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By: Lunga Memela (Communications Engagement Lead)
Looking forward to rolling out the Cervical Cancer Prevention and Control (CCPAC) Project in Zululand: HST's CCPAC Project Monitoring and Evaluation Officer, Sphakanyiswa Ndwandwe; KwaZulu-Natal's Department of Health Zululand District Clinical Specialist in Advanced Midwifery, Hlengiwe Myeza; and HST'S CCPAC Project Manager, Eugenny Booysen.
A critical baseline study has commenced in 12 clinics situated in Zululand sub-districts of Abaqulusi and eDumbe in KwaZulu-Natal, as part of the initial implementation phase of an important three-year Cervical Cancer Prevention and Control (CCPAC) project that is being piloted by the Health Systems Trust (HST) in support of the Provincial Department of Health (KZN DoH).
The CCPAC project is funded by the Bristol Myers Squibb Foundation and is being implemented under the auspices of a consortium comprising HST, the Zululand DoH (ZDoH), the Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU) of the University of KwaZulu-Natal (UKZN), and Genius Quality (GQ). The lack of adequate cervical cancer services in Zululand District has hindered the development of a sustainable and holistic approach to women's health being built into the district's health systems to improve outcomes for women.
The project is aimed at saving the lives of women and girls from cervical cancer – the only preventable cancer, and one which can be easily treated if it is detected early. Ninety-nine percent of cases are linked to infection with high-risk human papillomavirus (HPV), "an extremely common virus transmitted through sexual contact" and which is associated with HIV infection. The project therefore also addresses the alarming rate of sexually transmitted infections (STIs) – HPV and human immunodeficiency virus (HIV) – within the local communities.
Globally, HIV is still most prevalent in South Africa. The link between HIV and HPV infection, and cervical cancer is well established, and therefore, screening for cervical cancer for early detection is mandated in national health guidelines. However, low uptake and service interruptions the caused by the COVID-19 pandemic have reduced the widespread screening that is required. The project aims to re-energise screening, improve skills, and capacitate healthcare workers such that the efficacy of Pap smears is improved and all results are actioned timeously. The desired outcome of the project is improved early detection of and decreased mortality rates from cervical cancer in the district through improved patient-centred care.
The reality on the ground
HST's CCPAC Project Monitoring and Evaluation Officer, Sphakanyiswa Ndwandwe; Mondlo II Clinic Operational Manager, Sister Thandeka Mhlungu; and HST'S CCPAC Project Manager, Eugenny Booysen.
One of the facilities visited by the Project Manager and the Monitoring and Evaluation Officer during the baseline study was Mondlo II Clinic. They were received by the warm-hearted Clinic Operational Manager, Sister Thandeka Mhlungu (pictured above). The facility has a catchment population of 20 825 and is open for 24 hours, seven days a week. HST supports the facility with services, including the provision of antiretroviral therapy (ART) to HIV-positive patients. These services are now being expanded to improve cervical cancer screening, prevention, early detection, and care and treatment.
HST's Project Monitoring and Evaluation Officer, Sphakanyiswa Ndwandwe; Thembumusa Clinic Professional Nurse, Busisiwe Mtshali; Thembumusa Clinic Catchment Operational Manager, Thuli Zulu; and HST'S CCPAC Project Manager, Eugenny Booysen.
Thembumusa Clinic, which has a catchment of 25 132, services three wards. The facility's Operational Manager, Thuli Zulu, together with Professional Nurse, Busisiwe Mtshali, said they are glad that the Health Department has lowered the cervical cancer screening age from 30 to 20 years. As with Mondlo II Clinic, their numbers for cervical cancer detection and prevention are on the rise. They also need more equipment for Pap smears, including mobile screens. HST staff are thanked for their continued hard work and support.
Project Monitoring and Evaluation Officer, Sphakanyiswa Ndwandwe; Zululand District Clinical Specialist in Advanced Midwifery, Hlengiwe Myeza; and HST'S CCPAC Project Manager, Eugenny Booysen.
Passionate about the project, the trio (pictured above) are determined to make a difference. Chatting with HST's Communications Unit, Advanced Midwife, Hlengiwe Myeza, and HST'S CCPAC Project Manager, Eugenny Booysen are both mothers of two daughters and custodians of women's and young girls' health. Despite some feeling that it is an uncomfortable conversation, they insist that mothers and fathers should confront the reality of STIs and be able to speak to their sons and daughters about sex and its associated risks. The project's Monitoring and Evaluation Officer, Sphakanyiswa Ndwandwe, also feels strongly that men have an active role to play in protecting women from STIs and other health issues. "Eradicating the problem will take collective action," they agree. "Sex should not be a taboo subject, and open conversations must be had in order to save lives!"
What men should know
Men's health fora, including the DoH MINA Campaign, Phila Ndoda and Isibaya samadoda, are gaining momentum in KZN. The three campaigns are socially constructed, creating a new school of thought for young and older men that is intended to promote behaviour change that will foster healthier societies. One of the factors to be reckoned with is that men can and should protect women's health. The machismo associated with having multiple sexual partners is a major sexual health risk that has a negative impact on both women and men, exposing them to elevated risk of STIs such as HIV and HPV, and women to the risk of cervical cancer. Conversations that encourage delayed sexual debut for young men and women must be encouraged.
Without bias, Myeza and Booysen said that young men need to know that all their actions have consequences. "Yes, it's a glamorous time of life, but you have to be in control of your emotions. You have to think about the person you love and take each other on a protective journey. Young men should be educated to understand that they don't need to prove their manhood sexually."
Ndwandwe noted that Life Orientation as a school subject is contributing effectively to promoting health consciousness among children and adolescents. However, while this is valued, it is health professionals who understand disease progression. "The subject has assisted in laying the foundation for health education. We need more healthcare professions on board, because they understand the disease process." The colleagues also observe that there is a national shortage of Oncologists, and Cancer and Palliative Care Nurses – all of whom can play an active role in preventing cervical cancer. The CCPAC project enables DoH staff members, healthcare workers and other stakeholders to pursue additional training and education to improve capacity in cancer prevention, treatment and palliative care.
About the Project Manager
HST has entrusted Eugenny Booysen (pictured above) to manage the project. In addition to her years of expertise, she spent three years as an Oncology Nurse in Saudi Arabia, and strongly advocates for cancer prevention. She said: "Because I come from an oncological background and worked in a chemotherapy suite, I have observed many women coming in with late-stage cervical cancer. The biggest problem in State hospitals is that women with cancer need to have radiotherapy and chemotherapy together. The waiting list is long. Once the cancer is too advanced, we then have to refer the patient to palliative care. Resources are a challenge."
Booysen feels that awareness should be raised about cervical cancer, especially among HIV-positive women, and that men should be more involved. "The woman comes by herself to the clinic for treatment and there's no spouse or partner to help counsel her. Also, men are carriers of HIV and HPV. Worst still, if the woman comes home and reports to be diagnosed with cervical cancer, she may be stigmatised or even fear mentioning it at all, making it difficult for the health issue to be dealt with."
Booysen and Nurse Myeza stressed that even if women test HIV-negative, if they are sexually active, they still need to receive a Pap smear every three years for ongoing prevention of cervical cancer and to ensure their sexual and reproductive health.
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