Cervical cancer care: thinking locally and globally Chad Hammond, Postdoctoral Fellow University of Ottawa

Cervical Cancer in Uganda Two Major Prevention Strategies HPV Vaccine: wipes out certain strands of one of the major causes of cervical cancer Cervical Cancer Screening: catches (pre)cancerous lesions early and removes them before they become advanced

Cervical Cancer in uganda (Cont’d) Economic Barriers Pap smears are expensive and not readily accessible, especially to rural populations The HPV Vaccine is one of the most costly vaccines out there (~$300) Uganda can’t afford bulk purchase of vaccine, unless at a subsidized rate through Gavi, the Vaccine Alliance

Cervical Cancer in uganda (Cont’d) Socio-Cultural Barriers Lack of education around screening and treatment Cervical cancer stigmatized as “bewitchment” and “death sentence” People often choose traditional medicines (e.g., herbalists) over biomedicine Concerns that administering STI vaccinations to young girls will encourage sexual activity

How do we Proceed from here? Rotary 4-Way Test Is it the truth? Is it fair to all concerned? Will it be beneficial to all concerned? Will it build goodwill and better friendships?

Is it the Truth? Whose truth is it? There is wide disagreement locally and internationally over cervical cancer prevention Vaccination E.g., Questions and suspicions in Canada and Japan around effectiveness, risks, interests Screening E.g., Pap smear testing as perceived by The Canadian Task Force on Preventative Health Care, primary care physicians, and provincial/ territorial decision-makers Is this simply a matter of lacking proper education?

Is it the Truth? (Cont’d) Traditional medicine as a barrier? Traditional/local medicines are embraced by billions of people across the world, often in complement to biomedicine E.g., In Cameroon, ~75% of the population practice traditional medicines and ~25% use medical and missionary care* E.g., In Canada, many Aboriginal and non-Aboriginal peoples use traditional or alternative medicines and spiritual healing These different treatments are not given equal status, more so because of colonization than their alleged effectiveness Cultural and moral issues of cervical cancer are pervasive across the globe, esp. why they got cancer Perhaps there’s room to see the truth of cancer prevention and treatment as context-dependent *Wamba & Groleau (2012), Nordic Journal of African Studies.

Is it Fair and Beneficial to All Concerned? Universal access to prevention and treatment is essential to fairness Visual inspection and acetic acid (VIA) is a promising, affordable alternative to PAP smears Gavi has taken steps to make HPV vaccine more widely available Fairness also means negotiating with local paths toward health and a meaningful life E.g., focus groups including physicians, healers, priests, and diviners in Cameroon led to learning on all sides and more willingness to collaborate E.g., An HIV prevention program in Africa driven by a local community found success by incorporating condoms into the headdresses of the spiritual healers

Will it Build Goodwill and Friendship? Friendships are built by mutual respect and lateral knowledge transfer Sort out “barriers” from “culturally meaningful protocols” Work to undo the colonial legacies that continue to push certain interests Attend to the strengths and resilience of those often defined as “poor” and “uneducated” Ensure women are participants in the decisions and understandings around their bodies

Addressing Cervical Cancer Locally and Abroad Rotary International Motto: “Service Above Self” An invitation to transcend ourselves and attend to lives other than our own