CCI seed grant - Inquiry toward a “Single Visit Approach” to Cervical Cancer Prevention and Treatment : Pilot in Karawang District, Indonesia

A widow, Ibu Suryati lives with her youngest daughter and helps care for her grandchildren. At age 61, she felt healthy and saw no reason to participate in a local effort in her village of Cadas Kertajaya in the Karawang district, province of West Java in Indonesia to screen women for cervical cancer. 

Although cervical cancer is the leading cancer killer of women in the developing world, Ibu Suryati initially refused a request by a local community health worker to attend a mobile screening service in 2009. She was shy about exposing herself to a health provider and had no health reason to suspect anything was wrong with her.  But after attending an education session held by a community midwife, Ibu Suryati learned that many women don’t realize they are at risk because there are no symptoms associated with precancerous lesions. Dr. Siti Nurjanah, a local physician, asked Ibu Suryati to reconsider her refusal to participate in the screening. 

With some prodding, Ibu Suryati was persuaded to participate in the screening that used the visual inspection with acetic acid method.  “I never felt anything wrong with myself,” says Ibu Suryati, who considers herself lucky that she heeded the words of Dr. Nurjanah and underwent the screening.

“There is no symptom at all to show that someone has pre-cancer lesions or even a low grade SIL (CIN I),’’ said Dr. Nurjanah “The only way to know is to open and look at their cervix. When we screened Ibu Suryati we all agreed that we suspected her to have cancer and we scheduled a referral visit with her to the district hospital.”

Dr. Unggul Yudatmo, the OBGYN at district hospital, performed a Colposcopy to confirm Ibu Suryati ‘s condition and referred her to Cipto Mangunkusomo National Hospital in Jakarta for treatment and follow-up care.  

Ibu Suryati is one of 32,315 women who have benefitted from the cervical cancer prevention and screening program that has been in place in Karawang District since 2007. Jhpiego in collaboration with the Ford Foundation, Karawang District Health office, and most recently Union for International Cancer Control (UICC) is implementing the Cervical cancer prevention program. Seventeen health centres provide VIA and cryotherapy services as part of a single visit approach. The service is free of charge through the government-supported “Jamkesmas” insurance for the poor. Even though treatment is free, many women refuse to go to a referral hospital because of other related costs such as transportation and hotel and paying the travel costs of an escort.

Ibu Suryati qualified to receive the government insurance and a local foundation helped pay for other expenses related to her trip to the national hospital in Jakarta. At the hospital, Ibu Suryati was relieved to learn that her cancer was at a stage where she could be treated for it. She returns every six months for a follow-up check, knowing that she is healthier because of the cervical cancer screening program and happy that she can spend more time with her family and watch her grandchildren grow. “I am happy to be healthy again, and I can help my daughter with looking after my grandchildren, women should get screened, because when they found the disease earlier, there is hope that you can get healthy” said Ibu Suryati.