Seeing is Believing

Seeing is Believing

On our third day in Botswana, we visited Princess Marina Hospital to understand the country’s approach to Cervical Cancer prevention, diagnosis and treatment.?

Here, when a woman comes in for screening, the entire experience is supported with educational visual imagery so she has a clear understanding of what her Cervix is and why Cervical Cancer prevention is so important.?

In the exam room, she’ll see:

1. Visuals of a cervix at various stages from healthy to precancerous to cancerous
2. A screening decision tree to help her understand the process ahead and the system that will support her through each step
3. A picture of her own cervix that the provider takes after screening to a) keep in the woman’s record, and b) so each woman knows what her own cervix looks like

The Background

Funded by the wealth of diamond resources, the Botswana government provides its citizens healthcare and education. At the Princess Marina Hospital, Dr. Surbhi Grover and her team have designed and implemented a multidisciplinary approach where women are seen in a single setting for screening, treatment and follow-up care. Further, women’s participation and progress is captured in a central database to measure the impact of simplifying and expanding access to care -- no surprise, this approach has dramatically improved women’s outcomes because their cases are more closely tracked and treated, as opposed to falling through cracks in follow-up care.?

The Context:?

As many as 30% women of child-bearing age in Botswana are HIV+, putting them at 6X the risk for developing Cervical Cancer. As such, half the hospital’s oncology practice is focused on Cervical Cancer treatment. Since 2015, medical oncologists, gynecologic oncologists, pathology and radiology have worked collaboratively to streamline patient care, navigation and communication.?

Patients are captured in a database, tracked through follow-up care necessary and supported with government-funded resources through and after treatment. Beyond the measurable gains in process improvement and patient outcomes, the multidisciplinary approach gives the clinic a stronger voice and platform for the benefits and scalability of the model. Further, the clinic strives to offer women a “sisterhood,” where they feel safe, services are free and they and their families are supported through care.?

What the US can learn from abroad:

Creative adaptations in lower-resource settings like using simple visual aids can go a long way in engaging each patient by simply giving her a deeper understanding of her own body. Reporting on personal experience, I can’t recall a single screening setting I’ve been in in the US -- Washington, DC, Missouri, Illinois, New York -- where visual cues and tools are incorporated in exam rooms. Simple visuals and picture capture seem to be an easy way to familiarize women about their own Cervical Health arm them with critical information at a critical care touchpoint.

What I’m curious to see the data on:

• % of women who have seen a picture of their own cervix

Key questions to ask:

• What creative solutions are in place in low-resource settings that are also highly applicable in high-resource settings?
• How does health literacy improve when visual aids are incorporated in care?

On a personal note …

It wasn’t until after my own Cervical Cancer diagnosis and treatment that I first saw a picture of my own cervix in a follow-up surveillance appointment. I was amazed at how tiny and beautiful it looked -- and amazed that it must have looked so very different?merely months before when a tumor was visibly evident. I would learn that, like many women, I’d never previously known what my own cervix looked like; according to a 2017 UK study, half of women don’t know what the cervix is.

It strikes me that women everywhere would be much more informed about Cervical Health if we knew and saw our own cervixes from our first screening appointment. I suspect it would also improve our likelihood to follow-up on abnormal results if we understood that screening was just the first step of a longer process to prevent or treat an early diagnosis.

Visual aids are such a simple, low-cost, patient-centric improvement to US care that goes a long way to empower each person to own their Cervical Health and cancer prevention strategy through their lifetimes.

Source: Dr. Surbhi Grover & Princess Marina Hospital, Botswana