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Global Initiative Against HPV and Cervical Cancer (GIAHC, USA), Weill Cornell Medical College (Cornell University, USA), Christian Medical College Vellore, India, and Sydney Medical School (University of Sydney, Australia) have formed a partnership to work together to build a cervical cancer prevention program for women in India.

GIAHC acts as a coordinating platform between communities at grassroots level, and academic/training institutions, to help raise awareness about HPV-related diseases and cervical cancer in a culturally sensitive manner. Our model works on the principle of task shifting: to shift less sophisticated procedures such as cervical cancer screening and early treatment from highly trained professionals (such as physicians) to nurses and community health workers (CHWs) with appropriate training, particularly in regions of the world where there are acute shortages in human resources.

We are currently using the visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI) to detect early precancerous changes. We also strive to initiate treatment on site (with cryotherapy for early changes and precancerous stages) and refer those with advanced disease to appropriate physicians/hospitals, wherever possible. Our goal is to promote self-sustaining models that focus on education, prevention, screening and treatment.

In the near future, we hope to adapt to objective, more accurate cost effective technologies such as HPV DNA testing and biomarkers that identify host cell integration as a precursor to cervical pre-cancer and cancer. GIAHC and its partners sponsor training programs in cervical cancer screening for physicians, nurses and community health workers. The partnership will help to identify/establish more training centers across India in the near future.

 

Our program in Tamil Nadu, India at Rural Unit for Health and Social Affairs (RUSHA) at the Christian Medical College, Vellore

History: The hospital was founded by Ida Sophia Scudder in 1900. Ida Scudder was the daughter of an American missionary couple who were living in India. As a young girl, she was reluctant to follow her parent’s footsteps in missionary work. However, this all changed one evening when three men came to their home requesting medical help for their wives who were in labor but rejected Dr. John Scudder’s professional help because he was a man. Unfortunately, all three women died in labor that night. The incident rocked young Ida. She took this as a sign from God. She went back to America and completed her medical course in 1899 at Cornell University Weill Medical College and came back to India with a "fiery passion to change things." She eventually set up a ministry dedicated to the health needs of the people of India, particularly women, children poor, disabled and the neglected in India.

Thus the Christian Medical College was born in 1900. It opened as a one-bed clinic in Vellore, the forerunner of today’s 1700-bed medical center. In 1909, Scudder started the School of Nursing and in 1918, her fondest dream came true with the opening of a medical school for women, which later admitted men in 1947.

Rural Unit for Health and Social Affairs (RUHSA) was started responding to the felt need for providing health care services to a most backward rural development block in Vellore district – K.V.Kuppam block by Christian Medical College, Vellore (CMCH). RUHSA directs several programs to advance the health, education, and socio economic status of the community. From its inception RUHSA has believed that a team of professionals are needed from various sectors like medical, sociology and agriculture for holistic development of a community and only doctors in isolation should not be the only professional serving the rural communities. So RUHSA is involved in training various levels of health care professionals to support the system of health care in India.

Population: The K.V Kuppam Block is one of the 20 government administrative blocks that make up the Vellore administrative district in Tamil Nadu and there are 39 panchayats, 89 revenue villages within the block. The total population of K.V Kuppam block is 128,033. It is a 100% rural area. Majority of the block residents follow Hindu religion and about 3% belongs to other religions including Muslims and Christians. Most of the inhabitants in the block live on agriculture and linked occupations. There is a recent trend among young men in the rural areas to migrate to the nearby urban towns and cities to work as laborers or get into alternate professions. Some of the other occupations are weaving, running poultry farms, dairy industry and “Beedi”(country cigarettes) making. The overall literacy rate is 64%. Male literacy rate is 73.4% and Female literacy rate is 57.4%.

Health Services:

  • Base Hospital Services: The 70 bed base hospital and the 23 peripheral service sub-centers continue to provide both secondary and primary level health care services to the people of K.V.Kuppam block and to the residents of other neighboring blocks. Outpatient services include general clinic and special clinics for antenatal, well baby, diabetes, TB, HIV, ENT, ophthalmology, psychiatry, dental, cancer and orthopedics care. About 4000 in-patients are treated every year that include 1000 deliveries 900 pediatric cases with common illnesses, 1000 surgeries and 1000 common medical illnesses.
  • Outreach health services: About 35,000-40,000 patients are seen annually through 23 peripheral health centers. A variety of medical conditions are seen and treated at RUSHA including HIV, diabetes, high blood pressure and other medical conditions.
  • Cervical Cancer Prevention Program: Cervical and breast cancers are the most common cancers amongst Indian women. The focus of this collaboration is on cervical cancer prevention. The ‘Educate, Screen & Treat’ program is intended to detect cervical cancer and initiate treatment in the early stages of disease. The Cancer Prevention project is based in RHUSA, the rural hospital of Christian Medical College (CMC), approximately 3.5 hours drive south of Chennai. The project involves community-based peer education and implementation of cervical cancer screening through 18 of the 23 community-health-center-based clinics in the Kavikupam block of Tamil Nadu.

In a resource-poor setting like rural Tamil Nadu, there is good evidence that visual inspection with acetic acid (VIA) is an effective strategy for detecting early precancerous lesions of cervix and thereby reducing the incidence of advanced invasive forms of cervical cancer through VIA, a low technology method is used in the ‘Educate, Screen, Treat’ program at CMC Hospital.

Other GIAHC projects include Kutch Mahila Vikas Sangathan/Bhojay hospital project in Kutch, Gujarat and the ICTPH project in Tanjore India.

Kutch Mahila Vikas Sangathan/Bhojay hospital project

Kutch Mahila Vikas Sangathan (KMVS) is a grassroots collective of rural women in the Kutch district of Gujarat, India.

Women Waiting for Screening

The primary goal of KMVS is empowerment of women through interventions, which address the issues concerning their lives.

KMVS has worked on public health issues for over twenty years, but the focus on the reproductive and child health program began in 1998 when KMVS first coordinated with Bhojay Sarvoday Trust, an organization committed to provide basic medical facilities to rural Kutch.

The idea for the cervical screening program started when Dr. Krishnan, visited KMVS and the Bhojay Sarvoday Hospital to discuss simple and cost effective methods to diagnose cervical cancer in rural and low resource settings without use of a laboratory. Motivated by the high prevalence of cervical cancer in India, KMVS/Bhojay agreed to launch a cervical cancer prevention program.

Krishnan  Speaking Kutch

The idea for the Cervical Screening program started when Dr. Shobha Krishnan, a primary care physician and gynecologist working in New York, visited KMVS and the Bhojay Sarvoday Hospital to discuss simple and cost effective methods to diagnose cervical cancer in rural and low resource settings without use of a laboratory. Motivated by the high prevalence of cervical cancer in India, Dr. Krishnan's advice, and the success of their past collaboration, KMVS and Bhojay Sarvoday Trust are again working together. Their goal is to raise awareness about HPV and cervical cancer and to lower rates of cervical cancer by getting women tested and treated. KMVS will use its skills and experience working with women in the area to organize education and training and raise awareness about this issue on the grassroots level. KMVS staff will assist the health workers from Bhojay to conduct the mass cervical screening. Women identified at these camps as potentially having cancer are referred to Bhojay Sarvoday Trust Hospital for treatment.

 

About Bhojay Trust Hospital

Bhojay Hospital

Bhojay hospital is a trust hospital mainly funded by Jain communities originally from Bhojay that are invested in development work in the region. Most of the work at Bhojay involves gynecology camps and ophthalmology camps. Camps are conducted every two to three months.

About ICTPH

GIAHC facilited to train staff at ICTPH at Tanjore site of ICTPH have been trained at our flagship-training center at The Adyar Cancer Institute and will be commencing their cervical cancer education, screening and treatment program shortly.