​What kinds of symptoms do patients experience before receiving treatment?

Patients requiring hysterectomies at our medical partner's care center generally have one of three conditions: uterine fibroids, cervical cancer, or chronic bleeding. Women with uterine fibroids may experience chronic pelvic pain. Women with cervical cancer are often symptom-free and are only diagnosed upon screening. Finally, women with chronic bleeding experience atypical and excessive vaginal bleeding.

​What is the impact on patients’ lives of living with these conditions?

These three conditions may impact the patient's life in different ways. Women with pelvic pain and bleeding may be unable to work or be active. Women who experience bleeding may feel weak, due to the loss of blood and inaccessibility of blood products in Malawi. Women with cervical cancer are at risk of cancer metastasis.

What cultural or regional factors affect the treatment of these conditions?

Cervical cancer is the top killer of women in Malawi, which has the highest rate of this type of cancer in the world. There are several factors that lead to these high rates, including early sexual initiation, high HIV prevalence, and lack of screening and treatment. Although health facilities nationwide are supposed to provide screenings, many do not. Therefore, women are never screened, and the cancer can progress to an untreatable stage. In addition, women with cervical cancer often experience no symptoms and may not go in for a screening. Women with vaginal bleeding may experience stigmatization. In Malawi, menstruation can be a challenge. It is difficult to keep fabric clean, as there is often little access to sanitary products.

What does the treatment process look like?

A hysterectomy is a surgical operation to remove all or part of the uterus. Surgeons perform radical hysterectomies on women with cervical cancer. This is an aggressive surgical approach to combat cancer. Women with fibroids or bleeding may receive alternative treatments before a hysterectomy.

What is the impact of this treatment on the patient’s life?

For patients with cervical cancer, a hysterectomy is a lifesaving operation. Without treatment, the cancer will continue to spread and ultimately become untreatable. Chemotherapy has not been proven effective in treating cervical cancer, so a hysterectomy is the best option for women. Women with fibroids or bleeding will be able to return to their daily lives without chronic pain and bleeding.

What potential side effects or risks come with this treatment?

There are risks associated with any surgical procedure. In this case, there is a risk of damage to the ureters and the tubes that connect the kidney to the bladder, as they are near the reproductive system.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

There is one public hospital in Malawi's Central Region that provides hysterectomies. Unfortunately, the wait time can be very, very long. Women may not be treated in time or may stop showing up for scheduled surgeries as they continue to be delayed. Other private facilities provide hysterectomies, but at rates that are unaffordable to our patients.

What are the alternatives to this treatment?

For patients with cervical cancer, there are no good alternatives. For patients with fibroids, it is possible to remove the fibroid alone. This procedure is often done on young women who are still of childbearing age. Some women with fibroids or bleeding receive hormonal treatment before attempting a hysterectomy. In many cases, less aggressive treatments are tried before the patient receives a hysterectomy.