The inspiring young women championing cervical cancer awareness in Dadaab

By: Abjata Khalif

DAADAB—It’s early morning in Dadaab Refugee complex in Garissa, Northern Kenya, and the punishing heat of the later day is yet to rise. Taking advantage of the cooler hours, when residents gather outdoors, a group of ten young women wander the spaces between the housing blocks of Hagadera camp, striking up conversation with their peers.

They are called “Young Girls’ HPV Vaccine Champions.” Refugee residents of Dadaab themselves, and enlisted by the International Rescue Committee (IRC) —which runs the only hospital in the camp—to conduct a cervical cancer awareness campaign. Their message is important: HPV ( Human Papillomavirus Vaccines) vaccination, early screening and scientific medical care save lives. Cervical cancer is the second most common cancer in Kenya, and 63% of the more than 5,000 annual cases are attributable to two strains of the human papillomavirus.

Some in their teens, and some in their early twenties, the ten Champions have all had both doses of the HPV vaccine themselves. As they converse with the girls clustered outside the housing blocks, they encourage “defaulters” – eligible girls who have received just one dose, or none – to head over to the health facility and get their outstanding jabs.

Outreach and awareness sessions like this one take planning. Before they set out, the Champions evaluate the security situation, monitoring the informal, but highly efficient communication networks of the camp communities for early indications of trouble. “The three refugee camps in Dadaab are close to Kenya-Somalia border and anything can happen. The areas near the camps have registered a number of incidents in the past, attributed to local armed bandits, and some major ones linked to Al-Shabaab terrorist group,” says Champion Muslima Adow, aged 21.

Daadab Refugee Camp (Nichole Sobecki)

The three camps that make up Dadaab—Hagadera, Dagahaley and Ifo—have a total population of 233,736 people.

“The majority of refugees in Dadaab are from Somalia, and they are an oral community,” Adow explains. “So, our education and awareness campaign targets women and girls so that they can send the positive message on the vaccine to many people, and give the community oral communication space true, informative and balanced information on the vaccine,” he added.

Besides mobilising women and girls to get protected, the Champions aim to enlist new recruits to their ranks from the housing blocks they visit. They’re especially dogged in their efforts to reach school-aged girls, whom they’ve identified as particularly at risk.

“We run girls’ spaces or meet-ups in the camps and schools,” says Adow. By “girls’ spaces,” she means informal clusters of girls and young women; natural “safe spaces” in public zones, where girls sit and tell each other stories, away from groups of boys and older people.

“We use the same platform in pursuing defaulters and linking them to the vaccination sites in Hagadera Refugee Hospital managed by International Rescue Committee,” Adow adds.

“Young girls are sexually active, and it’s our determination to educate them on how cervical cancer is sexually transmitted [via the cancer-causing HPV virus] and thus the importance of them taking HPV vaccine,” Adow explains.

Kenya Red Cross nurse adminstering vaccination at Dadaab refugee camp in northern Kenya. (Abjata Khalif)

While the HPV Vaccine Champions comb through the sprawling camps amid the biting heat and personal risk involved to seek out and protect the at-risk, another programme is broadcasting cervical cancer information to a much wider refugee population via the internet.

The Julisha.info portal helps refugees get information and expert views from community health officers and other medical experts.

On this morning, the platform is hosting a regular Facebook Live session. It’s aimed at Dadaab and Kakuma refugees, but it’s an open digital event, and Somali-speakers from elsewhere in Kenya tune in.

Participants—including culturally conservative individuals, who espouse dangerously unscientific treatments for cervical cancer—have the opportunity to ask real-time questions and receive real-time expert answers to guide their actions.

A composed Abdi Jamal, community health officer with the International Rescue Committee, takes the questions, field concerns and addresses diverse understandings of cervical cancer and the available HPV vaccine.

“It’s an interactive Facebook session meant to impart knowledge and education on cervical cancer and uptake of HPV vaccine. It also eliminates wrong beliefs and taboos on HPV vaccine by offering refugees and host communities education, information as well as linking them to screening and vaccination centres in Hagadera refugee camp,” noted Jamal.

Majority of refugees here subscribe to traditional methods of treatment, despite the availability of an science-based medical services in the refugee camp through the IRC.

“It’s all about attitude and culture…and that is what fuels unproven and unreliable traditional methods of treatment which causes more sufferings and even death to the patients,” says Ummi Salam, an independent cross-border conflict and migration expert based in Garissa.

The COVID-19 containment effort has affected the administration of the HPV vaccine in refugee settings in the Horn of Africa region, she explains.

She continued: “Diversion of resources, manpower, expertise and campaigns to address COVID-19 and administration of mass COVID-19 vaccination rolled back efforts by refugee agencies in addressing cervical cancer through HPV vaccinebadministration and refugee community outreaches.”

The risks of such setback are not lost to Abdi Mursal, a resident of Hagadera camp who lost his wife to cervical cancer.

“My wife showed signs of cervical cancer and she got treatment from a traditional healer in Hulugho area. She took various concoctions and later on, the healer decided to “burn” her uterus.

“After complication, I took her to Garissa Referral Hospital where she was diagnosed with last stage cervical cancer. She succumbed. I regret that I did not take her to IRC Hagadera Refugee Hospital,” he reveals, visibly pained.

In addition to vaccination, Hagadera Hospital offers testing. When a suspected cancer lesion is detected, the case is referred to a tertiary facility, the IRC’s facilities, Jamal explained.

The establishment of a fully-fledged cancer centre in Garissa town this month promises specialised testing and treatment to the thousands of communities in Wajir, Mandera, and Garissa Counties, including the vast population of the Dadaab complex.

Garissa county’s cancer centre is “one of its kind in the northern Kenya region”, declared the Garissa County Executive Committee member for Health and Sanitation, Ahmednadhir Omar.

“We are able to handle cases of testing and offering quality treatment for both regional communities and refugee population,” he noted.

The Kenyan government has introduced HPV vaccine into the routine immunisation schedule for 10-year-old girls and Garissa County is rolling out a massive campaign, both to administer the HPV jabs, and to educate communities on the vaccine’s importance.

[This article previously appeared on VaccinesWork]