An ambition to end cervical cancer
Rotary members work toward eliminating cervical cancer in Latin America
We're negotiating the tight curves around Bolivia's Amboró National Park in an ancient red Jeep with Juan Carlos at the wheel, Irma, Carol, and Mirna in the back, and me riding shotgun in the passenger seat. The mountains tower over us and are thick with a green mosaic of jacaranda and oak trees and cascading shrubs. Juan dodges the cows and dogs wandering along the two-lane highway, while cumulus clouds float overhead, still reluctant, as they have been for the last two years, to release any rain.
It's December 2022, and we are driving toward Santa Cruz, Bolivia's largest city. Behind us lies tranquil Vallegrande, which we left about three hours earlier. Working there with the local hospital team, we have started an ambitious project to eliminate cervical cancer — a project we hope to implement elsewhere in Latin America.
Bolivia has the highest rate of cervical cancer in South America, recording 1,985 new cases and 1,054 deaths in 2020. In the city of Santa Cruz alone, 90 women come to a hospital annually only to die of this preventable disease because of late diagnosis. Worldwide, 341,000 people die from cervical cancer each year, one every minute and a half. More often than not, they will be from a lower income country. Many will have left behind children and spouses who depended on them even as the cancer spread. Equally significant is the degree of suffering any terminally ill woman with the disease will experience as the condition advances toward its inevitable conclusion.
That's why we're dedicated to bringing the newest screening and treatment technologies to Bolivia, where doctors and nurses quickly learn how to employ them. Combining those human skills and medical innovations, we can screen upward of 600 patients in a day and treat early cancer in 40 seconds. Our goal is to test 7,500 patients, a project that may take three years to complete. But as the adage sometimes linked to U.S. President John F. Kennedy insists, "Every accomplishment starts with the decision to try."
"Combining those human skills and medical innovations, we can screen upward of 600 patients in a day and treat early cancer in 40 seconds."
After arriving in Santa Cruz, I meet with Jorge Mehdi, chief of surgery at the city’s children’s hospital and president of the Rotary Club of Urbari in town. Mehdi takes me on a hospital tour, and later we have a critical meeting to get letters of support from the government that would allow us to bring in the new equipment needed for the large-scale screening and treatment project we are hoping to implement. The government’s approval is essential, and I’m apprehensive. But Mehdi has a winning smile and a way about him that puts everyone at ease. And so, at our meeting, Bolivia’s minister of health says that he’s happy to sign the letters to allow our medical equipment into the county — and there’s a twinkle in Mehdi’s eyes as the minister delivers the news.
Illustrations by Jennifer Maravillas-Bell
How did this work begin for me? In 2007 I was a surgical oncologist at a busy hospital in California. I had a patient I saw with some regularity, and after a third and difficult cancer surgery, he asked me to come to a Rotary meeting with him. I declined, but he repeatedly extended the invitation. Finally, impressed by his perseverance, I agreed to accompany him.
And my life changed. At the Rotary Club of Niles (Fremont), I discovered friendships and inspiration I had never realized were waiting for me. Looking back, I realized that, while I may have removed some 10,000 cancers — not uncommon in a surgeon's career — how much better it would be to prevent cancer in the first place. Working with Rotary made that possible all around the world.
Here's one example of a successful project and the innovative treatments and technologies that fueled its success. Rotary clubs in District 5170 (California) and PINCC, a nonprofit focused on cervical cancer prevention, have recently completed a four-year project in Guatemala, where we introduced a new technology for genetic screening for human papillomavirus. HPV is the principal cause of cervical cancer.
We also "trained the trainers" in new treatment methods. We spent three years screening women who visited the hospital using a fairly basic procedure known by its shorthand name VIA. With a speculum, a headlamp, and an application of acetic acid, clinicians are able to visually identify early signs of the cancer. Then, using a new device called a thermal ablator, we were able to treat those early cancers in less than a minute.
Seems simple, right? The news only gets better. In 2022 we introduced an HPV genetic screening technology that allows women to test themselves at home. The majority of people will test negative and won't have to retest for at least three to five years. The testing is easier on the women because they don't have to travel to a hospital and on the clinicians, who only have to screen the patients in the hospital who do test positive. These quantum leaps in technology allow programs like the one we introduced in Guatemala and the one we've begun in Bolivia to move forward quickly. In September we will bring a similar program to Nepal — and in May, at the Rotary International Convention in Melbourne, Australia, it was announced that United to End Cervical Cancer in Egypt was the recipient of Rotary's third annual Programs of Scale award, which comes with a $2 million grant from The Rotary Foundation.
As in Guatemala, the project in Bolivia is conducted in Spanish. My Spanish language skills are OK, but it's a special Rotary experience to work in multiple languages and try to build stronger connections. The Bolivian women speak to me a little more slowly and are very patient, and I know they will be leading the process of eliminating the only major cancer we currently can.
The men are equally determined — and they should be. HPV is associated with several cancers that affect men, including some types of head and neck cancers. A head and neck surgeon asked me if we could also screen for high-risk HPV. The equipment we work with, known as AmpFire, can test for the virus through oral samples, and it can also test for many infections, including COVID-19. A larger question is whether wide-scale HPV vaccination of children, including boys, will have some effect on these other kinds of cancers, and some medical data suggests that it will. And rest assured: As vaccines become more effective and less expensive, eventually they will be offered to all children, not just the girls, in lower-income countries.
The work in Guatemala, in the Petén region, did have its share of pleasurable moments. Our team of volunteers made excursions to the Tikal and Yaxha pyramids, went swimming in Lake Petén Itzá, and enjoyed típico cuisine. We loved the camaraderie we shared with members of the Rotary Club of Tikal Petén as we attended their meetings and exchanged stories and laughter. There were also long days in the hospital, where we worked alongside Dr. Fabrizio Palma. The new self-testing techniques have been a godsend, both for the patients and for our team, but even after we had screened and triaged hundreds of patients in a sweltering, humid clinic, a crowd of women still waited anxiously, hoping to have their exams. On the upside, the results of our work in Guatemala have been published, and today Palma leads the program on his own as we move on to new locations.
With these new techniques, however, it’s essential to collaborate with our partners in different countries and not try to force or encourage changes until they are wanted. Years ago I learned in the Peace Corps what all volunteers come to know: You gain more from new cultures than you can ever hope to teach, whether it be a new language, new customs, or a better understanding of human nature. That’s a gift as great or greater than anything we might provide.
"It’s essential to collaborate with our partners in different countries and not try to force or encourage changes until they are wanted."
As I write this, I am anticipating a third trip to Bolivia, where I will climb again into the red Jeep and head back to Vallegrande. I look forward to seeing Juan Carlos, and I can't wait to bite into an achachairú, the egg-shaped fruit that has a deliciously sweet mango-berry-orange taste.
I am especially thankful to the Rotary clubs of Chicago, Los Angeles, Oakland, San Francisco, and Seattle that make this work possible. The initiator of all this is the Rotary Club of Urbari in Santa Cruz, where Irma Danny Rojas Arteaga, Carol Genevieve Viscarra Guillen, Mirna Ruth Claure de Toledo, and other club members are guiding a project that will in time spread across the entire country.
Bolivia, like every country, faces the challenge of immunizing all children, but lacks the resources to provide enough vaccines. Looking back at the early days of Rotary's PolioPlus program, it was an arduous process to fund the initial vaccination efforts — and yet today, the program is closing in on its ultimate goal of eradicating polio. We can dream of a time when Rotary might have the same impact on cervical cancer.
In fact, the idea is more than a dream. There is a growing surge of health care workers from or sponsored by Rotary clubs around the world who are taking on the scourge of cervical cancer. We will find funding, new technology, cheaper vaccines, and intrepid volunteers. After all, we have not merely made the decision to try. We are trying — and we intend to succeed.
A retired surgical oncologist, aspiring apiarist, and published novelist, Richard Godfrey is a member of the Rotary Club of Niles (Fremont), California.
This story originally appeared in the September 2023 issue of Rotary magazine.