By Britten Schear, Special to JTNews
In Peru, as in many developing countries, cervical cancer is an unparalleled killer.
Although it is a widely feared, despised, and humiliating process, American women are resigned to the fact that their yearly medical checkups will likely include a test for cervical cancer.
There is no question that a routine gynecological exam is the most dependable tool for early detection and treatment of pre-cancerous cervical lesions. This is why Americans are familiar with lung and breast cancer deaths, but cervical cancer deaths are almost unheard of.
Jenny Winkler of Seattle-based Program for Appropriate Technology in Health has been commuting between her Ballard office and the Peruvian village of San Martin since 1999. As a program officer with PATH’s TATI project (the Spanish acronym for “Screening and Immediate Treatment”), Winkler is helping to establish a method of identification and immediate treatment of cervical lesions among local women. In 2004, at the end of the five-year project, Winkler’s goal will be to have given San Martin the “capacity to maintain the health project” independent of outside organizations.
The project has yielded some promising results so far, but its implementation has by no means been an easy task.
The lush surrounding jungle and unpaved roads of San Martin are conspicuously interwoven with 25 Internet cafés that have sprung up in the town during the last three years. In some areas of town, families live together in mud huts, surrounded by oppressive poverty. Some have had electricity recently installed, but many go without it altogether. Health care is slowly moving into the modern world, but like the town, many old values still remain.
“Women value their husband’s health, their children’s health,” says Winkler, “but they don’t value their own health.”
“Some women are – using the ‘necklace method’ [for birth control],” explains Winkler. The Ministry of Health introduced this method, the equivalent of a temperature chart that graphs ovulation: one bead moved over for every day of the month, and when the different colored beads are reached, a woman is supposedly ovulating. Needless to say, this is one of many reasons that women in San Martin get pregnant and bear children by the age of 15.
That women need to see a doctor or midwife while pregnant is obvious, but yearly checks for cervical cancer are not common practice at all. What is more, even if a woman does have a checkup, she won’t necessarily return for treatment if pre-cancerous lesions are found —this, of course, is if she receives the results in the mail at all.
So how does Winkler, a young Jewish woman from Seattle with a Master’s degree in Public Health effectively communicate with the strongly Catholic women of San Martin who have a practiced aversion to medical clinics?
For starters, Winkler is a fluid Spanish speaker and salsa dancer. She has lived in Costa Rica and Venezuela, and has a working knowledge of the Peruvian government. Winkler has not experienced much resistance to the TATI project in San Martin or any resentment to its presence.
In regards to her being Jewish, Winkler has found San Martin to be secluded enough that residents are “somewhat surprised that people can be something other than Catholic.” The differences between Judaism and Catholicism have only come up at friendly dinner table conversations, and are generally approached with a good-natured curiosity.
In fact, if there is any ill will at all toward the project, it is directed at Peru’s Ministry of Health, which works in coordination with PATH. Winkler explains that TATI is “grounded work with existing organizations and resources in the region,” but there are “big gaps in the Ministry of Health not knowing how to reach smaller communities,” and in their tendency to talk down to women.
The teams of medical professionals in San Martin avoid this obstacle by mixing their groups with Ministry of Health providers and community volunteers, in addition to the PATH workers. If a patient feels uncomfortable with a doctor from Lima, she can be reassured that he works side by side with a provider from San Martin. These teams also work together in a “community promotion strategy” that is aimed at educating locals about vaginal infections, cervical cancer and even self-esteem.
Despite this apparent harmony, there has been a struggle with the new President of Peru, Alejandro Toledo, to get funding for women’s health.
“The current director of the Ministry of Health has taken some steps backwards,” Winkler says.
Under former President Alberto Fujimori’s administration, there was a push to make family planning more accessible, but it also resulted in women being coerced into sterilization. Fujimori fled the country in November of 2001 and is now living in Japan, wanted in Peru on corruption and murder charges. Many believe that Toledo’s administration is using Fujimori’s iniquities as an excuse to cut funding, according to Winkler.
Funding for the TATI project — $10 million from the Bill and Melinda Gates Foundation, spread over the five years — will not run out for another year, which in the best possible circumstances will leave enough time to establish a self-sufficient program in San Martin.
Winkler is set to go back to San Matin in three to four months.