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by Susan Cotton, Executive Chair
As we prepare to launch The Lily Project later this month (Mission: To deliver preventive health care to women in rural Nicaragua reducing the number of women newly diagnosed with terminal cervical cancer 30% by 2020) I have had the wonderful opportunity to meet with a quite a number of potential partners, donors and supporters. As I’ve shared our story, the most common reaction I’ve received is ”I honestly had no idea…” about this cancer, its prevention and why the work we are doing in Nicaragua is so important. To do my part for Cervical Cancer Awareness Month, I will be sharing information with all of you, with the hope that this knowledge will spread and do good things. #3: A Drop of Vinegar…A Life is Saved Given the lack of success in relying on Pap tests to prevent cervical cancer in developing 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 and need to leave 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 promoter 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 a simple, cost-effective procedure to bring health to women in the communities we serve. Up Next: The Lily Project Blooms in Nicaragua
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By Anielka Medina, Executive Director
Often, the work required to organize and mobilize communities in preparation to provide the annual services to the women can be underestimated. This week, our team has been focused on our next stop: Miramar. Miramar is small fishing village with about 1500 inhabitants located about 20 kilometers south of the port town, Puerto Sandino. While Puerto Sandino receives substantial attention from the government in terms of medical and educational support, the small communities on the outskirts are often forgotten. Perhaps 20 kilometers, about 13 miles, does not seem very far, but when you are a mother of three without transportation, 20 kilometers is a big task; and unfortunately, a task that often outweighs the risk of cervical cancer. If you’ve been following our work, you already know that cervical cáncer is the most preventable cancer in the world. Truly, an annual exam is the great barrier between those who survive and those who do not. Yet, in Nicaragua, cervical cancer is the #1 killer of women. We were pleased this week to have the opportunity to work with the town leader, Ivania, who has been absolutely incredible in terms of organizing and mobilizing the women (and even a few men!). A critical part of the work we do is centered on participating WITH the community WITH their norms and culture in mind. When we find participants like Ivania, we know the exams will be a success. We are hoping for at least 200 women to participate in the VIA / PAP exams next week, but Ivania is saying she will get 300 participants. If we have 250 participate we will be achieving the expected 85% turnout of the eligible population. In addition to providing the incredible support of organizing and mobilizing the women, Ivania also has promised to feed our team over the two weeks we are working in the community. One strategic challenge we were struggling with was the food we’ll need to provide to the team while we’re on the road (there are no McDonald’s in these parts of the world!). We’re hoping and praying for a mobile unit in the future, but until then, we are expecting to eat a substantial amount of food from a can! However, the support Ivania has promised came as a surprise and huge blessing. We’ve offered to bring the rice and beans, and the town has promised to cook and provide fish or chicken. During the meeting with the town to finalize the details of the two weeks of exams and treatment, we had the opportunity to explain the process of The Lily Project. Feedback from the attendees was fascinating and reinforcement our current mission. Three key parts of our project REALLY resonated with the town: 1. Accessibility: The Lily Project is focused on bringing services to the women in rural communities. While other foundations set up clinics and ask the women to find a way there, Lily overcomes this primary obstacle by going to the women directly. 2. No Cost: We are working in poor, rural villages where $5 makes the difference between food on the table or not. Exams and treatment at other non-profits cost between $5 - $50. If women have to pay, their participation drops dramatically. 3. Treatment: We provide on-site, in-community treatment for eligible women. Occasionally, rural communities are blessed to have teams of doctors visit. However, traditional clinics do not provide treatment which requires the women to make a 2-3 hour trip to the capital to receive treatment. Studies have shown participation in treatment is about 10% when required to make an arduous journey to receive it. After hearing about The Lily Project plans in Miramar, the ladies are thrilled and ready to participate. We expect to have a great turn out next week (January 26-February 7), and we are looking forward to sharing the results. Next Perspectives: Miramar Participates By Susan Cotton
As we prepare to launch The Lily Project later this month (Mission: To deliver preventive health care to women in rural Nicaragua reducing the number of women newly diagnosed with terminal cervical cancer 30% by 2020) I have had the wonderful opportunity to meet with a quite a number of potential partners, donors and supporters. As I’ve shared our story, the most common reaction I’ve received is ”I honestly had no idea…” about this cancer, its prevention and why the work we are doing in Nicaragua is so important. To do my part for Cervical Cancer Awareness Month, I will be sharing information with all of you, with the hope that this knowledge will spread and do good things. #2: Why Nicaragua? Cervical Cancer is NOT an equal opportunity cancer. Today, more than 85% of cervical cancer deaths occur in low resource countries, where health systems are not equipped to provide broad-based and high quality screening or the necessary follow-up and treatment for women with early stages of cancer. Without proper screening and treatment, most women don’t discover they have the cancer until it has advanced to a late and deadly stage. According to the Society of Obstetricians and Gynecologists of Canada, left untreated, “growths on the cervix enlarge, pushing in through the vagina and into other areas of the body causing irregular bleeding and obstruction of the urinary tract. Women will essentially bleed to death and die from anemia and uremia…To die of cervical cancer, without access to medication, is excruciating.” 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 coastal 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. This disease often hits women with children - and with an estimated 40% of households managed by a woman without a partner or spouse - it destroys families and leaves children on their own, with extended family or at the care of the community. Cervical cancer is one of the many contributors to Nicaragua’s extreme rural poverty where more than 68% of the population lives on a little more than $1.00 per day. Up Next: A Drop of Vinegar…A Life is Saved |
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