A letter from Sue Makin in Malawi
August 31, 2009
Half a bottle of vinegar
Greetings! I have just had an encouraging experience with Malawian brother and sister health care workers. I was invited to present a short training course in cervical cancer prevention with visual inspection of the cervix by a former student of mine, now a clinical officer, and by the Carmelite Sisters of Mtengowanthenga Hospital, about 15 miles north of Lilongwe, the capital of Malawi. Remembering the warm hospitality and fellowship of Catholic sisters from my years working in the Democratic Republic of Congo, I was looking forward to a similar experience. I certainly was not disappointed and received a warm welcome from all the people at the hospital, especially from the sisters.
Mtengowanthenga Hospital is at least a seven-hour drive from Mulanje Mission Hospital where I usually work. Fortunately, the Lilongwe Women’s Golf Championships were taking place the weekend before I was scheduled to arrive at Mtengowanthenga. Since the golf competition was on the way to Mtengowanthenga, I naturally had to stop and enjoy two days of golf before reporting for duty. I took second place in the Women’s A Division. If only the ball had rolled more willingly into the hole, the story would have been different.
Anyway, at Mtengowanthenga I had the opportunity to present one day of teaching in an appropriate method for preventing cancer of the cervix in Malawi. The method is called “visual inspection of the cervix with acetic acid” and is safe, effective, acceptable, and economical. Cancer of the cervix is the most common cancer in women in Malawi because Malawi does not have an effective screening program with early treatment of pre-cancerous lesions. Pap smears have been available in developed countries for over 60 years, but most developing countries lack the infrastructure to offer pap smears. Ninety percent of the new cases of invasive cervical cancer occur in developing countries, a scandal when one realizes that this is a very preventable disease.
Clinical Officer George Matapandeu discussing prevention of cervical cancer during counseling session at Mtengowanthenga.
The first day of the training was spent in explaining the causes, risk factors, and natural history of the disease, along with instructions on how to perform the screening test. We made preparations to hold a free clinic the next day to offer the service to as many women as possible, with the time and materials we had on hand. Of course, we did not know how the public response would be in this area, as this health screening method had never been offered before. Imagine our surprise and joy when over 80 women showed up at the clinic for screening. We had to stop at 5:00 p.m. with 20 women still waiting because we were out of clean speculums.
One of the essential elements in this method is the use of white vinegar, which is actually 4 to 5 percent acetic acid. This strength of acetic acid is readily available all over Malawi at local shops that sell vinegar. The application of vinegar to the cervix causes absolutely no pain. After swabbing the cervix with vinegar, the service provider waits one minute for a chemical reaction to take place. The vinegar coagulates the proteins in more rapidly dividing cells on the cervix. Areas with more rapidly dividing cells are areas where a frank cancer may occur in the future. These areas turn into a thick, white patch with vinegar, visible by the naked eye. The service providers are trained to identify these white patches. We were able to screen 60 women with just half a bottle of vinegar. This is about 50 cents worth of vinegar, surely a very cost-effective medical test.
The very encouraging part of the training experience for me was the eagerness and willingness of the five participants, who listened attentively and were quick to grasp important information. They also willingly and faithfully came to the clinic and cooperated with each other to provide the services. I have high hopes that they will continue to provide this life-saving screening test in this area for many years to come.
Yours sincerely,
Dr. Sue Makin
The 2009 Mission Yearbook for Prayer & Study, p. 44
