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A perspective from Dr. Groesbeck Parham 

Cervical cancer kills more women in the world’s poorest nations than any other malignancy. Experts predict a substantial increase in both new cases and deaths over the next 20 years. It is vital to help the women living in these settings access prevention and treatment services. Zambia is a southern African country of 16 million people, 60 percent of whom are women. Cervical cancer kills 20 times more women in Zambia each year than it does in the U.S.

This is due primarily to the fact that women in Zambia don’t have the opportunity to be screened and treated for cervical cancer. In most cases when they do discover they have the disease, it is too late to be treated and they die very painful deaths.

Over the past decade UNC Global Women’s Health faculty have been collaborating with the Zambian Ministry of Health to build a foundation for the early detection and prevention of cervical cancer. The first step was the creation of a nurse-led cervical cancer screening program in 2006, through which more than 600,000 women have now been screened, and more than 20,000 treated, for cervical precancer. In 2015, the program was integrated into the Zambian Ministry of Health as the country’s national cervical cancer prevention program and is being scaled up across the nation.

The second step consisted of HPV vaccination of adolescent girls. This began in 2012 with a demonstration project of HPV vaccination of 15,000 girls between ages 9 and 12 years initiated by UNC faculty. The results were used by the Ministry of Health to apply for GAVI (Global Alliance for Vaccines and Immunizations) support for a nationwide HPV vaccination program of adolescent girls, which will start June 2019.

The third and last step in laying the foundation was the 2015 initiation of a new gynecologic oncology division in the Department of Obstetrics and Gynecology at University Teaching Hospital, Zambia’s lone tertiary hospital. The purpose was to provide specialized surgical care for women with cervical cancer and other gynecologic malignancies.

Dr. Groesbeck Parham teaches a case in the operating room at University Teaching Hospital in Lusaka, Zambia.

A newly established gynecologic oncology fellowship training program was started this year, sponsored by the International Gynecologic Cancer Society (IGCS), in collaboration with the UNC OB-GYN Division of Gynecologic Oncology. UNC made a critical investment in women’s cancer care by supporting its faculty in Zambia who were committed to partnering with the Zambian government and medical university to address the country’s need for a public sector cervical cancer prevention and treatment program. That investment has now grown to the point where Zambia is in a strategic position to eliminate the disease.

Disease elimination is a multifaceted process. In addition to effective and efficient clinical services it must also consider business operations, public health strategy, management, and human capacity technological infrastructure development. Our faculty will be on site, every step of the way, to help implement these programs, as will many of the departments’ residents who will travel to spend time with UNC GWH faculty and fellows in Zambia. Involving UNC’s young professionals will expose them to the practice of medicine where one must rely heavily on clinical skills, in contrast to the U.S. where medicine is heavily driven by advanced technology. It’s important to learn what can accomplished with one’s brain and five senses. It also gives them the opportunity to explore how modern technology can be adapted to low-income circumstances.

One is much more effective when one works shoulder- to-shoulder with their colleagues, sharing the challenges, frustrations and disappointments, as well as successes, on a day-to-day basis. It allows your colleagues to see you as an integral part of their team, and as someone they can rely on and trust. It gives you credibility. You also gain a better understanding  of ‘gaps in the healthcare system’ and what it really  means, because you live with it every day – such as  when your decision-making ability is hampered by the  absence of laboratory results because the machines  are broken, or you can’t perform surgical procedures  because you don’t have enough oxygen or blood.  You gain a new perspective of just how difficult it is to try and deliver health care in a very low-resource environment. Almost every day you are thrown to the mat, but you have to find a way to pick yourself up and keep going, despite the difficulties. Your importance as a physician and the nobility of the profession come into full focus. You see that being embedded in the community and becoming part of the culture is central to bringing about sustainable and impactful change.

Dr. Groesbeck Parham, a professor of gynecologic oncology in the UNC OB-GYN’s Division of Global Women’s Health in Zambia, has lived and worked in Zambia for more than a decade. Parham is the only gynecologic oncologist in Zambia, and one of only a handful on the continent of Africa.

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