On the HPV Vaccine Debate; What I Learned About Sexual Risk from a Colleague in Medical School, By Dr. Leonard Sowah

Barriers to healthcare Cervical cancer Cervical Cancer Prevention Disease Control Ghana Global Health immunization Public health Policy Reproductive Rights Sexual Health society and health vaccine safety women's health

Anytime I hear any debate on the HPV vaccine Gardasil, I remember a fact that most of us tend to forget.  This simple piece of common sense was brought to my attention by a classmate in a class on sexual risk and cervical cancer.

I can still hear his voice ringing in my ears;

“Sowee; de ting ino bi how many people the chick sleep with, sometimes all you need is one bad dick”

He went on to explain this with an analogy using cars, he compared 50,000 miles on the German Autobahn to 10, 000 miles on some of the atrocious roads in rural Ghana. When he made that analogy, I was very familiar with the roads in Ghana but whilst I knew of the Autobahn I was yet to ever travel on those famous European highways.

Autobahn A7 - Motorway

“Autobahn A7 – Motorway” by oxfordian.world is licensed under CC BY-NC-ND 2.0

One reason why  this analogy stuck with me was probably related to the colorful nature of his explanation. He was instrumental in helping me slowly transcend the myth that cervical cancer afflicts promiscuous women only. It reminded me of one basic fact of life; bad things happen to good people too, if I could ever bring myself to use that adjective in that sense.

Since that classroom experience, I have seen many cases of warts and cervical cancer in many places. I remember one lady in Haiti whose tumor smelled so bad we had to house her in a tent outside the hospital building. I never got her full story but we could not discharge her because her family would not take her.  After my time in the hospital was over, I never managed to find out what happened to her or rather did not want to know.

My colleagues at Korle-Bu Teaching Hospital in Accra are probably aware of the corner in Ward E where only the brave ventured on account of the stench from advanced cases of cervical cancer. I have not been in that part of the hospital in ages and cannot confirm if this situation has changed.

With the horrible nature of this disease and the extraordinary changes it made to the lives of afflicted women I had expected that a vaccine with 65 – 72% efficacy in preventing cervical cancer would be very popular. Unfortunately that is not the case, ever since Gardasil was approved in 2006 I have been involved in debates with many physician colleagues including many senior colleagues many of them had taught and supervised me.  In many of these debates I could not contain my frustrations because each argument against Gardasil gave me flashbacks to the worst cases I had encountered in my more than 20 year career.

Prefilled Syringe of Gardasil 9, the New 9-Valent HPV Vaccine – Image Courtesy of Ted Eytan, Washington DC

My experience with the young lady in Haiti who had to spend the latter part of her life in a tent because of this disease was traumatic enough for me to hope I never had to encounter another case of advanced stage cervical cancer. If there is one thing that I can be certain of, it is the fact that in resource constrained countries like, Ghana, Haiti or Guyana, a vaccine like Gardasil was  our best chance at saving a few girls from this ordeal.

Unfortunately the morality gospel of many colleagues, continues to be preached. The hollow gospel that our ladies do not need a vaccine to give them the license to be promiscuous. To that popular ideology preached by many that I was raised to respect like demigods, I would humbly say this; my medical school colleague whose name I would not mention here taught me these simple words of wisdom:

“Sometimes all you need is one bad dick”, if I am allowed to use that adjective.

Leonard Sowah is a physician in Baltimore, Maryland

For information on cervical cancer screening sites in Ghana click on the link below

A physician providing primary medical care to patients across the lifespan