Tale of Malawian women: A journey to Kenya and a lifeline against cervical cancer
Christina Cheweda (left) and Dorothy Masasa during an interview at the Nairobi Hospital Cancer Centre on February 27, 2024.
What you need to know:
- Their fearless journey symbolises cervical cancer’s merciless toll, and the extraordinary lengths resilient women will go, overcoming borders and barriers to survive.
- According to the World Health Organisation, more than 70,000 women died of cervical cancer in 2020 in Africa;
- Doctors Without Borders/Médecins Sans Frontières says Malawi has the second highest burden on the continent
On a courageous and poignant journey spanning borders and defying odds, a group of 30 Malawian women embarked for Kenya in pursuit of life-saving radiotherapy services.
Faced with the harsh reality of limited healthcare options in their country, they chose to traverse miles of unfamiliar terrain to combat cancer and reclaim their future.
According to the World Health Organisation, more than 70,000 women died of cervical cancer in 2020 in Africa. Doctors Without Borders/Médecins Sans Frontières (MSF) adds that Malawi has the second highest cervical cancer burden on the continent.
Every year, more than 4,000 women are diagnosed with cervical cancer and 2,905 die from the disease in Malawi, according to the Catalan Institute of Oncology and the International Agency for Research on Cancer HPV Information Centre.
This makes the story of these Malawian women not merely one of geographical distance bridged, but a testament to the resilience and solidarity of women battling against the scourge of illness.
We meet the women at Nairobi Hospital where they have been recuperating from radiotherapy treatment. They are in a private room seated on gatch beds.
They speak in low tones, exchanging gentle words in Chichewa (one of Malawi's official national languages). I am told that it is their last day in Kenya.
One of them, Dorothy Masasa, 39, tells me about the home she left behind and her undying hope that she will be free of cervical cancer.
“I live in Tayari Village, Chiolo District, which is in the southern part of Malawi. Back home, agriculture is the primary livelihood. Green vegetables are a staple crop, and many in the community grow and sell them. This is also what I did for my daily upkeep,” she begins.
She adds that she is married with three children, the youngest, she tells me, is a four-month-old miracle baby.
Also read: Cervical cancer: A battle we can win
Then Dorothy shares how she learned she had cervical cancer. Sometime early last year, she noticed she had an abnormal vaginal discharge. When she visited a local clinic, she was told that she was 13 weeks pregnant, and misdiagnosed with a sexually transmitted infection.
“I had to inform my husband of my diagnosis as treatment necessitated both partners’ involvement. Upon hearing the news, he was deeply shocked, questioning how it occurred as we both believed ourselves to be faithful. Despite his initial disbelief, we agreed to proceed with treatment,” she says.
Also read: Act early to prevent cancer of the cervix
Despite being on treatment, Dorothy still had abnormal discharge, so she went back to the clinic. That is when they mentioned the possibility of cervical cancer and suggested an examination to confirm the diagnosis.
One of the attending nurses informs me that in rural Malawi, a syndromic approach is often used for diagnosis, relying on symptom presentations rather than lab tests.
Medical professionals follow a chart, assessing symptoms until a diagnosis is reached. Thus, despite undergoing treatment, specifics regarding the type of infection are not disclosed. This could have been the reason for Dorothy being misdiagnosed in the first instance.
The mother of three was informed a biopsy would be necessary. The doctor also proposed reaching out to an organisation at Queen Elizabeth Central Hospital to enquire about conducting the biopsy at a subsidised rate. After the test, Dorothy was confirmed to have cervical cancer.
Also read: Learn, screen, and prevent cervical cancer
“Honestly, it was something that really shocked me. I was so sad. I knew one of the treatment options would be chemotherapy, yet I was pregnant. I thought I would give birth to a child with deformities, but I asked God to save my child. Thank goodness, my baby is just okay,” she says.
Dorothy was also informed that the estimated cost of treatment, specifically chemotherapy, is about 500,000 Malawi Kwacha (Ksh40,000). Considering her financial status, she knew she could not afford the treatment.
Fortunately, Doctors Without Borders/ Médecins Sans Frontières (MSF) agreed to fund her treatment.
However, before she could start chemotherapy, doctors advised her to terminate the pregnancy.
“Both my husband and family initially supported the doctors’ recommendation, emphasising my wellbeing. However, I firmly decided against termination, despite their counsel.
"I believed that if it was my life at stake, I should have the final say. Thus, I continued with chemotherapy while pregnant,” she explains.
Also read: Making cancer treatment accessible in Kenya
Dorothy underwent seven chemotherapy sessions over six months while still pregnant. During that time, she continued attending antenatal clinics. By the time she was due for her seventh session in September last year, she went into labour prematurely.
She was informed that a caesarean section would be performed to deliver her baby, and simultaneously, her uterus would be removed as part of her cervical cancer treatment.
Grim reality
“I knew that the procedure meant that I couldn't carry another child in the future. I was worried because I still hoped to have more children. Despite that, I had to accept the reality that this might be my last opportunity to be cancer free.
"I found solace in the assurance from my doctors that removing my uterus was crucial for treating the cancer,’’ she says.
Throughout her treatment, Dorothy and her family used to travel about 50 kilometres from her home to Queen Elizabeth Central Hospital for treatment.
Also read: Let’s close the cancer care gap
“The route includes stops at Tayari, Limbi, and Blantyre. I would typically leave home the night before my appointment and stay at a guardian shelter, then head for the clinic the next morning.”
Christina Cheweda, another Malawian in Kenya for radiotherapy treatment, says she had to make similar sacrifices to access treatment. “I live in Chikwawa in South Malawi.
It is a hot district that often experiences floods. I have lived all 53 years of my life there. Most days, I sold charcoal and rice to support my family of five until I started experiencing severe pain on the left side of my leg,” she shares.
That was early last year. Christina decided to buy some medication from a local pharmacy to manage the pain.
“At first, I did not take the pain seriously because as a woman, I’m supposed to be strong. Whenever I feel discomfort, I don’t just rush to the clinic, I’ll just buy some painkillers before I go to hospital.
"I only made a decision to go to the clinic when I started experiencing menstrual bleeding,” she says.
The bleeding was abnormal because Christina had undergone tubal ligation and hit menopause. Concerned, she visited the district hospital, a journey that cost her 10,000 Malawi kwacha (Ksh800) to reach a facility, 80 kilometres from where they lived.
Following a biopsy, she was diagnosed with cervical cancer and referred to Queen Elizabeth Central Hospital for further treatment.
“When I was told I had cervical cancer, I became depressed. This is because I had heard that most of the people who have been diagnosed with it died. So, I just felt like, oh okay! I'm also going to die. My husband was the one engaging the doctor, trying to find out if there were any treatment options.”
She was put on chemotherapy under the same sponsorship programme as Dorothy. She explains that when she felt strong enough, she handled most household tasks independently.
However, when her health deteriorated, her family, especially her children, stepped up to assist with cooking, fetching water, and other chores.
“Whenever I left for medical appointments, my eldest daughter, who is 31 years old, was my primary caregiver. Before leaving, I made arrangements to ease the burden on my husband.
"We sometimes prepared meals in advance, ensuring he could manage other tasks more easily while caring for our youngest child,” she adds.
Gruelling chemo sessions
“I would spend the entire day seated, as there were no beds available. We only had chairs, which meant that sometimes when I needed to use the bathroom, I had to bring my drip stand along.
"It was uncomfortable, especially when I started vomiting while still seated on the chair. Whenever I was back home, I would be sick for the entire week, sometimes even longer,” Christina says.
After seven months of chemotherapy, both women were advised by doctors that they still needed radiotherapy. Dr Anthony Nderitu, a clinical and radiation oncologist, explains why this is the case.
“The aggressiveness of cervical cancer lies in its ability to spread to nearby areas even after the uterus is removed. The cancer may originate in the cervix but can extend to adjacent structures such as the uterus, intestines and bladder.
"If left untreated, this spread of cancer cells, known as metastasis, can occur rapidly and extensively,” Dr Nderitu says.
He adds that when treating cervical cancer, doctors have to consider the cancer stage and other associated risk factors. For instance, early-stage cancer may be operable followed by additional treatment to prevent recurrence.
However, in more advanced stages like stage two or beyond, radiotherapy and chemotherapy may become the primary treatment.
As to why Dorothy and Christina had to travel all the way to Kenya for treatment, he says that access to radiotherapy services is severely limited in some regions.
“Malawi does not have a radiotherapy facility. They not only lack the infrastructure but also expertise required to provide radiotherapy treatment.
"While there are efforts to establish these services, challenges such as high cost of construction and equipment, as well as the intensive maintenance required, pose significant barriers.
“Even in Kenya, there is scarcity of specialists in this field. As a result, the provision of radiotherapy remains a challenge, leaving many without access to essential cancer treatment,” he explains.
Despite their initial reluctance, Dorothy and Christina made the decision to undergo radiotherapy in Kenya to ensure that any remaining cancerous cells were addressed.
For Dorothy, the prospect of leaving her young child behind weighed heavily on her.
“I spoke to my family about the situation. To my relief, my elder sister stepped forward and offered to care for my baby in my absence, reassuring me that everything would be taken care of,” she explains.
“Even as I am in Kenya, I continue to worry about my baby's well-being. However, my focus is on getting well so that I can return to my children and family.”
Regarding their time in Kenya, the women were scheduled for six weeks of radiotherapy. When we met them, they were preparing to return to Malawi having completed their treatment.
“Our journey from Malawi has been incredibly positive. Despite initial worries about communication and navigating a new environment, we were warmly welcomed upon arrival. The hospital staff were friendly and spoke to us kindly, which immediately put us at ease,” Dorothy says.
“As I prepare to return home. I am filled with excitement. I never imagined I would reach this point. Once back home, I plan to resume my business selling charcoal to provide financial support for my family.
"I now feel confident in my strength and ability to care for my children. I am grateful for the treatment I received, and I am optimistic that my life will be transformed for the better upon my return home,” Christina says.
Prevention
Dr Nderitu now advises HPV vaccination, particularly targeting young individuals before potential exposure through sexual activity. This is because HPV infection is considered a primary cause, accounting for up to 99 per cent of cases.
Other preventive measures include frequent screening and recognising symptoms such as abnormal vaginal bleeding or pelvic pain.
“Regarding treatment, radiotherapy is a crucial component, especially for advanced-stage cancers. While it may not always cure advanced cases, it can improve quality of life.
Also read: Awareness is a major weapon against cancer
"Treatment outcomes vary depending on the cancer stage and response to therapy, with regular monitoring required even after treatment,” he concludes.
Since the beginning of its cervical cancer project in Blantyre District, Malawi, MSF has treated 4,750 cervical cancer patients, including 50 who were referred to Kenya for radiotherapy.
