The Trip

This trip started as a big “what if” over a year ago. It went kind of like this: “What if I could live and work in a small Guatemalan village for a year? And what if I could get school to give me credit for this endeavor?” My vision was kind of like Dr. Quinn (medicine woman) meets the Peace Corps. Puja was on the exact same page, and we first talked about it at a presentation for the global health experiences that are already offered by school. Instead of signing up for one of the existing programs, we wanted to create our own. We spoke with Anne (Toledo Ob/Gyn who’s been traveling to Guatemala for over 13 years – we had both been on trips with her already) and that’s when the trip really took off. Before we knew it, our little plan of being small town village doctors turned into a project bigger than any of us could have anticipated.

Background: (Sorry to bore you, but this is important. And I may have done a lot of research on it.) Cervical cancer is the leading cause of cancer deaths in women in Central America. 80% of cervical cancer cases worldwide occur in developing countries. Effective screening programs involve repeated screening of each woman throughout her lifetime, but this obviously requires a great deal of infrastructure, money, and training. Due to these limitations, a large proportion of women remain without access to screening. In addition, other methods have been developed that are cheaper and require less training for providers. One is Visual Inspection with Acetic Acid (VIAA), which involves washing the cervix with acetic acid (vinegar), waiting a minute, and looking for abnormal lesions, which should turn white.

In developed countries, the emphasis is placed on identifying and treating precancerous lesions before they progress to cervical cancer (a process that usually takes over 10 years). Since pap smear programs started, the incidence of cervical cancer in the United States has decreased by 90%. In countries like Guatemala where less than 5% of the population is screened to catch early stages of disease, two thirds of cervical cancer cases are diagnosed at advanced stages when the prognosis is poor. When caught early, simple therapies (such as cryotherapy) can eliminate 80-90% of lesions.

The Project: Our overarching goal is to develop a successful cervical cancer prevention program in the Petén department of Guatemala. To this end, we are undertaking a month-long mass screening campaign based in 4 communities in the region. We hope to screen 1,000 women with both VIAA and conventional pap smears. We have cytotechnologists from Toledo Hospital with us, who will read the pap smears immediately for results within about an hour – we never even get that in the United States! For patients with abnormal results, biopsies will be taken and, if appropriate, cryotherapy treatment will be provided. Additionally, we are collecting a large survey of history data from each patients, including information about exposure to a number of potential cervical cancer risk factors. We hope to compile this data to guide further work Sew Hope does in the Petén and also to help other groups doing similar work. It’s hard to wrap my head around the breadth of the issue and the impact this project could make.