Source: IRIN
In the obstetrics and gynaecology ward of St Mary's Hospital Lacor in northern Uganda's Gulu District, Apilli Kilara lies on the floor under a blood-stained sheet, staring at the ceiling.

Kilara, 43, and the mother of seven children, is in the advanced stages of cervical cancer.

"I started experiencing funny itching in my private parts after my fifth delivery in 2007. In November 2011 when I delivered my seventh child, I began noticing an on-and-off sharp pain in my pelvis with sudden bleeding in between my periods," she told IRIN. "The pain and bleeding didn't stop, that's when I started imagining something was wrong with me."

If Kilara had sought medical help when her symptoms first started, she could have been treated successfully, but she knew nothing of cervical cancer at the time. As it is, the doctors fear she may not live much longer.

Lying next to her is another patient diagnosed with cervical cancer; Akello* is 39, and when her symptoms started, she thought witchcraft was behind them, and sought treatment from a local healer.

"I had been visiting a traditional herbalist for treatment in vain, that is what women suffering similar ailments in my village do," she said.

Cervical cancer is the most common form of cancer affecting Ugandan women, according to the UN World Health Organization, which reports that every year, 3,577 women are diagnosed with cervical cancer and 2,464 die from the disease. By comparison, 1,100 women die of breast cancer every year, according to the Uganda Women's Health Initiative (UWHI). To put this figure into further context, 2,594 people in Uganda died in road accidents in 2010.

About 33.6 percent of women in the general population are estimated to harbour cervical human papillomavirus infection - the main cause of cervical cancer - at any given time.

Limited treatment capacity

According to Pontius Bayo, head of obstetrics and gynaecology at St Mary's Hospital Lacor, the hospital is limited in its ability to treat them. "We can't treat cervical cancer in its advance stage. We refer such cases to the Uganda Cancer Institute at Mulago Hospital in Kampala for further management," he said.

Statistics obtained from St Mary's Hospital Lacor indicate that 2 percent of all admissions at the maternity ward present with cervical cancer, most in advance stages; 11percent of deaths in the maternity ward are the result of cervical cancer.

Few women in rural Uganda can afford the cost of treatment at Mulago Hospital, the country's largest referral facility; many can't even raise the cost of transport to the capital.

With little information on the disease available to women, health workers worry that it will continue to go undiagnosed and untreated. "It's a concern in a situation where there is no adequate outreach programme for screening and treating the disease in its early stages," said Bayo.

There is little information available on screening for cervical cancer, but a 2006 study conducted on medical workers at Mulago Hospital found that 19 percent of them had never been screened for the disease, and 78 percent said they never asked patients if they had been screened or referred for screening.

Uganda Cancer Institute director Jackson Orem said a lack of funding was constraining the government's efforts to fight the disease. "Hospitals are constrained with inadequate facilities and trained staff to treat patients," he said.

UWHI, which conducts cervical cancer screening around the country, says even major referral hospitals do not offer regular screening. "There is very high need for women and their husbands to be sensitized so that they know the symptoms of cervical cancer," said UWHI's Tom Otim, adding that many women mistook early symptoms of the disease - such as bleeding in between menstrual periods - as normal occurrences.

"It's a neglected area that requires attention," he said.

*not her real name


Cervical cancer is the most common malignancy affecting Ugandan wome

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