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PHASE Cervical Cancer Screening in Nepal

 

PHASE has a cervical cancer screening partnership with the Nepal Network for Cancer Treatment and Research (NNCTR). 

 

In 2002, NNCTR began introducing mass screening for cervical cancer in Nepal, in collaboration with the World Health Organisation (WHO) and the International Agency of Research on Cancer (IARC). To date over 20,000 women have been screened.

However, the management of screen positive patients was problematic as colposcopy services were poorly developed and many patients were subjected to over-treatment. A Memorandum of Understanding was therefore agreed between PHASE’s colposcopy group and NNCTR to develop cervical cancer services and training in Nepal.

Our colposcopy group is a collaboration of colposcopists from the UK working voluntarily with the NNCTR, which involves travelling to Nepal to provide training to PHASE’s Nepalese health staff.

The context of cervical cancer in Nepal

According to WHO, cervical cancer is the most frequent occurring type of cancer among women in Nepal. The disease is preventable by screening.

Screening programmes require a coordinated effort from screening camps, to colposcopy (treatment of women who are screen positive), to pathological interpretation of tissue that is removed from the cervix. A reduction in the death rates from cervical cancer in Nepal will only happen when all aspects of the process are addressed with on-going training, mentoring and quality assurance through audit.

The government of Nepal agreed to a national cervical screening programme with the aim of reducing deaths from cervical cancer. The goal was to screen 50% of women in Nepal by 2014.

Who are our colposcopy group?

Our colposcopy team are a group of doctors and nurse colposcopists who provide a colposcopy service within the UK National Health Service, and Gerda Pohl – a PHASE Trustee and our Medical Coordinator based in Kathmandu.

  • David Nunns: Chair of the group, a PHASE Trustee, Consultant Gynaecological Oncologist, Nottingham City Hospital
  • Rafiat Adekunle: Consultant Gynaecologist, Dewsbury Hospital
  • David Fenton: Retired Consultant Gynaecologist
  • Sherryl Goodhall: Nurse Colposcopist, Royal Shrewsbury Hospital
  • Esther Moss: Consultant Gynaecological Oncologist, Leicester Royal Infirmary
  • Jane Panikker: Consultant Gynaecologist, Royal Shrewsbury Hospital
  • Beth Devonald: Retired Colposcopist
  • Chris Ang: Consultant Gynaecological Oncologist, Gateshead

For further information please contact dnunns@ntlworld.com.

david-n-with-thermo-981x661Dr. David Nunns with members of our Nepalese health staff and the thermocoagulator.

What are the colposcopy group’s aims?

1. To develop a sustainable, high quality colposcopy service to the women of the Kathmandu valley referred following screening from camps organised by the NNCTR and the local clinicians.

2. To strengthen existing services through training and education.

3. To develop a pool of high quality, well trained colposcopists in Nepal.

4. Enable advocacy for fighting cervical cancer at a local and national, governmental level.

5. To help develop the vision of a population based cervical screening programme with the aim of reducing cervical cancer death rates.

What have they achieved?

1. In November 2014, a thermocoagulator was transported to Nepal through PHASE Worldwide’s funding. This medical equipment provides vital treatment for women suffering from cervical cancer living in remote communities who have little access to hospitals.

2. Two weekly fully functional colposcopy clinics at the Maternity Hospital in Kathmandu, offering diagnosis and treatment to those who have been referred from the regional screening programmes.

3. Three 3-day colposcopy workshops with lectures and hands-on training for Nepalese gynaecologists.

4. Four exchange visits to the UK of six senior Nepalese doctors and two Nepali nurses to train in colposcopy.

5. An increase in the number of colposcopists working in the country.

6. Advocacy for a cervical screening programme in the country.

7. One 2-day workshop for pathologists in cervical pathology attended by 25% of the countries’ pathologists.

8. Funding from the UKAID programme for a two year project to train more colpscopists and pathologists.

9. The latest screening training was carried out in Nepal in February 2015, and here is the Chair of the group Dr. David Nunn’s account of this programme and what they have achieved.

3The Nepalese doctors and nurses who participated in the cervical cancer screening programme in February 2015.

 Reports and useful information

Here are a range of reports of PHASE and NNCTR’s colposcopy partnership and the work that they have been carrying out in Nepal, as well as additional information documents:

Cervical Cancer: Our Vision

Memorandum of Understanding between PHASE and NNCTR

National Guideline for Cervical Cancer Screening and Prevention in Nepal

Report of Three-Day Colposcopy Course in Kathmandu: June 2006

Report of One-Day Colposcopy Course in Kathmandu: May 2010

Evaluation Report of Nurse Colposcopy Training in Royal Shrewsbury Hospital NHS: May 2011

A Nepalese Nurse’s Report Following Their Visit to Royal Shrewsbury Hospital NHS: May 2011

A Biomedical Scientist’s Report: October 2012

Report of Cervical Pathology Workshop: November 2012

Colposcopy Report, Kathmandu Maternity Hospital: 2012

The NNCTR provides cervical and breast screening camps as well as HPV vaccination programmes in the Kathmandu area, and now also works in partnership with the PHASE colposcopy group.

IARC is a part of WHO, and their mission is to coordinate and conduct research on the causes of human cancer and the mechanisms of carcinogenesis, and to develop scientific strategies for cancer prevention and control. IARC is involved in both epidemiological and laboratory research, and disseminates scientific information through publications, meetings, courses, and fellowships. Here is a good pool of resources of IARC on cancer screening and cervical cancer, including lectures (with voice overs), atlases of colposcopy and pathology, information on VIA/VILI, and issues surrounding cervical screening.

The British Society for the Study of Colposcopy and Cervical Pathology is the professional UK organisation which represents colposcopists. They provide education, training and quality assurance in colposcopy. This society have been keen sponsors of PHASE’s cervical cancer programme with NNCTR.

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