How rituals and superstitions are fueling cervical cancer, deaths in Turkana

Anne Atabo shares her diagnostic and treatment of cervical cancer story during an interview with The Standard. [Edna Rono, Standard] At 72, Anne Atabo moves gently around her homestead in Nakukulas, Turkana Central. She wears a hopeful smile, but behind it lies a quiet fear. She is battling cervical cancer. Each passing day, she feels her strength slipping away. Her journey began in 2020, when severe abdominal pain drove her to Lodwar County Referral Hospital. Tests revealed the diagnosis she dreaded most; cervical cancer at Stage 3. "The test came back positive for cervical cancer. I was terrified. I thought it was only a matter of time before death swallowed me," she recalls. Atabo was referred to Moi Teaching and Referral Hospital (MTRH) in Eldoret for further tests and specialised treatment. Chemotherapy and radiotherapy offered a glimmer of hope, but the disease had spread. She is on treatment, that she says it is costly. What still pains her most is knowing that this was her very first cancer screening. In Turkana, her story is far from unique. Many women in the community avoid cervical cancer screening - a decision shaped by deeply rooted cultural beliefs, myths and misinformation. READ: What is cervical cancer and how can it be prevented? Traditionally, it is considered taboo for a woman's private parts to be seen by anyone other than her husband. This belief alone has kept countless women away from lifesaving tests. "I used to fear any procedure that involved my private parts because they are so personal to me, but I regretted it deeply. By the time I was tested, the cancer had already spread to my uterus and other parts of the body," she regrets. Now, she uses her experience to urge women and girls to get screened early, when abnormal cells can be detected and treated before they turn into cancer. But in Turkana, vaccine uptake remains dangerously low, driven by entrenched beliefs that it causes infertility or is a form of hidden family planning, misconceptions that continue to cost lives. In Turkana County, cervical cancer silently claims more women's lives than any other cancer, outpacing prostate, breast and colon cancers combined. Locally, it is commonly known as amoding, a term meaning "growth." Many believe "amoding" disappear on their own, others kill, and some remain in the body without causing harm. Individuals found with cancer in the community are also isolated, for ritual performance. Treatment in isolation involves use of herbal remedies, rituals and superstitions. This ranges from smearing lesions with clay to slaughtering goats and making vows. The practises, however, have no proven medical benefit. "Many who die of cancer never know the type they had. Malignant cases are treated without effective drugs," says Boniface Lokale, Director of Culture. He stresses the need for research to determine if lifestyle or environmental factors play a role. Cultural beliefs, illiteracy and poor health access have turned a preventable disease into one of the county's deadliest killers. "How do you fight an enemy you don't know?" poses Gilchrist Lokoel, Director of Medical Services in Turkana. "Ignorance is our biggest challenge. People cannot protect themselves from what they don't understand." Turkana's pastoralist society, early marriages, polygamy and multiple sexual partners are widely accepted, factors that increase exposure to high-risk strains of the Human Papillomavirus (HPV), the primary cause of cervical cancer. HPV can remain hidden in men for years, regardless of hygiene and can be passed to multiple partners. Yet vaccine uptake is low, says the official. Many parents wrongly believe the HPV vaccine will make their daughters barren, while others distrust government programmes. Illiteracy level in Turkana stands at 70 per cent, making community education an uphill task. "In our culture, it's acceptable for a man to marry several women," Lokoel says. "Unfortunately, this puts women at higher risk and turns them into victims of cultural practices." Cervical cancer screening and treatment for the disease, however, remains low. For instance, the proportion of women aged 25 and 49 years screened this year stands at 6.28 per cent, compared to 18.29 per cent last year, 8 per cent in 2023, and only 1 percent in 2022. In absolute numbers, 634 women in this age group have been screened so far this year, a decline from 1,894 last year. Lack of adequate human resource for diagnostic and treatment also remains a major issue in the county. For instance, the county has only three gynaecologists and 24 medical officers, all based at sub-county hospitals. There are about 700 gynaecologists in the country, and most of them are based in Nairobi. By the time women present at health facilities, the disease is often at stage three or beyond, with symptoms like foul-smelling discharge, bleeding or fistulas. Stigma and fear further keep them away. Sulekha Edaan, an Oncology and Palliative Care nurse at Lodwar County Referral Hospital, has lived the realities of cancer care in Turkana. "It's true, especially in the interior," she says. "Culturally, it's taboo to show your private parts to anyone who's not your husband. Women only agree to screening when they already have a problem." Her passion for cancer awareness stems from losing her aunt-whraised her after her parents' death-to oesophageal cancer in 2009. Armed with a higher Diploma in Oncology nursing and a Bachelor's degree in Palliative Care from Makerere University, she is committed to eliminating cancer. In 2020, she founded the Turkana Cancer Support Group, comprising patients, caregivers, and community members. The group trains health promoters, raises awareness in churches and chief's barazas and advocates for HPV vaccination. "With time, locals are gradually adopting screening and treatment," she says. "It's painless and simple. Once they know this, they embrace it." Her efforts led to the establishment of an oncology unit at Lodwar Hospital, handling cancers such as breast, cervical, colorectal, liver, oesophageal, ovarian and prostate. Since last year, 115 cases have been reviewed. Her dedication has earned national recognition: she was named Kenya's best oncology nurse last year and honoured by the National Cancer Institute in July for her cancer care work. Ministry of Health data shows that cervical cancer is the leading cause of cancer deaths among women in Kenya, and the second most commonly diagnosed. It kills at least nine women in the country every day, statistics that Dr Dulcie Wanda says should alarm every Kenyan. ALSO READ: Despite being treatable and preventable, cervical cancer still a nightmare for women "We are losing too many patients to cancer of the cervix," warns Wanda, "yet this is a disease we can prevent and treat if caught early". "The best thing we can do is prevent it before it starts," says Dr Wanda. "That means ensuring our girls are vaccinated against HPV before their first sexual debut. This drastically reduces the chances of infection, because malignant changes in the cervix can happen silently over time." Dr Wanda, a clinical oncologist at Nakuru Regional Cancer Center, stresses that early detection is key to beating cervical cancer. Screening can identify pre-malignant lesions and abnormal cells that, if left untreated, may turn deadly. Through a "screen-and-treat" approach, doctors can often treat these lesions immediately, greatly improving outcomes. Cervical cancer is caused by high-risk HPV infections, which slowly trigger cancerous changes over time. "Those diagnosed early can benefit from treatments such as surgery, brachytherapy, or targeted therapies, offering a high chance of cure," Dr. Wanda explains. However, once the disease progresses, treatment becomes more complex, often requiring chemotherapy and radiation. Sexually active women are advised to begin screening at 30, or at 25 for high-risk groups, and continue until 65, provided they have consistently tested negative for at least 10 years. High-risk individuals-including women living with HIV, immunosuppressed patients, or those with a history of pre-malignant lesions-should screen annually.

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