Mariam Nonguierma is a Burkinabe midwife with more than 20 years of experience. In her 15 years of service at the University Hospital Yalgado Ouedraogo in Ouagadougou, she has been responsible for a range of services from routine maternity care, prevention of mother to child transmission of HIV and more recently cervical cancer prevention. Mariam participated in a training in 2010, funded by a grant from the Izumi Foundation and led by Jhpiego, where she learned the “see and treat” technique for cervical cancer prevention. This consists of visual inspection with acetic acid, and cryotherapy to remove lesions detected. Mariam appreciates the simple and practical technique which allows the staff to screen and treat more women per day than they could before. With the daily information sessions about cervical cancer screening that Mariam and her fellow midwives present in the clinic waiting area, as well as publicity through radio and television, many more women are coming to the clinic for screening. Some days Mariam and her colleagues cannot keep up with the increasing demand for consultations. She is pleased to see more sites offering these services, however, still more is needed, particularly in Ouagadougou.
On a fairly typical day, Mariam and her colleagues screened 14 women for cervical cancer; five women were negative for signs of precancerous lesions and were advised to come back in a few years to be screened again. Two clients received cryotherapy to remove the lesion detected; Mariam counseled these women that the treatment today was to remove precancerous cells and was not a diagnosis of cancer; by treating the lesion today it is likely to resolve completely. The women were advised to return in a year to be checked again. Five more women had lesions too large to be removed by cryotherapy and a biopsy was taken in order to determine what the next steps will be; two more biopsies were performed for suspected cancer. As this is the national referral hospital, Mariam sees a lot of women who likely already have aggressive cancers and although treatment options are limited, Mariam and the team of providers in the clinic do what they can to help women get the care they need. One of the main reasons she would like to see more sites that can offer screening and prevention is so that precancerous conditions do not have the chance to develop into something potentially life-threatening.
Rasmata recently came to CHUYO for screening. Rasmata is a 37 year old mother of 2 children who works as a pharmacist at a private clinic. Her husband, who works outside of Burkina Faso most of the time, noticed a change during a recent visit home and suggested that she get checked. The clinic where Rasmata works does provide gynecology consultations but does not provide cervical cancer screening. Rasmata was nervous coming to the hospital today for screening, but once she came into the consultation room, the staff explained the screening exam and helped to put her at ease. Visual inspection with acetic acid (vinegar), revealed a lesion on her cervix. The midwife explained to her that they could treat her today using cryotherapy to freeze the lesion and destroy it. The treatment took less than ten minutes. The midwife was reassuring when she explained that the screening showed cells that could be pre-cancerous and removing it was the best way to prevent it from becoming a bigger problem. Rasmata will come back in a year for follow-up. After her experience today, Rasmata wants to tell her friends and family that they should come for screening too.