Playing on radios in Zambia this month is an upbeat piano piece with a female radio personality warning words for women who have always been considered taboo.
Words like pelvic area, periods and even cervix.
“We’re a very conservative society, and it’s hard to discuss things like cervical cancer because it’s gynecological. It’s hard to talk about everything under the band,” said Karen Nakawala, who started the Teal Sisters Foundation which created the radio messages.
As the World Health Organization (WHO) launches a global strategy this week to intensify all efforts to eliminate cervical cancer – a disease that can be prevented or cured in most cases, but which has been allowed to become the most common form of cancer among women in Africa. , Nakawala and the Teal Sisters passionately ignore the harmful taboos in public discourse.
Told by ten radio personalities, including four men, the radio and similar text messages increase the volume of words that can save lives by encouraging women to go for a gynecological show.
Zambia is not unique with its cultural ban. “Across the region, things related to genitals and female reproductive organs, including the breasts, are not something that can be talked about freely in the public domain,” said Dr Prebo Barango, a medical officer at WHO Intercountry Support. Team for East and Southern Africa, based in Zimbabwe.
HPV is the most commonly sexually-acquired virus, he adds, with two of the subtypes (16 and 18) most commonly associated with cervical cancer. “But if there’s something wrong with a person’s genitals, the suspicion is that they did something wrong,” says Dr Barango. This stigma further prevents women from seeking investigations.
Accelerated Strategy to Eliminate Cervical Cancer
Along with raising the three cornerstones of the WHO Global Strategy of (i) Prevention by Vaccination for the Human Papillomavirus (HPV) (which is the primary cause of cervical cancer), (ii) increased screening and treatment of cancerous lesions and (iii) life-saving necessity for universal access to treatment and palliative care, the breaking down of language boundaries, says Nakawala, a tireless personality in fashion and music in Zambia and a survivor of cervical cancer.
“If we’re going to win this battle, we should definitely have this conversation,” she says, referring to what she calls the “private parts chats” to inform women about the need for an early detection investigation. “The cervix is in the cervix – you can not insert it into the arm.”
Zambia has the third largest burden of cervical cancer in WHO Africa, behind the Kingdom of Eswatini and Malawi.
But the burden, says Nakawala, is not just the result of linguistic taboos. The limited number of female doctors also prevents many women from undergoing a gynecological examination, in part because their husband refuses to be examined by a man.
Dr Barango says this is another challenge across the continent. Therefore, WHO promotes a screen-and-treat approach that can be managed by nurses (mostly female) at any health clinic. Trained nurses may perform an HPV DNA test and / or a visual inspection with acetic acid to detect any pre-existing lesion and then immediately burn or freeze a lesion.
Cervicography, which is also encouraged by WHO, makes the display accurate. Nurses can send a photo of a patient’s cervix to an expert anywhere in the world who can help with interpretation in real time, as well as supervision and guidance.
Although the HPV DNA test is expensive, Dr Barango emphasizes that it is more sensitive and compared to the cost of treating women due to the preventative cancer, it would be much cheaper in the long run.
WHO also supports integration of cervical cancer screening as part of standard HIV services in Africa. “It’s like a perfect storm: women who are HIV – positive are more likely to get HPV, and because their immune system is at risk, they will progress faster to cancer,” says Dr. Barango.
Change the conversation in Zambia
Nakawala is a very public figure in Zambia, with a popular weekly radio program, a television talk show, a magazine and the organizer of Zambia Fashion Week and the Zambian Women of the Year Awards. Yet she told few people about her cancer diagnosis, chemotherapy and radiation treatments in 2019.
She did not want a “sorry party”, she says. “To be honest, I never thought I would ever get cervical cancer because I was healthy, ate well and exercised regularly. At the time of my diagnosis, I attributed the few symptoms to the onset of menopause, and “I thought the slight and dull back pain was because I was on high heels forever. After I was diagnosed, I wondered how many other women like me.”
Prior to her diagnosis, she rarely heard anyone talk about cervical cancer.
So, one night in January 2020, she finally became public. She founded a Facebook group called the Teal Sisters Foundation to encourage conversations about cervical cancer (suggested by a breeding ribbon). She expected that there would possibly be 100 women joining. By morning she had 10,000 members, and many asked where they were going to look.
Ten months later it counts membership 137,594. And they are not all Zambians. About a quarter of them come from nearby countries such as Kenya, Malawi and Nigeria and from as far away as India, England and the United States.
Nor are they all survivors of cervical cancer. She asks survivors, current patients, caregivers or women in fear to send a ‘beautiful picture and a message about everything they want to say about cancer’ and to see how they can ‘help eliminate cervical cancer’.
To celebrate the global launch of the WHO Cervical Cancer Initiative, the Teal Sisters, which has become a formal entity, has teamed up with the Ministry of Health and the Ministry of Home Affairs to conduct a one-day survey for up to 200 of the women often overlooked in prison.
“If we are going to eliminate cervical cancer, we need to start with those who do not have the means or access to screening facilities,” says Nakawala.
As for the radio messages from private parts penetrating the airways, Nakawala surprisingly had no setback. “I think we just had to keep saying it like it is for people to understand and be moved to act positively.”