Over 300,000 people live crammed into the slums of Tondo, which cling to the docks of the port of Manila, the capital of the Philippines. Tondo has a paltry number of doctors—just one for every 36,000 inhabitants.
In these deprived districts, Médecins Sans Frontières (MSF) launched a large-scale operation to vaccinate 25,000 young girls against the human papillomavirus (HPV), one of the main causes of cervical cancer.
Every day, 12 women in the Philippines die of cervical cancer. In 2015, the government stepped up its efforts to combat the disease, giving priority to the country’s poorest regions. Manila, also the financial capital, isn’t one of them. And while only a few kilometres separate the city’s affluent business districts from the neighbourhoods of Tondo, the gap between rich and poor is immense.
With the support of Manila City Health and in partnership with local organisation Likhaan, MSF launched a first round of vaccinations in February 2017. Over 25,000 young girls aged 9 to 13 received the first dose of a vaccine which, to be effective, requires a second dose six months later.
Tondo’s slums can feel like a maze, and many of its residents lead unpredictable lives. It’s common for people to move suddenly, depending on their living conditions and economic opportunities.
Manila is one of the world’s most densely populated cities, with over 70,000 inhabitants per square kilometre. And although the names of its slums can sound picturesque, they reflect the challenging conditions its residents live in. One is called ‘Happyland’, a play on the word hapilan, which means ‘dump site’ in a local language. Another, ‘Aroma’, evokes the strong smells wafting from the mountains of garbage surrounding the slums.
Most dwellings – and their inhabitants – lack an official address. Vast and disused warehouses have become makeshift shelters, each one accommodating up to hundreds of families. In this chaos, seeking out 25,000 young girls at the beginning of the year was a challenge. Finding them again only six months later even more so.
The relative lack of access to health education in Tondo could have undermined awareness of the second dose’s crucial importance. Moreover, it was not an option to plan appointments six months in advance for these young girls, whose families often live a hand-to-mouth existence in deprived conditions.
This is where Likhaan’s knowledge of the slums proved vital.
With Likhaan, Médecins Sans Frontières conducted a large-scale information campaign. Likhaan has supported women’s health and family planning in the Philippines for over 20 years. The campaign’s goal was to mobilise families and encourage young girls to come back for their second vaccine dose.
Known as community mobilisers, local social workers combed miles of streets, door-to-door, to follow up with as many girls as they could.
They also organised a text message campaign targeting the 10,000 phone numbers registered during the first round of vaccinations, to send reminders about the second dose.
Finally, they held community education sessions in the slums to remind people of the importance of this vaccination, on top of their usual sessions about reproductive health and family planning.
After weeks of hard work, the teams achieved a result that far exceeded expectations: almost 90% of the young girls received the second injection. In this type of campaign – where patients are expected to come to a health centre themselves – organisers typically manage to remobilise between 60 and 70% of those who received the first dose.
The World Health Organization recommends vaccinating girls under the age of 15 to reduce the number of women who develop cervical cancer as they grow older. In 2011, the Philippine government integrated the HPV vaccination into the national programme and then extended it in 2015, but older women for whom the vaccine did not exist when they were teenagers are far more likely to contract the disease.
MSF and Likhaan have also set up screening and treatment programmes. Their teams provide information on cervical cancer and give consultations and free treatment in their Tondo clinic, as well as a mobile clinic: a van that criss-crosses the poorer districts of Manila to reach a greater number of women.
Routine screening takes just three minutes. Women with precancerous cells are immediately treated with cryotherapy, while those suspected of being at a more advanced stage of the disease are referred to hospital for diagnosis. The team support these women at every stage in the process.
Over 1,200 women were screened between January and September 2017.