How Scottish money and three determined women are saving countless lives from terrible premature end

A report published this week by one of a handful of investment analysts in the country states baldly that the country’s entire foreign exchange reserves – the cash held by the government, its agencies and the private sector – total £424 million. As economists argue over the impact of Rachel Reeves’ Budget with its tax hikes of £40 billion, the contrast between Scotland and Malawi could not be more stark.

We have a population of 5.4 million, our government in Edinburgh has an annual budget for devolved public services of over £50 billion and counting. We spend nearly £20 billion a year on our NHS alone. Malawi’s government has to beg or borrow enough dollars to buy petrol and diesel to keep the country moving.

It needs to import almost everything, from fertiliser to bundles of second-hand clothes, discarded by us here in the Global North. Its population is 20 million and growing. “All we have to export is our labour, our people,” a friend told me earlier this week.

A heartbreaking statistic

Malawi’s health service is rudimentary, a patchwork of public, private and church-run services across the country. Almost every girl in secondary school wants to be a nurse, but there is no money to employ the ones already trained.

Those with private resources travel to India for life-saving treatment. The majority, who live in rural villages, rely on paracetamol to relieve their symptoms, sometimes even when the pain is caused by late-stage cancer. Many of those will be young women, their bodies destroyed by cervical cancer. Yet another heartbreaking statistic to add to the litany of Malawi’s woes is that the country has the second highest rate of cervical cancer in the world and the highest mortality rate.

Later this month, global experts in human papillomavirus (HPV) – the virus that causes most cases of cervical cancer – will gather in Edinburgh for the 36th International Papillomavirus Conference. Among the speakers will be a quietly determined Scot who, as a member of the Malscot project – a small team from Edinburgh University and healthcare staff, mainly nurses from Malawi – has successfully pioneered low-tech testing and treatment for cervical cancer.

Same-day treatment

Professor Heather Cubie and her colleagues, Dr Christine Campbell and Sister Beatrice Kabota, have, since 2013, developed a programme that provides cervical cancer screening by visual inspection with acetic acid and same-day treatment of early lesions. They have trained 120 health workers to deliver the service, and so far over 150,000 women have been screened. Those whose symptoms require further investigation are referred to specialists. Those whose cancer is beyond treatment are guided towards palliative care.

The programme, which is far more affordable and practical for Malawi than the UK screening process that depends on high-tech labs and sophisticated treatment regimes, was supported for nine years by a grant from the Scottish Government and is now accepted as valid by Malawi’s Ministry of Health.

The money has been essential to the success of the scheme, but as Beatrice Kabota says, the partnership between the women involved is what guaranteed its success. “The determined women who have led our programmes in Scotland and across Malawi have been quite amazing. They have worked together to make a difference for their fellow women, particularly finding practical solutions to challenging problems."

A remarkable achievement

But as Professor Cubie will tell conference delegates in a few days’ time, there is still much to be done if Malawi is to tackle the scourge of cervical cancer among its young women. It has rolled out a vaccination programme for girls at school, with support from, among others, Unicef and the World Health Organisation. But the take-up rates are much lower than in Scotland, where a recent study by Public Health Scotland showed that no cervical cancer cases have been detected in the women fully vaccinated against human papillomavirus (HPV) since the programme began in 2008. A quite remarkable achievement.

“Vaccination is a game-changer for future generations of women across the world,” she will say. “But screening is still essential for those who missed out, and in Malawi this needs to be free for women aged 25 to 49, and there must be funding to make treatment available for those who need it.”

Healing power of sisterhood

As she reflects on the past decade, which is the culmination of her life’s work as one of the world’s leading experts in HPV, she is confident that cervical cancer cases in Malawi will drop as the long-term success of the screening programme bears fruit, and she credits financial support from Scotland for helping save lives.

“Malawi will cherish the impact that this partnership has brought, many women have been saved from developing cervical cancer because of the investment Scottish Government has planted in Malawi, it will go a long way,” Dr Cubie says.

As ever, she is too modest. The money is crucial of course, but at the heart of Malscot’s success are three resolute women: Sister Beatrice Kabota, Dr Christine Campbell and Professor Heather Cubie.

Their expertise, their professionalism honed in such different contexts, and their solidarity with their fellow women have saved the lives of many who might otherwise die a terrible, premature death, often denied adequate painkillers as the cancer ravages their fragile bodies. Without fuss, these three women have shown us the healing power of sisterhood.