Karen Nakawala continues to advocate for better treatment for cervical cancer patients in Zambia

Inside Zambia's Cancer Disease Hospital complex, there's a small space with 2 containers. They have just been painted in bright teal - a colour that represents advocacy for cervical cancer. This is where Karen Nakawala will base herself today, while she continues her work to advocate for the elimination of cervical cancer in Zambia. As a survivor of cervical cancer herself, she understands what many of the patients go through.

Today, 2 women came to look for Karen, seeking her advice. Their mother has been diagnosed with cervical cancer, but with limited treatment options and finances, she feels unable to do anything about it. The daughters are devastated by the news, but they also don't know what they can do.

"This is a typical situation where women come to ask for my thoughts. Of course they can't give up, but with limited treatment available here in Zambia, they are looking at other options, options that will cost money and can plunge a family into poverty." Karen told us.

Zambia has the third highest burden of cervical cancer in the world, with an incidence rate of 71.5 per 100 000 women and a mortality rate of 49.4 per 100 000 women in 2022. Despite being a preventable and treatable disease, cervical cancer accounts for 23.8% of all new cancer cases and 41.1% of all new cancer cases in women in the country.

To address this challenge, the Government has been scaling HPV vaccination, cervical cancer screening and treatment programmes over the past 21 years.

HPV vaccine have been in use over the past 18 years. Its safety is constantly monitored and has proven to be excellent. It is highly effective, even after a single dose. In September 2023, Zambia launched a major HPV vaccine campaign where over 63% of the country's 1.42 million girls between 9-14 years old received a vaccine dose. For those who are living with HIV, 3 doses of vaccine are still needed.

In 2019, Zambia had also introduced HPV DNA testing, a more sensitive method compared to visual inspection with acetic acid (VIA)-based screening, alone. By combining HPV DNA testing with visual VIA, Zambia is aiming to expand its screening coverage to reach as many women and girls in the country as possible. If diagnosed early and managed effectively, cervical cancer is one of the most successfully treatable forms of cancer.

Cervical cancer prevention and treatment, Chipata First Level Hospital, Lusaka, Zambia, April 2024.
Photo credit: WHO / Stanley Makumba

The Government's efforts to strengthen cervical cancer programmes are only made possible with the help of well trained and dedicated health care workers like Gloria Mwale, a nurse at Chipata First Level Hospital in Lusaka. She is one of a cadre of nurses in the country trained to perform loop electrosurgical excision procedure (LEEP), an office-based method of treating precancerous cells found on the cervix. Due to her exceptional skills, Nurse Mwale now trains doctors and nurses in Zambia and from other African countries. Zambia has been an important hub for south-to-south collaboration on building a robust health workforce, supporting other African countries including Botswana, Cameroon, Democratic Republic of the Congo, Eswatini, Kenya, Lesotho, Malawi, Rwanda, Senegal, Sierra Leone, South Africa, and Zimbabwe.

Back in Zambia's Cancer Disease Hospital, a patient - Mitondo - arrives to pick up her cancer medication. She is tall and appears thin, something she attributes to her recent radiotherapy. Nonetheless, she wears a colourful dress with matching lip colour, looking defiantly strong and beautiful.

Cervical cancer prevention and treatment, Zambia Cancer Hospital, Lusaka, April 2024.
Photo credit: WHO / Stanley Makumba

"The treatment for cervical cancer wasn't straightforward for me once I was diagnosed. Even though the Government has a programme to send patients to India for treatment, the wait list is very long" says Mitondo. "I have a young daughter, and as a single mother, it was an incredibly tough time. We lived far from the capital city with no treatment options, I had to get enough money and organize myself to get treatment in another country, leaving my daughter behind with relatives for months. It was a lot of physical, emotional and financial stress we all had to go through, and we continue to feel the impact."

Karen supported Mitondo during her battle with cervical cancer. "We are happy to see the progress the country has made on cervical cancer programmes over the past years, but as I get to know and support more and more women battling or battled against cervical cancer like myself, there is so much more we can do to ensure these women are well supported," she says. "So many of these women are mothers like myself, and many [are] breadwinners of the family. We struggled through treatment, and we continue to struggle sometimes with reduced energy levels, prolonged side effects from treatment. We really need more support, so our family don't plunge into poverty because of cancer, and our children can grow up with their mothers and a bright future ahead."