“The public health system should have the medicines and injections necessary to treat HPV. I had to buy the vaccine; There are two doses and they are sold separately. I had to figure out how to buy them because they cost more than 3,000 lempiras each. It is not easy to go from pharmacy to pharmacy listing the prices of the vaccines, looking for the ones that fit my budget, enduring bad looks because it is practically going with a label that I have HPV. People judge you without knowing the background and that they could also go through the same thing as me; we need support networks that make us feel less alone and sullied”, said Cecilia.
The long road for a cytology
Cytology, or Papanicolaou, is the exam that doctors recommend that every woman should have every year after starting her sexual life. However, it is not a service that is usually offered in all hospitals and health centers. Only the Hospital Escuela, in the capital, Tegucigalpa, and the Mario Catarino Rivas Hospital, in San Pedro Sula, in the north of the country, are the hospital centers that almost always have the supplies to carry out this analysis.
The State has at its disposal the Comprehensive Care Service (SAI), a center in charge of monitoring sexually transmitted diseases, whose main objective is to care for patients living with the Human Immunodeficiency Virus (HIV). Dr. Ana Uclés, director of the regional SAI of La Ceiba, announced that, until now, “the State has maintained (at least in that center) sufficient reagents to diagnose HIV, syphilis and human papillomavirus. Here we try to keep a good control of STIs [Infecciones de Transmisión Sexual] and the prevention of cervical cancer.
This health service is a support for those patients with HIV positive. This is where they are monitored for life, since due to their low immune system, they have a greater chance of suffering from cervical cancer.
At the Hospital Escuela Universitario (HEU) located in Tegucigalpa, the SAI cares for 1064 patients, 60% of these reside in the Department of Francisco Morazán, and the remaining 40% come from other departments.
The Hospital Escuela Universitario (HEU), located in the central zone of the country, and the Hospital Mario Catarino Rivas, in the north, are the largest care centers in the country and, in turn, are the ones with the highest influx of patients from rural areas. receive, both have the area of Gynecology and Obstetrics, where their main focus is delivery rooms, care and control of pregnant women. If patients wish to treat other conditions such as HPV, they are referred to care centers such as the Alonzo Suazo Health Center, and in the event of an emergency, they are again sent to the HEU.
This is part of a process that patients like Mrs. Adriana Henández, 46, have to deal with, who decided to leave her town Oropolí in El Paraíso for the capital, Tegucigalpa, because they could not find the cause of the pain at her health center. Constant pelvic pain that he has suffered for five months.
«I come from the Gabriela Alvarado Hospital in Danlí, from there they sent me here to the School Hospital, because they found nothing there and I continue with the same pain, I traveled from my village in Oropolí to Güinope, to Danlí, and from there I They sent Tegucigalpa here, and they still haven’t taken care of me. Since five in the morning I’ve been here lining up and I’m still waiting,” said Doña Adriana, whose case, since it was not considered an emergency, could not be treated at the Hospital Escuela.
When asked if a Pap smear had been performed at the Danlí hospital, or if she expected it to be done at the Hospital Escuela, Doña Adriana assured that she did not know if they would do this test, “I don’t know if they will do that, I don’t remember that they will do it to me.” they did not even send me to do tests, they only did an ultrasound and told me that I had nothing,” he said.
Even though healthcare centers, such as the Alonzo Suazo Health Center, have HPV and cervical cancer awareness and diagnosis programs, not all women who attend them know this information.
This is the case of Bianca Rivera, a 38-year-old woman from Tegucigalpa and a patient at the Alonzo Suazo Health Center. Bianca told her that after seven years attending public centers and hospitals for checkups for polycystic ovaries, she had never had a cytology done, «I didn’t know that this existed or that I had to do that every year to prevent cancer, they only do ultrasounds and that’s it».
For her part, Sandra Mejía, 28, assured that Social Security did a Pap smear two years ago but never gave her the results. Ana María Trochez, 21, a patient at the Alonzo Suazo Health Center, reported that her Pap smears are always performed in Ciudad Mujer, since she does not have the necessary resources to go to a private clinic and the health center does not include this test at checkups.
Health personnel in care centers such as Alonzo Suazo, assure that they permanently offer cytology analysis to all those women who require it, but even so, some women, such as Bianca and Ana, are unaware that it is one of the centers to those who can come to take this exam.
According to data provided by Dr. Leonela Lozano, coordinator of the Cervical Pathology unit at the Alonso Suazo Health Center, –one of the 15 primary care centers that operate in the Central District– during 2022, 1,601 tests were performed at this center. Pap smears. Of these, 34 were positive for the Human Papilloma Virus. So far in 2023, 596 Pap smears have been performed at this same center, obtaining a positivity of 82 HPV cases. They currently care for 164 patients with the active virus.
Likewise, Leonela Lozano announced that, in 2022, 1,449 girls were vaccinated within the vaccination scheme and until May of this year, 55 girls aged 11 to 12 have been vaccinated against the Human Papillomavirus. Similarly, the health center staff confirmed that they currently have HPV vaccines for girls of age within the vaccination regimen, leaving out all other women and girls whose ages are not within this scheme.
In 2022, the World Health Organization (WHO) recommended that, in the alternative scheme for the HPV vaccine, the main objective is girls and adolescents from 9 to 14 years of age. However, in Honduras this recommendation is not met.
Dr. Xiomara Erazo, head of the Expanded Immunization Program (PAI) of the Ministry of Health, explained that “the guideline was made when the vaccine was introduced in 2015 and the National Immunization Advisory Council is gathering all the scientific information available to be able to expand the age range to girls from 11 to 14 years, since the WHO suggests applying one dose, instead of two doses, to expand coverage.
In Honduras, HPV immunization does not include children since “the population affected by HPV is lower in men than in women, who are those who suffer from cervical cancer, and the National Immunization Advisory Council has not considered the benefit of immunization of both genders» added Erazo.
In turn, Erazo showed that one of the reasons why adult women are not considered in the current vaccination scheme is that they seek to capture them before exposure to the virus. However, he did not rule out the possibility that adult women could receive the HPV vaccine in the future, but “due to the cost involved in purchasing vaccines, the budgetary impact of that investment will have to be considered.”
According to INE estimates, the population of women in the Central District amounts to 684,298, which represents 52.9% of the inhabitants. According to data provided by the spokesperson for the Hospital Escuela, Said Norales, around 25,000 Pap smears are performed annually at this hospital, which represents coverage of only 3% of the female population of the capital.
Kristell Rodriguez, in charge of projects at the Center for Health Promotion and Family Assistance (CEPROSAF), stated that “cytology is a service that is not provided by all health centers due to lack of resources and supplies. We are one of the organizations that schedule brigades to detect cervical cancer on time. In the case of having advanced cancer, women who are detected on the Atlantic coast must travel to San Pedro Sula or Tegucigalpa, and if we are talking about Colón or Garífuna communities, it is even more difficult for them to qualify for treatment.” .
For her part, Dr. Alejandra Pereira, from Ciudad Mujer, makes an important caveat, and warns that, although “cytology is the most common test for detecting anomalies to prevent the progression of cervical cancer, it only has 65% sensitivity, and the HPV laboratory test and VIA have up to 96 to 98% detection sensitivity. In Honduras there are no HPV tests and we are hoping that all health centers have this laboratory test.
According to the study “Situation of the Health System in Honduras and the New Proposed Health Model” carried out by the National Autonomous University of Honduras (UNAH) and published by iMedPub Journals, there are only 0.4 hospitals for every 100,000 inhabitants. The country has 29 hospitals distributed in the 18 departments, but most lack the essentials and, when patients with serious ailments arrive, they are referred to the hospitals of Tegucigalpa and San Pedro Sula, causing an excess demand that directly affects the quality of services.
Far from proper care
The municipality of Juticalpa, Olancho, some 180 kilometers from the capital, has just over 145,213 inhabitants of which, according to INE data, 52.94% are women. Martha*, a nurse at the San Francisco de Juticalpa Hospital, said that so far in 2023, no cytology has been performed at this care center. «When they are done, it is due to a promotion and there is a wait of 20 to 45 days to give the results to the patients. Here it is for campaigns, it is not a service that we always offer in this hospital, they generally attend private clinics or travel to Tegucigalpa, “she explained.
The supplies to carry out the cytology analysis are not distributed to all hospitals in the country to permanently offer this service, forcing women in the department of Olancho to travel more than 100 kilometers to the capital, Tegucigalpa, or to private centers if they have with the economic resources for a complete gynecological check-up.
Meanwhile, there are some private or non-profit organizations, such as Doctors Without Borders or the League Against Cancer, who works in the north of the country, who offer the services that the State does not provide. The League performs 25,000 Pap smears annually. In 2021, 270 cases of cervical cancer were detected and 145 in 2022. After detection, this organization seeks to provide the necessary supplies and services at a low cost to treat and eliminate cancer.
Adequate attention to sexual and reproductive health is still far from being a reality in the country. Cecilia, for example, is still afraid: “I’m afraid it will turn into cancer because I still have warts, they didn’t explain to me that they can take time to disappear, and since they don’t have acetic acid at the Hospital Escuela, I had to buy it so they could check me out.” six months after the last vaccination. I am afraid that the virus will not stop and I will get cancer because the doctor told me that this has no cure, “she said.
2023-06-12 23:18:14
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