Bananas

Off Our Backs, Mar/Apr 2004 by Moody, Maryam

I never imagined I'd find myself washing fake ejaculate off a penis model in a little bathroom with a tin door, tin roof, broken sink, and a bucket-flush toilet with no seat. As I cleaned spermicide from the pelvic model and wiped the penis model dry, I wondered just what I had gotten myself into. The models were for a workshop I was giving to 150 Salvadoran middle- and high-school students. Fortunately, my presentation partner was fluent in Spanish, so she would be handling the condom activity. Now, we just needed to buy bananas....

Fake genitals aside, I could barely believe I was on a school trip. This past January, I and eight other college students traveled to San Sebastian, El Salvador, as part of a course titled "Issues in Women's Health in Developing Countries." My presentation, on contraception and sexually transmitted infections, was one of four workshops our group performed with youth in this rural mountain town. We were working with a nonprofit organization called BasicHealth: El Salvador, which organizes annual medical delegations to rural towns in desperate need of free health care. Teams of physicians, students and local Red Cross volunteers set up a health clinic in San Sebastian, where we conducted a cervical cancer screening program, distributed medical supplies and offered acute care consultations. We also ran a popular vision screening with an on-site optometrist who distributed donated eyeglasses that students had collected.

El Salvador was like a spell: the fierce women carrying big baskets of sweet bread or laundry on their heads, the irrepressible roosters at five in the morning and the mariachi bands parading through the market during fiesta week, tossing candy into the crowd. I saw brightly painted buses, trucks full of people, and chickens in every yard, drank soda from glass bottles and water from plastic bags. I stared at the women's bloomers, dirt-covered toes and dusty feet, and marveled at streets called calle 3 de septiembre. I felt like I could walk in those streets for weeks and I'd still be learning from the pinched, sun-browned faces sitting out on the stoops, saying "Buenos dias" as I walked past.

"Buenos," I would reply. But it all stopped seeming quite so enchanting when I realized how many of the women we saw in the clinic did not know how to make a proper X, much less sign their names or read. The people's creased brown eyes began to seem less charming and more hurting, especially when I learned how many of them can't afford fresh food for their children, or clean water, or shoes. We couldn't fix those problems in a single trip. But we could address a health crisis that is killing young Salvadoran women at rates unparalleled anywhere in the developed world: cervical cancer.

Dr. Miriam Cremer, an ob-gyn and the founder of BasicHealth: El Salvador, has focused her efforts on the cervical cancer screening because it is a sustainable way to provide quality preventative healthcare. In its early pre-cancerous stages, cervical cancer is a curable disease. In the United States, the Pap smear screening test is accessible for most people. Women with abnormal results, which indicate a possible precancerous condition called dysplasia, are referred for further tests. The annual screening increases the possibility that cervical abnormalities missed one year will most likely be detected the next.

However, cervical cancer is a much more severe health problem in developing countries like El Salvador. These countries lack the health care infrastructure that has made cervical cancer both preventable and treatable in the U.S. Each step of the screening process-from patient recruitment to sample collection to shipping, analysis, and follow up-presents unique problems. For women in developing countries, practitioners. and equipment are difficult to find, and testing can be expensive. After the test results come back, it can be hard to locate patients, who often do not have access to a phone.

The development of cervical precancer is associated with the human papillomavirus (HPV). HPV is a sexually transmitted infection. Some strains cause genital warts, while others have been linked with cervical cancer. It is important to remember that this connection is not a simple cause-and-effect formula. While not every woman who contracts HPV will develop cervical cancer, all cervical cancer patients have been found to have HPV.

Because women in the developing world do not have access to consistent and comprehensive screening, 80 percent of new cervical cancer cases worldwide occur in developing countries. Today "women's cancer" kills more Latin American women than any other type of cancer. And while Salvadoran women have a remarkably low incidence of certain risk factors for cervical cancer (such as HIV infection, smoking, and multiple sexual partners), they are highly vulnerable to contracting HPV from their husbands. In El Salvador, it is culturally accepted, and even expected, for men to frequent prostitutes at an early age. Many men then infect their female partners with the virus.