Cooperation for the Prevention and Treatment of Cervical Cancer in Nepal

Background

Two of the founding trustees of PHASE, Dr Rafiat Adekunle and Dr Gerda Pohl, have long been involved in cervical screening and colposcopy in the UK, and have many connections with colposcopy specialists. So, when the Nepal Network for Cancer Treatment and Research (NNCTR) was looking for specialists to help in the skills development in this field in Nepal, the PHASE Worldwide trustees assembled a team from the United Kingdom to undertake a three day Colposcopy Course in Kathmandu.

The drive behind this cooperation is the desire to reduce the mortality from cervical cancer in Nepal. Nepal is a country of 25 million with the majority of the population living in scattered villages. Consequently, access to health care is difficult, often involving a journey on foot of many hours or even days. At present, the majority of women suffering from cervical cancer present with advanced disease, if they seek medical help at all. The mortality among known cases is around 80%. (Compare this with less than 20% in the UK) Sadly, it is very likely that a significant number of cases die without ever seeking help.

Although hard data is difficult to verify, the NNCTR believe that cervical cancer causes a lot of potentially preventable deaths in Nepalese women – usually in their late 40s and 50s when they are still essential to hold the family together. Because of this, The NNCTR is trying to introduce screening. However, the existing screening tools in Nepal are imprecise, and colposcopic evaluation (which in our country is the second stage of the screening process) is seen as part of the screening process as well as a means of directing conservative management:

In the absence of colposcopic assessment and directed management a significant number of women who are thought to have abnormalities of the cervix are being subjected to unnecessary hysterectomy.

Colposcopy update March 2008

March 2008

Again we have two Nepalese doctors visiting the UK to learn more about the organisation of cervical cancer screening and treatment in the UK: Dr Meeta Singh from the TU Teaching Hospital and Dr Chandra Laxmi Shrestha from the Chetrapati Community Hospital are going to divide the 6 weeks of their stay between Rotherham, Dewsbury and Nottingham.

They will also take part in a basic Colposcopy Course in Sheffield, and the annual meeting of the BSCCP (British Society for Colposcopy and Cervical Pathology) in Birmingham, before returning to Nepal

In June 2008, another colposcopy workshop will take place in Kathmandu: Dr Rafiat Adekunle from Dewsbury , Mr David Nunns from Nottingham and Mr Sotiris Vimplis from Leeds will be the UK colposcopists leading the workshop and hands on training in 3 different hospitals of the colposcopy network.

December 2007

The second colposcopy workshop in Kathmandu in late November 2007 was a big success: the participating hospitals had obviously made big steps forward in their cervical screening programmes and the screened cases being brought to the clinical teaching sessions were much more appropriate this time: in fact, two early cancers were detected, and a number of pre-cancerous lesions could be treated during the workshop.

Colposcopy team

One colposcope had been purchased through a donation by Mrs Sandra Blockley MBE from Rotherham, who has been raising funds for cervical cancer treatment and prevention for many years.

Handover of colspocope

April 2007

Two senior Nepalese doctors, Dr Sheela Verma from the National Maternity Hospital and Dr Aarati Shah from eth Bir Hospital in Kathmandu, spent 8 weeks in Rotherham and Dewsbury, to learn more about the management and setup of colposcopy and cervical cancer screening in the UK. The purpose of the visit was to learn as much as possible about all aspects of the service, so they can later transfer the more suitable aspects of the orgasniational structure to their own country.

The visit included a visit to the Royal College of Obstetricians and gynaecologists in London, a Basic Colposcopy course in Sheffield and the annual meeting of the BSCCP (British Society for Colposcopy and Cervical Pathology) in Sheffield.

Dr Sheela and Dr Aarati returned to Nepal full of ideas, and have already implemented a lot of changes in their respective hospitals.

WORKSHOP AT MATERNITY HOSPITAL, KATHMANDU, 20TH – 22ND JUNE 2006

In the second half of June, a team of three colposcopy trainers flew to Kathmandu together with the PHASE Medical Coordinator: Mr David W Fenton is the clinical lead for the Rotherham colposcopy services, and Sheila Ibbotson is a nurse consultant in the same hospital. Mrs Rafiat Adekunle, who did part of her training with David and Sheila years ago, is now the colposcopy lead consultant in Dewsbury and District Hospital.

The aim of the three day course was to introduce the basic principles of a conservative approach and demonstrate these over two days of practical tuition. Consequently, the first day was taken up with a series of lectures explaining the basic concepts of screening and conservative management.

Thereafter, each registrant was given a clear introduction to the colposcope and associated equipment. The participants were divided into three groups consisting of medical and nursing personnel. All participants had the opportunity to perform colposcopy under supervision and discuss findings and treatment plans with the UK trainers.

During the two practical training days of the workshop approximately 60 women who had previously been identified as screen positive were assessed colposcopically, and those who were found to have pathology were treated at the time, or a course of action agreed, after a biopsy was taken.

As this was the first such course in Nepal, both registrants and trainers had a steep learning curve to absorb. However, we hope that this will be the first step for a long-standing cooperation to decrease and prevent cervical cancer in Nepal. We are hoping that it will be possible to bring several Nepalese Gynaecologists or senior nurses to the UK to train them to be trainers in colposcopy back in Nepal.