“Some people in the deep rural areas don’t believe that there is cervical cancer and that it can affect them,” says Mabohlokoa Selemele (31), a “Mentor Mother” at mothers2mothers (m2m) in Lesotho. Mentor Mothers are trained and employed by m2m as community health workers, and travel to remote areas equipped with basic yet effective diagnostic tools, allowing women to get screened without traveling long distances.
“Some believe it is a myth, and there are a lot of misconceptions that prevent people from seeking medical help,” she adds.
Through her work with m2m, Selemele traverses mountainous terrain to reach rural communities with little to no close access to health facilities. She educates women and adolescents about cervical cancer, highlighting the importance of screening, early detection, and treatment.
Her day-to-day efforts include home visits, during which she can see up to 13 households, and working at Mafikeng Hospital, where she interacts with 25 to 30 women daily. At the hospital, she also educates adolescents on the importance of the human papillomavirus (HPV) vaccine, which can prevent cervical cancer.
When detected early, cervical cancer is among the most preventable and treatable forms of cancer. Yet, it continues to claim lives and devastate families, particularly in low-resource settings like Lesotho.
This mountainous nation in Southern Africa faces significant barriers in the fight against cervical cancer, from limited healthcare access and cultural stigmas to a high prevalence of risk factors such as HIV. These challenges exacerbate the disease burden that is largely avoidable with timely intervention.
Despite these hurdles, organizations like m2m are working to educate communities, provide screenings, and ensure women can access lifesaving care.
Mabohlokoa Selemela is photographed during a home visit with a client in Maseru, Lesotho, on Nov. 6, 2024.
Challenges in Lesotho’s Fight Against Cervical Cancer
In Lesotho, over 771,897 women aged 15 and older are at risk of developing cervical cancer. Each year, an estimated 541 women are diagnosed with the disease, and 362 lose their lives to it.
“It is not easy for people to screen because most say they are healthy and don’t see the need to screen. So relationship building is important until we get them to a point of screening,” says Selemele.
Her insight underscores the importance of education, trust, and proactive efforts to encourage lifesaving screening and prevention.
In Lesotho, poor road infrastructure creates significant barriers for residents and healthcare workers trying to access healthcare facilities. This geographical isolation, coupled with low literacy rates and limited health education, leaves rural women particularly vulnerable to cervical cancer and often unaware of the benefits of HPV vaccination.
Mentor Mothers have creatively met this challenge, using motorbikes, horses, boats, and even helicopters when available to reach remote communities. “In this line of work, I have learned to value shepherds so much that they have become my best friends. They help us to cross the river with our medical supplies on a pumped [air] mattress. They sometimes walk us along the path so that we feel safe,” Selemele explains.
Mothers2Mothers
Exterior of St Joseph's Health Centre, Koro Koro, Maseru, Lesotho on Nov. 6, 2024.
Mothers2Mothers
Maqenehelo Mphunyetsane prepares the necessary equipment for a cervical cancer screening procedure at the St Joseph's Health Centre in Koro Koro, Maseru, Lesotho, on Nov. 6, 2024.
Mothers2Mothers
Maqenehelo Mphunyetsane presents VIA results to her client regarding a cervical cancer screening at the St Joseph's Health Centre in Koro Koro, Maseru, Lesotho on Nov. 6, 2024.
Maqenehelo Mphunyetsane, a m2m maternal and child health nurse, highlights another barrier: fear and misinformation. “There are a lot of perceptions on cervical cancer and HPV. Most believe it is due to sexual exposure and bad behavior. Some people believe that screening and testing are only for HIV-positive people. That is where we come in and give the correct information and why it is important to screen and test,” Mphunyetsane adds.
She also notes that demonstrating the instruments used during screenings has been a game-changer. “When we show the people what we use and how we use it, it calms them down. They are now more open to doing the screening and asking questions,” she says.
These innovative strategies and community-centered approaches have led to better cervical cancer prevention and care.
Understanding Cervical Cancer and HPV
Cervical cancer develops in the cells of the cervix, the lower part of the uterus that connects to the vagina. Almost all cases are caused by persistent infections with certain high-risk types of HPV, a common sexually transmitted infection.
While most HPV infections clear up on their own, persistent infections with high-risk types can lead to abnormalities in cervical cells that may develop into cancer over time. While HPV affects both men and women, cervical cancer disproportionately impacts women, particularly those without access to preventative care. “Without regular screening and early detection,” Mphunyetsane says, “many women in Lesotho only discover they have cervical cancer when it has reached advanced stages, making treatment more difficult and less effective.”
In 2022, the Ministry of Health in Lesetho launched a huge nationwide campaign calling for screening and vaccination for cervical cancer and HPV. m2m was one of the stakeholders involved in this campaign and contributed significantly to the number of adolescents who were vaccinated.
As of August 2024, Lesotho has made significant strides in preventing cervical cancer, achieving 93% HPV vaccination coverage among girls ages 9 to 14, with more than 139,000 girls vaccinated. This surpasses the 90% target set for the campaign and the 91% coverage achieved in a previous campaign that was halted in 2015.
Maqenehelo Mphunyetsane, a m2m MCH Nurse, prepares the HPV vaccine for girls between the ages of 9 and 14 yrs at the St Joseph's Health Centre, Koro Koro, Maseru Lesotho, on Nov. 6, 2024.
“We go to schools and make sure those that are eligible for the HPV vaccine get it,” says Mphunyetsane. “There is also still a huge challenge with the learners because they don’t see the need, but with information sharing and highlighting the benefits, more and more learners are open to taking the vaccine.”
mothers2mothers: A Mission of Hope
mothers2mothers (m2m) was established in 2001 in South Africa during the height of the HIV epidemic. At that time, stigma and a lack of knowledge prevented many people from accessing the care they desperately needed.
The organization pioneered a community-based model, employing and training local women as Mentor Mothers. These mothers work hand-in-hand with doctors and nurses at health facilities to provide care, guidance, and support for individuals living with HIV, ensuring they stay on treatment and receive the care they need.
Over two decades later, m2m has expanded its reach to hundreds of health centers and communities across ten African countries, impacting the lives of over 16 million pregnant women, new mothers, children, adolescents, and families and keeping more than 3 million at-risk women and children alive. In 2023, m2m also reached a major milestone, achieving virtual elimination of HIV transmission from mother to baby among its enrolled clients and with the support of its partners.
While HIV prevention, care, and treatment remain core to its mission, the organization has expanded its focus to offer holistic healthcare services, including screening for non-communicable diseases, tuberculosis, and malaria. In Lesotho, where m2m began operations in 2007, cervical cancer prevention has become a key part of their work. The organization aims to be a “one-stop shop” for health services, particularly for those who struggle to access traditional health facilities.
Doctor Leseli Letsatsi poses for a portrait in the mothers2mothers offices in Maseru, Lesotho, on Nov. 6, 2024.
Dr. Leseli Letsatsi, technical project director for m2m in Lesotho, emphasizes the importance of their approach. “If we can screen for most [diseases] just in one sitting, it will be a win. We aim to provide user-friendly services, and this is where Mentor Mothers play a critical role,” she says.
Dr. Letsatsi also highlights the challenges of addressing cervical cancer in Lesotho. “Cervical cancer screening is a crucial step in early detection, but access to screening facilities is scarce in the lowlands. We conduct regular vaccination drives in rural schools, targeting girls before they reach an age where they might be exposed to HPV. However, the logistical challenges are substantial: rural schools are often hard to reach, and some communities are spread out over vast distances,” she explains.
Cervical cancer and HPV continue to pose significant challenges for women in Lesotho, but the efforts of organizations like m2m are making a tangible difference. Follow them to learn more about how education, accessible screening, timely treatment, and dedicated health workers are saving lives — every day.
Young girls walk away from the St Joseph's Health Centre in Koro Koro, Maseru, Lesotho on Nov. 6, 2024.
Editor’s Note: This article is part of a content series that was made possible with funding from the Bill and Melinda Gates Foundation.