Cervical cancer screening workshop

You may at this point be wondering what the purpose is of my being in Ethiopia.  The short answer is, it's not entirely clear, the long answer is, well, long (maybe I'll get to it in a future post), and the medium-sized answer is, finding ways to help improve training of doctors at Addis Ababa University.  Toward that end, today was the first day of the third annual cervical dysplasia (precancer) screening and treatment workshop held at AAU by Dr. G (this year, with myself as well).  This is the only concrete plan I had on coming to Addis.  The idea is that many places in the world don't have pap smears to screen for the precancerous changes that can lead to cervical cancer-- it takes a functioning pathology department, expensive reagents, and multiple visits for the patient (pap smear, results, and possibly further treatment).  All this is too much to ask a low-resource health system, but cervical cancer continues to be a big killer, particularly in eastern Africa.  Someone brilliant from Johns Hopkins developed a cervical cancer screening and treatment algorithm that uses acetic acid (that is, standard store-bought vinegar) as the main reagent to apply to and examine the cervix for precancerous changes.  The most low-cost option for treating lesions shy of cancer is cryotherapy, or freezing these lesions with a carbon dioxide gun.  As Dr. G put it, if there is beer, there is CO2.  The method has proven very successful in many low income countries and can even be done by lower-level medical providers in places where doctors aren't plentiful.

We are holding a three-day training in visual inspection of the cervix with acetic acid (VIA) and cryotherapy (freezing).  Our audience is about 7 OB/GYN residents, 5 family medicine residents, 2 nurses from the GYN outpatient clinic, and a health officer (a sort of mid-level provider possibly akin to a nurse practitioner) from a community health center.  Today we did several lectures, myself taking on the public health and global scope of HPV and cervical cancer, and then we did simulations of cryotherapy with hot dogs as cervices.

CO2 gun in action on the simulated pelvis.
(Hot dog cervix visible only with the speculum!)

Well.  Let me tell you.  Finding hot dogs in Addis Ababa is no small feat.  It was actually kind of nice that no one knew what a hot dog was, as I think they are one of the most disgusting American food inventions ever, but made them hard to locate.  The hot dog, though, provides the ideal size and consistency for actually simulating freezing the cervix.  We finally found them at the biggest most faranji (foreigner) supermarket after looking at 3 others, only to find that once they thawed they were not actually the consistency of hot dogs at all, necessitating another mid-workshop taxi trip back to the supermarket to get a different variety (this time beef, after learning that not only the Muslims in our workshop but also the majority Ethiopian Orthodox Christians find any pork distasteful).  This is not to mention driving around the city in a Lada taxi from the 70’s with a 45 kg tank of CO2 strapped to the roof.  (For further reference, CO2 can be found in shops that sell fire extinguishers.  Yes, there are shops that sell only fire extinguishers.)

OB/GYN resident, health officer, and fam med resident
working together and scratching heads over the mysterious cervix.

I think day 1 went well.  The family medicine residents, nurses, and health officer were really enthusiastic and engaged.  The OB/GYNs were interested but also looked distracted and exhausted.  (Been there.)  By the end of the day, we had every participant either freezing off hot dog cervical cancer or reviewing our image flashcards, and that felt pretty great.  Planning and executing this has been taking up a lot of my time and energy, so not much time for cultural observations.  After we finish with this frantic pace and Dr. G. leaves on Saturday, I’m sure that I will go back to being a bit bored and lonely and will have more time to write.  Miss you all.