When antiretroviral treatment finally came to the people who needed it in Zambia, the HIV epidemic had produced another challenge there: People were dying of cancers that are routinely diagnosed and treated in wealthy countries. For a country where still-growing HIV and tuberculosis epidemics had overwhelmed an ill-equipped and under-financed health system and depleted its health workforce, the needs of cancer patients seemed destined to continue to go unaddressed.
By 2004 about 5000 cancer patients in Zambia waited to go to South Africa for treatment, but at a cost of about $10,000 per patient, only about 300 made it.
“You can imagine what happened to the rest,” Dr. Kennedy Lishimpi, now head of the Cancer Diseases Hospital that opened in the nation’s capital in 2007 said during an April 24 panel discussion in Washington, DC. Dr. Lishimpi was speaking during an event focusing on “The Global Experience in Addressing Cervical Cancer,” that highlighted, as much as anything else, a diversity of experiences.
While speakers in a previous panel — from London, from the National Institutes of Health in Bethesda — discussed the public relations hurdles that come with the vaccine to prevent the sexually transmitted infection that causes cervical cancer, Lishimpi discussed the high mortality rates that come with late disease diagnosis. The chance to change that began, Lishimpi said, with a doctor from the University of Alabama who came to see Victoria Falls and stayed to start a cervical cancer screening program. In Zambia, where the cost of the routine Pap smears through which cervical cancers are detected in developed countries would be prohibitive, the method used is visual inspection with acetic acid used to highlight potentially cancerous lesions. The method requires less complex technology than examining cells under a microscope, and less training. Still, Lishimpi said, the obstacles to speeding access to testing throughout the country were considerable enough, initially, to limit screening to women living with HIV.
Clinicians raised awareness among policy makers by highlighting the impact of a disease killing women who raised children and cared for sick and elderly family members, Lishimpi said. “The most powerful thing they did is look at women as economic drivers of households. Don’t lose focus on the effect of mortality.”
By 2011 a change in government brought a focus on community-based approaches to health care, as well as a first lady and minister of health who were gynecologists. By the time funding came through the public private partnership of Pink Ribbon Red Ribbon, plans for nationwide cervical cancer screening were already in place. “We knew what we wanted to do,” Lishimpi said.
The program currently screens 200,000 women. Survival rates from cervical cancer remain low, because screening still comes too late for many. Lishimpi, though, still looks ahead, to the day when the program shows what early diagnosis can do to cancer in Zambia.