April 23, 2015 |

Protecting Aisha from cervical cancer

PATH staff first saw Aisha on a BBC video covering an HPV vaccination campaign. Her story was so compelling we went to Uganda to meet her.
Aisha Nanyombi sitting on a bench with her father Musa Maka.
Aisha Nanyombi (pictured with her father) was among the very first girls in Africa to be vaccinated against human papillomavirus, which can cause cervical cancer. Photo: PATH/Will Boase.

This post is part of PATH’s Protecting Kids blog series for World Immunization Week. Read the whole series here.

The first time I saw Aisha, she was wearing her blue school uniform and wiping tears from her face. She’d just been vaccinated, but it wasn’t the shot that upset her. She was crying because her mother had died of the very disease she was being protected from—cervical cancer.

That was more than five years ago, but I was so haunted by how Aisha told her story in a BBC video that when I traveled to Uganda this past winter, my team tracked her down to see how she was.

Aisha is now 17, tall and healthy. She is also painfully shy, though I imagine the group of Americans descending on her isolated homestead was a bit overwhelming. Talking about her mother is still very hard.

Her father, Musa, shared the story with us. Listening to him, cervical cancer took on a whole new dimension. Women so rarely die from the disease in the US—thanks to our sophisticated (and costly) Pap smears—that until he spoke, I hadn’t understood what a horrific death it is.

“The sickness was long,” Musa said. “From the time my wife fell sick, it took one-and-a-half years. We moved through hospitals until she couldn’t take it anymore. She bled so much.”

In the end, all the family could do was put rags under her to soak up the blood.

How to reach a preteen

Cervical cancer is the leading cause of cancer deaths for women in Uganda and much of Africa. Nearly 25 years ago, PATH was among the first global health organizations to recognize the gravity of the issue and to search for affordable cervical screening alternatives to Pap smears. And in 2006, when vaccines protecting against the types of human papillomavirus (HPV) that cause most cervical cancer became available, we threw ourselves into finding the best way to get them to girls like Aisha—so they never have to suffer like their mothers and aunties.

The vaccines are nearly 100 percent effective against the most important cancer-causing types of HPV strains, as long as girls are vaccinated before they’ve been exposed to the virus—in other words, before they become sexually active. Few countries routinely vaccinate this group, so new approaches are needed to reach them. PATH worked with the Ministry of Health in Uganda, as well as India, Peru, and Vietnam, to determine best strategies.

Aisha was one of 10,000 Ugandan girls who received the vaccine in schools and clinics as part of this demonstration project. The data from the project provided key evidence to the government of Uganda about when and how to best introduce the cervical cancer vaccine nationwide.

A room full of adolescent girls.
At Nakasangola Primary School, one of the sites for PATH’s HPV vaccine project, preteen girls were eager to talk about the importance of vaccines to prevent cervical cancer. Photo: PATH/Will Boase.

Our findings also contributed to the decision by Gavi, the Vaccine Alliance, to subsidize HPV vaccines for the world’s poorest countries. With support from Gavi and PATH, Uganda is set to roll out the vaccine nationwide in the fall of 2015, using the study results to ensure that girls are reached and their families are well informed.

Educated girls

The day we visited Aisha’s old primary school, which was among the schools where the demonstration project was held, it was mobbed with rambunctious kids who were being let out for the Christmas holidays. But one classroom was still jammed with girls who wanted to talk. When we asked who could tell us about cervical cancer, the hands went up.

Students walking outside past a window.
Students in Nakasongola Primary School pass by a window. Photo: PATH/Will Boase.

“Cervical cancer is a disease in which the cells go out of control,” said 11-year-old Veronica. She added, “I don’t want to die of cervical cancer. I want to be a doctor and reduce the rate of people dying in my country.”

A mother who lives

Aisha wants to be a doctor, too. She still remembers the day she got the vaccine under the school tree. She was happy to get it, she said.

She remembers her mother as pretty and kind. It’s easy to imagine that Aisha will be just as lovely a mother someday. And maybe a healer, too. If that happens, she likely won’t see much cervical cancer in her practice because Uganda will be routinely vaccinating all its girls and offering cervical cancer screening and treatment to adult women, too.

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