My experience in the Cervical Cancer Prevention Program in Zambia (CCPPZ)

Before being matched to Lusaka for my Fogarty year, I thought I knew what there was to know about cervical cancer. As a third-year medical student, I performed Pap smears and learned that they are doing a great job of making cervical cancer a rare cause of morbidity and mortality in countries like the USA. And the new HPV vaccine is going to help reduce the incidence of cervical cancer even more, at least in those countries that could access the vaccine. If needed, I could describe staging of cervical cancer, but I had never actually seen a patient with the disease during my 2.5 week gynecology rotation.

Within days of arriving in Lusaka, I realized how different my experience would have been if I had done my gynecology rotation in Zambia. I toured half of the 9 clinics that had been established since January 2006 within the Cervical Cancer Prevention Program in Zambia (CCPPZ), co-directed by Professor Groesbeck Parham and Dr. Mulindi Mwanahamuntu. These clinics are a joint venture by a variety of institutions in Zambia, including the Ministry of Health, University Teaching Hospital, and the Centre for Infectious Disease Research in Zambia (CIDRZ). I met the nurses who ran the clinics. They each screen between 10 and 20 new women each day for cervical cancer. I met the peer educators who not only act as clinic assistants, autoclaving equipment and cleaning the clinic, but also give 3 or 4 talks every morning to patients waiting in other clinics (out-patient, pediatrics, obstetrics, and HIV care) to “sensitize” a community to the impact of cervical cancer and the importance of routine screening. It is a community which in fact knows personally the impact of cervical cancer, the number one cause of cancer mortality in Zambia. The peers give a name to a set of symptoms that many families have come to accept as part of life. These sensitization talks serve to educate the public and to entice women to come for screening. I was impressed by the dedication and passion that the nurses and peers demonstrated, and amazed that the program had screened almost 20,000 women since its inception. There was nothing else like it in Zambia, and it is a model for other developing nations.

Within the first month of arriving in Zambia, we held a conference with representatives from 5 other African nations. The CCPPZ model truly was a model for cervical cancer screening in low-resource settings. Utilizing low-cost supplies such as vinegar and cotton wool, and increasingly affordable technology such as laptop computers and digital cameras, the CCPPZ nurses were doing visual inspection with acetic acid (VIA), taking digital photographs of the cervix (cervigrams), and providing patient care, treatment, and education.

The model is not without kinks, but with good communication, passionate team members, rapid responses, and weekly quality control meetings, the number of women screened in Zambia is increasing day by day. Starting in November 2008, I helped contribute to those numbers. So far, I have screened 300 women in the 10th clinic to open in Lusaka. I work with two peer educators who sensitize patients within the gynecology wards of University Teaching Hospital or at the HIV care clinic. In addition to performing the exam, I have explained cervical cancer causes, prevention, and treatment. I have listened to the women’s stories, and I have shared my own. I have discussed HIV prevention and care, offered advice about family planning, and explained the menstrual cycle and normal discharge patterns.

I have also worked with peer educators to create a video for patients to watch as they sit in the waiting room, helped create forms to integrate HIV care clinics and cervical cancer clinics, and presented an abstract at the Conference on Retroviruses and Opportunistic Infections (CROI) in Montreal regarding digital images and HIV status. I have glimpsed the global, academic, multi-million dollar, big-picture part of international research, both behind the scenes and in the media. And I have met the individual women who come to clinic with questions, worries, skepticism, trust, who walk out of the clinic with a smile of relief and a picture of their own cervix saved on their cell phone, or an appointment for further evaluation. For medical students attempting to find a niche in an ever-expanding global community of researchers and clinicians, the experience as a FICRS is invaluable. As a future Ob-Gyn (I’ve decided!), I will be poised to guide and care for women who, inevitably, care for everyone around them, and I now have an idea of how international research can fit into my clinical future.

Check out Jennifer's CROI poster: Click Here!