Going mobile

Nazarene Health Ministries started a cervical cancer prevention program some years back.  Pauline is a community health worker who runs the clinic.  Women come to the White House for pap smears on Tuesdays and Thursdays.  She screens 20 patients or so every week, or about 6000 since the program began.  They pay 4K (about $1.50) for the test.  Pap smear slides are mailed to Meripath, a non-profit organization in Australia that provides pathology services to more than 20 cervical cancer screening programs around PNG.  After 2 months, patients return to the clinic to get the results.  Those with abnormal pap smears are referred to me.  I examine them and look for signs of cervical dysplsia, early changes that could someday become cancer.  A simple procedure can cure the patient long before her dysplasia progresses to cancer.  Every time one of those procedures is done, a woman's life is saved.

The biggest challenges to the program are information, transportation, and follow-up.  Many women do not know that they need to have a pap smear or about the services that we provide.  Some are afraid to come for an exam.  Others are unable to travel to Nazarene Hospital because the road is bad or they don't have the money.  We also depend on women to follow up at the clinic for results.  If they don't return or have a working phone, we have no way to notify them of their need for treatment.

A few months ago, we began to dream about how we could expand our program and reach more women in outlying areas.  Primary Health Services is the division that provides services such as prenatal care and immunizations to the surrounding communities.  Mr. Gabriel is the director.  He agreed to do a pilot project in which PHS would partner with one of the local health centers for a mobile pap smear clinic.  He selected one of the bigger and more remote health centers at one far end of our valley.  Nondugul turned out to be the perfect place to start!  Pauline's husband is from that village and she sometimes works at the health center on weekends.  Mr. Gabbie and Pauline made a visit to Nondugul to talk with the health center staff about cervical cancer and the proposed partnership.  They were just as excited about the project as we were, and began recruiting patients almost immediately.

On Friday morning, Pauline and I met at the White House to gather up the supplies we would need.  We spent some time in prayer as we waited for the rest of the team to arrive.  Mr. Gabbie, Pastor Kiap, and a reporter from one of the local newspapers pulled up in the green PHS cruiser.  We loaded our stuff, recruited one of the nursing students to join us, and headed out to Nondugul.  The fog was just beginning to lift as the cruiser climbed out of the valley and to the surrounding foothills.  The view was spectacular.

We arrived at Nondugul health center about 45 minutes later.  We were greeted by the on-duty staff.  John is a Health Extension Officer (PNG equivalent of PA) and is also in charge of the health center.  Sister Lucy looks after the labor ward, and would be helping us for the day.  The health center was much bigger than I expected.  There is one building for immunizations and outpatient visits, another inpatient ward, and also a building for the labor ward.

We set up for our clinic in the maternity building.  The spacious postnatal ward was rather empty.  Apparently there used be some beds in there, but some rascals recently broke in and stole almost everything.  The room was quite a nice place for the women to gather and wait to be seen.  Pauline welcomed them, explained what cervical cancer was and why they needed to have a pap smear.  She also explained what we would be doing, as many of the ladies had never had a pelvic exam.  

Sister Lucy and Elijah the nursing student began registering patients.  Pauline and I armed ourselves with head lamps and speculums.  We moved to two smaller rooms, one with a delivery bed and the other with a mattress-less bed frame, where we would do the paps.  Sister Lucy was the first in line--she wanted to be an example for the rest of the women!  Once things got started, we really moved... 76 paps smears in just about 3 hours.  WOW.  I would have never believed it could be done!  Thank the Lord for helping us to go quickly so that everyone could be seen on that one day.  Of all the women that we examined, my second patient of the day was the only one to have an obvious cervical cancer.  The others will follow up in December for their results and referrals.

We concluded our visit with a wonderful lunch provided by the staff of Nondugul health center.  They were so appreciative of our visit, of the service that we provided for the women of their community.  They were ready to recruit more patients and asked when we could return!  HEO John also requested more information so that they could continue to educate patients about cervical cancer. 

What an awesome day.

Well, my preliminary assessment is that our pilot project was a cervical cancer smashing success.  In just one morning, we were able to screen as many patients as Pauline sees at Kudjip in one month.  And many of these ladies would have never made the trip to Nazarene Hospital just for a pap smear.  Of course the project will be ongoing.  We will be returning to Nondugul in December to notify the patients of their results, and those with abnormal paps will need to come to the hospital for further care.  But we are on our way in the fight against cervical cancer.

Mr. Gabbie hopes to continue the mobile pap smear clinic as one of the regular PHS services.  Once a month, a team of CHW's, nurses, and doctors will travel to a different health center to provide cervical cancer education and do pap smears.  Improving access to screening will increase detection, allow for early treatment treatment, and ultimately prevent new cases of cervical cancer.  And most importantly, lives will be saved.

"Jesus went through all the towns and villages, teaching in their synagogues, proclaiming the good news of the kingdom and healing every disease and sickness.  When he saw the crowds, he had compassion on them..."

~ Matthew 9:35-36a