More than 600 women received screening for cervical cancer during a week-long training delegation held earlier this month at St. Luc’s Manitane clinic, an affiliate of St. Damien’s Hospital and long-time partner of Direct Relief in Port-au-Prince, Haiti.
Cervical cancer claims the lives of 270,000 women annually and 85 percent of these deaths occur in low-resource settings, says the World Health Organization. Almost all of these deaths are preventable with screening and early detection; however, in countries like Haiti, competing financial resources; insufficient health infrastructure; and a limited number of trained providers make screening extremely challenging.
Dr. Rachel Masch from nonprofit Basic Health International (BHI) headed this initiative, bringing a team of volunteer obstetrician/gynecologists and support staff to train St. Luc and St. Damien staff in visual inspection with acetic acid (VIA). The VIA procedure is a low-cost and safe alternative for cervical cancer screening in settings where Pap smears cannot be implemented effectively.
The VIA procedure is simple. The healthcare provider simply swabs vinegar, i.e. acetic acid, on the cervix and looks for areas that change color. Normal cervical tissue remains unaffected by the acetic acid, but abnormal tissue—such as that found in pre-cancerous or cancerous lesions—turns white. The provider can then immediately remove the damaged tissue on the spot using cryotherapy, an 11 minute procedure that freezes the abnormal cervical tissue and usually only causes some mild cramping.
Women who receive treatment are able to carry on with their lives with minimal disruption immediately after their visit. VIA is an appropriate cervical cancer screening method for use in low-resource settings where Pap smears and HPV tests are inaccessible due to lack of infrastructure or high per-test cost. VIA has an advantage for traditionally underserved patients who may have difficulty coming in for follow-up care. Since screening and treatment are done at the same visit, there is no need to wait for results and then return to the doctor.
Training eight members of the St. Luc/St. Damien staff began with a pre-test to assess their current knowledge base, followed by a morning of didactic training by Dr. Masch, cryotherapy practice, and, finally, role playing with the BHI volunteer physicians. The eight trainees—three obstetricians, two general physicians, and three midwives—were then ready for hands-on training at St. Luc Manitane clinic.
Trainees were paired with BHI volunteer physicians, and together the teams screened patients from the local community—many of whom were receiving cervical cancer screening for the very first time. Over the course of the one-week training delegation, 608 women were screened for cervical cancer. At the end of the week, the trainees took a post-training test and received their certificates of completion.
Two additional training delegations will take place later in the year with the objective of training an additional 16 to 20 local health providers in Haiti.
Direct Relief is providing funding, medicines, and medical equipment to support the program. Direct Relief is especially grateful to Wallach Surgical for the essential donation of cryoguns and associated accessories, making it possible for 61 women to receive cryotherapy treatment in this initial effort. An additional 17 women will receive treatment in the coming weeks by the newly trained providers.