在印度，一种对抗癌症的秘密武器：醋
https://www.pbs.org/newshour/health/in-india-a-secret-weapon-against-cancer-vinegar
健康 2012 年 12 月 12 日
在美国，宫颈癌造成的死亡人数超过任何其他癌症。如今，由于一项已有数十年历史的检测方法，即巴氏涂片检查，可以实现早期发现和治疗，美国几乎闻所未闻的宫颈癌死亡病例。
然而，在印度，每年仍有数万名女性死于宫颈癌。
“我们不可能像西方那样频繁地提供 [巴氏涂片检查]，”孟买塔塔纪念医院的癌症专家 Surendra Shastri 博士说。
巴氏涂片检查需要训练有素的人员和设备齐全的实验室，而印度许多地方都没有这些实验室。
“那么我们该怎么办？”Shastri 问道。 “我们不能让这些妇女死去。”
答案可能很简单。这是约翰霍普金斯大学和其他机构的科学家开发的一种廉价而简单的测试。它依赖于你厨房里可能就有的东西。
酸性测试
我来到印度马哈拉施特拉邦的德万村，看看这个测试是如何进行的。
医生们在一家空商店的空壳里设立了一个临时诊所。天花板上挂着一张床单，以提供一些隐私。店面没有电——甚至连灯泡都没有。
大约有十几名戴着头巾的穆斯林妇女来接受测试。其中一名妇女坐在检查台上，长长的棕色裙子被推到一边。她的朋友坐在附近，她看起来很平静，准备好了。
Archana Saunke 医生用棉签将透明液体涂在妇女的子宫颈上。
“我们等了一分钟，看看是否有任何斑块——黄色斑块，”她解释说。
如果液体使通常呈粉红色的宫颈变白或变黄，则意味着存在癌前细胞——可能成为癌症的细胞。
一两分钟内，医生就告诉了病人一个好消息。
“这很正常，”Saunke 说。那位女士笑得很开心。
如果检查结果显示有癌前细胞，则可以通过喷射液氮当场将其去除。无需再来回检查。
那么 Saunke 医生使用的这种透明液体是什么呢？
“醋酸，”她说。常见的家用醋。
克服阻力
这里进行的测试是 Tata 纪念医院和 Walawalkar 医院正在开展的试验计划的一部分，Suvarna Patil 医生是这两家医院的医疗主任。
Patil 说，当醋测试首次引入村庄时，妇女们并不感兴趣，尽管它是免费的。
“每当我们过去去他们家时，他们都会关上门。他们会说，‘不，我们不要 [它]。 “你走开。”
帕蒂尔说，许多女性发现检查很麻烦。她们羞于接受阴道检查，为什么呢？她们认为癌症是无法治愈的。
印度是一个高科技和低科技解决方案并存的国家，帕蒂尔派出卫生工作者，带着装有 PowerPoint 演示文稿的电脑。他们在镇上张贴海报，表演戏剧。他们在学校与学生和村领导交谈。
帕蒂尔说，尽管如此，妇女们还是不会来。
“穆斯林女士永远不会来，因为这是她们的文化，”她说。“即使是印度女士，她们也很害羞。所以我们首先做的是任命一名全女性工作人员。”
工作人员接受了意识培训。他们被教导不仅要检测宫颈癌，还要检测高血压、牙齿问题、糖尿病和其他女性担心的疾病。男性也被邀请参加其他筛查——男性对该计划的支持是女性的一个关键因素。
所有这些都让女性走进了大门。然后，态度的改变只是时间问题了。
积极的结果
帕蒂尔说，当女性们看到其他女性真的战胜了癌症时，她们会感到很不一样。
“现在她们看到了结果，因为如果癌症在早期被发现，患者会恢复得很好，”她说。“人们来找我们，告诉我们，‘请为我们的女士们安排一个癌症筛查营。’但这花了八年时间。这太难了。”
显然，这八年得到了回报。
回到临时检测诊所，索贾塔·桑杰·卡普里尔说她很高兴接受了筛查。她的测试结果是阴性，但她说，如果发现异常，“那么我们就可以治愈它。”
现在，醋法已被几个国家采用，还有另一种更昂贵的宫颈癌检测方法，有人说，这种方法最终可能会被证明更好。
这些测试每年可以挽救印度数万名女性的生命——只要女性继续被说服使用它们。
本报道是 PRI 制作的五集系列报道中的第三集，由普利策危机报道中心提供支持。12 月 10 日那周，PBS N
ewsHour 每天会发布一个系列故事。您可以在 PRI 网站上查看整个系列，也可以在此处查看故事中的其他信息图。
相关内容
第一部分：癌症的新战场：发展中国家
第二部分：在治疗稀缺的地方与乳腺癌共存
In India, A Secret Weapon Against Cancer: Vinegar
https://www.pbs.org/newshour/health/in-india-a-secret-weapon-against-cancer-vinegar
Health
Cervical cancer used to kill more women in the United States than any other cancer. Today, deaths in the U.S. are almost unheard of thanks to a decades-old test called a Pap smear, which allows for early detection and treatment.
In India, however, tens of thousands of women still die each year from cervical cancer.
“It's just not possible for us to provide [the Pap test] as frequently as it is done in the West,” says Dr. Surendra Shastri, a cancer specialist at Tata Memorial Hospital in Mumbai.
The Pap test requires trained personnel and well-equipped labs, which many parts of India do not have.
“So what do we do?” Shastri asks. “We can't let the women die.”
It turns out there may be a simple answer. It's a cheap and easy test developed by scientists at Johns Hopkins University and other institutions. And it relies on something you probably have in your kitchen.
Acid Test
I came to the village of Dervan in the Indian state of Maharashtra to see how the test works.
Doctors had set up a temporary clinic in the shell of an empty store. A sheet hung from the ceiling to provide some privacy. There was no electricity — not even a light bulb — in the storefront.
About a dozen Muslim women in headscarves had come for the test. One was on the exam table, her long brown skirt pushed aside. With her friends sitting nearby, she looked calm and ready.
Dr. Archana Saunke took a cotton swab and applied a clear liquid to the woman's cervix.
“We wait for one minute, and we see if there is any patch — yellowish patch,” she explained.
If the liquid makes the normally pink cervix turn white or yellow, that means there are precancerous cells — cells that could become cancer.
Within a minute or two, the doctor had some good news for her patient.
“It's normal,” Saunke said. The woman smiled broadly.
When tests yield bad news and show precancerous cells, those can be removed on the spot with a squirt of liquid nitrogen. No return trip is needed.
So what is this clear liquid Dr. Saunke applied?
“Acetic acid,” she says. Common household vinegar.
Overcoming Resistance
The tests being done here are part of a trial program being run by Tata Memorial Hospital and Walawalkar Hospital, where Dr. Suvarna Patil is medical director.
Patil says when the vinegar test was first brought to the villages, women were not interested, even though it was free.
“Whenever we used to go to their houses, they used to shut the doors. They would say, ‘No, we don’t want [it]. You go away.'”
Patil says many women found testing a bother. They were embarrassed to have a vaginal exam, and for what? They didn’t think cancer could be treated.
India being a country of high- and low-tech solutions, Patil sent out health workers with computers loaded with PowerPoint presentations. They put up posters around town and performed plays. They talked to students in schools and to village leaders.
Still, Patil says, the women wouldn’t come.
“Muslim ladies, they will never come because it’s their culture,” she says. “Even Indian ladies, they are very shy. So first what we did is we appointed [an] all-female staff.”
The staff got awareness training. They were taught to test not just for cervical cancer, but also for high blood pressure, dental problems, diabetes, and other diseases women were worried about. Men were also invited for those other screenings — and male support for the program was a key factor for the women.
All that got women in the door. Then it was a matter of time for attitudes to change.
Positive Results
Patil says it made a big difference when women saw other women actually beat cancer.
“Now they are seeing the results, because if the cancer is picked up in early condition, the patient is doing well,” she says. “People are coming to us and telling us, ‘Please arrange a cancer screening camp for our ladies.’ But it took eight years. It was so difficult.”
It is evident that those eight years have paid off.
Back at the temporary testing clinic, Sojata Sanjay Kapril said she was happy she underwent the screening. Her test result was negative, but she said if an abnormality had been found, “then we can cure it.”
The vinegar technique has been adopted in several countries now, and there’s another more expensive test for cervical cancer that some say may eventually prove to be even better.
These tests could save the lives of tens of thousands of women in India each year–as long as women continue to be convinced to use them.
This story is the third in a five-part series produced by PRI and with the support of the Pulitzer Center on Crisis Reporting. The week of Dec. 10, the PBS NewsHour will post one story from the series per day. You can view the entire series on PRI’s website or view additional infographics from the stories here.
Related Content
This story is part of a series, Cancer's New Battleground: the Developing World. Above: Indian women participate in a women’s march in Mumbai on Monday. Photo by Roberto Schmidt/AFP/Getty Images.
