A Zimbabwean OB/GYN described to Scott Wittet the smell of a local hospital's cancer ward.
The doctor said he took his interns to visit patients lucky enough to receive treatment or palliative care. As they approached one wing, they were hit by an intense stench. It was overpowering. Many of the interns had to stop, unable to stomach going further.
The OB/GYN explained the source of the odor is more unpleasant than the smell. It comes from a strain of bacteria that finds breeding ground in conditions caused by cervical cancer.
"He told me, 'I'm not telling you this so you can feel sorry for my interns,'" says Wittet, who works with the Cervical Cancers Prevention Programs at PATH, a non-profit focusing on global health. "He said, 'I'm telling you this so you can think about the women dealing with it in their villages.'"
Cervical cancer is diagnosed in about 500,000 women every year. About 250,000 will die. More horrifying, an estimated 80 per cent of those deaths occur in the developing world.
But cervical cancer is largely preventable. It begins with slow-growing, pre-cancerous lesions which can be indentified with screening and removed with cryosurgery, the freezing technique used to remove warts, moles and small skin cancers.
Screening has proven extremely effective. In the United States, the American Cancer Society credits Pap smears, one of the most common methods, with helping to reduce the cervical cancer death rate by 74 per cent between 1955 and 1992.
But, Pap tests remain largely unavailable outside the West.
"It's been so unfair that women in the developing world haven't benefiting from screening," explains Wittet. "But, the Pap test is very sophisticated. It hasn't proved sustainable except for in large cities like Bangkok or Kampala."
In low-resource settings, the laboratories that process samples and the accompanied training simply aren't available. Also, results take weeks to be processed. Because women often have to travel hours to reach a clinic, they are rarely able to return for follow-up and treatment.
This means they miss out on early diagnosis and the lesions often progress to cancer. With little access to chemotherapy or radiation, cervical cancer becomes the leading cause of cancer death in women in the developing world.
With limited palliative care, that death can be horrific. The cancer causes tremendous pain. As the odor-causing bacteria manifests, women without access to cancer wards like the one visited by the Zimbabwean doctor end up leaving home.
"Not only are they facing their own mortality and tremendous pain, they are facing stigma and loneliness," says Wittet.
But this doesn't have to be.
There are screening methods more appropriate for low-resource settings. With the political will to fund and train healthcare workers, they could be made available.
Visual inspection is an easier and faster way screen. Wittet explains vinegar is used to turn pre-cancerous lesions white. Through training, they can be seen with the naked eye. Then, cryosurgery is performed in the same visit to destroy the abnormal cells. Wittet explains freezing is cheap, effective and transferable to low-resource settings.
In regions where these programs are in effect, the results are promising.
"There are many countries that are building up their visual inspection methods," says Wittet. "Through a five-day training session for local health providers, we create the opportunity to create a cadre of people who can go into the communities."
That's something being desperately sought.
"They've seen this disease in their villages," says Wittet. "This is the disease their aunt, their mom, their grandma died of so painfully."
But, with proper access to screening, that can change. Much of the pain, the loneliness, the loss can be prevented. That is, if we take the OB/GYN's advice and start thinking about the women in the villages.