Volunteering at CerviCusco in Peru.

Abstract

Cervical cancer is the leading cancer-specific cause of death in Peruvian women.1 The incidence of cervical cancer in Peru is double that seen in other South American countries and approximately 10 times the incidence rate in the United States. The prevalence of high-risk human papillomavirus (HPV) in adult Peruvian women is equally high and ranges between 12% and 35%.2, 3 The morbidity and mortality of impoverished women who develop invasive squamous cell carcinoma of the cervix in this resource-poor setting are dismaying. Unfortunately, there are several challenges for adequately controlling cervical cancer in Peru, including cultural and geographic barriers, a lack of education, a limited number of specialists in rural areas, the loss of women with abnormal Papanicolaou (Pap) tests to follow-up, inadequate HPV vaccination, and no widespread HPV testing.2, 4, 5 To address this public health need, Dr. Daron Ferris from Augusta University in Augusta, Georgia, started a nonprofit clinic in the city of Cusco called CerviCusco. Cusco, once the capital of the Inca Empire, is the gateway to Machu Picchu. The clinic offers comprehensive and culturally sensitive prevention, screening, diagnosis, and treatment of cervical cancer.6 CerviCusco is relatively well equipped and staffed by Peruvian gynecologists, several nurse midwives, nurses, and local cytotechnologist Erika P. Escalante. The clinic provides free gynecological examinations with Pap tests and liquid-based Pap test screening and, when necessary, offers follow-up colposcopy. Ferris visits the clinic regularly to perform colposcopy. Dr. David Wilbur from Massachusetts General Hospital in Boston, Massachusetts, previously donated a telepathology system to the clinic. This has enabled Escalante to have weekly telecytology sessions with experts in the United States, who help her to resolve challenging abnormal Pap tests.7 The adoption of a novel mobile clinic model in rural Peru has been shown to reduce some of the barriers to cervical cancer screening.8 Hence, for women who live deep in the Andes Mountains, the clinic staff partake in regular campaigns in which they drive to these indigenous communities. There, they set up shop, educate women about the value of getting a Pap test, and perform free Pap smears on those individuals who opt to have one. Some of the main barriers to receiving Pap smears for Peruvian women are fear, embarrassment, and a lack of knowledge.9 Many of the women arrive accompanied by their children. Within no time, these makeshift clinics are accordingly buzzing with numerous kids. Therefore, providing everyone present with some musical entertainment, food, and perhaps even hot chocolate is an equally important task during these campaigns. Not surprisingly, CerviCusco previously received the American Society for Clinical Pathology humanitarian award. CerviCusco has started offering HPV vaccinations for free to children in the region. The clinic has continued to expand its services, and it is currently working on providing mammography and hopefully soon HPV testing of Pap tests. The success of CerviCusco is largely due to generous donations from several corporations and institutions in the United States. For example, Beckton Dickinson donated equipment, reagents, and plenty of slides to perform tens of thousands of free SurePath Pap tests. Volunteers at CerviCusco are of immense help and are always welcome. Volunteers can have varying skills and levels of training. They may include cytologists, physicians, and medical students as well as any health care providers or students. They get to participate in clinic-based care and remote mobile clinics. Dr. Liron Pantanowitz (cytopathologist) and his son Joshua Pantanowitz (premedical college student) recently volunteered at CerviCusco. This entailed screening of Pap tests (Fig. 1A), aiding with processing of specimens (Fig. 1B), and helping with outreach campaigns (Fig. 1C,D). Peru is a remarkable country with spectacular geography, including rainbow-colored mountains that nestle glaciers, a desert that abuts the coastline, and parts of the Amazon jungle. Therefore, when people are not volunteering, there are ample tourist sites to visit (Fig. 1E). Thanks to a generous grant from Hologic, Escalante was subsequently able to visit the University of Pittsburgh Medical Center for 3 weeks (Fig. 1F). During her visit, she benefitted from spending valuable time with many of the cytotechnologists and received continuing education, including ThinPrep screening certification, and she was trained to perform HPV testing on Pap test samples. In conclusion, if you are feeling adventurous and looking to apply your cytology skills toward something meaningful, we strongly recommend that you consider volunteering at CerviCusco in Peru. To volunteer, visit https://www.friendsofcervicusco.org/ or email Friends of CerviCusco at [email protected]. No specific funding was disclosed. Erika P. Escalante reports employment by CerviCusco. Debra Krotish reports nonfinancial support from CerviCusco and personal fees from Friends of CerviCusco outside the submitted work. The other authors made no disclosures.