This project is led by:
- Rita Isaac, MD, MPH, Director of CMC’s RUHSA Program
- Madelon Finkel, PhD, Professor of Clinical Public Health and Director of the Office of Global Health at New York’s Weill Cornell Medical College
- Lyndal Trevena, MD, PhD, Associate Professor, Primary Health Care and Public Health in the School of Public Health at The University of Sydney (Australia)
- Ian Olver, MD, PhD, Chief Executive Officer of Cancer Council Australia (Sydney), and Clinical Professor of Cancer Care, Department of Medicine, University of Sydney
This collaborative project was initiated to address the high burden of cervical cancer among rural, poor women. Collaborating partners with CMC’s Rural Unit for Health and Social Affairs (RUHSA) include the Weill Cornell Medical College (New York, USA), the University of Sydney (Australia), and the Cancer Council Australia. RUHSA is an outreach program of CMC that has been providing inpatient, emergency care, and outpatient primary health care services to an estimated 128,000 population in rural Tamil Nadu India for over 60 years. In an effort to reduce the prevalence of cervical cancer in Vellore district, as well as to educate women about the signs, symptoms, and characteristics of the disease, women aged 35 to 50 years who seek care at RUHSA were (and still are) invited to participate in a low-tech screening program (no Pap smear, rather VIA is being used to screen for cancer cervix). There is more than sufficient evidence to show that the low-tech screening procedures VIA and VILI that rely on visual inspection of the cervix after acetic acid 5% application (VIA) or with visual inspection with Lugol’s iodine (VILI) do reduce morbidity and mortality in women living in low-resource settings. Key findings from an initial evaluation showed that (1) rural women are amenable to being screened for cervical cancer, (2) women who test positive often fail to follow up with treatment, and (3) many women were not being screened because they receive care from a local primary care practitioner, the majority of who do not routinely screen for cervical cancer. Through an improved educational campaign, the message that cervical cancer screening can save lives has led to an increase in the number of women willing to be screened. Encouraging local practitioners to incorporate screening into their practices was deemed very important as the next step in reducing the incidence of this cancer. In order to expand access to cervical cancer screening in rural Vellore district, the partners designed a two-day cervical cancer screening training workshop program for interested local primary care practitioners. The goals of the workshop are (1) to educate practitioners about the importance and the benefits of screening for cancer cervix, (2) to provide participants with counseling skills needed to talk with women about cervical cancer, including diagnosis and treatment options, and (3) to provide participants with the knowledge and skills needed to perform VIA, VILI, colposcopy, and cryotherapy, and (4) to influence in a positive way, participant attitude regarding the benefits and appropriate use of cervical cancer screening tests and follow up treatment. In November 2012, a training workshop was designed to include both educational lectures and hands-on training. Over the course of the two days, 35 practitioners participated in the training program and 20 women were screened. After taking the training workshop, the participants were more confident about their ability to screen for cervical cancer; to counsel women about cervical cancer screening; to take a biopsy, perform LEEP (loop electrosurgical excision procedure), and treat lesions with cryotherapy. A post-training survey showed that the two-day intensive workshop aimed at improving knowledge and skills among primary care providers was viewed as being very beneficial. A second workshop was held in November 2013, with similar results. Future workshops are being planned. RUHSA has established a cervical cancer screening database to track women who have been screened, and the newly-formed network of local practitioners are being encouraged to submit their data to this database. Further, with funding from AusAid, an innovative program using mobile phones to deliver educational messages has been very well received. Pairing educational programs with screening and with provider training workshops hopefully will result in a reduction of cervical cancer among the women in the RUHSA catchment area.