Before April 2013, Betty Kayegi was a healthy young business woman in Kikindu market, Mbale Town.
At the age of 16, Kayegi who hails from Buluganya, in Bunambozo village, Bulambuli District dropped out of primary school after she got pregnant.
She started selling agricultural produce at Kamu Trading Centre in Bulambuli to make ends meet before relocating to Mbale municipality.
But her monthly period of April 2013 was strange. Her blood flow could not stop.
But unfortunate for the 40-year-old, what seemed like a prolonged menstrual period would later be a sign of cervical cancer.
“I started experiencing funny itching in my private parts when my menstrual period was approaching and later, I began noticing an inconsistent sharp pain in my pelvis with sudden bleeding in between my period,” says Kayegi. “When the pain and bleeding didn’t stop, I started suspecting that something may be wrong with me.”
And in September 2013, Kayegi’s menstrual blood was thick and she felt a lot of pain as it flowed. “I would feel a heavy clot coming out painfully. I would be tempted to push as though pushing out a baby yet it was heavy blood clots. This prompted me to see a doctor at TASO,” she narrates.
Kayegi was examined at TASO and Mbale Regional Referral Hospital and a surgeon revealed she had cervical cancer. “I just got scared and knew that my death had come,” Kayegi recounts.
With a smile on her face, Kayegi says: “What always scared me the most was the number of other cancer patients who were dying each day. I always prayed that I would not be the next. Thank God I am still surviving.”
According to Kayegi, prayers kept her going during the treatment process. “If it had not been for God, I would not be speaking to you now. Every doctor who worked on me told me, had I delayed for another month or so, I would have died. People find it hard to believe that I am 40 and a cancer survivor.”
Free at last
She reveals that doctors at TASO and Mbale Regional Referral Hospital have already pronounced her a cancer-free woman.
According to Dr Tom Otim, a former Mbale Regional Referral Hospital gynecologist, the hospital is limited in its ability to treat cervical cancer.
“The hospital can’t treat cervical cancer in its advanced stage. Such cases are referred to the Uganda Cancer Institute at Mulago hospital,” Dr Otim says.
Reports from the hospital indicate that few women in rural Uganda can afford the cost of cancer treatment at Mulago hospital, including failure to afford transport costs to the facility in Kampala.
Dr Muhammed Mulongo, the Bulambuli District health officer, says as health workers, they are worried that the disease will remain undiagnosed and untreated because of the little information available on the disease to women.
“There are inadequate outreach programmes for screening so that the disease is treated in its early stages,” said Dr Mulongo.
The gynaecologists said a 2006 study conducted on medical workers at Mulago hospital found out that 19 per cent of them had never been screened and 78 per cent had never asked patients if they had ever been screened or referred them for screening. He said a lack of funding was constraining the government’s efforts to fight the disease.
“Hospitals are constrained with inadequate facilities and trained staff to treat patients,” he added.
According to the Uganda Cancer Institute, cervical cancer is the most common cancer in women in sub-Saharan Africa, including Uganda. It accounts for 22 of every 100 women with cancer in the region. According to health experts, handling cervical cancer in advanced stages is very difficult but if diagnosed early, it can be treated.
“And by comparison 1,100 women die of breast cancer every year according to Uganda Women Health Initiative [UWHI and that about 33.6 per cent of the women in the general population are estimated to harbor cervical human papillomavirus infection-the main cause of cervical cancer at a given time,” reads a July 1, 2015 report by UWHI, an organisation which conducts cervical cancer screening around the country.
The report says even major referral hospitals do not offer regular screening. “There is very high need for women and their husbands to be sensitised so that they know the symptoms of cervical cancer,” said UWHI’s Dr Otim, adding that many women mistake early symptoms of the disease - such as bleeding in between menstrual periods - as normal occurrences.
According to Dr Jaffer Balyejusa, a consultant surgeon at Mbale Regional Hospital, cervical cancer occurs when abnormal cells on the cervix grow out of control but adds that it can be treated once detected early through a pap test.
He says cervical cancer is caused by a virus called human papillomavirus [HPV] and that you can get HPV by having sexual contact with someone who has it.
“Most adults who have been infected by HPV at some time, the infection may go away on its own but at times it can cause cervical cancer that is why it is important for women to have regular pap tests because this test can find changes in cervical cells before they turn into cancer,” said Dr Balyejusa.
According to the Uganda Cancer Institute, cervical cell changes rarely cause symptoms but one may have cancer if those cell changes grow into cervical cancer and these include; abnormal bleeding from the vagina such as between menstrual periods, after sex or after menopause.
Dr Andrew Kasolo of Mbale Regional Hospital, says cervical cancer patients complain of pain in the lower abdomen or pelvis, during sex and vaginal discharge that is not normal. Dr Kasolo adds that the doctor may also do pap test and take a sample of the tissues [biopsy] if you have symptoms of cervical cancer, such as bleeding after sex.
Diagnosing cervical cancer
Colposcopy. Dr Mulongo says if you have had a cervical screening test result that suggests that you have cancer, your doctor will then carry out a colposcopy, this is an examination to look for abnormities in your cervix.
He adds that during colposcopy, a small microscope with a light source at the end [Colposcopy] will is used as well as thorough examination of the cervix and a small tissue sample [biopsy] may be removed to be checked under the microscope for cancerous cells.
Cone biopsy. In cases, a mirror operation called a cone biopsy may be carried out. The operation is carried out in hospital, usually under a local anesthetic.
During a cone biopsy, a small, cone shaped section of your cervix will be removed so that it can be examined under a microscope for cancerous cells and at this stage you may experience vaginal bleeding for up to four weeks with period like pains after procedure.
Dr Mulongo says if the results of the biopsy reveal that you have cervical cancer and there is risk that cancer may have spread, you will be recommended for further tests to assess how widespread the cancer could be.