Deborah Nantenza learned about cervical cancer screening at a hospital in eastern Uganda, a rural region where early diagnosis is rare. She knew women who had died of the disease yet feared being tested. "The health workers encouraged me," Nantenza says.
Clinical staff found precancerous cervical cells during that June 2022 clinic screening, and the 46-year-old mother of six was quickly treated. "I'm feeling better," says Nantenza, who now advocates for other women, many never screened before.
The cancer screening, education and treatment were led by a hospice — an institution traditionally limited to easing the pain of the dying.
The team at Rays of Hope Hospice Jinja in Uganda had long wanted to do more. Even with liquid morphine and other pain medications the hospice provided to ease symptoms, women with cervical cancer "didn't just die a normal death. They died after suffering, suffering," says Sylvia Nakami, executive director of the 20-year-old nonprofit.
So back in 2018, they expanded beyond such end-of-life care into prevention, offering cervical and breast cancer exams in the mostly rural Busoga region. Since then, the hospice has conducted nearly 29,000 screenings.
Staff clinical workers also provide on-site treatments for precancerous cervical lesions and educate communities about the HPV vaccine, which protects against cervical cancer, countering myths about infertility.
And in a project launched in 2023, Rays of Hope has helped the district health department bring HPV vaccinations to more than 47,000 girls.
"There is something we can do about it. And it gives us hope," says Nakami, adding that staff members no longer witness just "one exit: death."
The hospice's unusual prevention initiative marks an emerging paradigm shift elsewhere in palliative care, supporting wider cancer screening, prevention education and oncology referrals in Africa, India and other places.
Cervical cancer in particular remains a stubborn killer — with 350,000 deaths worldwide each year and 4,600 annually in Uganda, making it the country's top cause of cancer deaths, according to the HPV Information Centre. With such losses, Nakami and her staff were desperate to save women's lives — a concern shared in regions hardest hit by the disease, especially sub-Saharan Africa.
How it began
Back in 2017, Nakami and her team dug into their data for about 700 patients, finding that more than 60% of cancer cases among women were cervical or breast cancer. They knew both could usually be treated successfully if detected early. So they focused their prevention efforts there, screening 12,782 women for breast cancer and 16,003 women for cervical cancer by the end of 2025 while also offering hospice and palliative care to patients with HIV and other diseases.
When the hospice launched its prevention work, some in Africa's palliative care community "were a bit uncomfortable with our new strategy," says Nakami, noting worries that "we were abandoning palliative care." Instead, they've doubled the number of hospice and palliative care patients from about 750 in 2018, expanding staff from 16 that year to 34 by 2025 due to growing regional needs. Overall in 2025, Rays of Hope team members made 8,844 visits with their patients.
The hospice's first mass screening in 2019 meanwhile lasted a few days and drew almost 700 women, says Nakami. Fewer than one in 20 had been screened for cervical cancer before.
"This is something that is doable, and it puts a very significant dent in the occurrence of cervical cancer before it develops into something very serious for the women and for the health system," says Emmanuel Luyirika, recently retired executive director of the African Palliative Care Association (APCA), which recommends screening and HPV vaccination support to its more than 500 members across 52 African countries.
A need for more money
Prevention efforts like these take money. To cover its $600,000 annual operational budget and any expansions, Rays of Hope relies on donors, including private individuals and U.S. and Danish fundraising organizations. But the need continues to grow, and this is not an opportune time to seek support. Global health funding plummeted by an estimated $10.5 billion (a 21% decline) between 2024 and 2025, according to the Institute for Health Metrics and Evaluation. That's also put pressure on NGOs and nonprofits trying to fill health care gaps, especially in nations like Uganda, which has ranked first in Africa in palliative care efforts.
Last year, Rays of Hope witnessed a particular surge in patients, including some with advanced HIV/AIDS cases following funding cuts, says Margrethe Juncker, a Danish physician and hospice doctor. By August, the number of hospice patients treated regularly already passed the 1,300 assisted in 2024. The 2025 total exceeded 1,500, with USAID-funded HIV clinics closing doors, amidst other losses. "We will have to raise more funds," Juncker says, "because there will be more people sick."
That traditional hospice and palliative care work in symptom relief remains critical.
Deborah Nanyonga, a 35-year-old widow with seven children, is battling advanced cervical cancer and HIV. She relies on Rays of Hope for help with food, pain medications and social support.
On good days, Nanyonga works washing clothes, making about $2. On bad days, she says she hurts so much she can barely move.
With no family support, she cannot afford to travel to the Uganda Cancer Institute in Kampala, several hours away, says Joanita Mbabazi, Rays of Hope's clinical coordinator. Team workers visit Nanyonga monthly, bringing 3 kilos of rice, 2 kilos of beans, 1 kilo of sugar and a bar of soap.
Sitting beside her son, Prosper, 9, and daughter, Jovia, 5, Nanyonga says she's grateful for the assistance. Though nothing can stop her worries, especially about her girls since females face greater risks for socioeconomic and health threats, including gender-based violence. "May God help me," she says, "that when I leave this earth, my girls are in school."
Expanding prevention
Hospices that also provide cancer prevention programs appear relatively few so far, partly due to funding limitations. One progressive model is Island Hospice and Healthcare in Zimbabwe, known as Africa's first hospice, founded in 1979.
Across much of Africa, patients are referred for cancer care late — sometimes with Stage 3 or Stage 4 cancer. "We thought we needed to be involved from the start," says Elias Masendu, the hospice's program manager. "If we teach people how to prevent it, there will be less demand for palliative care. It was an eye opener."
About a decade ago, Island Hospice began offering services such as breast cancer screening. In October, health workers screened more than 300 women during Pinktober. Island partly funds prevention and other programs by charging fees for external services such as its private nursing agency, Masendu explains.
Research on innovations by palliative care groups is drawing interest elsewhere, including rural India. In Assam state, a 2025 study co-led by the Tata Cancer Care Foundation, health workers visited more than 2,000 households — screening, counseling for diagnostics and facilitating some care. Researchers found that visits have the potential to deliver effective cancer control strategies.
Rays of Hope, with academic colleagues, is pursuing its own research, showing that insufficient rural health care and other factors are fueling the advanced breast cancer and cervical cancer cases.
"They are able to reach more patients," Luyirika says of Rays of Hope, urging similar models. "We are operating in the context of limited resources," he adds. "There is need."
There's also hope that those who benefit from new prevention services will serve as a grassroots promotional effort, with peer advocacy already showing results.
That's how Deborah Nantenza has responded to her diagnosis, as well as the thermal-coagulation treatment, which uses heat to remove the lesion, and medications.
Nantenza had a follow-up screening last summer: No cancer. She now tells her story to two to three women weekly, with a sense of confidence that encourages them to act.
She says: "I found that at least you'd rather get treated than get cancer."
This story was supported by the Pulitzer Center.
Joanne Cavanaugh Simpson, MFA, is a two-time Pulitzer Center grantee and adviser. Her work has appeared in The Washington Post, Miami Herald and Scientific American, among other venues.
Brian W. Simpson, MPH, is editor in chief of Global Health NOW, a Pulitzer Center grantee, and a freelance journalist whose articles have appeared in NPR, Smithsonian and other venues.
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