March three, I landed on Indonesian soil to support, as needed, the Female Cancer Program (FCP). My work base is in the Gynecology and Oncology Department at the leading academic hospital Cipto Mangunkusumo, located in the heart of bustling and chaotic Jakarta.
With my colleagues at the hospital
In Jakarta, from the University of Indonesia, a strong FCP team of physicians and midwives has been working since 2004, committed to the fight against cervical cancer, building their expertise and experience over the years. Due to the success and strength of the Jakarta team, since 2007 the FCP has expanded to other sub-areas: Bali, South Kalimantan, North Sumatra, East Java, Central Java/Tasikmalaya and North Sulawesi. Lombok was added in 2013. With the tremendous support, both medico-organizational and financial, from the Female Cancer Foundation, the FCP team has been able to launch and support cervical cancer prevention programs there for several years. In 2015, the FCP will expand again, this time to the islands of Flores and West Papua.
Awareness in Mataram, Lombok
Screening in Mataram, Lombok
From March 14 to 24, I went on a mission with FCF project manager Carlien Marree and several gynecologists from FCP Jakarta to the islands of Flores, Lombok and West Papua.
The mission had two main objectives: evaluation of the ongoing female cancer program in Lombok and establishing important contacts in Ende (Flores) and Sorong (West Papua) with the local government and various agencies within the health care system as a foundation for the start of the program in these areas. This was the perfect opportunity for me to learn more about their working methods and experience the start-up of the program from the beginning. It has been enormously instructive and has also made me realize that implementing a well thought-out program with simple screening and treatment is not always so easy. The most difficult barrier lies mainly in communication, cultural and religious differences which often result in opinions, principles, norms and values within the Indonesian population, which are sometimes difficult for us Dutch to understand. There are women whose screening with acetic acid (the VIA technique) shows that they have an increased risk of developing cervical cancer due to abnormal cell formation. Therefore, they are eligible for direct treatment with cryotherapy, and FCP can offer this at no cost. However, some women do not want the treatment because their husbands do not consent to it, thus closing the discussion. In the Netherlands, this would be incomprehensible to many people.
Dr. Gatot (FCP) gives a presentation to midwives and doctors at the district hospital in Ende, Flores.
In the course of my work, I realize that the biggest challenge to maintaining the FCP is particularly about changing mindsets among people. This is something that you do not achieve within a short period of time, but requires a lot of patience. In the end, hopefully the perseverer will win and patience will pay off. During the mission to Lombok, I was surprised by the wonderful enthusiasm of the doctors and midwives and their ambition to improve the program and expand it to a larger area in Lombok. There is good cooperation between the hospital, the puskesmas (small health centers), other health authorities and support from the local government. During the first contacts with the doctors and midwives in Ende and Sorong we saw the same positive strength and drive. The local government also supports the program.
Last year, the Ministry of Health launched a national cervical cancer prevention program. Implementation of this program represents a huge change within the system and ultimately provides access to screen all women within certain age range for cervical cancer in the future. Women have the right to good care and the possibility of early treatment. The Netherlands has had the population screening for cervical cancer in women between the ages of 30 and 60 since 1976, who receive invitations every 5 years from the National Institute for Public Health and the Environment. Because of this prevention program, advanced stages of this cancer are now rare. It would be so wonderful if Indonesia can also reach this point in the future and fewer women die from this terrible form of cancer. FCP is creating a pathway to this ultimate goal and saving many women in the process.
Meeting with the head of the district government in Sorong, West Papua.
At the end of May, doctors and midwives in Flores and West Papua will be trained to perform VIA screening and cryotherapy. After that, awareness will be created among locals and I hope as many women (and men!) as possible will understand the importance of their own body's health and come to the See & Treat.
Meanwhile, I enjoy my work here, the lovely people around me and the delicious Indonesian food.
