As WASN is part of the ATI campaign being spearheaded by MISA, letters were written to the Director of City Health to enable WASN staff interview health personnel at Wilkins Hopital on the uptake of VIAC by women and girls, on 22 June, 2017. After the approval WASN had an opportunity to interview the Sister in Charge of VIAC services. Below are the officers who were present and what transpired thereafter.
The WASN team arrived at Wilkins hospital at 8 am, and were welcomed by Sister in Charge, Dzawara and Sister Muzarabani. Both nurses were very open and willing to share their experiences and challenges with women. WASN had the opportunity to ask many questions regarding cervical cancer and the state of VIAC services in Harare as well as conduct a survey on the knowledge levels of the women who had come for screening that day
Sister Dzawara explained that VIAC is for free. There is one doctor to attend to women every Wednesday for quality control. The women are first given pamphlets to read before an educational session. The session is given in the local language despite that the pamphlets are in English. The women are given opportunity to ask questions and dispel all fears of undertaking screening.
The Sister in Charge informed WASN that under normal circumstances VIAC screening has to be conducted with two nurses, one taking pictures and the other analyzing the pictures and inputting data into the computer, but due to staff shortages only one nurse is stationed at all times. As the clinic offers VIAC, Sexual Gender Based Violence (SGBV) and Sexually Transmitted Infections (STIs) the nurses are sometimes overwhelmed by the numbers of people who come to access the services resulting in the Sister in Charge coming to assist especially when other nurses are off duty.
She further highlighted that after screening if there are suspicious cells depending on the stages the hospital offer the following services mentioned below.
- There is what is called Cryotherapy one of the methods for treating precancerous cells of the cervix by freezing them using an ice-cold gas. This service is available at Wilkins and it is for free.
- Another method called LEEP (Loop Electrosurgical Excision Procedure) used to remove precancerous tissues from the cervix using a thin wire heated with electricity. Sister Dzawara informed WASN that this services is only offered at Wilkins however at the moment due to lack of resources they are not able to treat women who might want to access LEEP. It is not for free, LEEP costs $80-00.
Wilkins Hospital has no resident gynaecologist. After screening if a patient requires further treatment that is not Cryotherapy or LEEP the hospital refers to Parirenyatwa Hospital under the supervision of a Gynaecologist. If the patient requires Punch-Biopsy which is a procedure to remove tissue from the cervix to test for abnormal or precancerous condition or cervical cancer the hospital refers to Edith Opperman in Mbare.
At first there were many awareness campaigns in the country and the response was overwhelming. Women during the inception of the program used to come in numbers and some women would go back home unattended as the Hospital could not meet the demand. The situation is different now as they are few women coming for screening and there are no more campaigns on Cervical screening.
Quality of services
- There is need to for financial and human resources to improve on service delivery and quality of services.
- New clients are impressed with services and want more information especially women who are HIV positive.
What challenges are encountered at the Clinic?
Sister Dzawara and Sister Muzarabani articulated a lot of issues that are affecting service delivery on VIAC screening.
- Human and financial challenges are contributing to failure in meeting the demands by hospitals. The nurses ended up being overwhelmed with work contributing to less quality time with clients. Sister Dzawara further pointed out this is compromising the quality of education and quality work. She gave an example under normal circumstance VIAC screening is done with two nurses but sometimes only one nurse will be doing all the work.
- There is one doctor in Harare who is operating in all hospitals for quality control and cannot exceed a maximum number of 3 if it’s LEEP.
- Late disbursements of funds.
These challenges affect the moral of the health personnel.
The meeting and the observations indicated the need to scale up the campaign on VIAC services. As WASN works with women and girls it is important to disseminate information that is specific and targeted to women and girls it is imperative that various stakeholders be involved to enable wider reach through families, communities and social media