Screening in government houses in Jakarta

Report by FCF supervising physician Chrétienne Bowier -

On Sunday, May 24, a screening for breast and cervical cancer took place , especially for the women who live in Jakarta's "government houses. My colleague told me that families with little money are assigned housing by the government. Large tall flats, called 'governmental buildings', consisting of hundreds of homes. We expected around 800 women, spread across different poor neighborhoods of Jakarta, to come to the screening. I decided to go to a neighborhood in West Jakarta because this is where the largest number of women would be screened.

It took me a little longer than expected to reach the destination - Rusunawa Tambora - as the cab driver did not immediately recognize the address. Upon arrival, it immediately became clear to me that this neighborhood is less endowed than the average neighborhoods in Jakarta: poorly maintained small houses, some of which look as if the owner wanted to incorporate all the materials he could find into the house. The laundry hanging outside to dry over the railing of the many balconies gave a lively look to the dilapidated homes. I noticed that the large government flat looked well maintained. I walked toward the flat and saw the large crowd already looming. Since I was the only "bule" - the name Indonesians give to a stranger from another country - people looked at me as if I were lost. Soon I was spotted by Ferdy, a doctor from IDI, the foundation of Indonesian doctors. Ferdy I had met before and he escorted me to the place "where the magic happens. VIA screening for cervical cancer.

Again -as I am now used to from previous screenings- I found a makeshift arrangement of five little rooms : gynecological examination couches separated by only a dark green cloth. The rooms were assigned to an obstetrician with supervising primary care physician from various puskesmas (health centers). While final preparations were being made - such as preparing the specula and mixing the acetic acid for the VIA in proper proportion with water - a large queue of women who had registered for the screening was already forming.

During the screening, I noticed the enthusiasm and drive of the midwives and doctors. The women examined were often less enthusiastic about undergoing the screening and some looked anxious. Yet they came to the screening because they were happy to see the usefulness and benefit of it, something that is very important because it is not always so obvious. For example, some women don't come to screening or don't seek treatment because they don't always understand the concept of prevention: 'why should I undergo screening or treatment when I feel fine?I don't suffer fromanything'. In addition, many women are afraid of gynecological screening and postpone a visit to the doctor or do not visit at all. Reason for this may also be because they do not have money to see a doctor. For example, there was a woman who had been walking with vaginal complaints for more than a year and was also suffering badly from them. However, she had never visited a doctor. During the VIA screening, she was found to have a severe cervical infection for which she eventually received a strong course of antibiotics.

While I took a break, the screening went on, and while eating I looked over the shoulder of an obstetrician between the legs of a woman being screened. Here in Indonesia, no one pays attention to this situation and it is considered "normal"; in the Netherlands, we would not be able to imagine this unusual setting. Funny how big the differences in culture and norms/values can be. Photographs of the cervix were also taken by the midwives with cell phones - after the consent of the woman being examined, of course - so that later the interpretation of the cervical assessment can be discussed as a learning moment. Fortunately, no advanced stages of cervical cancer were found, but some high-risk women were referred for cryotherapy later in the week. Unfortunately, no "single visit" with immediate treatment, which we normally aim for, but hopefully they will return for treatment after a consent form from their husbands.

All in all, like previous times during a screening, there was again a relaxed and nice atmosphere between all the midwives and doctors, and they helped each other when results didn't seem quite clear. Great teamwork!