Two minutes of shame on a pap smear table: Shy. Naïve. Exposed. Naked. Vulnerable

In my capacity as a journalist, I have been talking to a lot of cancer patients lately after the recent breakdown of radiotherapy machines at Kenyatta National Hospital. I have heard a lot of heartbreaking stories, stories of pain and loss and hopelessness.

Those stories have had my role elevated to not just that of a story teller, but that of a counsellor as well. When someone chooses to share his or her pain with you, you have a responsibility to not only listen, but to also offer whatever emotional support you can.

You have an obligation to peddle hope and restore some sense of faith in those whose bodies are systematically failing, wracked by a disease so ruthless it has become a metaphor for the bad things in life, like “the cancer of corruption”.

In all those conversations, one thing stands out: none of those I talked to had ever gone for cancer screening until they started feeling sick, went to hospital and the doctors recommended it.

It’s easy to see why. Cancer is one of those diseases that you never really think about until you or someone close to you gets it. We tend to worry more about more “visible” and familiar sicknesses such as malaria, typhoid and chest infections because these are the illnesses we are well acquainted with, illnesses that we have been fighting since childhood.

Cancer just seems too vague, too foreign and otherworldly. Something that happens to other people. It is definitely not the first thing we think about when our stomachs start hurting, our cough refuses to go away or our headaches become vicious and incessant.

In addition, cancer screening can be an uncomfortable experience, as I recently learned. I went to hospital a few days ago for test results that have been collecting dust for several months now. It is not that I have not had time to go get my labs, it is just that every time I thought about doing it, something much better came up and I postponed it.

INVASIVE TEST

I procrastinate. A lot. But in this case, it was not just that I was feeling lazy about making the trip all the way to Mater Hospital; it is that I was genuinely a little nervous about getting those results back. I had a nagging “what if” that played on repeat mode in my head, like a scratchy, broken record stuck on an annoying song.

And so as I waited outside the laboratory for the friendly technician to dig up my results from October last year, I felt my palms get slick with sweat. I put aside the book I was holding and stopped pretending to read. I was too worked up to concentrate and the words were beginning to run into each other.

You see, as scary as it was to get the test done, it was scarier getting the results. Somehow, sitting on a hard chair outside the lab trying to tame my overactive imagination was more unnerving than lying on my back half naked getting a pap smear done.

A pap smear is a test where a doctor scrapes some cells off the cervix and has them screened for any abnormalities that may cause cervical cancer, the second most common cancer among women, after breast cancer.

It is a particularly vicious disease that attacks the cervix, resulting in lower abdominal pain and bleeding in between monthly periods. If left untreated, it can very easily spread to neighbouring organs such as the uterus and the ovaries.

Breast cancer is the most common cancer in Kenya, contributing to 23.3 per cent of all cancer cases in the country. It is closely followed by cervical cancer at 20 per cent, with prostate cancer coming a distant third at 9.4 per cent. Therefore, based on purely physiological reasons, a woman is more likely to contract cancer than a man.

In 2006, 2,354 women were diagnosed with cervical cancer. 65 per cent died of the disease. Although we do not have more recent statistics, those numbers are most certainly higher today. And a pap smear is the surest way of detecting cervical cancer before symptoms present.

But as lab tests go, the pap smear has to be the most invasive one. It is as unpleasant as they come. Men might disagree and start whining about the prostate gland check, but I am telling you, pap smears are worse. At least mine was.

I was ushered into a small room the size of a large broom closet. It was bright, though, with a translucent window and a fluorescent bulb burning on the ceiling. It was entirely dominated by a long and narrow examination table (question for doctors in the house: do fat people ever fit onto those tables?), a chest of drawers and an array of instruments that I did not want to look at too closely. It smelled faintly of antiseptic and misery (yes, really).

“Take off your jeans and panties, then lie down on your back, your head on the pillows. The doctor will be in shortly,” instructed the cheerful nurse with a bright smile.

SECOND THOUGHTS

I wanted to joke about wanting to be wined and dined before doing anything of the sort but I wisely refrained from it. I was so nervous that my tongue would likely have tumbled over the words and I would have ended up making a complete fool of myself.

So I mumbled an inaudible “okay” and she left the room.

I loosened my belt slowly, surveying my surroundings more closely. There was a lamp at the foot of the table where my legs were supposed to go, and a chair next to it. I studied the white sheet draped over the table. It had a big MATER printed on it in red block letters. The walls were bare, painted a sterile white.

I tried unsuccessfully to convince my stubborn fingers to undo the buttons on my jeans and just get it over with. I was beginning to seriously reconsider the wisdom of getting this test at all. Yes, the daunting possibility of a stranger seeing me naked was making me question whether cervical cancer even exists for real.

I tried to think about other things, like why it is that doctors and nurses wear such ugly shoes. They are all uniformly black and flat and formless. Boring. I began to wonder about how many millions I could make by distributing fashionable but sensible shoes to hospital staff. Shoes that at least have a bit of personality. It is dreary enough to work in a hospital; no need to compound the misery with ugly shoes.

Yes, I am very good at distracting myself. I forced myself to refocus my attention on the problem at hand.

“Stop being a baby. You can do this, you can do this,” chanted the little voice in my head. I took too long debating within myself because the nurse and the doctor walked in while I still had my jeans on.

The doctor raised her right eyebrow at me, snapping her gloves on.

“Well?” she said expectantly, cocking her head slightly to the left.

There was no chickening out at this point. So I swallowed hard, stripped out of the offending clothes and climbed onto the examination table, keeping my legs and eyes tightly shut. It was all I could do as I could not to cover myself with my hands. My mouth was dry, my face burning. I could hear them settling down at the foot of the bed and tearing open the packages of sterilised instruments.

“Okay, Jacqui, we are going to need you to bend your legs at the knees and spread wide,” the doctor said in a soothing voice.

My first instinct? A resounding Oh Hell No!

Because even though you know the procedure is purely medical, there is no beating the sense of vulnerability that comes with exposing yourself that much to another human being. Even worse in my case, exposing myself to two human beings. There was something surreal about lying there, exposed, your business on display for the world to see.

I hate hospitals. I really do. They take away all your dignity. So I defended myself the only way I could.

I shut my mind to my immediate environment and pretended I was not the scared girl lying stiff and half naked in full view of a couple of strangers. My mind drifted to happier places.

Places full of sunshine and unicorns and rainbows.

HUMILIATING EXPERIENCE

I could vaguely feel hands shifting my legs, I barely registered the intrusion of the speculum, I blocked out the discomfort of the actual cervical scraping. It was done in less than two minutes. I only opened my eyes when the doctor said: “You can get dressed now.”

I got up, carefully avoiding eye contact with either of them, pulled my clothes on and stalked out of the room without a word. Then I went home, called my best friend and curled into bed with a lollipop in my mouth. After what I felt was such a gross invasion, I needed a reminder of blissful childhood innocence.

Anyway, that was months ago. I got the results and all is well. Huge sigh of relief. I was advised to get tested every year, though, so that means I will have to go through all that nastiness again in a few months. I am definitely not looking forward to it. I actively refuse to think about it.

Yearly pap smears are recommended for women over the age of 25, although some countries set the age limit at 26. They are a necessary test, but my experience has me wondering, “if it was so uncomfortable for someone like me, someone who is exposed and learned, someone who knows the importance of taking this test, what must it be like for that woman in the village who has never heard of cancer?”

How much more humiliating must an experience like this be for our mothers and grandmothers whose strongest instincts instruct them to not only never show themselves to anyone, not even to their husbands, but also to never even talk about what might be happening “down there”?

To a woman like this, regular pap smears or breast examination in the absence of disease — especially in the absence of disease — do not make sense.

And I can see why the same discomfort would apply to an elderly man who is told that he needs to regularly go for a prostate exam, which involves a doctor sticking a gloved finger up a man’s anus to feel for the size of the prostate gland. An enlarged prostate means trouble and further tests need to be carried out. The prostate test is recommended for men over 40.

Prostate cancer is the leading cancer among men, and in 2006 it contributed to 9.4 per cent of all cancer cases, according to the same Nairobi cancer registry statistics quoted earlier. The Kenya Medical Research Institute (KEMRI) suggests that 80 per cent of cancer cases are diagnosed late, when very little can be achieved in terms of curative treatment, and it is easy to see why.

Such trepidation over regular tests has contributed to the high cancer mortality, which presently stands at 27,000 deaths in a year; from the 40,000 cases diagnosed yearly.

EARLY DIAGNOSIS

To have two out of three patients dying from the disease is a crisis that demands immediate attention. And one way to improve these numbers is to have the necessary cancer conversation in our homes. Awareness campaigns need to kick off in high gear.

What we did for HIV, we need to do for cancer.

The point of this article is to share the importance of looking after ourselves and making health a priority.

We need to sit our mothers and grandmothers down and explain about cancer, and why regular checkups are necessary.

Our fathers and grandfathers need to hear this conversation too. Early diagnosis saves lives and ensures that cancer does not become a death sentence.

And you who have read this and now know better, go get checked. As uncomfortable as it was, I am glad I got that test done. I got my breasts checked as well on that same day and it gives me immense peace of mind to know that I am fine.

Remember that most cancers can be treated if caught early. Also, remember that nobody is invulnerable.

The arrogance of youth gives you the illusion of immortality, but women as young as 20 are getting diagnosed with breast cancer.

Take charge of your body. It is the only real home you have.