Bringing Cryotherapy to Kedougou

As I’ve mentioned in previous posts, the cervical cancer prevention project I’ve been working on with the Chicago-based nonprofit, peacecare (www.peacecare.org), has been a major focus of my service. In case you haven’t read about it in other blog posts, I’ll give a little background. This project is the pilot project for the organization, started by Dr. Andrew Dykens, and the goal is to partner with Peace Corps Volunteers and a local health structure to create a sustainable program in a health topic chosen by the community. When the team did focus groups in Saraya a few years ago, cervical cancer was the health issue that they wanted peacecare to address. Peacecare doctors did a training of trainers and trained 2 midwives how to train others how to screen for cervical cancer using Visual Inspection with Acetic Acid (VIA). Since then, we have added some trainers and now have 4 women who can train the nurses and midwives in the region how to screen for cervical cancer. We’ve trained almost all of the nurses and midwives in the region how to screen, and the focus of the most recent trip was to train a few people at the hospital how to treat cervical precancer using cryotherapy. 

Before the peacecare team arrived, I had been in communication with the regional head doctor and the head doctors of each health district. They had chosen 3 people to participate in the cryotherapy training, including Fatou Traore, the head midwife in Saraya who has been involved in the project since the beginning. She has taken a leadership role in the project and has been at every training we have done for either nurses, midwives, or community health workers. The night before the peacecare team arrived, Fatou called me and said she had been summoned by the Ministry of Health to another region to lead a training. Now she would not be able to participate in the cryothearpy training. I felt so frustrated with the lack of control health professionals have over their schedules. You can plan a meeting months in advance, but if the boss tells a health professional at the last minute they have to go somewhere else, they have to go. This makes scheduling anything a challenge.

It was a setback, but once the peacecare team arrived, we were determined to carry on and do the 3-day training with the other trainees who were chosen.  Fatou sent a replacement trainee who came from a village in the Saraya health district, and she was motivated to learn. The CO2 tanks made it safely down to Kedougou, and all of the equipment worked!

The theory portion of the training, taught by Dr. Tracy Irwin, on the first day went well.  The three trainees demonstrated their ability to look at photos of cervices that were negative for precancer, positive for precancer, and those that had invasive cancer.  They learned how to decide if cryotherapy treatment was possible for the patient, and they did well during a photo test where they had to decide if the patient was positive for precancer and if the patient could receive cryotherapy.

The day before the training, Tracy mentioned that she needed some sausages for the practicum part of the training, so we went to the “Toubab store” and were able to find some. I was curious about how she was going to use these sausages, and when we began the practicum it made sense! Cryotherapy involves using a special gun hooked up to a CO2 tank and placing the gun tip on the cervix to freeze it for 3 minutes, thaw it for 5 minutes, and then freeze again for 3 minutes. Before the trainees performed the treatment on real patients, they practiced on sausages.

Ouli practicing on a sausage

In order for Tracy to certify each of the trainees, she needed to observe each of them performing at least 10 cryotherapy treatments. This meant that we needed at least 30 women who tested positive for precancer to come in for treatment. In December, Annē Linn and I helped the Dakar-based NGO, PREVENIR, do a mass cervical cancer screening at the Kedougou hospital. Our collaboration with PREVENIR allowed for us to treat the positives that they found during our cryotherapy training in February. From PREVENIR’s screening and other screenings the hospital had done in the past year, we in theory had enough positives for the training. Unfortunately, things did not go according to plan. All of the positives were called or given messages from their village aunt to come in during the 3-day cryotherapy training for treatment. Some of the women never came in, some of them were false positives, and some of them had lesions that were too big to be treated with cryotherapy. At the end of the training, the trainees were only able to do 2 cryotherapy treatments total, which was not sufficient to get certified. The trainees, volunteers, and peacecare team were all frustrated that the team was going to leave Senegal and no one would be able to perform cryotherapy in Kedougou.

We were all feeling discouraged when a woman came in for the last screening on our last day of training. She tested positive for precancer, and she was anxious to get cryotherapy treatment. The gratitude she expressed to the peacecare team and trainees who performed the treatment made us all remember why we were doing this. She had a huge smile across her face after the treatment and told us that health is the most important thing to her. If she doesn’t have her health, she doesn’t’ have anything. She recognized the importance of getting treatment for cervical precancer, and her energy and excitement about getting treatment re-energized all of us. We were going to make this work.

At the PREVENIR screening in December, Annē and I had met a Tamba-based gynecologist who performs cryotherapy. Since the peacecare team had to go back to the US soon, we thought this doctor could be a potential solution to our problem if he would agree to finish the training we had started. The team went up to Tamba to meet with him and discuss the possibility of him finishing the certification of the trainees. This doctor was on board and was enthusiastic about the possibility of cryotherapy treatment in Kedougou. Being from Kedougou himself, he recognized how far women would need to travel for treatment if they could not get it there. We are hopeful that we will have at least one of the trainees certified in cryotherapy in the next few months.

The rest of the peacecare trip involved a lot of strategic planning for the future. Organizing meetings with doctors here can be like herding cats with their busy schedules and lack of response to emails. Fortunately, we were able to get meetings with all of the head doctors, and we had some productive conversations about the future of the program. At this point in the program, peacecare is focusing on how this project can be sustained by the health structure itself when we phase ourselves out eventually. The local doctors and midwives renewed their motivation in the project, and both the volunteers and the peacecare team finished the visit feeling hopeful about the future of the project. The vision is to have cervical cancer screening and treatment available to everyone in the region, and we continue to get closer to that goal.

Working on this project has clarified for me that I want to continue doing work in women’s reproductive health. It has been an incredible opportunity to work with the peacecare doctors and local midwives and doctors on a program that I hope will be sustainable in the future. I can’t wait to continue doing further work in women’s global health as I begin graduate school in the fall. I was thrilled to find out recently that I was accepted to University of Washington’s Masters in Public Health in Epidemiology-Global Health Track program! I’m excited to pursue my dream of addressing women’s health needs around the world!