Friday, June 27, 2014

Cervical Cancer Screening in Haiti

Over the past two decades, numerous reports1-5 have promoted technological solutions to cervical cancer prevention in under resourced areas, i.e. HPV testing vs. cytology vs. visual inspection with acetic acid (VIA). Medicine For Peace has screened more than three thousand women at the Alma Mater Hospital and in rural dispensaries in the Gros Morne region in northwest Haiti. We have used the VIA (screen and treat) method, and have concluded that the success of a cancer screening program has less to do with the technology employed than with addressing systemic deficiencies in health care delivery, and in overcoming socio-economic obstacles resulting from deeply rooted poverty. We suggest a number of critical activities that can facilitate a successful cervical cancer screening campaign, and concurrently raise the level of health care delivery.

·    Educate continuously. There is a cohort of women who present for cancer screening immediately. However, the majority is recalcitrant, and will only respond to innovative, continuous cancer awareness education. We promote our cervical cancer screening before women’s groups, in churches, in the market, on the radio, and by public announcements in villages using a megaphone. The message is specifically directed to cervical cancer prevention, but broadly encourages women to take responsibility for their own health.

Intermittent education programs promoting periodic screening are inadequate in impoverished, high risk areas.

·    Build an infrastructure. Establishing a consultant referral network and providing transportation for patients to access that network are key components of a successful program. Skilled cyto-pathologists, radiologists, and cancer surgeons, all within travelling distance, should be incorporated into the program. When local expertise is needed, but not available, e.g. palliative care, we have assumed that responsibility.

Reliable transportation of patients and specimens is part of the infrastructure, and when patients are too ill to take public transportation, we provide them access to the hospital ambulance. Funds are budgeted in the screening program to pay for transportation, tests, consultations, medication, and surgery.

In order to minimize the number of patients lost to follow-up, we have developed a computer-based tracking system so that we aware of the dates of patient return visits, as well as pending laboratory results, and consultation reports.

·    Promote women’s health, not just cervical cancer prevention. In addition to colposcopy, a medical history, a complete physical examination, and screening for STI’s are performed. All patients with STI’s are treated immediately, and patients are referred to specialists when necessary. The screening visit is an opportunity to educate women on leading a healthy life style, also. To insure a high level of care, it is important to develop a working clinic manual containing a set of screening and treatment algorithms that are understood and agreed upon by all physicians and nurses working in the program.

·    Don’t presume you are saving lives: keep statistics. We maintain patient data on spreadsheets to assess disease incidence, complication rates (after cryosurgery), and patient compliance and follow-up. The database is shared with the hospital’s AIDS program so all HIV+ women are scheduled for periodic colposcopic exams. We periodically biopsy aceto-white lesions before cryosurgery to confirm our clinical diagnoses are correct. All new patient charts are reviewed by a senior staff member every three months. Since most rural health facilites do not have rigorous quality control, a well designed and implemented cancer screening program is an opportunity to encourage other health providers and hospital administrators to institute hospital wide quality assurance measures.

In summary, a successful cervical cancer screening program should not only lower cancer incidence rates, but bring large numbers of women into the health care system and improve the level of health care they receive.

We declare that we have no competing interests.

Michael V. Viola, Clarice Carroll

Medicine For Peace, Washington, DC, 20015, and Alma Mater Hospital, Gros Morne, Haiti

  1. Ferlay J, Shin HR, Bray F, et al. Estimates of world wide burden of cancer in 2008:GLOBOCAN 2008. Int J Cancer 2010: 127:2893-2917.
  1. Sankaranarayanan R, Esmy, PO, Rajkumar R, et al. Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomized trial. Lancet 2007: 370: 398-406.
  1. Burns A, Sanghvi H, Lu R, et al. Saving women’s lives from cervical cancer. Lancet 2011: 377:1318.
  1. Sankaranarayanan R, Neme BM, Shastri SS, et al. HPV screening for cervical cancer in rural India. N Engl J Med 2009; 360: 1385-1394
  1. Goldie S, Gaffican L, Goldhaber-Fiebert J, et al. Cost effectiveness of cervical cancer screening in five developing countries. N Eng J Med 2005; 353: 2158- 2168.

Wednesday, June 4, 2014

MFP Volunteer Receives Prestigious Award

Judy English, RN, MSN, examining a child in the Hurria clinic in Baghdad

Judith English, RN, MSN, a Medicine For Peace volunteer, has been awarded the prestigious 2014 Carole DeMille Achievement Award given to a health professional working in infection control who best exemplifies the ideals of Carole DeMille, a pioneer in the field. The award will be presented later this month at the annual meeting of the Association for Professionals in Infection Control and Epidemiology. She is being recognized for her contributions in the fields of infection prevention, bioterrorism, and disaster preparedness and response.  She is currently an infection prevention consultant for the U.S. Navy Bureau of Medicine and Surgery.

Judy English, far right, with members of the Women's Association of Kozarac, Bosnia

Judy has been a loyal supporter, and provided valuable assistance to MFP’s efforts in Iraq and Bosnia. She helped conduct MFP’s childhood nutrition study in the Hurria district of Baghdad following the first Gulf War. In addition, she was part of the MFP team sent to Bosnia to help survivors of the ethnic cleansing of the town of Kozarac during the Bosnian War. She was a tireless and compassionate colleague on both missions.

The Board of MFP joins with all of our volunteers to congratulate Judy on receiving this well deserved award.

Thursday, April 24, 2014

New MFP Board Members

Karen Hanscom
Karen Hansom, PhD.

Karen Hanscom, PhD. and William Schaffner, M.D. were recently appointed to Medicine For Peace’s Advisory Board, and Executive Board, respectively.

Dr. Karen Hanscom is one of the founders and is the current Executive Director of Advocates for Survivors of Torture and Trauma (ASTT), a human services organization in Baltimore and Washington, DC. The mission of ASTT is to relieve the suffering of individuals who have experienced torture in other countries, and to educate the local, national and world community about the needs of torture survivors. She is a leader in the world-wide campaign to abolish State-sponsored torture. After receiving a Doctorate in Psychology, Dr. Hanscom worked with the Guatemala Human Rights Commission training elders to recognize and treat post-traumatic stress syndrome, for which she received the International Humanitarian Award of the American Psychology Association. In 2005, she was the recipient of the Maryland Psychology Association’s Outstanding Service to the Public Award. Dr. Hanscom is also an Adjunct Professor at the Georgetown Law School
William Schaffner
William Schaffner, M.D.

Dr. William Schaffner is Professor of Medicine and Health Policy, and past- Chairman of the Department of Preventative Medicine at Vanderbilt School of Medicine. He is an international expert on many aspects of infectious diseases, including epidemiology, infection control and immunization. Dr. Schaffner has worked extensively on the effective use of vaccines in both pediatric and adult populations.

Dr. Schaffner has authored or co-authored more than 400 published studies, reviews and book chapters on infectious diseases. He is the immediate past-president of the National Foundation for Infectious Diseases, and he serves on the editorial board of a number of scientific journals, including Journal of Infectious Diseases, Vaccine and the CDC’s Morbidity and Mortality Weekly Report. Dr. Schaffner is the recipient of numerous awards, including the James D. Bruce Award from the American College of Physicians for “distinguished contributions to preventive medicine”.