In this interview with Mmika Solomon, Dr. Raisima explains both how cervical cancer works and how she tackles the disease head on.
Q. Please introduce yourself to our readers.
My names are Mmakgomo Mimi Raesima. I am married with four children, 3 sons and a daughter. I am from Kanye.
Q. What do you do in life?
I am the Programmes Manager for National Cervical Cancer Prevention Programme (NCCPP) in the Ministry of Health.
Q. Where did you study?
I studied at St George’s University in Grenada, West Indies. I am a General Practitioner.
Q. Are you married to a doctor?
I was smart enough not to marry somebody in the medical field. My husband is in the ICT field.
Q. As a Doctor, when you are ill what kind of health facility do you use?
I use the nearest facility next to my house. I prefer public health facilities.
However, when I gave birth I used private clinic simply because I didn’t want my colleagues to see me conceive.
On a serious note Princess Marina has the best doctors in the country despite the challenges they may face like shortage of medicines.
Q. Exactly what do you do in your office?
I am responsible for making sure the public is offered screening for cervical cancer normally referred to as Pap smear.
We introduced the Visual Inspection using Acidic Acid referred to as the vinegar test.
Most importantly I am tasked with making sure that women who had an abnormal result for Pap smear or the Vinegar test are treated.
Q. Elaborate further on Pap smear.
Pap smear, we get a swab from the cervix and then we put that on a glass slide, and take that to the lab for diagnosis.
Pap smear requires time to be processed at the lab and the patient has to come back for results and then come back again for treatment.
Without treatment you are still at risk of getting cervical cancer.
Q. What about the vinegar test?
With the vinegar test we take cotton wool which has been soaked in vinegar and place it on the cervix, after three minutes we remove the cotton wool and look for the changes on the cervix, which could be caused by Human Papillomavirus (HPV).
If we can visualize changes on the cervix then we offer treatment in the form of Cryotherapy commonly known as freezing technique.
The vinegar test offers screening and treatment in one visit.
Q. If I recall very well my encounter with women I have met, they always talk of visiting a Gynaecologist as opposed to seeing a nurse.
Or I am wrong?
You are right.
Some women prefer to see a Gynaecologist in private clinics.
However, in public health facilities your first contact will be a nurse.
In our case the vinegar test can be done by a nurse, you do not need a specialist.
Q. Are you saying Nurses in Botswana know what to do when it comes to cervical cancer?
Absolutely. Currently we train them on the job, but we are working towards introducing the training at all health training institutions across the country so that when they complete their training they are capacitated.
Most nurses know the basics of Pap smear screening which is important hence no patient will be returned from a public health facility.
Q. Is this a Gaborone thing?
The fight of cervical cancer is a national project.
Cervical cancer is the number one cancer to affect women.
It is also the number one cancer killer of women.
We call it a silent killer because we usually see symptoms when the disease is advanced.
Botswana government has long been fighting cervical cancer, however, for over 20 years. We introduced the vinegar test in 2009 as a pilot in partnership with UPenn and CDC Botswana.
We are now scaling up nationally to ten sides namely Maun, Francistown, Mahalapye, Selibi-Phikwe, Kanye, Lobatse, Molepolole, Kang, Kasane and Ghanzi.
Q. What challenges do you face in dealing with the issue of cervical cancer?
The biggest challenge in Botswana is capacity, the number of specialists that are required to get women treated is not enough.
The cone biopsy is done by specialist and it takes 3 days in a hospital and it is done by operation and mostly is done in Nyangabgwe and Marina.
The other challenge is that we need to train all health personnel in the country so that they can meet the demand of the public.
Q. What really causes this cancer?
Cervical Cancer is caused by HPV. HPV is not seen by naked eye, what we see are the changes on the cervix caused by HPV.
In order to prevent the changes from becoming cancer, we have to offer treatment.
Q. So, the good Doctor what advise can you give to women?
My advice is that women who have results need to understand them first and seek treatment if the results are abnormal.
Those who have not received the results, need to wait for their results so that they don’t overwhelm the laboratory further.
Those women who have not screened, we highly encourage them to go for screening especially those who are in the age range of 30 to 49 years old.
Q. Interesting that now you mention the age group, so this cervical cancer is an adult thing?
You can say so, but between the ages of 30 to 49 years is where you find pre-cancer or early stage cancer that we can treat.
Cancer is mostly found in ladies who are over 50 years old. Even if you are under the age of 30 you can still get cervical cancer though.
Q. Prevention is better than cure Doctor, why not mention it?
The risk of HPV can be prevented by delaying sexual debut when you are young.
Sexual intercourse should be avoided at an early age especially because HPV is transmitted by skin to skin.
Also one should avoid multiple concurrent or serial partners and tobacco use.
Unprotected sex can lead to sexually transmitted diseases including HIV which will increase ones chance of getting cervical cancer.
The cost of treating one patient is more than P100 000.00 this excludes doctor’s fees.
It is very expensive to treat a patient. Hence, we encourage people to test early.
Q. Do people who have cervical cancer die?
Yes, they die. In fact most of the women in our hospitals who present to our hospitals do that when they come to us with late stages cancer and this is because they have never screened in their lives.
Q. What are the symptoms?
Sometimes when you have the cancer, you will experience blood spots in between your menstruation period.
(That is when you are not in period).
You will also have a discharge that smells. However, some of the discharge could be for other causes like sexually transmitted diseases.
Discharge by the way can be normal so as a person you need to know what is normal for yourself.
Other common symptoms include back pain. Sometimes one has incontinence, that is, where you cannot control urine and sometimes faeces.
This disease is really terrible.
Q. Is it communicable?
It is not communicable, except HPV through skin to skin during sexual intercourse.
There is also the danger of throat cancer which one can get through oral sex or simply poor oral hygiene.
Q. Will a male partner be able to see the disease?
Yes, HPV causes penile cancer and penile warts.
Men have to be on the lookout for skin changes on the penis and ulcers that do not seem to heal which are often painless.
Q. Doctor, let’s talk about the treatment.
Oh! Yeah, the treatment for the changes or pre cancer can be removal of part of the cervix or uterus.
The woman who has her uterus removed still enjoys sex like before.
However, she will not be able to conceive after the removal of the uterus.
Other forms of treatment include Cryotherapy or call it the freezing technique which is given if the vinegar test is abnormal.
If you have cervical cancer sometimes we give medicines we call chemotherapy and again we can use radiation therapy where we use rays (marang jaaka X-ray) to kill cancer cells.
Q. Is there a special fund reserved for the treatment of cervical cancer?
We have received funding through Pink Ribbon Red Ribbon, it’s a public partnership with USA government at the tune of US$ 3 Million for five years.
NACA has also assisted with funding through Botswana National HIV/AIDS Prevention Support (BNAPS).
The rest of the funding is from the Ministry of Health.
Q. Lastly why did you opt for administration work as opposed to practice?
I like both administrative work and clinic work. But I prefer the public health as it means I reach to the greater masses.