Cervical Cancer Awareness and Knowledge Campaign: Health Promoters of Rural El Salvador

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Cervical Cancer Awareness and Knowledge Campaign
Health Promoters of Rural El Salvador
Proposal by Basic Health International, Inc.
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The basics about Basic Health International
(BHI)

• NGO founded by Dr. Miriam Cremer, MD MPH at Mount
  Sinai School of Medicine, New York City.
• Our Vision Eradicate Cervical Cancer in Latin
  America and the Caribbean.
• To achieve this goal we
• Train healthcare providers in low-cost, low-tech
  methods of cervical cancer screening and
  treatment
• Provide Direct Patient Care
• Conduct research
• Help shape cervical cancer policy

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El Salvador Needs Assessment cervical cancer is
the primary cancer killer of women in El
Salvador.
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El Salvador Needs Assessment continued
This is due to the fact that women of rural El
Salvador have a very low rate of cervical cancer
screening.
Pap Smear Coverage () for Rural Women Pap Smear Coverage () for Rural Women
Ever (in lifetime) 82.7
Past two years 63.3
There is also a vast lack of knowledge about the
human papillomavirus (HPV).
Percentage of women (aged 15-49) who have heard of HPV 29.1
Encuesta Nacional,de Salud, FESAL 2008 Familiar.
October 2009
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MISSION OF PROPOSED PROGRAM

• Improve the awareness and knowledge of HPV
  infection and cervical cancer prevention among
  health promoters serving the Department of San
  Vicente, El Salvador.

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SCOPE OF WORK

• Develop a curriculum for health promoter
  education on cervical cancer prevention.
• Conduct education trainings for the health
  promoters of the Department of San Vicente, El
  Salvador.
• Work with the health promoters to develop a
  targeted cervical cancer prevention program for
  members of their communities.

Ethel Peralta. BHI Program Manager, explaining
forms to health promoters and nurses during a
Basic Health delegation.
Health promoters studying cervical cancer
prevention material.
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TARGET POPULATIONS

• 125 Health Promoters working in San Vicente, El
  Salvador It is our goal to provide health
  promoters with a comprehensive knowledge-base
  about HPV and cervical cancer.
• During the course, health Promoters will develop
  targeted informational campaigns for
• Sexually active women
• Goal To improve knowledge about methods to
  prevent cervical cancer, and to improve
  understanding of the history of HPV and its
  progression to cervical cancer.
• Sexually active men
• Goal To encourage involvement in the process
  of cervical cancer screening with their partners,
  decrease the negative stigma associated with
  gynecological exams in order to ensure they are
  not a barrier to their partners cervical cancer
  screening and treatment.

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Program of Action
WHO ARE HEALTH PROMOTERS? Health promoters are
members of the rural community that keep track of
their constituents health needs, and informs
about disease prevention and healthcare
campaigns.
BHI technical advisors will conduct cervical
cancer awareness trainings to the health
promoters in order to arm them with tools
necessary to successfully educate members of
their community.
Health promoters will develop targeted campaigns
for their community, with a focus on presenting
information to both men and women.
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Program of Action Health Promoter training
DAY ACTIVITY MATERIALS
1 Morning Focus Understanding the basics of HPV infection, cervical cancer screening (Pap Smear, VIA, HPV-DNA test), and cervical cancer. In groups, participants will present different topics about cervical cancer, including epidemiology, natural history of HPV, classification, diagnosis and treatment of cervical pre-cancers and cancers. The facilitator will explain the variety of screening techniques for cervical cancer detection. Computer, projector for power point presentations and bibliographic material to present the topics
1- Afternoon Focus Overview of educational techniques to present knowledge The facilitator will present different educational techniques that can be used to transmit knowledge, with a focus on shaping the info for a target audience. Facilitator will present a sample healthcare education campaign to health promoters Flipcharts, power point presentations and dynamic exercises that will include the participants
2- Morning Focus Developing methods to present information to the female community. Health promoters will work in groups to develop campaigns targeted at women in their community. Health promoters will conduct mock-interactions to practice campaign. Dynamic exercises with the participants, power point presentation, flip charts, public health outreach materials.
2- Afternoon Focus Developing methods to present information to the male community, and putting it all together. The facilitator will present different techniques to talk with men in the community about the history of cervical cancer, and womens rights to cervical cancer screening, in an effort to ensure men feel like an Important part of their partners evaluation and treatment. Health promoters will work in groups to develop campaigns targeted at males in their community. Flipcharts, power point presentations, public health outreach material, dynamic exercises with the participants.
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Outcomes

• Quantitative improvement in health promoter
  knowledge of HPV infection and cervical cancer
  prevention (pre-and post course tests).
• Implementation of educational HPV/Cervical Cancer
  campaigns reaching over 73,000 rural Salvadorans.
  
• Free web-based programmatic materials to
  implement health promoter education course in
  low-resource settings globally.
• Program description and outcomes published in
  peer-reviewed journal.

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Cervical Cancer Informational brochure we have
developed and distributed to health promoters
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• Please go to http//www.youtube.com/BasicHealth
• to view a short video about Basic Health
  Internationals
• work in El Salvador.
• Please refer to our website www.basichealth.org
  for more
• information.
• The following slides provide additional
  background information about Basic Health
  International.

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BHI and Policy

• Develop national cervical cancer guidelines with
  the Ministry of Health, including the integration
  of the single-visit approach into an existing
  cytology program.
• Conduct annual regional Cervical Cancer Screening
  Symposium in San Salvador, El Salvador. (Upcoming
  event January 28, 2010)
• Work with community organizers to develop the
  best practices to implement cervical cancer
  screening initiatives and programs.

Dr. Miriam Cremer, President and Founder of BHI,
talking at the 2008 cervical cancer symposium.
Over 250 people from Central America attended
the 2008 cervical cancer symposium.
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Training OBGYNs, Generalist Physicians, Nurses
and Health Promoters

• BHI holds tri-annual delegations to El Salvador
  during which Salvadoran Healthcare providers
  receive a 5-day training on visual inspection
  with acetic acid and cryotherapy.

Women waiting in line for their exam.
BHI trainer Dr. Rachel Masch training Salvadoran
physician.
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Patient CareNumber of women screened during
delegations between 2006 and 2008.
YEAR MONTH LOCATION Women
2006 JANUARY Jucuarán 614
2006 AUGUST San Vicente 358
2007 MARCH San Vicente 578
2007 MARCH Arcatao 153
2007 NOVEMBER Arcatao 112
2007 NOVEMBER Cojutepeque 683
2008 MAY Ilobasco 698
2008 JULY-AUGUST San Vicente - Jucuarán - Arcatao 108
2008 NOVEMBER Suchitoto 527
2009 JANUARY Process Evaluation 283
2009 APRIL Sensutepeque 883
    TOTAL 4997
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2006-2008 Lesions and Invasive Cancers Detected
Year Invasive Cancer CIN 1 CIN 2 CIN 3
2006 1 18 8 5
2007 5 10 11 5
2008 2 5 7 3
TOTAL 8 33 26 13

• 72 pre-cancers have been treated.
• 8 invasive cancers have been detected and
  treated.

CIN CLASIFICATIONS CIN CLASIFICATIONS
CIN 1 Mild dysplasia abnormal cells can be found in 1/3 of the lining of the cervix
CIN 2 Moderate dysplasia abnormal cells can be found in 2/3 of the lining of the cervix
CIN 3 Severe dysplasia abnormal cells can be found in more than 2/3 of the lining of the cervix and up to the full thickness of the lining
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Research

• 11 Publications
• 21 Abstracts
• First prize for original research, Federation of
  Latin American Obstetrics and Gynecology (FLASOG)
  Conference, San Salvador, El Salvador, 1999
• 14 current research projects

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• THANK YOU
• Contacts
• Dr. Miriam Cremer, President and Founder
• miriam.cremer_at_mssm.edu
• Dr. Mauricio Maza, Medical Director
• mmaza_at_basichealth.org
• Lauren Ditzian, Program Manager
• lditzian_at_basichealth.org

www.basichealth.org