‘Don’t ignore the danger’
PAHO/WHO Country Representative, Dr. William Adu-Krow detailing facts about cervical cancer and the importance of HPV vaccines in the presence of the MCH Director, Dr. Ertenisa Hamilton on his right and the DCMO, Dr. Karen Boyle, on his left. (Photo by Delano Williams)
PAHO/WHO Country Representative, Dr. William Adu-Krow detailing facts about cervical cancer and the importance of HPV vaccines in the presence of the MCH Director, Dr. Ertenisa Hamilton on his right and the DCMO, Dr. Karen Boyle, on his left. (Photo by Delano Williams)

…elderly cancer survivor bats for HPV vaccine
…urges early screening

A 64-year-old woman who survived cervical cancer after being diagnosed with the disease earlier this year has now become a staunch advocate for early screening and is urging parents to encourage their children to take the Human Papilloma Virus (HPV) vaccine,

Photograph showing the outer layer of the cervix when it is in its normal stage to when it starts to develop cancer. (Mobieg Photo)

which is soon to be made available during a countrywide campaign.

“If they get a vaccine that can prevent cervical cancer, I think we should use it. We shouldn’t wait fuh things get bad before we try fuh get help,” Rukhmin Mortley told the Guyana Chronicle during an exclusive interview at her Eccles, East Bank Demerara home.

Her message is coming at a time when the Public Health Ministry in collaboration with the Pan American Health Organisation/World Health Organisation (PAHO/WHO) is on the verge of rolling out a comprehensive Human Papilloma Virus (HPV) Vaccination Campaign with the aim of immunising approximately 36, 000 girls between the ages of 9 and 13 across Guyana. The vaccine is intended to protect them from the Human Papilloma Virus (HPV) as they grow older.

HPV, the most common sexually transmitted infection (STI), has the potential to develop genital warts and cancer, in particular cervical cancer among women, according to the Centers for Disease Control and Prevention.
Recounting the events that led up to her being diagnosed, Mortley said: “I just wake up one morning and I start to bleed and my daughter took me to emergency.”

Gardasil is the preferred vaccine used by the Public Health Ministry. (Mobieg Photo)

It was not long after that she was diagnosed with Stage 3 Cervical Cancer – the cancer had already spread from the cervix into the structures around it. Mortley said, she was advised by the doctors that surgery was not the best option, because the cancer had already advanced.

“She [the doctor] said I would have to do 25 radiations, five chemo, and three internal. So immediately, I start doing the treatment,” she related. From February 23 to May 2017, Mortley underwent her rigid treatment at the Cancer Institute of Guyana, completing 25 radiation therapies, one session of chemotherapy, and three internal radiation therapies. The therapies had cost her $750, 000, of which Government contributed $200,000. “It was a painful experience. I couldn’t ah bathe for 25 days, I couldn’t ah cook, I couldn’t wash nothing. The radiation is something not too nice,” the

Having been cured of cervical cancer, 64-year-old Rukhmin Mortley is now calling on parents to protect their girlchildren from the disease (Photo by Samuel Maughn)

housewife noted.

Fifteen days after completing her treatment, Mortley, in July, was again scanned, and was told by the oncologists at the Cancer Institute that she was free of cancer. “Since then, everything normal, I aint getting no treatment, I ain’t living on no treatment,” she said.
The cancer survivor said she is thankful for the overwhelming support she received from her family, friends, doctors, and church members, noting that she and her husband, David, could not have done it.

Mortley, backed by her husband, is now endorsing the use of the HPV vaccine, saying that if the vaccine had been available to her in her younger days, she would not have had to put up with cervical cancer at age 63. “I would like to advise parents who have their girlchildren from 9-13, go and get this vaccine as they have the opportunity now fuh get the vaccine because this cancer, the treatment is not nice, it is not something nice to go through, so that will avoid them from having the cancer,” she pleaded.

Pap smear
Additionally, the mother of two is also encouraging women who are sexually active to get their pap smears and visual inspection with acetic acid (VIA) done to determine whether they have cancerous cells in the cervix.

A new lease on life! After months of battling cervical cancer, Rukhmin Mortley is now enjoying a cancer-free life with her husband, David. In the photo, they are enjoying one of their specialties “chicken-curry.” (Photo by Samuel Maughn)

The HPV vaccine was first introduced in Guyana during a campaign from 2012-2014, however, there were mixed reactions, with some persons objecting. When random calls were made to parents, some parents signalled their willingness while others objected. Lavern Stoll-Clyne, the owner of a taxi service in central Georgetown, said she would allow her 13-year-old daughter to receive the HPV vaccine. She said she had watched a compelling documentary on cervical cancer, in which a patient had blamed her mother for not allowing her to take the vaccine.

“I don’t want my daughter to ever have the cause to blame me, so yes! I would allow her to take it,” Stoll-Clyne said, even as she applauded the move by the health authorities to make the vaccine readily available.
Marla Douglas, a Linden mother of three, said when the campaign is launched she would be more than willing to allow her nine-year-old daughter to have the vaccine taken. “I have been hearing a lot about cervical cancer and I don’t ever want my child to get it. So I will protect her from now, and if it means that she has to take it, she will,” Douglas said, while calling on parents to place emphasis on sex education among their children.

A public servant and West Bank Demerara mother of two, who requested anonymity, did not object to the HPV vaccine, but stated that she would have to conduct her research. “I wouldn’t allow my daughters to be vaccinated in a public campaign. As a parent I’m responsible for their health and general well-being. It is my decision what types of vaccines they get, how frequent and at what age. My issue is not particularly with the vaccines, but with the state imposing it at their will,” she stated.

When told that the vaccine was optional, the West Bank Demerara mother said “It’s for the government to make those vaccines available if and when I decide to access them.”

Myths about HPV
Dr. Syed Ghazi, Director of Outreach at the Cancer Institute, told the Guyana Chronicle that there are many myths associated with vaccines and treatments such as the HPV vaccine, but stressed that after years of research, the HPV vaccine has proven to be effective in the prevention of cervical cancer and genital warts.

One such myth is that the teenagers become more sexually active after taking the vaccine, but Dr. Ghazi said there is no such evidence. Dr. Ghazi said the Cancer Institute for years has been conducting extensive outreaches not only in Georgetown, but in the hinterland regions, screening persons for the various types of cancer, including cervical cancer.

He noted too that major emphasis has been placed on educating persons, pointing out that people are more receptive now towards the HVP vaccine, VIA testing and Pap smears.
Like Mortley, Dr. Ghazi is calling on parents to embrace the use of the HPV vaccine. “We at the Cancer Institute of Guyana believe that prevention is better than cure, and early detection saves lives. Cervical cancer is a monster which has caused of a lot of deaths in the Caribbean and in Guyana…Prevention is to get a vaccine. I know that young girls have to get it, and parents sometimes are anxious but guess what, if you do that you will save their lives.”

Second most common
During a recent Media Brown Bag Meeting at the PAHO/WHO Country Office, its Country Representative, Dr. William Adu-Krow, said cervical cancer is a public health concern. “Data from WHO clearly identifies cervical cancer as the second most common cancer in women of reproductive age group, and if there is something that we can use to prevent it, then it is high time that we get unto using it,” he told health journalists.

Alluding to statistical reports produced by PAHO/WHO, the Country Representative pointed out that over 83,000 women were diagnosed with cervical cancer and almost 36,000 died from the disease in the Region of the Americas, in 2012.

“If this trend continues, the number of deaths in the Americas is projected to increase by 45% by the year 2030,” he warned. Added to that, Dr. Adu-Krow pointed out that cervical cancer mortality rates are three times higher in Latin America and the Caribbean than in North America. However, it must be noted that approximately 70 per cent of cancer cases could be avoided through HPV vaccination of adolescent girls.

Director of Maternal Child Health (MCH), Dr. Ertenisa Hamilton, who was also among the panellists that addressed the health journalists, explained that while HPV is a sexually transmitted disease, a person can become infected if he or she comes into direct contact with the virus from broken skin from any part of the body. Babies can also be infected during delivery if their mothers are infected.

Dr. Hamilton noted too that it takes 15 to 20 years for cervical cancer to develop in women with normal immune systems; however, it can take only 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection. Symptoms of cervical cancer tend to appear only after the cancer has reached an advanced stage, the MCH Director noted, while pointing out that symptoms include abnormal vaginal bleeding after sexual intercourse; back, leg or pelvic pain; fatigue, weight loss, loss of appetite; vaginal discomfort or odorous discharge; and swollen legs. It was noted however that not all vaginal bleeding is linked to cervical cancer.

In Guyana, cervical cancer is the second most common cancer among women with the number of cases increasing. For the period 2003-2012, Dr. Hamilton said 4 per cent of the cancer was detected in stage one with 96 per cent of all other cancers detected at later stages. She pointed out that every year 27 out of every 100,000 women die from cervical cancer.

“Two-thirds of all these cases was women under the age of 60. The age group that we found most at risk is 15-39,” she posited. While there is provision within the health care system for the screening and pap smear of women to detect cancer at an early state, allowing for treatment, Dr. Hamilton was adamant that the most effective way of preventing cervical cancer is the HPV vaccine.

Turning her attention to the countrywide HPV Vaccination Campaign, which is set to commence on October 16, Dr. Hamilton said the HPV Vaccination is nothing new to Guyana, explaining that from 2012-2014, the HPV vaccine was introduced to the country with a donation of 21,600 doses. Vaccines were administered to girls 11-13 in Regions Three, Four, Five and Six.

Though HPV is common among males as well, the MCH Director said the current focus is on the vulnerable population, including girls and women. “If we do a very good job and achieve at least 95% of the girls within the age group, it means that the boys within that age group will be automatically protected,” she posited.

With the consent of their parents, girls age 9-13 will be immunised in the schools, hospitals and health centres across the country, and even at private health institutions at no cost.
Outreaches are also expected to be conducted in remote areas to ensure the majority of girls within the targeted group are covered. Six months after the first dose, they would receive a second dose of Gardasil, the preferred HPV vaccine used by the Public Health Ministry.

Dr. Hamilton said the Public Health Ministry is collaborating with the Education Ministry and private health Institutions and practitioners to facilitate a successful campaign. Additionally, health personnel in the various regions at all levels are being trained and edified about the HPV Vaccine.

The campaign is heavily funded by the Guyana Government with assistance from Global Alliance for Vaccines and Immunization (GAVI) and PAHO/WHO. Some 40, 000 doses of the vaccine have already been secured.

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