The Real Lady Killer

Segment 1

TITLE: Kill or Cure
SARAH NYOMBI: In our African culture, you know, they will think they are bewitched. Sometimes women don't know what's wrong with them and they are in huge amounts of pain. So to avoid burdening their families they take themselves to remote areas such as this to die lonely. It is a tragedy.
TITLE: The Real Lady Killer
VOICEOVER: Sarah Nyombi, a Ugandan politician, is on a mission. She's trying to halt a silent killer stalking her country, from which every woman in Uganda is under threat. It's called cervical cancer and in the developing world it's the leading cause of female cancer deaths.
SARAH NYOMBI: It is a horrible cancer, it kills hundreds and hundreds of thousands of women each year, it's not a nice way for women to die
VOICEOVER: Today Sarah, a former nurse turned women's health campaigner, is visiting Margret Makakoni, a lady whose mother died of cervical cancer.
MARGRET MAKAKONI: I feel week and drained.
SARAH NYOMBI: Mmm, of course. It must be the constant reliving of the memory.
VOICEOVER: Sarah knows exactly what Margret's going through. She's also lost people she loves.
SARAH NYOMBI: I have known lots of people who have really died of cervical cancer. My auntie, the pain she was going through. Her children couldn't help, we couldn't help, so really we were devastated.
VOICEOVER: Cancer kills more people than AIDS, TB, or malaria. And there could be an even greater number of cancer victims who don't know what it is they're suffering from.
SARAH NYOMBI: I have heard about stories about people, but not even knowing that they're dying of cervical cancer. They think that patient was bewitched. In Africa there is that bewitching belief in our heads.
VOICEOVER: In March this year, as part of her efforts to dispel such myths, Sarah travelled 4,000 miles to Oxford in the UK, to see how the cancer is dealt with in the developed world. Here, screening is widely available and last year, a vaccine which could cut cervical cancer deaths by 50 percent worldwide, was introduced into schools. The vaccine prevents two types of a virus called HPV, known to cause 70 percent of all cervical cancer cases. HPV is sexually transmitted, but unlike HIV, condoms can't prevent it entirely. It infects most people at some stage of their lives, so the aim is to vaccinate girls before they're exposed. In the UK, girls are vaccinated at the age of 12.
SARAH NYOMBI: I'm going to a school to really interact with girls who have been vaccinated with the HPV vaccination, and to see and find out how they really found it.
VOICEOVER: Just like in Uganda, knowledge about the cancer is limited.
SARAH NYOMBI: Did you hear about cervical cancer before?
ALICE B [schoolgirl]: No. At primary school they told us a little bit about cancer but not cervical cancer.
SARAH NYOMBI: OK, just other cancers.
BOTH SCHOOLGIRLS: Yeah.
VOICEOVER: But when they heard that cervical cancer affects almost half a million women each year, they all wanted the vaccine.
ALICE B: I think it was popular here. I think everyone wanted to have it, it wasn't just the parents pushing them to do it but I think they wanted to have it.
SARAH NYOMBI: The students themselves wanted it for themselves.
SCHOOLGIRL: And I think anybody who didn't was soon convinced by everyone who was like, this is going to save our life in the future, this is a good decision to make.
SARAH NYOMBI: I had a good time chatting with the girls. This is a vaccine which has that appeal to almost all girls in this world. So if every girl could have it, it would be wonderful. But the affordability ... it is so expensive.

Segment 2

VOICEOVER: In Uganda, the government hasn't been able to afford to include the cervical cancer vaccine in its national program so far. To buy it privately here would cost at least USD$300, almost the same as the average Ugandan earns in a year. In two districts of the country, however, a project is underway which could change all that. An American NGO called PATH has organized for 12,000 girls to be vaccinated.
DR. AISHA JUMAAN [Director, HPV vaccine project, PATH]: This is a demonstration project, to demonstrate how the vaccine can be introduced into a country.
VOICEOVER: They've launched similar projects in India, Peru, and Vietnam. The aim is to show governments around the globe ways in which the cervical cancer vaccine can be delivered in the developing world. One of the things the project hopes to discover is whether a vaccine for young girls will be accepted here as it has been in the UK. In Uganda, it's targeted at young adolescent girls like Aisha. This morning, she's on her way to school where the vaccinations are taking place. Because the vaccination prevents a sexually transmitted infection, there are fears people will be suspicious.
DR. AISHA JUMAAN: There is a stigma that people think if you give girls a vaccine that protects them against a sexually transmitted disease then you are encouraging them to start sexual activity.
SARAH NYOMBI: If you bring it, a vaccination, to girls who have not even been exposed to sex, it was like you are now making them think about sex at that early age.
VOICEOVER: It's something Sarah's worried about, so she's heading to Aisha's school to see for herself how the vaccine is being received.
SARAH NYOMBI: I really want to see what's going on there and I believe it to be of great importance to Uganda and the whole of Africa.
TEACHER [to class]: What are we immunizing against? Hands up if you know the answer. What was that?
SCHOOLGIRL: Cervical cancer.
TEACHER: Well done, give her a round of applause.
SARAH NYOMBI [to schoolchildren]: Do you know who's going to be vaccinated for the first time? Are they here? Put your hands up. They will check your vaccination cards. Boys are not vaccinated, only girls.
VOICEOVER: Everyone, it seems, wants to be vaccinated. And fears that injections for young girls would be viewed with suspicion have proved unfounded.
DR. EMMANUEL MUGISHA [HPV Vaccine Project Manager, PATH]: We haven't had any negative issues. Instead we are seeing the opposite, that there is much more demand for the vaccine. Many parents ended up lying about the age of their daughters, so even if someone was 13 they would say she's 10 so that they can be vaccinated.
VOICEOVER: It's Aisha's turn, and as a former nurse, Sarah knows all the tricks.
SARAH NYOMBI: The medical personnel was telling me that they don't inject on a hand regularly used so there is no excuse for these children to go back to class and say, 'Teacher, I cannot write because my hand has been ...' So, there is no excuse.
VOICEOVER: All the girls have been told what they are being vaccinated against, but Sarah soon discovers Aisha knows a lot more about cervical cancer than her classmates.
AISHA [schoolgirl]: Why is it when you have cervical cancer you start bleeding?
SARAH NYOMBI: You know that because you have seen it?
AISHA: Yes.
VOICEOVER: Two years ago, Aisha's mother died of cervical cancer.
AISHA: My mum started bleeding and vomiting.
SARAH NYOMBI: So she was vomiting, and bleeding from her private parts?
AISHA: Yes. After that, she passed out.
SARAH NYOMBI: Was she taken to hospital?
AISHA: Yes, she was. Later they took her to a herbalist called Mawenjje who told them if they took her to hospital again she would die. She kept seeing the herbalist but eventually died.
VOICEOVER: It isn't the only tragedy Aisha has to deal with. On the same day the crew is filming, her cousin Betty dies of malaria. She is buried the next day. Malaria is just one of the health crises with which Uganda has to do battle. Premature death is common here. But it doesn't make losing someone any easier to bear. Each year, the Ugandan health budget is USD$143 per person. The cervical cancer vaccine is USD$300. The next morning, Sarah and the local health worker, Justine [Kajura Justine Makityo], pay their respects to Aisha's family. Her mother's death, like so many others, never made official cancer records. But there's no doubt what killed her.
MUSA: She was 46 years old and the bleeding went from bad to worse. I was advised to go to Nakaseke to see Dr Mawenjje. He told me to take her back home and visit him regularly for the medicine. But her condition deteriorated. She couldn't walk. Then she kept getting weaker and weaker. I am terrified of cancer after everything I saw my wife go through. I'd rather die from AIDS than have cancer.
VOICEOVER: He's relieved a vaccine might be able to save his daughters from the same fate.
SARAH NYOMBI: Mr. Makah wanted all girls in his house vaccinated, from age 1 to age 16, because what he saw and what he went through was so horrible.
VOICEOVER: By the time the PATH project finishes in 2011, 12,000 girls will have been vaccinated. But families like Aisha's, and thousands of others, will continue to suffer if the government isn't able to keep on vaccinating. Back in her office in Kampala, it's something of which Sarah is acutely aware.
SARAH NYOMBI: Yeah, there is a lot of work to be done. After this trip, I feel there is a lot of work to be done. HPV vaccine is very expensive. So we have a meeting of members of parliament tomorrow to get an update of the progress of the vaccination of these young girls. I would really wish to get as many women as possible to know about this cancer and get screening and tested early, not really end up dying like my aunt did.

Segment 3

TITLE: Kill or Cure
VOICEOVER: Sarah Nyombi is a politician and former nurse. Today, she's visiting a hospital in the Ugandan capital, Kampala. Sarah is visiting the gynecological ward where almost a third of the beds are filled with people suffering from cervical cancer.
SARAH NYOMBI: Greetings to you all. My sympathies for your illness.
VOICEOVER: It's one of the few places in the country that keeps any cancer records. Each year, cancer causes more than seven and a half million deaths globally. Seventy percent of them are in the developing world.
DR. EMMANUEL MUGISHA [HPV Vaccine Project Manager, PATH]: But even then that's the tip of an iceberg. Those are the few individuals who are able to go to the hospitals and get recorded. But many of the cancer patients actually don't. Whenever somebody hears of the word "cancer," it means "death." So they go back to their villages and die. So those are not recorded at all.
VOICEOVER: Here at Mulago Hospital, most patients with cervical cancer are admitted in the advanced stages, when there's little that can be done to help them. Rehema Namusisi is 35. She's been diagnosed with stage III cancer and is waiting to begin radiotherapy.
REHEMA NAMUSISI [cancer patient]: When I'd wash myself it felt sore. Stuff used to come out of me. It felt like ants crawling on my skin. On the 20th they sent me to the wing where they expose you to electricity.
SARAH NYOMBI: And do you feel any better?
REHEMA NAMUSISI: I'm in a lot of pain.
VOICEOVER: She might not seem it, but Rehema is one of the lucky ones. If cervical cancer isn't caught early, it kills: a quarter of a million women each year. Rehema might have been diagnosed in time to save her life. Most aren't. Across town, for one day only, a center for free cervical cancer screening has been set up to try and spread the word that women over 25 should be regularly checked for pre-cancerous lesions. Even if the vaccine is introduced here, it only protects against the two most dangerous types of HPV and cannot help the millions already infected, so screening is still vital. In wealthier countries, a test called a Pap smear has seen rates of cervical cancer fall dramatically. But such a high tech, expensive service isn't widely available in the developing world. Here, the best option is to try and introduce alternative, low-cost methods such as VIA [visual inspection with acetic acid], the method being used today. Vinegar, applied to the cervix, highlights any abnormalities, which can then be removed with cryotherapy, or freezing. When treated at this stage, cure rates can be 85 percent or higher. Back in the hospital labs, Sarah is finding out about future screening possibilities.
SARAH NYOMBI: I would like to know, if a woman wanted to be screened, what are the options?
DR. EMMANUEL MUGISHA: There are newer options which are about to be ready, such as the careHPV which basically tests for the virus. So you can test about 90 women at a go. It can run on a car battery so it doesn't require an electricity supply.
VOICEOVER: It's hoped, in conjunction with VIA, the test will help screening to become widely available in the developing world. Uganda is one of the first countries to conduct field evaluations of the test. But, as well as screening, Sarah wants the vaccine introduced nationwide too. This morning, she's organized a meeting for MPs to try and galvanize support.
SARAH NYOMBI: We organized this meeting to really reach out to the members of parliament. Cervical cancer is not to do with doctors only.
VOICEOVER: Overwhelming opinion is that the vaccine should be introduced in Uganda.
MAN IN MEETING #1: Madam chair, when do we have the mega-plan of ensuring that we roll it out all over in the whole country?
WOMAN IN MEETING #1: We should try to catch up different corners of Uganda.
WOMAN IN MEETING #2: As much as we need to roll out to other districts but even we have to look at the way how it's going to be sustainable.
VOICEOVER: First, they have to work out how to pay for it.
MAN IN MEETING #2: He put the question, "How much would be involved?" It is us who is going to pass the budget.
VOICEOVER: But the Ugandan Ministry of Health will struggle to afford the vaccine alone.

Segment 4

VOICEOVER: Hope lies in an organization called the GAVI alliance.
DR. AISHA JUMAAN [Director, HPV Vaccine Project, PATH]: The cost of the vaccine for many of the developing countries is very expensive. GAVI [Global Alliance for Vaccines and Immunisation] helps poor countries purchase vaccines at a subsidized price, like the HPV vaccine. They [governments] may be able to pay 20 cents per dose, where GAVI takes care of the rest of the price. And GAVI is able to purchase quite a bit of vaccine, and therefore are at a very good position to negotiate a better price for the vaccine than individual countries are able.
VOICEOVER: Four thousand miles away, in Oxford in the UK, a conference on cervical cancer is being held at the university. GAVI's chief executive, Julian Lob-Levyt, is going to be there. And so is Sarah.
SARAH NYOMBI: I hope now Julian is here, I will talk to him about this program in Africa, the taking up of the HPV vaccine by GAVI.
DR. EMMANUEL MUGISHA: Yeah I think it's high time they hear from the politicians.
VOICEOVER: GAVI has expressed an interest in adding the HPV vaccine to the list of those it already supports.
DR. JULIAN LOB-LEVYT [CEO, GAVI Alliance]: Yes, I'm here because GAVI has recently made a decision to explore the use of vaccines, including a vaccine against cervical cancer. In terms of effectiveness it's an astonishingly effective vaccine it gives very high protection.
VOICEOVER: But the current global financial crisis might make any commitment impossible.
DR. JULIAN LOB-LEVYT: We don't know yet how deep or how prolonged that crisis is going to be, or [what] the impact will be on development budgets. And essentially GAVI relies on the development finance from the rich countries of the West. So we won't really know that situation until 2010.
VOICEOVER: It's something Sarah is keen to talk more about.
SARAH NYOMBI: So, it's nice meeting you and I'm glad that you are here.
DR. JULIAN LOB-LEVYT: Well, I think the good news is our board has recognized, mid-November last year, the need, and the board has made a decision that GAVI should now explore the support to HPV vaccine introduction.
SARAH NYOMBI: So how long will that take?
DR. JULIAN LOB-LEVYT: It's all going to happen in the next few months, so that should happen fairly quickly. We're then going to want to look at countries for the feasibility of introduction, so we'll be looking for early adopter countries where there's strong political commitment.
SARAH NYOMBI: OK, like Uganda?
DR. JULIAN LOB-LEVYT: Absolutely, absolutely.
SARAH NYOMBI: So the funding really is so crucial to Africa, and Uganda in particular, so it's glad I met you and I will keep following you up and ...
DR. JULIAN LOB-LEVYT: Yeah, and you should chase me up on this one. [laughs]
SARAH NYOMBI: It really went so, so well that the journey was worth it, and I've talked to Julian, the CEO and president of GAVI, it's really exciting, and there is really hope.
VOICEOVER: Back in Uganda, Sarah is determined to keep up the momentum of her cervical cancer campaign. Over 500 people have turned up to an awareness march, and Sarah is optimistic about the future.
SARAH NYOMBI: My hope for the women of Uganda is that everyone gets aware that there is cervical cancer amongst us and that it is preventable. I'm a believer. I believe in God and I know God loves his people. These things will happen.
TITLE: [end credits]
TITLE: rockhopper TV

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