Testing for cervical cancer with vinegar
Smear tests to check for abnormal cells that lead to cervical cancer are expensive and require specialist equipment. So doctors in India are trying a different method - vinegar swabs.
Cervical cancer used to kill more women in the United States than any other cancer. Today, deaths in the US 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 don't 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 many people have in their kitchen.
In the village of Dervan in the state of Maharashtra, doctors have set up a temporary clinic in the shell of an empty store. A sheet hangs from the ceiling to provide some privacy. There is no electricity - not even a light bulb - in the storefront.
About a dozen Muslim women in headscarves have come for the test. One is on the exam table, her long brown skirt pushed aside. With her friends sitting nearby, she looks calm and ready.
Dr Archana Saunke takes a cotton swab and applies a clear liquid to the woman's cervix.
"We wait for one minute, and we see if there is any yellowish patch," she explains.
If the liquid makes the normally pink cervix turn white or yellow, that means there are pre-cancerous cells - cells that could become cancer.
Within a minute or two, the doctor has good news for her patient.
"It's normal," Saunke says. The woman smiles broadly.
When tests yield bad news and show abnormal cells, these can be removed on the spot with a squirt of liquid nitrogen. No return trip is needed.
So what is this clear liquid Saunke uses? Acetic acid, or common household vinegar.
These tests being done as part of a trial programme run by Mumbai's Tata Memorial Hospital and Walawalkar Hospital in Dervan, 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.'"
Many women found testing a bother, says Patil, and were embarrassed to have a vaginal exam. And for what? They assumed cancer couldn't be treated.
India being a country of hi- 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 we appointed 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 programme 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.
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 years have paid off.
Back at the temporary testing clinic, Sojata Sanjay Kapril says she's happy she underwent the screening. Her test result was negative, but 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 many thousands of women in India each year - as long as they continue to be convinced to use them.