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In Uganda, where every year nearly 2,500 women die from cervical cancer, a British specialist has set in motion a screening and care programme that is making a difference.
Early in 2005 Professor Ian Jacobs, an international authority on gynaecological cancer, visited Mulago Hospital in Kampala, the biggest hospital in Uganda. It was his first visit to Africa since he had worked there as a medical student 30 years before. Now he was leading a team from University College London's Institute for Women's Health, which he set up in 2004 to improve women's health worldwide. On this first fact-finding visit, meeting colleagues at Mulago Hospital, he was taken to one of the wards.
'It was an anguishing sight – a ward completely full of young women with advanced cancer of the cervix, beyond curative treatment. They had come from miles and miles to the only radiotherapy machine in Uganda that was working – a machine held together with sticky tape. In Britain, for the same population, we have more than 100 radiotherapy machines. And these women were the lucky ones because radiotherapy can, to some extent, relieve the pain. But most women in Uganda with cervical cancer don't have access to radiotherapy or to opiates. They will die a long and painful death.'
Every year nearly 2,500 women die of cervical cancer in Uganda, a country in east Africa roughly the size of the UK but with only half its population. Life expectancy is 52. Because of the lack of resources and information in Uganda, early symptoms of cervical cancer, such as abnormal bleeding, are often ignored. Malnutrition and HIV may also be contributing factors (rates of HIV have fallen dramatically in recent years, partly as a result of President Museveni's controversial ABC programme – Abstain, Be faithful, use Condoms). Cervical cancer is the largest cause of death from cancer among women in Uganda.
Standing in Mulago Hospital, Prof Jacobs felt an overwhelming sense of responsibility. 'I thought, we can't walk aw ay from this. We have to do something. The next question was – what?' The 'what' turned out to be the Uganda Women's Health Initiative (UWHI), set up by Prof Jacobs in 2005 as a collaboration between Britain and Uganda, and involving Mulago Hospital, Makerere University, Hospice Africa Uganda, the Institute for Women's Health at UCL and, crucially, the Uganda Ministry of Health. The UWHI's mission is to work towards the sustainable improvement of women's health in Uganda. A not-for-profit organisation administered by UCL, the UWHI has a joint UK/Ugandan board, a medical director, Dr Daniel Murokora, and a team of only four nurses. But it has already implemented nine full-scale projects that benefit women and their babies, including the resuscitation of newborns, the prevention of haemorrhage after childbirth and the building of a women's radiotherapy hostel at Mulago Hospital so that cancer patients, who come from all over Uganda, have somewhere to stay.
One of the largest projects, set up in January 2006, focuses on offering free screening and treatment for cervical cancer to women of all ages, initially in the capital Kampala and, since 2007 – through outreach programmes – in the surrounding countryside. Cervical cancer is an entirely preventable disease, and early detection of precancerous cells and then treatment with cryotherapy – which briefly freezes the cervix – have immediate results.
By Marianne Kavanagh: Telegraph 20-April-2012
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