Gondar, Ethiopia October 2014

CERVICAL CANCER PREVENTION USING A SINGLE VISIT APPROACH (SVA)

Go Doc Go’s first project launched October 2014. Dr. Maggie Carpenter and Ingrid Frengle-Burke, FNP traveled to Gondar, Ethiopia with over $10,000 in equipment and training materials. The University Hospital in Gondar services a 5 million person catchment area. Despite having extensive HIV/AIDS services and a multitude of international organizations providing medical assistance, there were no programs to combat cervical cancer, a disease that currently kills more women in Ethiopia than childbirth. While the introduction of pap smears in the developed world during the mid-20th century has brought the incidence of cervical cancer to near zero, the pap smear is too cost-prohibitive for low and middle income countries. The goal for this project was to teach providers visual inspection with acetic acid (VIA) as an alternative to pap smears and to train them in treating abnormalities using the equipment provided. In this way our program would be sustainable as the local providers continued on with the work on their own.

Maggie and Ingrid were warmly greeted by the physicans and nurses under the guidance of Dr. Genet Gebremedhin and Dr. Mulat Adefris. Thanks to their dedication and organization the week of training was most productive. Over the course of the week we trained 18 providers in both screening and treatment. Screening is recommended for all women between the ages of 30-45 every 5 years as long as their exam is normal. When the exam reveals an abnormality women are treated with either cryotherapy or LEEP. Ideally this is done the same day or the next day, thus the single visit approach. Studies have shown this to be the most effective way to screen women as many are traveling and a delay in treatment would mean that they never receive the proper care.

Go Doc GoOne of the first women screened during our training session had traveled from almost 400 miles away. At 45 it was unlikely that she would ever have this opportunity again. On exam she was found to have a small area that looked like early precancerous changes. The next day she returned and was the first woman in Gondar to receive cryotherapy on her cervix. Had she not been screened by our team it is likely she would have developed cervical cancer within the next 5-10 years at which point it would be too late for treatment.

During the week we screened 10 women and performed one cryotherapy and one LEEP. The providers were all observed doing VIA and the two lead physicians performed the procedures under our guidance. They were also instructed in the care and maintenance of the equipment. A number of other organizations have trained providers in other areas of Ethiopia in these procedures and they all have the same machines which should help with dealing with any technical difficulties.
An American Ob/Gyn, Kristen Austin, had recently arrived in Gondar and will be there for the next year. She has extensive experience in using the equipment and is able to continue the training and screening program in our absence.

In the month since our training almost 100 women have been screened and approximately 10% have required treatment. Among the trainees were nurses who will be recording the statistics and tracking these women. Our collaborators at the University of Ohio will be traveling to Gondar in March and will use these statistics for ongoing research.

This project would not have been as successful without the sincere commitment of the Ob/Gyn department at the University of Gondar Hospital. They were clearly prepared and understood the impact this program would have on their community.