PIMA Team Attacks Cervical Cancer in Kiribati

In a shock to our medical team late last month, more than 30 percent of Christmas Island women examined tested positive for cervical cancer lesions and were treated on the spot with cryotherapy to kill early cancer cells.

“We had hoped to provide a useful service to the women of Kiribati when we sent our Pacific Islands Medical Aid (PIMA) Women’s Health Team and two specialists to Christmas Island in late August to begin the process of developing a cervical cancer prevention program,” said PIMA president Carlton Smith, “but we had no idea how critical the need was.”

During the week-long course, local medical personnel were taught how to identify and treat (kill on the spot) cervical pre-cancer with the use of cryotherapy, by freezing the abnormal cells… a program that can be replicated throughout the island nation of Kiribati.

“We brought two specialists and a volunteer from world-recognized Grounds for Health organization and donated all the equipment necessary for the Ministry of Health there to begin the process of developing their own cervical cancer prevention program in the Line Islands group where Christmas Island is located and in Tarawa, their capital,” Carlton said.

“Two days of classroom learning prepared the local team with information about human papillomavirus (HPV), cervical cancer, screening methods and most importantly the way to provide effective and immediate treatment when needed, and referral when appropriate,” he said. “Without doubt, this was one of the most meaningful and rewarding of our missions to Kiribati during the last ten years,”Carlton said. The teachers were great. Here is their story:

By Ellen Starr, WHNP & Susan Hollinger, WHNP

We were welcomed and thoroughly supported by Dr. Teraira Bangao, medical officer in charge on Christmas Island. The ten trainees were sharp, engaged and totally motivated to learn. Tiareti, principle nursing officer, gathered nurses and midwives serving the local community as well as from the neighboring island of Tabuaeran, to receive training. Dr. Ioanna, ob/gyn from the capital of Tarawa, attended as well… having expressed a strong interest in learning about a successful prevention model that has begun to receive attention on a global level.

An X-ray clinic was converted and by Saturday, we were ready to welcome women for screening. Equipped with a headlamp, cotton swab, speculum and 5 percent vinegar, 27 women… mostly from the small village of Poland, were screened. Pre-cancer findings were treated on the spot with a cryotherapy unit attached to a carbon dioxide cylinder. The clinic continued on Monday and Tuesday, with all the trainees gaining experience, confidence and competence.

In the end, 99 women were seen for screening. There was an overall positive rate of 31 percent, which is substantially higher than global norms. Two women were found to have lesions suspicious for cancer. Cryotherapy treatment was performed on 83 percent of women found to have positive lesions. The remaining 17 percent were referred to Dr. Ioanna for biopsy because they were found to have lesions too big for cryotherapy.

What did it feel like: INCREDIBLE. The energy to do the work, the caring and compassion for each other, the intelligence and willingness to do whatever is needed was such a big part of what makes both the people of Christmas and support of PIMA (Pacific Islands Medical Aid) unique.

Our nurses laughed, sang, taught us songs and danced with us as we traveled through the week of learning and practice together. Patients were lovingly cared for, reassured and treated with respect by each and every trainee. Out in the courtyard, buckets were lined up for high-level speculum disinfection. Women lined up waiting to be screened while our intern, Tatum, provided talks about women’s health and cervical cancer.

We had a rock star of a program manager in Carlton, an amazing group of trainees who quickly convinced us that they were committed and able to carry on… and we successfully treated a group of women who might otherwise gone on to develop cervical cancer. What else could we have asked for?

Causes of Cervical Cancer

World Health Organization (WHO) publications say cervical cancer is caused primarily by the Human Papillomavirus (HPV) and mainly transmitted through sexual contact. Risk factors are early first sexual activity, multiple sexual partners and tobacco use.

There are currently two vaccines that protect against the virus strains which are known to cause 70 percent of cervical cancers, but are not presently available in Kiribati. The World Health Organization recommends vaccinations for girls aged 9-13 years old.