Finding and treating early stages of cervical cancer in Rwanda

	Clinicians in Rwanda learning a method known as Visual Inspection with Acetic Acid to screen for cervical cancer.

Rwanda recently held its first national training of trainers on quick and low-cost approaches for screening for cervical cancer using Visual Inspection with Acetic Acid, and treating pre-cancerous lesions with cryotherapy. 

Partners In Health (PIH) and its Rwandan sister organization Inshuti Mu Buzima (IMB) organized the three-week training in collaboration with the Ministry of Health and WE-ACTx, and with funding from the cervical cancer program of the nonprofit organization PATH, reported Dr. Jacklin Saint-Fleur, Director of Women's Health for PIH/IMB in Rwanda, who helped organize the training. Certificates were awarded to eight doctors and three nurses representing health facilities in Butaro, Ruhengeri, and Rwinkwavu, and from WE-ACTx.

For the screening method, known as Visual Inspection with Acetic Acid (VIA), clinicians swab a small amount of acetic acid—common vinegar—across the cervix. Normal cervical tissue remains unaffected by the solution, but damaged tissue found in pre-cancerous or cancerous lesions turns white. To treat these pre-cancerous lesions—which could develop into cervical cancer—the training participants were taught how to use cryotherapy, which removes the lesions by freezing them with carbon dioxide or nitrous oxide.

These procedures can be used to rapidly diagnose and treat the pre-cancerous lesions during the same patient visit. This can be a major asset to accessing care in areas where taking time to travel to a clinic can mean a day where the patient is unable to tend to her family or earn an income.

This training is part of PIH's work to support the development and implementation of Rwanda's National Cervical Cancer Plan, which includes primary prevention through vaccination and secondary prevention through screening with DNA testing for human papillomavirus (HPV)—the virus responsible for most cases of cervical pathology—and VIA, cryotherapy, radiotherapy for treating cancers, as well as palliative care.

Since August 2010, PIH has worked to enable Butaro, Rwinkwavu, and Ruhengeri Hospitals to offer cervical cancer screening, with support from PATH. Over 1,170 women have been screened and 56 have been treated with cryotherapy. In addition, three patients have been sent to Uganda for radiotherapy. PIH also furnished Butaro and Rwinkwavu hospitals with new equipment, including a LEEP machine and colposcope.

In her speech at the closing of the recent training, Diane Mutamba who represented MOH, said that the training was a perfect demonstration of PIH's commitment to building capacity in the public sector. The training also coincides with growing attention on the need to address cancer in the developing world. 

In PIH co-founder Paul Farmer's March 2011 interview with Mary Carmichael of Scientific American, he insisted that tackling the growing threat from cancer in the developing world could improve health care more broadly. The article highlighted PIH's role in the global task force working to marshal support for cancer treatment in low resource settings.

“We will continue to support our partners in the MOH to ensure that they are able to provide high quality services to Rwandan women,” said Dr. Saint-Fleur. “We still have a lot to achieve in the fight against cancer in Rwanda so we will still need the support of everyone.”