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Guatemala: A cervical cancer vaccine for girls

By Alba Trejo

Guatemala, May.– The announcement of a cervical cancer vaccine has been well received by the local population. The Ministry of Health hopes that it will provide final cure for a pathology that is the third cause of death (after respiratory and diarrheal diseases) in the country.

Public hospital doctors are planning to buy enough doses for girls who are 10 to 15 years of age and make up most breeding-age women getting pregnant.

Alejandro Silva, head of the Reproductive Health Department at the Ministry of Public Health, indicated that 90 percent of the three million fertile-age women in the country do not usually ask to have cytological tests performed on them.

The Family Wellbeing Association (APROFAM), a local NGO that has been working on reproductive and sexual health for 20 years, conducted 146,314 cytological tests all over Guatemala last year.

"The figure is low when one considers that there are 6.5 million women in the country and that half of them are over 15 years of age", said its marketing director Edilzar Castro.

Raúl Guillermo Rosal, a supervisor working with the Preventive Medicine Mother- and-Child Department at the Guatemalan Institute of Social Security, stressed that only 10 percent of local breeding-age women resort to these tests.

Héctor Guerra, director of the National Cancer Institute (INCAN), announced that one every two women under medical examination suffers from some cervical cancer. "The situation is even worse in the 30- to 59-year bracket", he stressed.

INCAN detected 900 new cases last year. Some patients were on radiotherapy, but others died. APROFAM determined 713 cases in the same period. The total number of diagnosed women was 1,613.

Most women suffering from cancer develop it in the cervix, ovaries, uterus or vagina.

María Elena Loarca, representative of the pharmaceutical company that will introduce the vaccine in the country, highlighted the significance of having such a product available in the local market.

The price, however, is likely to reach 300 dollars (twice the wage of a sweatshop employee over two months), Silva explained. "Poor women will not be able to afford it", she regretted.

According to the United Nations Development Programme (UNDP), poor people in Guatemala live off two dollars a day. This is to eat, move, send children to school and buy medicines if required.

"These people do not usually go to hospitals. Their low educational level does not make it possible for them to be aware of risks. They think they would spend too much on a test", she noted.

"Paradoxically enough, the vaccine will be available for professional women who have cytological tests performed every year", she emphasized.

APROFAM recently carried out a study on fertility and family planning. It showed that rural women are especially vulnerable to cervical cancer. Mayan men, for example, do not like to have their wives examined by doctors; they prefer midwives.

In an effort not to introduce the speculum into the vagina of indigenous women, the Health Ministry developed a new technique: apply vinegar on the matrix, see the color it takes and determine any patient risk through eye inspection. As the method is still being tested, results have not been measured yet.

Bolivia: Dignity versus pricing

By Helen Álvarez Virreira

La Paz, May.– As the winter approaches, temperatures go down. On Monday 7, for example, they were below six degrees Centigrade. Nevertheless, over 500 second-hand clothes dealers decided to spend the night outdoors, at the Heroes square in downtown La Paz.

This way, they accompanied 12 comrades on hunger strike, protesting against the government. A recent decree bans the sale of American and European used clothes.

Not far from there, hundreds of women opened their stands to sell hand-made clothes. They are called “the early risers” and make up a sector that is known as “the makers”.

They begin hanging their pieces at 5.00 a.m. and sell at wholesale prices until 10.00 a.m.

These two sectors have several things in common: most of them are women, heads of households and senior citizens. They are self-employed; their working conditions are really precarious; they make money just to survive, and have no other jobs. The former, however, is doing away with the latter.

The government enacted a decree in April 2006 banning the import of second-hand clothes as of April 21, 2007. It set a deadline (March 8, 2008) to sell out, provided training opportunities and extended loans for equipment procurement. While second-hand clothes dealers are protesting, makers are celebrating.

Many jobs

The sale of American used clothes has been steadily growing in the last ten years. The local government had authorized free import and marketing of clothes that were coming in as donations. They had always been sold, however, at agricultural fairs.

This informal business modality has helped overcome unemployment due to structural adjustment measures in the 1980s and 1990s and government inability to create new jobs. According to the Study Center for Labor and Agricultural Development, the State generates only 12 percent of the jobs required by the country. The unemployment rate is expected to reach 9.5 percent of the economically active population later this year.

The Early Risers Association has over 6,000 members, said its secretary general Martha Guzmán. Men who have been laid off have joined the organization.

On the other hand, the National Organization of Second-Hand Clothes Dealers and Shops has around 250,000 members. Out of this total, 60 percent are women and older people, announced René Poma, its local secretary general in El Alto city.

Quality versus prices

Mrs. Melma asked not to be fully identified. She said she pays 10 Bolivian pesos (1.25 dollars) per piece to the makers. As sale volumes have dropped, I can not pay more than that, she added. "People want to buy clothes for five pesos (0.62 dollars), but most of these garments are contaminated", she stressed.

A locally made, double-faced jacket ideal for the winter costs 65 pesos (eight dollars), while a similar American used piece can cost 20 or 30 pesos and one made of leather, 40 pesos.

"The problem is not price, but quality, she indicated. If the product is good, people will pay more, she commented. Our labor force produces quality pieces that are well recognized abroad", she added.

There are ads all over the city urging good tailors and makers to go to work in other countries. Some buyers, however, have complained about pieces that are not well finished, while some others have praised material quality and design in imported clothes.

What about dignity?

Hundreds of second-hand clothes dealers from all over the country arrived in La Paz last May 7 to participate in a march and demand a three-year sell-out extension period. Pedestrians catcalled and even threw garbage at them. It is true, however, that the clientele crowds up their markets and galleries every day.

In general, ordinary people oppose the idea of allowing imported clothes sale to go on, out of dignity. “They believe we have to use their garbage” and “Bolivia has become a refuse country” are some of the expressions most commonly heard. Some other people recognize that this business modality has been an effective way of dealing with the economic crisis.

In the countryside, where poverty is affecting 70 percent of the population, old clothes are sold at one peso (around 10 cents of a dollar) a unit, and three pieces are sometimes sold for such an amount. Middle-class people have bought boutique clothes at relatively low prices. A second-hand blouse can cost 30 pesos (four dollars), while a new one can easily cost 30 dollars.

In fact, shops in the most exclusive areas of the city began selling second-hand clothes as if they were new, a study corroborated. Carried out by Gabriela León, Humberto Valdéz and Víctor Hugo Vasquéz in 2003, it was entitled Kantuta: an agricultural market? It had been commissioned by the Bolivian Strategic Research Program.

Who wins?

The government says that importers are making most of the money generated by this business and that they are forcing retailers to go away.

The local ministry in charge of small- and medium-sized companies estimated that a leader makes over one million pesos (125,000 dollars) in three months, while retailers make around 400 pesos (50 dollars) a month. The latter include people like Mery Arana, secretary general of Fátima Village Association, which gathers 150 women, including single women, widows and older people.

La Prensa newspaper conducted a research work in Oruro city (the import place for used clothes). It showed that three families control the business and that Kantuta market is the hub for all operations.

PIEB study revealed that big traders are called parcel merchants because they bring clothes in parcels or bundles. Importers have over 50,000 dollars in capital and have set up companies of their own; non-importers operate on amounts exceeding 20,000 dollars; and rural dealers make around 2,000 dollars.

These importers do not only distribute goods throughout the country, but also sell the best parcels to foreign (Peruvian and Argentinean) dealers.

Another study by the Bolivian Institute of Foreign Trade showed that over 8,000 tons of second-hand clothes for 40 million dollars are imported every year. Out of this total, 93 percent comes in illegally. These imports made the local economy lose 500 million dollars (six percent of the GDP) in the 2000-2005 period. The most seriously hit sectors included the textile Industry (312 million dollars), trade (80 million dollars) and agriculture (32 million dollars).

Poma knows that those who take most benefits from retailers’ work are the importers, who have made profits out of poverty. Nonetheless, he justifies them because, just as any other guild, they need goods to make a living.

He agrees with the idea of providing new jobs to second-hand clothes dealers. "They should be given a three-year sell-out period, get trained in some other trades and have access to credits", he emphasized.

Guzmán and Melma believe that new jobs should be provided to these people, because they are not to blame for the current situation. They should sell domestically produced pieces. "We did not have such an opportunity when we started our business", they added.

There is no dialogue between the two sectors. They both put pressure on the authorities by staging protests and announcing radical threats. Any second-hand goods that come in get confiscated.

Arana (63) is a leader of the Local Senior Citizens Federation. She will not give in. She does not think getting trained in some other trade will be of any use at this point in her life. She spent a night in the street, along with her comrades and daughters, surrounded by hundreds of dealers from all over the country. She was under police control.

On the other hand, Melma is ready to get back to work, hoping to have more clients when second-hand clothes sale is over.

Teachers in Nicaragua: The value of vocation

By Sylvia Torres and Lindskat Legall

Managua, May.– Schoolchildren tend to imitate their teachers. The magic behind the meaning of words, the pleasure of reading and the mystery of mathematics make them pretend they are teachers.

Actual working conditions for most teachers in Nicaragua, however, are very far from children’s dream.

According to the National Association of Nicaraguan Educators (ANDEN), there are 42,000 teachers in the country, including 3,500 who began working this year. They include teachers, directors and deputy-directors at 9,000 public schools all over the nation.

The 2007 school year began last February. A total of 5,914 public schools could not open because of a strike convened by the National Confederation of Nicaraguan Teachers. This action has been taken for years to demand dignifying the guild.

Strikers are calling for higher wages, regular jobs and union recognition. Teachers are not happy with the 308-córdoba (17-dollar) raise introduced by Daniel Ortega's government. Previous administrations had agreed to 30-dollar raises.

They did not like to get the raise in bonds either. They have since 2005 demanded that the raise should be incorporated into their wages. Teachers managed to reach an agreement with Ortega's predecessor to be paid the same wages as their Central American colleagues. In fact, Ortega included this issue as a banner of his presidential campaign.

The basic wage of a primary schoolteacher in Nicaragua is 120 dollars a month, as compared to 515 dollars in Panama, 462 dollars in Guatemala, 564 dollars in El Salvador, 407 dollars in Costa Rica and 275 dollars in Honduras.

Union struggle, education and poverty

Last March and April were marked by organization and struggle. Teachers took over some schools; around 2,000 of them participated in a demonstration on April 5; and a group went on hunger strike. They staged a march on 1st May to demand better wages and appropriate infrastructure. The strike came to an end in the second week of May, with a wage raise lower than originally requested.

Cornelio Hopmann, an outstanding expert in information technology, said that Nicaragua does not have a miserable educational system because it is a poor country; it is a miserable country because it has a poor educational system.

"Except for oil emirates, no country in the world has improved its economy without first improving its education", he added.

A portrait of local teachers

According to ANDEN, most primary and secondary schoolteachers are women over 35 years of age. Many of them have worked for more than 20 years and take two shifts to complement their wages.

They are working out of vocation. An example: Angélica Mejía Carcache, with over 38 years in the profession. "The wage is low, but it is my vocation to teach", she stressed.

In 2006, ANDEN conducted a survey among 1,600 teachers at urban and rural schools in various departments of the country. Over 68 percent of respondents said that they have taken no training/upgrading course in the last 10 years. Only 19 percent indicated they took some training last year.

This finding would not be so alarming if empiricism levels were not so high. "Teachers have had no updating in techniques, methodology and information. This leaves a lot to be desired"said ANDEN leader Antonio Zepeda.

Education Minister Miguel de Castilla stressed shortly after ANDEN’s survey that over 50 percent of teachers are empiric. "In fact, only 42 percent of them have the scientific degrees required for elementary education", he stressed.

International goals

Against this background, the goals set in Dakar (Senegal) in April 2000, which included universal access to education, will not be achieved by Nicaragua.

Under a World Education Campaign, a meeting has been held in the country since 2003 to review the progress made. It has not been very outstanding. Another goal (guaranteeing that all boys and girls complete a full primary-education cycle) will also remain unattained.

It is difficult to meet such challenges without considering key actors, that is, teachers. As education is closely related to economic and social goals, solving educational problems is of vital importance to the nation.

ANDEN highlighted the need to promote teachers’ social recognition and commitment. Around 36 percent of them have served for over 20 years.

A MasterCard credit card styled comparison showed that the monthly salary of President Ortega, who merely has a bachelor’s degree, is 3,500 dollars, and that of a schoolteacher is 70 dollars. The fact that he makes twice as much in a day as a teacher in a month is unheard of.

Colombia: Controversial proposals on child sexual abuse

By Julia Londoño Bozzi

Bogotá, May.– The publication of names, photos and type of crime committed by child sexual abusers has just been approved by the local government in the capital city. And there are plans to take similar actions in other regions of the country.

The boards and posters showing those condemned for these crimes have been called “walls of infamy". Each of them will contain the photos of six child molesters.

The information will be reproduced twice a year in public service utility bills. It will also be contained in fliers to be distributed at shopping malls, movie theaters and schools.

At La Modelo de Bogotá, one of the four penitentiaries in the country where sexual criminals are sent, some prisoners went on hunger strike to protest against the proposal.

Paola Franceschi, director of Children for a New Planet in Cúcuta city, said that those criticizing the walls of infamy because, in their view, they do not help social reintegration of former prisoners are not armed with the power of reason. "The idea is to give priority to victim over victimizer rights", she added.

"Sexual assailants can not be fully reintegrated into society due to their personality traits. They are addicts to children and/or teenagers. Protecting the latter is the right thing to do", she stressed.

Children for a New Planet has been looking after sexually abused children in Colombia for seven years. One of the most emblematic cases was that of a four-month-old baby who was taken to the organization’s headquarters after having been abused by his stepfather in 2003.

His brothers and sisters had endured similar situations. An aunt took them to the organization, where her suspicions were confirmed. Their mother never reported the actions to the police out of fear.

Based on her experience, Franceschi insists the main thing is to try to prevent children’s rights from being violated.

Other people propose stronger measures. There were 30,000 cases reported to the police in 2004 alone. This is a conservative figure because most victims decide not to denounce their assailants.

Fabio Andrés Humar, a lawyer working at the Attorney’s General Office, feels that tougher sanctions should be imposed on child abusers. "We should recall that abused children can become abusers in the future", he stressed.

Franceschi indicated that statistical data show that 30 percent of sexually abused children tend to reproduce these crimes some years later. They move from victims to victimizers or permissive parents. She shares Humar's views in this connection.

She recommends imposing life imprisonment without the right to sentence reduction. Those who have served their sentences should be closely monitored and given jobs far away from minors.

Antecedents and consequences

The 2006 Children and Adolescents Code stipulated that the names and pictures of child sexual abusers condemned in the last 30 days should appear at least once a week on "the walls of infamy".

The code made it possible to develop these walls, following an initiative of local councilor Gilma Jiménez.

After the adoption of this proposal, other initiatives such as life imprisonment for child sexual abusers (sponsored by Bogotá alderman David Luna) are more likely to be passed into law. Luna’s bill was submitted last May 8.

Franceschi stressed that complementary actions will probably include publishing assailants' photos on packs of sweets and school materials, identifying their faces from door to door, etc.

With regard to the impact of the walls of infamy on victims and victimizers, Humar indicated that the measure does not make much difference to abused minors, but does prevent other children from being subjected to these aggressions.

"Abusers can be physically attacked", he thinks. The move will make them experience fear and discourage future actions, Franceschi believes.

"Exposing the victimizers in such a way will also help children victims not feel guilty or responsible, especially in a society that silences or forgets about acts of violence", she added.

In private and in public

These sexual crimes usually occur at home, the place where most children tend to feel safe. They are often raped by people who live with them. It is thus very difficult for the State to monitor these situations. This is a problem that requires not only punishment, but also education, prevention and monitoring, said Humar.

Children for a New Planet is presently following up 41 reported cases. Only one abuser has been condemned for having raped four smaller brothers and sisters. After eight months in prison, he was released. He is now working as a babysitter in Bolivar city, Franceschi noted.

"We have advised the police about some neighbors indicating that he keeps on abusing. He has not been arrested because there is not sufficient evidence against him", she added.

The case of the Cúcuta baby and his brothers and sisters remains unresolved. They are staying at the organization’s headquarters because they were facing risks at home. Their aunt has been given custody over the children and visits them every week. Four years after the crime was committed, the victimizer is still free due to lack of evidence to condemn him.

Colombia: Increased cervical cancer death rate

By Ángela Castellanos

Bogotá, June.– "Some of my friends do not go for smear tests although they have money and are aware of the importance of early cervical cancer detection. I think they have not developed a culture of self-care and prevention," Ángela Matallana, a 47-year-old resident in the capital city, told WNS.

She added that she goes for the Papanicolaou every year. When my results were positive, "I had a biopsy performed and a treatment indicated. Everything was brought under control", she stressed. The local Health Secretariat has adopted a number of measures to promote and facilitate smear tests with the aim of preventing uterine cervix cancer. This has become the second cause of death, after breast cancer, in women aged 30 to 59.

Cervical cancer is now ranking second because breast cancer incidence has grown, Elkin Osorio told WNS. He is the director of the Secretariat's Public Health Laboratory and a member of the Uterine Cervix Cancer Working Group.

The 2005 National Population and Health Survey (ENDS 2005) showed that the cervical cancer death rate had moved from 54 percent in 1995 to 69 percent in 2000 among women aged 40 to 69. The survey was conducted by Profamilia, a private, non-profit-making entity providing 65 percent of sexual and reproductive healthcare services in the country.

It also showed that the rate in 20- to 49-year-old women had moved from 34 percent to 37 percent in the period.

The Papanicolaou is a method used for early cancer detection by special staining of exfoliated cells. It can help reduce death rate by 60 percent in patients who usually go asymptomatic.

ENDS 2005 revealed that 85 percent of local women have had smear tests performed only at some points in their lives and 48 percent go for them once a year.

We are still far from universal coverage for many reasons, including poor healthcare service management and cultural factors. "The latter include male chauvinism (men deciding whether or not their wives go for the test)", Osorio added.

Many women do not take full treatment. ENDS corroborated that one third of positive women did not provide any follow-up to treatment because they are slothful or careless, and one every four women did not go to the doctor's again because they did not have money.

"Ten to 15 every 10,000 sexually active women living in Bogotá face some cervical cancer risk, while the death rate stands at 40 to 50 women every 10,000", Osorio announced.

"The highest incidence is being seen in women who begin to have sex early. They re more exposed to the Human Papilloma Virus, which is highly associated with uterine cervix cancer", he emphasized.

Such a cancer often occurs in low-income women whose immune system is weaker and sexual life begins earlier than in high-income women.

A smear test promotion campaign now underway includes TV advertisements designed for promoters working with women who have never gone for the test, use of vehicles to perform it in neighborhoods, and chats to highlight the importance of self-care.

Under Health Secretariat regulations, both public and private healthcare facilities are obliged to perform free tests without previous appointment.

The idea was to have the test performed on 235 000 women aged 25 to 69 in the first quarter of 2007. Only 22 percent of this total had gone for it by May.

This is in keeping with local conditions. ENDS 2005 showed that 99 percent of women aged 18 to 69 know what the test is all about and the cost involved.

Fourteen percent of those who have never gone for the test said that cost is not what matters most. ENDS identified the reasons behind such a behavior: carelessness (32 percent), fear (30 percent), shame (17 percent), feeling all right (15 percent), considering it unimportant (seven percent) and lack of money (five percent).

Asked about the incidence of other factors like service quality, Juan Carlos Vargas, a scientific advisor to Profamilia, told WNS that women believe it is important to respect their sexual and reproductive rights, including confidentiality. "That is why we deliver results only to women who have come for the test", he added.

"As the healthcare system is so fragmented (there are many service providers), some facilities do it right and some others do not", Osorio concluded.

The Women's News Service from Latin America and the Caribbean, International News Agency, offers this weekly service. No reproduction without authorization. Any comment o suggestion please contact us: semlac@redsemlac.net