Recalling the death of her mother in 2023, two years after her passing, was not the easiest of memory for Ann-Jell Joseph-Mapp. Her mother Veronica Joseph died from cervical cancer four years after she was diagnosed.
“Her death was not a shock because we, the children, learned about her cervical cancer diagnosed about four years before her death; but still, it was a long, hard and painful journey,” Joseph-Mapp said, while pointing out that as the eldest daughter, she became the provider and caregiver for her mother.
“My two brothers miss her a lot but they don’t speak about it much…her grandchildren miss her very much as she used to take them everywhere,” said Joseph-Mapp, who is still making adjustments to her personal life following the loss of her mother. Her mom was only 64 years when she died.
A hairdresser by profession, Joseph-Mapp said one outcome of the medical care journey after her mother’s diagnosis was the recognition that there is not enough public education about the risk factors of cervical cancer.
“That is when I realized that there was not enough education locally about the subject and not enough treatment available locally; we were left to make decisions on our own. All of this was happening during the COVID-19 pandemic, so it was just very stressful,” she said.
“Women should be encouraged to do an annual pap smear and other medical checkups that will let them know their status because it might be too late by the time they realize what is happening to them,” advised Joseph-Mapp.
More than 100 women died of cervical cancer between 2001 and 2021. However, medical doctors in Grenada refer to 2019 as a hopeful inflection point in battling the disease, with the commencement then of a change in cervical cancer prevention and reduction.
The Grenada Ministry of Health, in 2019, began offering the HPV Vaccine for free to preteens boys and girls. Health officials, in collaboration with other ministerial departments such as the Ministries of Education and Social Development, embarked on education outreach programs aimed at educating parents, particularly mothers, about the science behind this vaccine that’s aimed at preventing infection of four strains of HPV – 6, 11, 16, and 18.
The vaccine was first approved in 2006 for the four HPV strains. By 2014, it was further approved for five other strains of the HPV; namely, 31, 33, 45, 52, and 58. These strains, according to World Health Organisation data, are associated with the majority of cervical cancer, anal cancer, and throat cancer cases, as well as most genital warts cases.
“From the time of its introduction to this year 2023, approximately 1,117 girls within the age group of 9 to 10 have received the HPV vaccine,” said an official from the Ministry of Health vaccination program. Before administering the vaccine there were educational programs with parents at Parent Teachers’ Association meetings.
Dr Carol McIntosh, former Director of Hospital Services, said 70% of all cervical cancers have the HPV virus. “The human papillomavirus can cause warts in the hands and all over the body. It’s about 100 different viruses. So you have all these different types, but 30 of them can cause abnormal changes on the cervix,” Dr. McIntosh said in an interview.
“But if we get in there at that time, we can treat it and stop the road to cancer. That’s why if you can get the vaccine, it means that this HPV cannot act on your cervix; you can actually stop the road, stop the path, stop the issue of cancer. So cervical cancer is one that you actually can say…we have a potential cure for it,” she said, while explaining that the vaccine should be administered between the ages of 10 and 12.
Dr Martin Francis, General Practitioner, said the conversation on the HPV Vaccine has been around for more than a decade. “In fact, before it was taken on as part of the national formulary,’’ said Dr. Francis, “parents who were knowledgeable about it approached doctors, and in turn, doctors secured the vaccine for them and then allowed our young boys and girls to be vaccinated with it.” (link video here)
Cervical cancer is the second leading cause of cancer-related deaths in Grenada. Lives are lost as early as 25. Between 2001 and 2021, 14 deaths were reported for people in the age group 25 to 44.
Doctors and other healthcare providers in Grenada have admitted that there is a need for more education about the HPV vaccines and all other vaccines. But, there is a challenge from anti-vaxxers who seem to have come up with very created social media propaganda aimed at misleading the population about the benefits of vaccines.
“However, people need to know that vaccines have been the most successful medical intervention created by humans for protecting health,” said Dr Martin who, up until March 2021, served on the senior management team in the Ministry of Health.
“We don’t hear about yellow fever again – that is because of vaccines. We don’t hear much about measles, mumps, and rubella; that is because of vaccines…Our incidents and prevalence of liver cancer or hepatitis have decreased dramatically over the past couple decades – that is because we have introduced the hepatitis vaccine to persons,” he continued, pointing out that the hepatitis vaccine is also given to children.
“So, historically, vaccines are changing and improving life and if we are to continue in the same vain, then I see the HPV vaccine will result in a drastic decrease in cervical cancers, see a drastic decrease in cancer of the penis, a drastic decrease in genital warts and that will improve the quality of life for everyone and help us to live a better life,” said Dr. Martin, emphasizing that vaccine will not only assist women but also men.
Dr. Martin is also of the opinion that women need to take annual pap tests because it can result in early detection of cervical cancer. “A lot of the cases are identified because of the pap test; so women should be doing it annually. Right now, it’s the HPV for the young ones and pap test for the older ones. However, right now we should be encouraging the young ones to become inoculated with the HPV vaccine,” he said.
Dr Terrence Marryshow, who has provided medical care and support to women with cervical cancer and men with genital warts, believes that administering the vaccine to preteens can only bring about a positive medical outlook in cases of cervical cancer and genital warts.
“In the future, we are looking for a significant reduction in the rate of HPV infection, thus reducing cervical cancer risk in the population. We cannot forget the young boys because, as it stands right now, genital warts are one of the sexual-related conditions that is on the increase and the HPV Vaccine can stop it,” he said.
“The scientific evidence points to reduction, so we need to encourage young people to take it. If we have young people taking that vaccine, it will be good for the future when it comes to these two infections because they will be reduced to a minimum,” Dr. Marryshow asserted. “From what I have seen, genital warts are on the increase and if that can help our young men, that vaccine will not only reduce cervical cancer but also genital warts among young men.’’
This reporting was supported by the International Women’s Media Foundation’s Global Health Reporting Initiative: Vaccines and Immunization in the Caribbean, in partnership with Sabin Vaccine Institute.