Dr Nicole Fiolet leads the charge against cervical cancer and diabetes in rural Mpumalanga
Cervical cancer is the second most common cancer among South African women. Every year in South Africa, approximately 10,700 women are diagnosed with cervical cancer, and around 5,870 die from it. Yet in many rural areas, screening rates remain dangerously low. In rural areas, women often travel hours, sometimes changing taxis three times, only to find the clinic closed or without the equipment needed for basic tests. For preventable and treatable conditions like cervical cancer and diabetes, these delays can mean the difference between life and death.
It is in this reality that Dr Nicole Fiolet, a Dutch-trained doctor specialising in maternal and child health, has rooted her work. Arriving at Tintswalo Hospital, in Acornhoek, Mpumalanga as a Tshemba Foundation volunteer, she found that pap smear services had completely stopped during COVID-19, leaving years of missed diagnoses. What began as an effort to restart screening quickly evolved into building one of the province’s few dedicated women’s clinics.
In her first month at the HIV clinic, she was training a nurse and they manage to screen 134 women. More than half had abnormal results. Many of them faced months-long waits for treatment because the hospital could only manage one or two procedures a week, often cancelled to make way for emergency C-sections.
To address this backlog, Dr Fiolet and the Obstetrics and Gynaecology team established a LLETZ clinic (A specialised service clinic where women undergo the Large Loop Excision of the Transformation Zone procedure to remove abnormal cervical cells and prevent cervical cancer), which cut the treatment pathway from three separate visits and a three-day hospital admission to a single 30-minute outpatient procedure. The clinic became a dedicated space where women could access family planning, breast and cervical cancer screening, gynaecology ultrasounds and care, and one of the province’s only termination of pregnancy services. In its first year, 145 women were treated, preventing an estimated 75 future cervical cancer deaths and enabling early-stage cancer treatment for others.
But improving access to care meant tackling more than just hospital systems. Many women in rural Mpumalanga were still arriving late for screening, or not at all, because of the long journeys, stigma around women’s health, and lack of knowledge about available services. Dr Fiolet and her team began running community workshops in schools, shopping malls, and clinics, speaking openly about prevention and treatment options.
Once the women’s health programme was firmly established, Dr Fiolet turned her focus to another urgent threat: diabetes. The shift came after a patient with gestational diabetes lost her baby due to a late diagnosis. “When reading about gestational diabetes in South Africa, I realised the number one killer of South African women is diabetes!” she said.
She now leads a multidisciplinary diabetes clinic that combines screening, patient education, nutritional counselling, and advanced wound and ophthalmology support. Nurses and community health workers are trained in glucometer use, and educational booklets help patients manage their condition at home. The programme also works with traditional healers to encourage early detection and referral. But resource shortages remain a major challenge. For months, Mpumalanga had no glucose strips, preventing clinics from screening for diabetes and leaving insulin-dependent patients unable to monitor their blood sugar.
While diabetes affects more men globally, women are often diagnosed later and with more comorbidities such as obesity and cardiovascular disease. Hormonal changes during menopause, weight gain, and the pressures of prioritising family needs over personal health make treatment more complex. In rural areas, the difficulty of travelling to specialist care means many women go without it altogether.
For Dr Fiolet, building trust is as important as building clinics. She and other volunteers spend time in communities, running Q&A forums alongside sangomas (traditional healers) and working with “medical communicators,” unemployed nurse assistants who help bridge language and cultural gaps while taking health knowledge back to their communities. Respecting local beliefs, she says, is crucial to breaking down fear and stigma.
Her vision for the future is one where rural women have the same access to healthcare as their urban counterparts. This would mean more resources dedicated to rural health, practical improvements to referral systems, and better integration of community health workers into formal healthcare teams. Education campaigns that normalise screening for both women’s health and chronic diseases are also essential.
“Prevention is key,” she says.