See & Treat

Start of cervical cancer screening in City Garden Clinic.

Since 2014 Dr. Nick Zwinkels and Dr. Erdi Huizenga have been discussing cervical cancer screening for Sierra Leonean women. The large number of advanced cervical cancer that was seen at the hospital they work together triggered this. They started to discuss the issue of cervical cancer screening with each other, but also with others. The realization that a national cervical cancer screening was needed became more and more clear.

They came in contact with the people of the Female Cancer Foundation, who have a lot of experience in introducing cervical cancer screening in developing countries, and agreed to see how they could work together.

In Makeni dr. Erdi started working at City Garden Clinic, were the ideas of cervical cancer screening were enthusiastically received and encouraged. In Makeni also an other partner was found in World Hope International, to assist proper implementations of the plans. They have good connections and experience in working with the ministry of Health and Sanitation and working with the District Health Management Team. The writing of the plans and also contacts with the ministry of health has started and are

progressing. But this week dr. Nick spend half of his holiday in Sierra Leone, to make a start with the screening at City Garden Clinic.


Teaching of the staff of the clinic

Dr. Erdi had already been teaching about cervical cancer to the staff of City Garden Clinic. On Tuesday Dr Nick gave comments when an educational video was shown to the staff. The staff was told we would start the screenings on Wednesday, for anyone that wants to be screened. One of the first responses was: “ Doctor, can I also bring my relatives for screening?”


So after preparing the instruments, the room and ourselves (testing the ‘cold coagulation on pieces of chicken meat) on Tuesday, we actually started screening on Wednesday.

Start screening

We had 6 women that came for testing on Wednesday, all female nurses of the hospital. We had 7 women coming for screening on Thursday, some staff, some relatives and 6 women on Friday.  Once more the screening was explained, this time making use of flipcharts (thank you Marlieke for sharing them!) and demonstration of the instruments/equipment. All gave verbal consent and some basic information was collected (we are not sure yet, what questions would be interesting to analyse). Screening was done with 5% vinegar from the supermarket, various specula and other instruments from different donations, a mobile ODT donated by Rob Moss, and the Wisap Cold Coagulator donated by Smarter Hospital.

The mobile ODT works as a mobile colposcope, it is able to make pictures and store them together with some information about the patient.
We experienced some beginners problems, like not getting the pictures sharp due to too much movement on the ODT. Now we found the holder and installed that one, so hopefully, it will be better soon.
The women mostly experienced it as well doable. Some felt some cramps, when the vinegar was applied. One lady was very scared, but was with some counseling was able to be screened.

Near future

One of the nurses from the outpatient department, Kadiatu Turay, assisted in the screenings, after being screened herself as well. She will soon learn to do the screening herself. All screened woman were ready to become ‘ambassadors’ for the cervical cancer screening. Out of the 19 women screened we had one VIA positive, and she accepted the treatment with the WISAP cold coagulator. This was done in the same visit. From now on we will have cervical cancer screening every Thursday at City Garden Clinic.

In to the future

Nick, Erdi and Allieu (WHI) and Carrie Jo (WHI) also met to discuss the proposal/plans to expand the screening. This was very fruitful! The aim is to start in Bombali District with a static clinic and an outreach team visiting the PHU’s. We want to do that to make a ‘road map’ for the Ministry of Health and Sanitation, how they can expand this to all other district in Sierra Leone.

While implementing this we hope to gather additional data (research) that can help us doing a better job (eg better planning, better procedures, better convincing government and donors). We are looking forward to start the project with the Female Cancer Foundation and World Hope International.

We are very grateful to many people assisting and/or encouraging us to get to where we are. Thank you very much!

Start of new Project See & Treat.

The City Garden Clinic, with support of the Smarter Hospital Foundation is starting 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 dr. Erdi, with support of the Smarter Hospital Foundation is starting 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.