| Last week, The Lancet, a renowned medical journal, published a report by R Sankaranarayanan, an Indian researcher based in Europe, that said cervical cancer can be screened by a mere visual examination preceded by a swab with fresh acetic acid. |
| It made headlines. But for decades, another Indian, a gynaecologist by profession, has been fighting a crusade against cervical cancer with just her eyes as her weapon. |
| Screening of the deadly cancer, which accounts for 40 per cent of cancer deaths in Indian women, by a mere visual examination has been the strategy of Elizabeth Vallikad ever since she walked into the Kidwai Memorial Cancer Institute, Bangalore, in 1986. |
| "I finished my MD from the Vellore Christian Medical College and joined the Kidwai Institute where I saw women walking in to die. I went berserk," recalls the doctor. |
| "They were all victims of cervical cancer "" the third top killer in Indian rural women in the 15-44 age group after suicides and TB. |
| Pap smear, a medical test which can detect cervical cancer, was beyond the reach of illiterate villagers. |
| She promptly decided to reach out to these women and conduct a visual examination to screen them for cervical cancer. Between 1980 and 1986, an analysis showed that out of the 7,846 women with gynaecological malignancies visiting her department, 6941 had cervical cancer, this was 40 per cent of female malignancies and 88.47 per cent of gynaecological malignancies. |
| Elizabeth got a sanction for her proposal from the Indian Council for Medical Research and later assistance from the World health organisation and off she went to Karnataka's Shimoga district. The plan was to train each and every health worker there in the simple VIA procedure of detecting symptoms of cervical cancer. "The idea was to detect the disease at an early stage," she says. |
| It was not difficult to train auxiliary nurse midwives (ANMs) and anganwadi workers to create health awareness and the lady medical officers of primary health centres to do visual examination. About 1600 health workers and 160 doctors were trained. |
| The doctor found that the women were interested and 94 per cent even agreed to cooperate when contacted at home. Those women who came to primary health centres never got any visual examination done due to indifference of health officers. So the main finding of the experiment was that only an outreach programme could succeed. |
| "Acetic acid was not used deliberately," she says. "The health officials are reluctant to do visual examination even without acetic acid. Any additional task would have killed the initiative completely, as it would have required women to come to health centres," she says. |
| "It was a total failure, not because the method was wrong but because the public health system refused to do any visual examination," says Elizabeth. |
| However, she has not given up hope. "Now we are trying to light the fire from the bottom," she says, sitting in her activist husband's home in Delhi. "We are interacting with panchayat functionaries and women in the village and creating a demand for the VIA," she adds. |
| The method has been adopted in Kolar district and is expected to spread to the entire state in a tie-up between her present employer St John's Hospital Bangalore and the Karnataka government. |
| "Two NGOs are being roped in to create awareness among village women to demand visual examination as a matter of right, as the issue cannot be left to the choice of health functionaries," says the doctor. |
| In a bid to educate rural women about the disease, she is talking to film makers to prepare documentaries on cervical cancer. "Now examination of cervical cancer would not depend on the whims and fancies of the doctors and ANMs," she says with determination. |
| Will the women of Kolar show the way for the women of Indian villages? Vallikad is waiting with fingers crossed. |
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