One Woman Makes a Difference

By Ann LoLordo, Jane Otai and Catherine Ayuko

As the sun rises, Pauline Ochola arrives for work on the outskirts of one of Nairobi's many slums. Word has reached the tin-corrugated shacks of Viwandani that women must make their way along the winding, narrow lanes and alleys to reach Ms. Ochola and the clinic she runs at the Makadara Health Centre. The message was clear: mothers, daughters, sisters and wives need to be screened for the most prevalent cancer among women in Kenya, a cancer with few symptoms that will kill if left untreated.

What Ms. Ochola offers these women is a simple test that will show their vulnerability to cervical cancer and lead the way to treatment. What Pauline Ochola offers the women of Viwandani slum is hope and the chance to live another day, and they are arriving at her door daily.

Since the 36-year-old nurse started this early morning clinic in late 2008, she has screened 1,029 women from the slums for cancer of the cervix and counseled them on the need for vigilance in encouraging more women to be screened. Women in developing countries account for the majority of cases of cervical cancer worldwide and it’s in these same corners of the globe that the ability to test women for signs of cervical cancer is extremely limited. Pap tests aren’t an option for most because of cost, limited lab facilities to process samples and lack of access to health care centers. Cervical cancer, if caught early, can be quickly and successfully treated and that’s why Ms. Ochola’s outreach is so important.

In Kenya, as many as 2,635 women a year are diagnosed with cervical cancer; 2,111 will die from it, according to the World Health Organization (WHO). A leading cause of cervical cancer—the human papillomavirus—is found in an estimated 38.8 percent of women in Kenya at any time. The statistics illustrate what’s at stake here.

“Cervical cancer is the major cancer killer of women in the developing world,’’ said Dr. Pamela Lynam, the Kenya Country Director for Jhpiego, an international health nonprofit affiliated with The Johns Hopkins University. “In the United States and Europe, it is a curable condition if caught early enough. But in the developing world, women generally do not know they have this cancer until it is at a symptomatic and untreatable stage.”

In the slums of Nairobi, many residents don’t visit local health clinics. There is a level of mistrust and concern about the quality of care they will receive and the cost of a visit is unaffordable. After participating in a Jhpiego-run training for health care providers, Pauline Ochola recognized the need to reach out to her Viwandani neighbors. Her clinic in the Makadara Health Centre is an example of Jhpiego’s efforts to bring high-quality health care to impoverished urban communities. She is breaking down barriers, and with the help of community health workers, persuading women to step out of the shadows.

Of the 1,000 patients who come daily to Makadara Health Centre, the majority of whom are children, 20 or more women come for cervical cancer screening each day. Trained in Jhpiego’s pioneering “visual inspection approach,” Ms. Ochola examines patients and, with some basic but essential supplies (vinegar, cotton swabs and a strong light source), visually inspects the cervix for signs of cancer.

If pre-cancerous cells are found during testing, Ms. Ochola refers women to the local hospital for treatment. She may have a community health worker escort them and she has been known to arrange for transportation as well.

While Ms. Ochola’s clinic focuses on cervical cancer screening, she makes sure to talk to patients about the importance of planning their families and offers them a variety of contraceptive options. If women need HIV-testing or counseling, she will ensure that they receive it as well.

Born on the island of Mfangano in Lake Victoria, Ms. Ochola, the daughter of a nurse, was trained as a community health nurse and began working on the outskirts of the Viwandani slum in 2005. She decided to offer the cervical cancer screening service three years later after attending a training session on cervical cancer sponsored by Jhpiego, whose work focuses on improving maternal and child health. Women in the Nairobi slums can’t afford to protect themselves—they can’t spare the $2,500 Kenyan shillings (about USD$32)—to get a Pap test. That inequality outraged Ms. Ochola: “People are suffering and cannot afford to walk into good hospitals for treatment.” She saw a friend suffer with cervical cancer and she says she “would not want anyone to go through such a painful experience.”

With the help of Jhpiego, she marshaled a team of community health workers – mothers and hairdressers, daughters and church group leaders – and they fanned out across Viwandani. The power of the message on cervical cancer was this: It is treatable if we find it early!

Committed to her patients, Ms. Ochola also recognized that some of her fellow workers at Makadara Health Centre needed attention as well. Assisted by Jhpiego, she began a support group for community health workers. For some, their jobs were just a means to a paycheck. Some were burned out, others frustrated by a lack of supplies, the demands of work and the condition of the health centre. Never deterred from her mission, Ms. Ochola inspired the workers to involve themselves more fully and she issued a challenge to them:

"This health facility belongs to this community. Make it your own.” It was something they needed to hear and one many have embraced.

With the help of Jhpiego, Pauline Ochola has become a champion for cervical cancer screening. The many women of Viwandani, and across Nairobi, are reaping the benefits.