Preventing Cervical Cancer in South Africa

Posted on by nayavill

My practicum is with the UNC Global Women’s Health Division, specifically the UNC-Wits-Right to Care Partnership for Cervical Cancer Prevention in Johannesburg, South Africa (SA). In SA, cervical cancer is the leading cause of cancer death among women. Although cervical cancer is largely preventable through HPV vaccination, routine screening, and treatment of cervical precancer, there are significant disparities in access to these life-saving prevention strategies within and between countries. Currently, approximately 90% of cervical cancer mortality occurs in low- and middle-income countries. While SA is considered an upper-middle income country, it is also one of the most unequal societies in the world.

Overall, health outcomes in SA remain poor relative to the country’s economic development, and cervical cancer disparities by race and socioeconomic status are stark. According to the recently published SA Demographic and Health Survey, approximately 78% of White women in SA have had at least one Pap smear (to screen for cervical cancer and precancer) compared to just 32% of Black women. Not surprisingly, Black women in SA are also more likely to be diagnosed with cervical cancer. In 2014 the cervical cancer age standardized incidence rate (ASIR) in SA was about 27 per 100,000 Black women compared to 10 per 100,000 Asian women (the group with the lowest ASIR).

Staff at the cervical cancer team meeting
Top row (from left): Kopano Kgopa, Tafadzwa Pasipamire, Dr. Masangu Mulongo, Krista Scheffey, Patricia Mofokeng, Boikie Mohamme
Bottom row (from left): Bawinile Njoko, Sophie Williams, Rendani Nenzhelele, Ntombiyenkosi Rakhombe

The UNC-Wits-Right to Care team is working to reduce disparities in cervical cancer morbidity and mortality by providing free Pap smears and precancer treatment to thousands of women in SA. I’ve joined an amazing team of clinicians and researchers who have been extremely generous with their time and expertise as I get up to speed (and ask a million questions). Over the last few weeks I have been shadowing in clinic to better understand how the program operates and how clinicians educate and counsel patients. My main project this summer will be creating and updating patient communication materials to raise awareness and convey key educational messages about cervical cancer prevention with the goal of improving Pap smear screening coverage in program sites.

Observing Boikie and Bawinile at work on the mobile van in Diepsloot.

In addition to my time in the clinic, I’ve also been exploring Johannesburg and continuing to learn about SA’s history. This country provides a vivid example of the way that social factors, particularly historical and contemporary patterns of oppression, impact population health. While I’ve been doing a lot of reading, the opportunity to live and work in this city is a daily reminder that reality is much more complex than can be captured in journal articles. When I’m feeling guilty about spending time at one of Johannesburg’s downtown markets instead of working on my master’s paper (which I am also planning to write while I am here), I remind myself that closing the data visualizer, leaving the office, and taking time to learn first-hand about the community with which I’m working is also a critical part of public health practice.

Johannesburg from above. The Carlton Centre is the tallest office building on the continent and its observation deck is known as the “Top of Africa.”

I feel very lucky to be a part of a team that is doing such important work here in Johannesburg. Stay tuned for more journal articles, statistics, and photos in my next update. (To tide you over, here’s bonus reading: while cervical cancer is much less common in the United States compared to SA, disparities by race persist.)

Inside the Constitutional Court of South Africa.

– Krista

At home in Mauritius

Posted on by nayavill

It has now been three weeks since I landed in Mauritius, together with my husband and our two children. Many of you may know Mauritius as a tourist destination; Mark Twain is often quoted to have said: “You gather the idea that Mauritius was made first, and then heaven, and that heaven was copied after Mauritius.” Surrounded by stunning coral reefs, Mauritius spans less than 800 square miles and is home to over 1.3 million people. Beyond its flourishing tourism industry, Mauritius is often cited as a model of democracy amongst African nations and an example of social cohesion where people from African, Indian, Chinese and French heritage have created a peaceful co-existence.

Although I have been back several times to visit my family and on holidays, it has been 15 years since I first left to go study abroad. I have lived in different countries during that time, and when the possibility of completing my practicum in Mauritius arose, I knew that this was something that I should do. I was curious about how I could apply what I have learnt during my time at UNC to the reality here, and learn about the ways that I could give back to my home country.

Being a dual degree student with the School of Social Work and Public Health, I am working with two different organizations in order to complete all my required field hours: Gender Links (GL) and the Global Rainbow Foundation (GRF). Gender Links is a South African Women’s Right Organization with offices in ten Southern African Development Community (SADC) countries including Mauritius.

On the second day of my internship with GL, I was asked to be on a jury at the Voice and Choice Summit, which regrouped NGOS, local government councils, media organizations and individuals who are creating change in their communities across the island. The goal of the summit was to create a learning platform where each one came and presented their best practices for promoting gender equality through their current work. The presentations were made under various categories such as gender and climate change, gender and governance, sexual and reproductive health and rights, and others. A winner would then be chosen within each category to represent Mauritius at the African Regional Voice and Choice Summit in South Africa. For me this was an incredible opportunity for networking and for learning about the work of over 20 organizations in one sitting. I appreciated learning about how gender is intersecting with various issues such as poverty and education in Mauritius.

The jury.

GRF is dedicated to the service of those who live with a disability in their life, be it mental or physical. Their approach is to provide a one stop shop, where someone interacting with their foundation can receive all the services necessary to be a fully functional member of society. To this end, GRF makes and provides prosthesis to its clients, provides employability training, provides medical services by a team of doctors which includes an occupational therapist, psychologists, and a physical therapist. It also engages in advocacy work in order to promote the rights of individuals living with disabilities.

The bulk of my work with both organizations consists of strengthening their internal capacity for monitoring and evaluation. While there is a strong emphasis on regular monitoring of activities, the evaluation component is often minimal, in part because organizations are strapped for staff and resources.

I am looking forward to the coming months as my family settles into the rhythm of the island (which is sometimes not so slow) and as I gain more field experience through both of my practicums. Beyond that, I am also excited to be meeting various individuals and talking about future ideas for collaboration such as strengthening and standardizing the practice of Social Workers in Mauritius and encouraging more research around gender issues, so that NGOs can more frequently engage in evidence based practices. There is so much happening and I am loving it!

– Yovania

Life in Lusaka

Posted on by nayavill

I arrived in Lusaka, Zambia about three weeks ago, after a grueling 26 hours of travel, and jumped right into my internship with the UNC Improving Pregnancy with Progesterone (IPOP) Study. I spent my first week in the UNC Global Projects office familiarizing myself with the study and the issue of preterm birth in Zambia and getting settled into my new accommodation and neighborhood. I am now working mostly in the University Teaching Hospital (UTH) to finish collecting and cleaning the data that will be used to evaluate the cost-effectiveness of using progesterone during pregnancy as a way to prevent preterm birth among high-risk women.

UTH

It took me about a week to feel confident navigating the halls of UTH in Lusaka. A large hospital that also receives many transfer patients from other clinics, especially in the maternity ward where I am working. I recovered from my first day where I found myself locked in a bathroom for overthirty minutes before the door had to be broken in.This brought alot of laughter to the crowd of staff and patients that had gathered around the door to see if I would get outand is now one of my top embarrassing moments.Most of my time is spent in the NICU right now, observing preterm babies and recording allthe actions themedical staffperformto care for the infants,and the length of time spenton the care. There is a long list of activities we are following, including performing physical exams and setting up IVs to resuscitating babies and delivering oxygen. There are anumber of preterm babies in Zambia that never leave the hospital, these days are by far the most difficult.

The infants are regularly moved around and are difficult to keep track of and doctors and nurses are constantly in motion asI trail them with my notebook and timer. They work quickly and efficiently,movingvery much in sync. I am usually in awe with how effortlessly they move around each other, and me, in the often-crowded rooms. All of the staff are incredibly nice and accommodating andnever forget to start each day by saying “good morning” to everyoneandtheyare always willing to answer my many questions about the activities they are performing.It has been a great opportunity to not only learn more about the issue of preterm birth in Zambia but also about the local healthcare system more broadly.

Chaminuka National Park wildlife.

Outside of work there is plenty to do in Lusaka and around Zambia; so much that it would be impossible to see everything in the short ten weeks I am here. The winter weather here is very ideal and is a welcomed break from the North Carolina summer heat. Multiple national parks and animal nurseries are home to much of Zambia’s diverse wildlife, which the country is making a great effort to preserve. These are great day trips from Lusaka. I will soon be traveling to Livingston for a weekend to see Victoria Falls, one of the natural wonders of the world and a sight I hear is nothing short of amazing. In Lusaka, there are many restaurants and cafes serving food from all over the world. Local cuisine is heavily centered around nshima, a pounded white maize which is scooped up and rolled into a ball with your hands and eaten with different meats, beans and vegetables.

I have learned so much in the few short weeks I have been in Lusaka. Everyone has been incredibly welcoming and have quickly made me feel at home. I look forward to continuing to learn and collaborate throughout my internship and to see what life in Lusaka has in store for the next couple of months.

Chaminuka National Park.

-Taylor