Cambodia Cervical Cancer Screen Update

 

Dr Nara and Rotha doing VIA
Dr Nara and Rotha doing screening

The project that we started in Bonni’s honor in Phnom Pehn is moving along nicely, if slowly (but such is Cambodian time in many ways).  With Sihanouk hospital we have continued to identify staffing and move forward with training.  Our local physician, Dr. Nara, has proven to be outstanding and the hospital administration represented by Ellen Maring have been pushing hard to get the program moving.  We now have a dedicated clinic space with the necessary equipment.  A friend and Dartmouth colleague, Dr. Kathryn Duevel, spent 2 weeks in June in Cambodia to initiate some specific training and start the screening and education process with the first group of patients.  While we still face some administrative, training and staffing hurdles, I am confident these will be overcome in the next several months and our program will move ahead as a model for the country.

Clinic front door
front door of the clinic

A very positive part of this project for me personally has been the opportunity to speak and interact with the cervical cancer healthcare network worldwide.  I have spoken with doctors and administrators in Cambodia, Vietnam, Japan, Korea, Myanmar, as well as many in the US.  They have all been extraordinarily generous with their time, helpful, and display a rare passion for their cause.

We are now waiting for a final approval for our study protocol from the Cambodia ethics board.  I am continuing to recruit doctors to visit Cambodia to help develop and mentor the program.  I hope to return there in the late fall myself and have just sent a second grant from the Bonni Curran Philanthropic Fund to help with the next phase.  Finally the hospital just received a grant from a private US foundation that will help with recruiting an analyst who can help with some of our data.  All good.

Clinic
Clinic

Thank you all again for your support.  Peter

Cervical cancer screening in Cambodia

Jessie, Cody and I have been moving ahead with a project in Cambodia in Bonni’s memory and will use some of the money from her fund to support this.  This is an exciting project and is just the kind of thing she supported in the past.

Cambodia is a low-resource medical setting – medical care there is not great but they have made some significant gains in communicable disease management such as against malaria and HIV.  They are now starting to focus on non-communicable diseases such as diabetes and cancer.  Bonni was involved with Sihanouk hospital in Phnom Penh, among other things helping them to set up their women’s clinic.

Cervical cancer is the most common cancer in Cambodian women with probable rates almost 20 times in the US.  It can be prevented with screening to identify precancerous lesions which can be easily treated.  While cervical cancer screening is available for the wealthy, there are no programs in place for the general population.

Picture2

Sihanouk hospital is run by HOPE worldwide and focuses on indigent care plus medical training.  They have established research programs in infectious disease.

We are developing a screen and treat program with Sihanouk hospital.  This is based on a well-tested WHO model that uses direct visualization with acetic acid (VIA) and same day cryotherapy where appropriate.  This is a MUCH cheaper model than the Pap/culposcopy model used in the US and approximately as effective.  The big advantages from a Cambodian type of situation is that the results of the screening are available immediately and the woman who needs it can generally be offered treatment that day.  More advanced cases identified would need to come back for surgery which can also be offered under our program at the hospital.

We plan on starting with 1000 women, half of whom are HIV positive (higher risk of cervical cancer).  The hospital has been working closely with us; we have recruited a local doctor to take this on and are currently focusing on her training.  Local capacity building is a big part of this project.  We are ready to submit our IRB proposal – hoping that this can be published later as there is no data on cervical cancer prevalence in HIV positive or negative women in Cambodia.  We have recruited 2 experienced gynecologists to go to Cambodia this summer to work with the local doctor and are looking for 2 more.

Jessie, Cody and I were there in December and I would hope to go back in the fall.  Bonni’s fund of course is not paying for our travel, nor for the gynecologists – they are paying their own way and volunteering for the project.  The money is going to training and paying the local doctor ($8/hour, pretty cheap in Cambodia), her midwife (the hope is to train more mid-level providers to do these procedures down the road), and the expenses of the testing and treatments.  We also need to assume we will find some advanced cancers and need to be able to deal with these (surgery).

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Dr. Nara, sitting, and In Many (midwife, standing)

My guess is that out 1000 women we will be able to prevent 100-200 cancers and find 10-20 cancers that will need more advanced treatment.  Plus we will have trained 2 women to continue this work – and maybe more as we hope to coordinate with other local NGO’s interested in setting up similar programs.

Picture3

Dr. Nara teaching local midwives about VIA screening.

Happy to chat more if anyone is interested.  I will update this occasionally as the year progresses.

Peter