See and Treat

Start of new Project See & Treat

Together  with the City Garden Clinic we start a new project called See & Treat which is a Cervical Cancer screening in Sierra Leone.  Every year about 512 women get cervical cancer in Sierra Leone and about 372 woman die of cervical cancer (estimated numbers, as exact data not available – HPV information centre 2017). Cervical cancer can be prevented by treatment of pre-cancerous lesions of the cervix.

Most developed countries have a screening program in place where women get PAP-smear done. This is quite expensive as pathology testing of the specimen taken needs to be done by a specialist (pathologist).

The recommended method by the WHO for developing countries is the “See and Treat” method. This method consists of visual inspection of the cervix after application of vinegar. The vinegar will show if there are abnormal (pre-cancerous) cells. When a woman has these pre-cancerous cells, this can be treated immediately (during the same visit) by freezing them or heating them (this will kill the precancerous cells). By doing this further development of these cells to cancer is prevented, so the cancer is prevented. In Sierra Leone there is not yet such a program, but there is much suffering from cervical cancer. So it is high time to get cervical cancer screening introduced in Sierra Leone.

Therefore Smarter Hospital is assisting dr Erdi to start a pilot project in Makeni, to get the first experiences in Sierra Leone. This project is to pilot the ‘See and Treat’ method in Sierra Leone and to prepare for up scaling to district level and national level. The beneficiaries of this project are the estimated 12521 women of Makeni between the age of 30-49 years old. The recommended age group to do cervical cancer screening is between the age of 30-49 years old and it is recommended to do this screening every 3-5 years. Therefore in this first year we aim to screen 1/3 of the 12521 women, which are 4174 women. (According to the 2015 census of Sierra Leone, Makeni population (125970 persons) is about 20% of the Bombali District population (606544 persons); in Bombali District there are 60289 women between 30-49 years of age, which will give an estimated number of 12521 women between 30- 49 years of age in Makeni). Women that are screened can be found not to have any precancerous cells, they will be advised to be tested again in 3-5 years. Some women might be found to have precancerous cells, these will be offered treatment, with their consent, during the same visit.

For this pilot project we will use thermo coagulation (heating) for the treatment of precancerous cells using electric device, as the freezing (cryotherapy) will need a constant supply of good medical CO2, which would make up scaling of the project much harder. After treatment they are advice to come for check up. For the women that already have stages of cervical cancer that are too advanced to be treated with thermo coagulation, we will refer them for further management to the hospital. These women might need conus excision or hysterectomy (operation to remove the womb, including the cervix) if in still operable stage. Some women may need palliative care if the cancer is in advanced stage.

This projects aims to reduce the incidence and mortality of cervical cancer in Makeni.
The second aim is to learn lessons of implementation of the ‘See and Treat’ method in Sierra Leone, to aid a smooth scale up to district and national level. So you can support us for this project via the donation possibilities at our website.