Need to scale up cancer services in rural areas

Sikhulekelani Moyo, mskhulekelani16@gmail.com

MRS Navigator Bhebhe (56) from Mberengwa District in the Midlands province, one day, woke up early in the morning to do her chores as usual. 

But on this particular day, something was off.

As she was taking her early morning bath, she discovered a strange vaginal discharge, which came as a shock to her as many unsettling thoughts quickly came to her mind. 

Having heard about cervical cancer, her heart throbbed.

She called her husband to show him the discharge and he was equally surprised. 

“We thought of going to the nearby clinic to get assistance, but before going there, my husband spoke to a few people inquiring if the clinic had cancer screening facilities because the clinic is a little bit far from our homestead.

“We were told there was no such facility, but decided to go check for ourselves anyway. After reaching the clinic, it was confirmed that the clinic did not have the facility, but there was a visiting team that came once in a while to assist those who wanted cancer screening services,” said Mrs Bhebhe.

“I almost fainted because we didn’t have money to go to the hospitals in the city. We got a date for when the screening team would be at the clinic and we had to wait for that day.

“It was about a two-month wait. I was counting down the days and thinking, if it’s cancer, then I might be also counting down to my death.”

Mrs Bhebhe’s story mirrors that of many women living in the rural areas who fail to access timely cancer screening and treatment services. 

“Instead of counting down to the date when doctors were supposed to visit, I was counting down to my death as I thought I had cervical cancer, which would kill me,” she said.

“I waited, losing hope every day until the arrival of the screening team. When the doctors confirmed that I was cancer-free, I was so relieved. Although I wasn’t feeling any pain, I lost some weight during the waiting period as the anxiety was eating me every day.

“I appeal to the Government to consider establishing VIAC facilities at rural clinics so that we can also get the opportunity to do cancer screening and detect such conditions early,” said Mrs Bhebhe.

Visual inspection with acetic acid and camera, or VIAC, is an effective way to prevent cervical cancer in women aged 30 to 50 years old. 

It involves examining the opening of the womb, or the cervix, for changes that might lead to cancer.

In urban clinics, VIAC facilities are available and the screening is free.

Cervical cancer accounts for more than a third of deaths in the country.

HIV remains an important risk factor for cervical cancer and HIV-positive women are four to five times more likely to develop it compared to HIV-negative women.

Cervical cancer is, however, preventable and treatable if detected early.

All sexually active women should go for screening at least once in five years to reduce the chances of developing cervical cancer.

The Zimbabwe Demographic and Health Survey (ZDHS) 2015 report said 79 percent of women had heard of cervical cancer but only 13 percent ever had a cervical examination.

A village health worker, Mrs Gladwin Thangule from Gwambe Ward in Plumtree said they offer cancer awareness campaigns to different villages, which are meant to assist women in doing self-breast cancer screening for early detection.

She said because rural areas do not have cancer screening facilities, the Government occasionally takes those who want to get screening services from the rural areas to Plumtree District Hospital.

“There are a few cases of breast cancer, but it seems cervical cancer cases are rampant,” said Mrs Thangule.

“Those who want to be screened are taken to Plumtree Hospital or sometimes hospital personnel do visits for screening at local clinics.”

Zimbabwe observed Breast Cancer Awareness Month last October, which was running under the theme, “No one should face breast cancer alone”.

The theme aimed at bringing comfort to those battling the disease and served as a reminder to their loved ones that the fight is better managed with a strong support system.

In Zimbabwe, breast cancer has emerged as a significant public health concern, with the Zimbabwe National Cancer Registry reporting that the disease accounts for approximately 34 percent of all cancers in women.

Annually, 2 000 new cases of breast cancer are recorded in the country. At the United Bulawayo Hospitals (UBH), at least two to three women test positive for breast cancer weekly.

Early detection is crucial with statistics indicating that when caught early, the five-year survival rate can be as high as 90 percent.

Symptoms of breast cancer include a breast lump or thickening, often without pain, change in size, shape, or appearance of the breast, dimpling, redness, pitting, or other changes in the skin.

Matobo Ward 11 village health worker Mrs Lindiwe Moyo, said some women in her ward have been accessing cancer screening services.

She, however, said the opportunity is limited considering the distances they have to travel to access those services.

“Concerning cancer issues, women can go to hospitals to get screening services but some fail to get there because the hospitals are far away from their homes,” said Mrs Moyo.

“We appeal to different organisations to assist so that we can access cancer screening facilities from nearby clinics, which will enable everyone to get help,” she said. 

In an interview on the sidelines of the Pre-National Budget Conference held in Bulawayo recently, Minister of Finance, Economic Development and Investment Promotion Professor Mthuli Ncube, said the Government is moving one step at a time, with plans in the pipeline to establish cancer screening facilities in rural areas.

He said they had started by procuring equipment and drugs to respond to cancer issues.

“There is indeed a shortage of cancer screening facilities in rural areas, this is a work in progress. We are only waking up to cancer in the last year or so I think,” said Prof Ncube.

“For now, we have been focusing on procuring the right equipment and the drugs then we work on facilities.

“We spend more money on facilities. Imagine if we were to cover all our rural areas, it would be difficult but we would start at the provincial level and then cascade to the district level, but it’s a work in progress and it will take a long time.

“We also know that a disease like cancer will be with us for a long time as well, so we know what we are in for and we will keep improving. The sugar content levy is a start and we will keep going to make sure we can deal with and confront this cancer surge,” said Prof Ncube.

The Government has collected approximately US$18 million from the sugar tax since the start of 2024 and the funds will be channelled towards procurement of cancer treatment equipment and accessories in line with the Second Republic’s commitment to improving health care services in the country.

The new tax was announced in the 2024 National Budget in 2023 and came into effect at the beginning of 2024 as part of measures to reduce the consumption of high-sugar beverages.

When he proposed the new tax, Prof Ncube, clearly stated that the sugar tax funds were going to be ring-fenced towards therapy and procurement of cancer equipment for enhanced diagnosis. — @SikhulekelaniM1