PHASE Worldwide and the Nepal Network for Cancer Treatment and Research (NNCTR) recently completed a two year project, funded by the Tropical Health and Education Trust (DFID), which improved screening for cervical cancer in Nepal. Despite cervical cancer being the most common female cancer in women aged 15-44, and the leading cause of cancer death in Nepal, currently only 2.8% of women aged 30 to 60 in Nepal are screened.
As part of the project, PHASE utilised the Enhanced Visual Assessment (EVA) developed by MobileODT, an innovation that allows portable screening by Nepali health workers at the community level through screening camps.
The project screened women and treated those who needed it for precancerous changes of the cervix. A see and treat approach to cervical cancer prevention reduces the number of women who screen positive (i.e. have precancerous cells) and then do not go on to have treatment. This can happen if treatment is offered at a different time to the screening due to the distance women in Nepal have to travel for medical care and the domestic work burden of females in the household.
Through a screen and treat approach, we ensured all women who were positive for pre-cancer were treated the same day with a theromocoagulator, this limited the number of women who would forgo treatment given the distance and cost. The approach was led by nurses and did not require laboratories or expensive equipment.
I visited Nepal in November 2016 and took part in a five screening camps, which screened 997 women over five days. The work load was high, but the team worked well. I was particularly impressed by the diagnostic skills of the nurses, the dignity with which patients were treated and professional approach. The team was friendly and made everyone welcome. Seeing over 200 women in one day, with intermittent electricity and stunning mountain views from the clinic, was certainly very different to the UK National Health service setting I usually work in!
What we found was exciting. The project demonstrated that a single visit approach worked – over the course of the project the team screened more than 2,000 women, and identified 99 women with pre-cancer. A handful of advanced cases of cervical cancer were also identified and referred to local gynaecology colleges for on-going assessment and free treatment. Together, this likely led to lives saved.
We didn’t stop there – once we knew the approach was effective, we coordinated an expert-led ‘hands on’ colposcopy workshop to four ‘train the trainers champions’ to ensure lasting impact after the donor funding ended. In addition, a four day training was provided on advanced treatment and laboratory methods, led by two pathologists and two biomedical scientists from the United Kingdom.
The local trainers were there to provide training to new Nepali Health Workers, and also ensured follow up for women treated in screening camps. 16 delegates were subsequently trained in cervical screening and treatment in a ‘hands-on’ Government accredited course to scale the model across primary health care centres.
Over the course of the partnership, we also worked to empower communities, increase outreach, and raise awareness through education about cervical cancer in partnership with groups like the Housewife’s Association of Kathmandu, to help ensure long-term social norm change
As the efforts continue to grow, we can only hope this new, low-cost, connected approach, using the EVA System to capture quality image, engage patients, and build local capacity through remote supervision and mentorship can be a part of the larger Nepali narrative on how technology can help and improving skills of health staff can save lives.
Dr Will Parry Smith, 2017
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