Even as the number of women screened continues to increase, self-collection will relieve pressure on health facilities and staff, Schocken says, “because it requires less time by health care workers who, in Botswana and elsewhere, are overwhelmed.”
Nurses—who are the backbone of Botswana’s health system—are wholeheartedly embracing the self-collection approach, nurse Bakgaki Ratshaa says. Ratshaa, who heads up Jhpiego’s cervical cancer prevention program, is equally enthused about her country’s recent introduction of thermocoagulation, a treatment approach that zaps precancerous tissue with heat generated by a small, battery-powered device. Given its portability, it soon may end up freezing out cryotherapy, which involves the transport of unwieldy tanks full of gas.
“With funding from TogetHER, we have procured four thermocoagulation machines and are piloting the treatment in four districts,” she says. “Our expectation is to roll this out nationwide, just like self-collection.”
These new screening and treatment strategies collectively are paving the way toward cancer elimination, Ratshaa says, by tackling limited access to care and avoidance of pelvic exams.
A case in point: Koketso David, a 33-year-old hair stylist in Gaborone, avoided screening for years, until she visited the Nkoyaphiri Clinic in Gaborone this past winter and learned that it was now possible to collect her own HPV DNA specimen in private.
Then and there, David ventured into a consult room, where a nurse encouraged her to feel the soft brush designed for swabbing herself and showed her how to swirl it in a specimen vial filled with liquid preservative. A machine would analyze the specimen, detecting any presence of high-risk HPV even before visible changes occurred in her cervix. She’d get accurate results fast, a big advantage in a country where women often wait months for Pap results—or never hear back—because labs and pathologists are few.
Instilled with a new confidence, David retreated to the bathroom, alone, with the brush and vial. Later, she spoke of the new method’s appeal in Setswana, her native language, except for one word. “Speculum,” she said in English, loud and clear, and with pronounced distaste.