions become white and can be seen by the naked eye or with low magnification. The advantages of this screening method compared to Pap tests are it is less costly, doesn’t require highly skilled lab technicians and offers an immediate result. One reason the Pap testing method has been ineffective in low-resource countries including Nicaragua, is it often requires multiple visits to complete a full screening given there is a relatively high rate of false positives and need for repeat exams. In Nicaragua, this will often mean women will travel great distances leaving their children at home, creating a lifestyle barrier that is difficult to overcome.
Screen and Treat. A method of combining VIA, with cryotherapy, which freezes and destroys abnormal tissue on the cervix, is a procedure being adopted to combat these issues. A discussion paper presented at the United Nations in 2011 recommends cervical cancer screening using VIA and treatment of precancerous lesions through cryotherapy as a 'best buy' because it a highly cost-effective use of health dollars, costing less than US$ 0.50 per capita to implement in low income countries. The procedure is beautiful in its simplicity: a trained health provider swabs a women’s cervix with vinegar; infected cells, if any, become white; and cryotherapy is performed to freeze and destroy the abnormal tissue.
Leaving it up to a woman to travel to a clinic hours away to get a Pap test, then waiting months to receive her results, then traveling to a hospital even further away if treatment is required, is not a reasonable solution to this unreasonable problem. Instead, The Lily Project combines proactive outreach and sexual health education with this simple, cost-effective screen and treat procedure to bring health to women in the communities we serve.
The Lily Project, a women’s health NGO in Nicaragua, improves the lives of women and girls through a women-centered model of care and development. Lily’s mobile health clinics care for the whole woman - providing cervical cancer screening and treatment, reproductive and sexual health education, trauma counseling, and community building. Learn more: thelilyproject.org