A visit to the Hlokomela Clinic – Integrating cervical cancer screening into an existing HIV prevention and treatment programme in Limpopo, South Africa

Hlokomela-Clinic-Prescriptions-10-March-2015Hlokomela Clinic Prescriptions

Cervical Cancer is a highly preventable disease caused by infection with a Cancer-causing subtype of the Human Papilloma Virus (HPV) in concert with one or more high-risk behavioural factors. There are 500 000 new cases of cervical cancer diagnosed each year, and approximately 250 000 women die from this disease annually. The majority of cases and deaths occur in developing countries where screening and treatment options are limited. Women who are HIV positive are four to five times more likely to have cervical abnormalities detected by a pap smear. In South Africa, 16% of adults or over 5 Million people are living with HIV/AIDS. Among migrant farm workers and sex workers living in Limpopo Province this rate is a staggering 29%.

The Hoedspruit Endangered Species Centre (HESC), The Hoedspruit Training Trust and the Global Women’s Health Division of Mount Sinai Medical Centre in NY initiated a programme (which took 3 to 4 years to get off the ground) made possible by Anne-Marie Beddoe and her husband Peter to integrate cervical cancer screening into the HIV services provided at Hlokomela, using a “see and treat” approach, providing screening and treatment on the same visit.

This procedure is performed by using 5% of Acetic acid, which is actually ordinary table vinegar, and applying it to the cervix in order to highlight pre-cancerous lesions that are present. This procedure is often referred to as VIA (visual inspection with acetic acid) and can be readily taught to nurses and community health workers. Once the lesions are identified, the provider can immediately treat these lesions with one of several methods. The most common treatment is done using the cryotherapy system.


Hlokomela Clinic Cryotherapy

Cryotherapy literally means “Cold Treatment”. It is a procedure that uses a surgical device or probe that is placed against the cervix. The probe delivers temperatures of below -20C to the tissue, freezing it and allowing the destroyed cells to slough off over the following week or two. The temperature in the probe is obtained by causing the expansion of compressed carbon dioxide gas that is forced through the probe.

This procedure is relatively inexpensive and does not require electricity nor does it have any life threatening complications and it is a procedure that is easy to teach to the health workers and community workers.

Hlokomela-Clinic-explanations-10-March-2015Omara Afzal (From Mount Sinai Medical Centre, The Global Women’s Health Division) explaining to our US Friend Mrs. Roberts what Cryotherapy is and how it works.

This program will save the lives of numerous women who are now able to live with HIV due to the effective anti-retroviral drugs now made available to treat them. This is all thanks to:

Hoedspruit Training Trust (HTT) – The screening is being conducted at HTT’s 3 Wellness Clinics in Hoedspruit, and Phelwana. The Hlokomela clinic patients have volunteered to participate in the screening program. The staff at Hlokomela has had training workshops to enable them to perform the initial screening on all their female patients. As hosts of this programme, the HTT staff has been steadfast in their commitment and determination to running this successfully. A special thanks to Sister Lea Swart & Christine Du Preez, who work at the clinic.

Hoedspruit Endangered Species Centre (HESC) – has been the inspiration for this project and is providing financial and logistic support for this programme. One of the major goals of the HESC is to give back to the communities where many of their workers come from. This project further demonstrates their wholehearted investment in the women of their community.

US Friends of HESC  – is a US based not for profit organisation providing financial support to HESC, and have been instrumental in the implementation of this programme. The US Friends of HESC has been deeply involved in the financial and logistic component of the programme.

TheWomen.org – is a US based not for profit organisation with the mission to bring cancer care equity to women globally. Thewomen.org has financed the educational materials and medical equipment needed to jump-start this programme.

Mount Sinai Medical Centre – The Global Women’s Health Division of the Department of Obstetrics and Gynaecology has supported the salary (thanks to Anne-Marie & Peter Beddoe) of the Global Health Fellow (Omara) allowing her to remain in South Africa to oversee the successful completion of this program, and the Department has supported those staff members engaged in the development and execution of this programme.

We have been granted approval from Qiagen – a German medical company to utilise its careHPV test for screening patients enrolled in this programme for evidence of infection with high-risk HPV strains. This nucleic acid detection test can detect up to 14 different types of the human papilloma virus associated with cervical cancer. Of major importance to developing countries, this system can function without running water or electricity and has the ability to provide results in approximately three hours.

Hlokomela-Clinic-US-Friends-10-March-2015From the left: Mrs. (Heidi) & Mr. (Allan) Roberts (US Friends). On the couch; Lente Roode (HESC), Scott Zevon & Victoria Vanee (US Friends) , Laura Smith & Trevor Alford (HESC), Omara Afzal (From Mount Sinai Medical Center, The Global Women’s Health Division)

As Mrs Roberts (Heidi) says, “We take care of the animals and the animals take care of you”