Grounds For Health » Single Visit Approach

True Collaboration for Meaningful Impact

Justin Mool — Wed, 20 Jul 2011 14:59:37 +0000

August speaking at the PAHO meeting

Early last month Grounds for Health Executive Director August Burns and in-country doctor Barinia Osejo attended the Pan American Health Organization (PAHO) Workshop on VIA and cryotherapy. Grounds for Health joined representatives from 11 countries and the World Health Organization, Basic Health International, United Nations Population Fund, International Planned Parenthood Federation, PATH and Jhpiego. These organizations convened over two days to discuss experiences preventing cervical cancer in their respective countries.

This groundbreaking meeting represented the first time a group of health experts from across Latin America came together to focus on the Single Visit Approach, which is a key component of Grounds for Health’s work. The group shared their successes, failures, and lessons learned in implementing this new approach.

August and Dr. Osejo were sure to bring the voice of the “woman at the end of the road” to the meeting, presenting our community-based approach to outreach and follow-up. By speaking about Grounds for Health’s experience in poor, rural settings, August and Dr. Osejo were able to shift the conversation beyond just what to do, but to how to make it work—to assure that programs reach all women at risk.

August walked away feeling that Grounds for Health is truly part of a larger community committed to ending unnecessary deaths from cervical cancer. Thanks to strong alliances with the Nicaragua Ministry of Health, and invitations from other Ministries of Health, we have a great opportunity to expand our model across the region.

In the end, this meeting showed the true collaborative effort that is emerging to address issues of cervical cancer. These partnerships are absolutely necessary if we are to have a meaningful impact in saving lives from the city to the farm.

Key to VIA Success: Vision and Vinegar

August Burns — Tue, 29 Mar 2011 13:54:26 +0000

Vision and Vinegar

Sometimes it’s the simple things make all the difference.

Here at Grounds for Health, we use the Single Visit Approach to screen for cervical cancer. Applying a vinegar wash on the cervix allows us to make a visual confirmation of potentially cancerous cells. This is known as visual inspection with acetic acid (VIA). If the lesions match our treatment criteria, we freeze off the cells using an effective and safe procedure called cryotherapy.

All can be done in one 30-minute visit.

So maybe it’ll come as no surprise that four years experience in Mexico, Nicaragua and Tanzania has taught us that the success of the Single Visit Approach often boils down to two things: vision and vinegar.

First, there’s the issue of vision. Back in 2007 in Nicaragua, we found that some of the best students in the classroom, seasoned doctors and nurses in our training program, were missing clear positives when tested at close-range with VIA flash cards.

Good vision is essential

Someone offered one of the students a set of simple reading glasses. A-ha! Positives confirmed. These students were over 40, and although excellent health care providers, they didn’t know they needed reading glasses to see properly at arm’s length—the distance required to perform a visual inspection.

We now require that every clinician go through a simple eye exam before starting the training program.

… Then there’s the vinegar.

Our experience in Latin America taught us that positive VIA rates should range from 10-20%. But when we first began our program in Tanzania, in a remote region where we estimated that rates would be well over 10%, we found only 2% of women tested positive. At one point, over 100 women in a row tested negative using VIA. Something was wrong.

So we had a closer look at the local vinegar. Someone opened a fresh bottle, held it to her nose and took a taste. It seemed weak. We boiled the vinegar to concentrate it, and began experiencing more consistent results—close, but not quite normal.

When we returned to the States, we officially tested the Tanzanian off-the-shelf vinegar. It did not meet the 3-5% acidity level recommended for VIA.

Good vinegar = accurate results

On our return trip to Tanzania, we armed ourselves with Heinz-brand vinegar, and immediately saw a 10%+ positivity rate in the same population.

Grounds for Health now tests local brands for acidity levels before beginning any Single Visit Approach program.

Our experiences show that success is only possible when the simple things are done right.

January: Cervical Cancer Awareness Month – The Facts

Justin Mool — Tue, 28 Dec 2010 16:28:55 +0000

In developing countries, cervical cancer claims more women’s lives than any other form of cancer including breast cancer. This is despite the fact that cervical cancer is one of the easiest cancers to detect and cure. In countries with adequate health resources cervical cancer is a rare disease thanks to the combination of regular Pap tests followed by early treatment when necessary. However, in countries with weak or non-existent health care infrastructure, Pap technology is out of reach. Women living in rural coffee producing regions face perhaps the greatest obstacles to this simple prevention as is documented by their current rate of mortality.

The world now has an extraordinary opportunity to address this leading cause of death for women in their prime. Thanks in large part to results from intensive research over the past two decades funded by the Gates Foundation and others, there are now viable prevention strategies that can work even in the lowest-resource communities. The global community is mobilizing, and Grounds for Health is at the forefront.

Cervical Cancer Facts

One woman dies every two minutes from cervical cancer
Cervical cancer kills over 270,000 women yearly
80% of deaths occur in emerging world
In the emerging world, cervical cancer kills more women than any other form of cancer
Cervical cancer kills women in their primes, which has a devastating impact on their families and communities

Cervical cancer is 100% preventable when detected and treated early
Cervical cancer is the only cancer known to be caused by a common virus
The Single Visit Approach is a proven method to screen and provide preventive treatment in rural, low-resource settings
If every woman was seen using the Single Visit Approach just once in her lifetime, we could reduce the worldwide rate of cervical cancer by 30%

The Single Visit Approach

Grounds for Health: From the Community’s Perspective

Update from Annah in Tanzania

Elisa Vandervort — Tue, 31 Aug 2010 13:02:49 +0000

Dr. Annah’s update from Kigoma is full of positive news about our newly trained clinicians from July 2010 and their rapid establishment of screening and cryotherapy treatment services in Kigoma Region. All new sites are on track in terms of the goals and implementation plans each created as part of our training.

Two sites (of four new ones) already have begun providing screening and treatment services for women on a weekly basis. This is further proof that our training programs are working. Over the coming weeks, Annah will visit the other two sites and ensure that they have the needed materials and supplies to begin offering services in screening with VIA and treatment with cryotherapy.

Nurses Catherine and Grencia of Kasulu District Hospital and Dr. Terezia and nurse Dafroza of Kibondo District Hospital were the first of newly trained clinicians to bring their new cervical cancer prevention skills to women in their communities. Kazi njuri!

Click on image to enlarge. Use < > to navigate.

Tanzania Trip Report: Training

staff — Thu, 29 Jul 2010 15:00:39 +0000

From June 17 through July 5, 2010, we conducted a two-week training and cervical cancer screening campaign in Kigoma, Tanzania. This trip marked our fourth visit to Kigoma and third training and screening campaign at this site. As in our other sites, we continue to focus on the implementation of the Single Visit Approach for the prevention of cervical cancer.

Martha Caswell, who is our program director for Latin America, came to Tanzania for the first time to bring her training expertise. We were also joined by an expert cohort of women’s health clinicians and Grounds for Health volunteers: Mary Cunnane, Madelyn Hamilton, Susan Hollinger and Ellen Starr. Our heartfelt gratitude goes out to all the volunteers for the completion of another incredible trip.

HIGHLIGHTS

Successful VIA training of 9 new providers, which brings VIA screening access to a total of 12 sites in the region.
5 Participants became certified to administer cryotherapy treatment. This will make the Single Visit Approach possible at 4 additional sites in Kigoma, bringing the number of SVA sites to 6 total in the region, with all but one district hospital represented.
Continued cooperation with Jhpiego: Dr. Mary Rose Giattas, a Jhpiego MD again was outstanding as our lead trainer.
Continued support of ICAP: 4 Cryotherapy Units, 10 CO₂ Tanks and 112 specula were purchased and donated by ICAP to equip four district hospitals in ability to provide SVA.
Ministry of Health acknowledged the Grounds for Health / Jane Goodall Institute / Kanyovu Collaborative Cervical Cancer Prevention Project as a national demonstration pilot project.
ICAP agreed to provide ongoing access to essential supplies for screening and treatment at all current participating health facilities. ICAP also agreed to provide transportation for GFH in-country staff Annah Kichambati for monthly supportive supervision visits at all twelve sites in Kigoma. Thanks ICAP!
Further discussions and early planning began with ICAP and local Ministries of Health to facilitate roll-out of program throughout the region of Kigoma.

Editor’s Note: Martha and Elisa are currently on well-deserved vacations. When they return we will post some personal narratives from the trip and update the photos below with captions. Stay tuned!

Click on any image to see full screen:

Single Visit Approach Refresher Video

Justin Mool — Wed, 07 Apr 2010 11:05:20 +0000

If you haven’t seen Jhpiego’s short video on the Single Visit Approach, take a couple minutes; it’s worth it. Vice President and Medical Director at Jhpiego and Grounds for Health Advisory Board member Dr. Harshad Sanghvi provides a succinct explanation of our methods. It is because of the important work of Dr. Sanghvi and his colleagues that Grounds for Health is making such great progress in coffee-growing countries. We couldn’t say it better ourselves, so we thought we’d let Harshad do the talking: