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- #thefutureisfemale
What happens when women cannot easily get to the healthcare they need? On this episode of #TheFutureIsFemale, Melisa Idris speaks with Dr Abigail Rembui anak Jerip, Obstetrician and Gynaecologist and founder of Pink & Teal EmpowHer, about bringing cervical cancer screening closer to rural and underserved women in Sarawak, meeting communities where they are, and why one-stop healthcare is crucial especially when women so often put their own health last.
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00:10hello and good evening i'm melissa idris welcome to the future is female this is the show where we
00:16find the extraordinary in every woman and i'm delighted to introduce my guest today dr abigail
00:21raboi anadjarib who is a senior medical lecturer with the department of obstetrics at obstetrics
00:26and gynecology at the faculty of medicine and health sciences in university malaysia sarawak
00:32or unimas alongside her clinical and academic work dr abigail founded pink and teal empower
00:39which is a charity organization focused on improving women's health awareness and access to
00:44breast cancer cervical cancer screening particularly among rural and underserved communities in sarawak
00:50so i'm delighted to welcome to the show welcome to the show thank you thank you for having me thank
00:56you so much for being here um so tell me a little bit about your journey your work what first
01:01drew
01:01you to the field of women's health i i guess i'm wondering how did you come to realize that this
01:07was the work that you wanted to dedicate your life to all right uh thank you for that question i
01:12really
01:13love being asked that question because then i get to talk about two of my favorite people on earth my
01:16mom and my dad so it began with them when i was younger my i would follow my mom to
01:22all this ladies
01:22fellowship and i would like just listen in on the problems that they were facing and part of me
01:28during that process of growing up i realized that i instinctively understood what they were complaining
01:33about even when they probably didn't have the words to describe it and i'm super curious i'm super
01:40inquisitive so that i think that led to me choosing medicine because i feel like in medicine
01:46they tried their best to answer the question of why okay yeah and in that process also my dad was
01:52a
01:52rural gp general practitioner and he showed me how as a general practitioner in medicine we also have to
02:01think about the underserved communities so after work we would always take his old beat up to yoda
02:07which i'm sure survived like the japanese occupation and we would just take all the hilly roads up into the
02:13rural villages and that is where he would render medical help most of the time for free and we'll
02:19bring like chickens and fruits back home from the rural places yes as payment and i think from there
02:28both of those things just mesh together and it really conglomerated and was the basis of me loving
02:37women's health and rural health care at the same time okay so then how did you um start or why
02:43did
02:43you then start uh pink and teal power oh that has two names and two faces right those were the
02:51two
02:51patients which really left a mark on me when i was a young impressionable trainee specialist one was
02:58norazrina she was a young cancer survivor and we were just with her um in the clinic trying to help
03:06her
03:08mitigate the aftermath of surviving cervical cancer because she was only 27 28 at that point in time
03:14yes and so we were preparing her for marriage we were trying to rehabilitate the reproductive
03:22um organs so that she has a chance at living her best life after she fell in love so so
03:30then there was
03:30then that i understood that cervical cancer can happen to the serocan cohort in earlier age
03:38and cervical cancer need not be a death sentence that we women do survive treatment for it so what is
03:45there after that so we talk about fertility we talk about screening and so that was her i met her
03:52very
03:53young so we are still in contact and we support each other a lot and the second lady who unfortunately
03:59was not as fortunate she falls into the demographic that we usually see in cervical cancer whereby they
04:08present a little later so because they come in stage three stage four we know that the survival rate
04:15in those stages are about 10 to 13 percent um in the next five years cervical cancer yeah okay all
04:24right so
04:25then you um you set up this organization to bring um testing and screening and awareness to women in rural
04:35settings and i do want to ask you how what that entails what did you have to essentially learn and
04:43unlearn about
04:44delivering healthcare because you're meeting these women where they're at where they are so um in their
04:51homes their villages their long houses what did you have to kind of think about when you were setting
04:56up or thinking about delivering rural healthcare right so a lot of that came from the fact that our
05:02cervical screening uptake is probably 40 percent at best okay is that sarawak or uh malaysia hollow
05:09malaysia is 40 percent at best and um it falls below our stipulated goals of um 90 vaccinated 70
05:19um screened and 90 treated which is stipulated by the who to achieve by 2030 for us to be on
05:30the
05:30trajectory to eliminate cervical cancer 40 i didn't realize the number was so low it is of course it varies
05:36in urban
05:37areas where the more affluent affluent have access to like regular health checks then maybe it could
05:43fall between 60 to 76 seven so it really is about um access right okay so tell me about um
05:52what you
05:53you learned about uh delivering these type the screening right so we realized that business as usual
05:59that approach could no longer be we had to really meet the women where they need us most so that
06:05was the
06:05first thing um we meet them in the balais the ruwais the remindiaks and we met them because invariably
06:14women always put themselves last okay invariably they put themselves last so we had to find a way
06:21to make it as part of a family event we had to make it as part of a health pesta
06:26right so we ensured that
06:28the husbands got their screening the children got some dental program and then we'll just slide our
06:34cervical cancer thing in so so we we really did try to have a multi-faceted approach to this and
06:42when we
06:43came we came bearing gifts because we know in this economy you know we we we also assist them with
06:48rations and so we met them so that's the first part actually reaching them and having them come forward
06:56then beyond that it was about this would probably be the only time we ever meet them in their lives
07:02how do
07:03we just make it a one-stop solution thing because up until then in 2016 we have been very smear
07:11based so
07:12basically smear base is when we take a scraping of the cervix which is the neck of the womb and
07:18then we
07:18transfer it to either a media or a slide we hope it's packed up nicely we send it over for
07:24pathologists to
07:25take a look at the cells so that has been the mainstay of screening for a while and the turnaround
07:32time for that is two weeks or more oh wow to get the results to get the results yeah um
07:39juxtaposed
07:41against now when we actually have something called the hpv dna testing where we actually find the
07:48causative effect the we get we get to find the cause that causative agent for cervical cancer
07:54and so it's a lot like the covid test whereby we swab ourselves now ladies can swab themselves and hand
08:00us that sample and and i really do have to thank covid and the just the knowledge and science technology
08:08boom that happened after that because we were able to extrapolate from the the pcr testing yes and
08:16utilize it for hpv testing whereby we're able to get the results within the hour so it has really
08:23become a one-stop screen and treat process and that is one of the things that we're really really proud
08:30of in our program in surround because we know once we go there once they see us that may be
08:34the only time
08:35they ever see us so we take a swab we get them the results within the hour and then after
08:41that if it's
08:42positive we tell them we need to take a look at your cervix and see how it goes if we
08:47can treat we
08:47would treat here and now what what does treating entail in that in a setting like that in a setting
08:53like that we have portable um heating devices so it's like a little it's like a little iron okay like
09:02an iron is shaped like a gun so it's like that so we will do a internal exam we will
09:08take a look at the
09:08cervix we'll put some solution on it and we'll see if there are any changes to the cervix if there
09:13are
09:14changes indicative of early cancer or pre-invasive conditions then we will see if our device can treat it if
09:23it's big enough to cover the area and we can treat it there and then yeah oh that's amazing yes
09:29you can treat
09:29any uh any growth or any not not major growths but any free and any anything that we're suspicious of
09:38a pre-invasive disease yes they're in whatever you know place we find ourselves yeah that's remarkable
09:46has that been that technology been around for a while uh that yes this this technology has been around for
09:52a
09:52while in fact there are numerous um programs utilizing this um technology in central asia sub-saharan africa
10:03um bangladesh nepal is it is it common have you have you seen it being used in other rural areas
10:11in
10:11malaysia rural areas one in sabah there is one there's one such project in sabah um and they do amazing
10:20work
10:20um there's also one such project in um i believe that is uh mostly for within their clinic but to
10:31actually take it out into these rural areas i think so far it's us so far tell me why that's
10:38important
10:38why is it important to be able to bring not just the screening but the results and the treatment to
10:45these women and i i cannot um stress how groundbreaking this is this is really important
10:50because thank you it really is difficult to i can't imagine someone getting a positive result
10:55maybe two weeks later and then having to think about access to medical care what pathway is there
11:02when um you know access to hospitals can be quite limited yes that's an amazing question and we ask
11:08ourselves that all the time like why do we have to bring this to stakeholders and why should they
11:12support us and the reason is that in our journey we have found that there is up to a 50
11:20percent
11:20defaulter rate up to 50 percent even if they know it's positive meaning they don't go for they don't
11:26come back they don't come back for any form of further investigation or follow-up so it's so important
11:34you said that's half of the women in the rural areas and we recently completed another study which was
11:40done in an urban setting we did it with postpartum women we screen all of the postpartum women um
11:47before they went home and then we did a callback at six months at three months just to find out
11:52what
11:53is the dropout rate because at the point of delivery when they were about to go home they all said
11:58yes
11:58let's do this we had like a near universal 99.7 uptake of the screening right so then uh but
12:06after that
12:07during the callback we had like a 60 percent dropout so when we asked them to come back again for
12:12the
12:12second test which was just a concordant test only 40 percent turn up and that literally translate to
12:18our national figures so what what do you think it is why do you think there is such a high
12:24dropout rate
12:26there was a question that we asked ourselves the researchers we really asked ourselves and we actually
12:30did a we put all the data we put all that data into this statistical analysis it's like a sandbox
12:37so it's called a multi-variate linear regression statistical test that sounds very very technical
12:44it sounds so technical i we just basically we find all the possibilities like age number of children
12:50distance from the nearest health care every variable that we can think of we just put it in and we
12:56see
12:56the outcome and knowledge as well because we did a knowledge exchange so we also found out we also
13:00asked them what is the baseline knowledge coming into that and from there we found out that
13:09there's no particular reason if if if regardless of what we may think it is there's really
13:18no main barrier besides the fact that again women invariably put themselves last wow that is heartbreaking to
13:25hear which is why you then went to them right okay one um area that i i also wanted to
13:32talk to you
13:32about apart from the the great work that you're doing with the kind of one-stop service is the fact
13:39that your research has found that hpv types among women in stroke in particular um are different from the
13:48types that are targeted by existing vaccines did do i have have i encapsulated that correctly yes that's
13:54right that's right that's right so part of um our research is to find out the strains of hpv that
14:01besiege the sorokin women um because we different there are different strains of hpv and different
14:07is it different communities or different geographical areas have different strains okay that's right
14:12that's right um because hpv generally is everywhere just like how the jerubu is everywhere right but not
14:20everybody but not everybody like catches a disease or not everybody catches a respiratory
14:25ailment so what we have what we know from science is that um eight to nine out of ten sexually
14:33active
14:34adults actually have hpv but out of these numbers only one to two out of ten have the high risk
14:42hpv okay so
14:43the different uh variants different risk uh profiles yes and of these high risk hpvs then we have found
14:50out that the more virulent ones are known as a 16-18 um and then there are non-16-18
14:57strains
14:58so up until now most of the programs have been with the two strain vaccine and and the uptake has
15:06been
15:06good i think malaysians generally they believe in preventive medicine so that's great
15:10um and during the course of which we actually found out that um in surawa especially when we when we
15:18utilize the two valence we are invariably only covering 25 percent of our girls wow yeah so we're so so
15:31because the the the hpv strains that are endemic to us are actually not fully covered under the two
15:38strain or the four strain that's 75 percent of girls about that yeah about that okay right so then
15:46this was important to us because in surawa we do have some level of healthcare autonomy for example
15:52historically we have our own je right we our children are vaccinated against japanese encephalitis but it's
15:59not the same here in the west malaysia because it was not an endemic problem so with that uh with
16:05this
16:05information we're hoping to tabulate this at some point with our health director and just say like
16:10hey you know we already got the je could we possibly have a more all-encompassing um vaccine that will
16:17actually help our girls because when we take the more extensive variant the nine variant um nine valent
16:25vaccine we're potentially able to cover more than 50 percent of us rockin girls so have you had an
16:32opportunity to speak to policy makers how would you like policy makers to respond to this startling
16:37finding i am so impressed that um looking at local data is so important when you're making evidence-based
16:43decisions right right yes because um we have always had a close relationship with our health department
16:51dr jamila and now dr veronica she has always they have always been so helpful in pushing forward
16:59evidence-based medicine i love to hear that it's women the future is female so um but i think uh
17:09we
17:09are slowly just moving towards um polishing up the data because we don't just want to come in with
17:15vaccination we want to be able to give them the three-pronged approach which is the vaccination
17:21the screening and the treatment so we're still collecting the data we're hoping to have it published
17:27soon and uh write a policy paper together so that we can move forward actually for surawa okay so so
17:33it's in the works so you've got the data you've you're just uh putting it all together to make sure
17:38that it's the best timing and to hit all three at one yes yes um when so a lot of
17:44the conversations
17:44around hpv so that's the policy makers but you also have to prime the ground for this right yes um
17:50and i think
17:50there is still unfortunately even in 2026 a lot of um stigma a lot of i guess uh misconception
17:59discomfort talking about hpv because it is sexually transmitted and i wanted to talk to you about that
18:05in your work particularly when you go to the ground in rural areas how do you make sure that that
18:11communication um isn't shrouded by stigma and that um women feel comfortable talking about hpv the
18:19de-stigmatization yeah yeah so again we go back to the fact that hpv is a very common virus right
18:26it's transmitted from skin to skin contact you touch your boyfriend you get it you hug you will get it
18:32and what is more important about it is again the high risk strains and the fact that when the hpv
18:41is in certain areas of the body with susceptible cells that is when we see that the hpv after a
18:51prolonged exposure could potentially cause the mutation of the cells into what we know as a malignant
18:59process okay yes so hpv can be on your skin but it may not cause cancer but if the hpv
19:05is say in the
19:07mouth cavity and your genital regions then they can recover okay do you have you had a positive reaction
19:16to when you know you communicate you try to destigmatize how do you make sure that that it's um that
19:21communication is it lands are there techniques you use you speak in in local dialects you make sure that
19:28it's you know digestible information sometimes the technical medical language may not uh land with
19:34most people how do you do it how do we do it well um i speak the local language i
19:40try to speak to the
19:41patients be it in mandarin in iban in bedayu or whatever local sarkin language that we can speak to
19:47we try to use less technical terms um we also explain to them that hpv is essentially not hiv
19:56and it's not um something that we should be afraid of because if we know early then we can do
20:03something
20:03early yeah it's not a death sentence right exactly is there a role for boys and men to play in
20:10this
20:10definitely i think from from boys and men first of all as partners right they can encourage their
20:17their girlfriends their wives their sisters right to get screened to get vaccinated
20:21um if they're in a relationship they can always put on um they can always use healthy lifestyle
20:29changes for example for example it was um actually one of in one of our research papers it said that
20:35regular condom use can actually reduce um hpv infection oh wow with regular okay because you talked
20:44about prolonged exposure right that was the kind of key term that you use yes yes yes um when you
20:49talked about there being a late presentation you know unfortunately that's the case sometimes without
20:55early screening i i do wonder whether you know sometimes we put the onus on women so much right
21:02that the language of um awareness really puts the onus the responsibility back on women almost as
21:09though like only if they knew better they would automatically have better health outcomes and i
21:13do want to ask you about that where the responsibility of health systems should begin particularly with um
21:20with you what should we be doing differently uh not just in sarah but you know i guess um everywhere
21:27where you would like to see how health systems can do things differently so that prevention doesn't
21:34depend depend entirely on the woman um so that you know they they have um no excuse to put themselves
21:45last as you you put it earlier yeah okay all right so that's an excellent question and something that we
21:53really do ask ourselves all the time that where does with whom does the buck stop okay where does it
21:59stop
21:59right um i believe that it's all about communication right we always ask ourselves what are the women
22:07trying to tell us so tell us one like but i feel like it's more important to listen to what
22:16they're
22:16not telling us and what they're actually doing which is they're not coming so that in itself communicates
22:21a lot right so some of the most successful programs i've seen are the programs that are really
22:28integrated into the workplace if it's part of the work screening then they'll definitely get it
22:33okay when it's part of their child care program like the carnival then when it involves the family
22:41exactly when it involves the family so again when we talk about screening a woman and preventing cancer
22:48in her preventing cancer in cervical cancer in a woman we're talking about not just preventing
22:53one woman one life but we're talking about preventing all the women all the roles that she
22:59is as a wife to her husband as a caregiver to children caregiver to elderly parents you know and
23:07also a member of the workforce so when we think about it's not just her one woman but we think
23:11about
23:11all the roles that she play there are many many opportunities for us to meet the women where they need
23:16us
23:16most yeah you know it's remarkable the things that you would learn in uh as part of rural health care
23:24that you may not learn sitting in a hospital or a clinic because like you said there are things that
23:30are not being said that you can observe that you can see for yourself um and the people who you
23:36meet
23:36on the ground are not the same people who come to you know the waiting rooms in hospitals and clinics
23:42and be
23:42as it and and that is an excellent um observation because when we talk about on paper it's all
23:48vaccination screening and treatment but then vaccination is done by primary health care is done by schools
23:55and then screening again is not done by ong specialists sitting in their clinics it's done by
24:00nurses midwives who are in the clinics or doing the health care outreach and by the time it reaches
24:07us as gynecologists we are seeing the cancer right right so so among ourselves among our peers there
24:14there has to be some form of communication as well because then it will be like oh this is already
24:19cancer i cannot screen her it becomes the ong problem or you know i'm a gynecologist i'm not
24:24supposed to talk about vaccination i'm not supposed to talk about screening you know it's a primary
24:29health care problem it's a school program problem so then i think um lately as we move towards the
24:3610-year mark of our who 90 70 90. our 10-year report card is coming up oh wow right
24:42so so we started
24:43in 2018 so it's going to be 2028 soon so the 10-year mark is coming i think uh a
24:49lot more programs are
24:50geared towards having conversation in between these what used to be silos so now the conversation is
24:57happening so that when the 10-year mark comes we'll be on a trajectory to reach the 90 70 90
25:03by 2030
25:05so that we can have cervical cancer elimination by 2130 do you think we could do you think we can
25:12make it there are countries already uh on track there are i think um never say never okay definitely
25:20there is a there's a space there's definitely a space that we can expand into to make sure that we
25:25reach uh our targets on time and in the few minutes that we have left can i ask you for
25:30the women who are wonderful caretakers looking after everyone else's health what would you say
25:38about not postponing looking after your own early screening saves lives screening in itself means that
25:49you have to come when there are no symptoms so get vaccinated get screened knowing is better than
25:56not knowing a hundred percent dr abby thank you so much for speaking with me but also for the work
26:01that you do i really appreciate your time thank you thanks that's all the time we have for you on
26:05this episode of the future is female i'm melissa idris signing off for evening thank you so much for
26:10watching
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