A Champion for Cervical Cancer Prevention Programs in Burkina Faso
By Tsigué Pleah and Megan Harris
Ouagadougou, Burkina Faso – As a physician, Jean Lankoande has a hard time telling a patient that she has cervical cancer. At that stage, he says, he can offer a woman little hope. He knows that early detection is the key to treating this preventable disease. But rather than be overcome by his sense of frustration, Dr. Lankoande has channeled his energy into championing cervical cancer prevention programs for women across the West African nation of Burkina Faso.
Dr. Lankoande, 58, has been collaborating with Jhpiego as a trainer and consultant and working toward greater access to cervical cancer screening since 2008, when he attended a training course in Malawi on Jhpiego’s pioneering, single visit approach to screening and treatment. This screening method uses visual inspection of the cervix after it has been swabbed with vinegar to detect precancerous cells. If precancerous cells are identified, the provider offers treatment with cryotherapy—a freezing technique that destroys potentially lethal cells—in the same visit. The single visit approach ensures that women receive their screening results and treatment on the same day, thus reducing loss to follow-up.
According to a World Health Organization survey of cancer in Burkina Faso, an estimated 921 women are diagnosed with cervical cancer every year and 724 women die from the disease. Of all the deaths from cancer among women in Burkina Faso aged 15–44, cervical cancer is the highest, at 13.7 deaths per 100,000.
Jhpiego, in partnership with the Ministry of Health, has been working to strengthen health systems and build capacity in maternal and newborn health in Burkina Faso since 1995. A demonstration project on improving basic and comprehensive emergency obstetric and newborn care in health centers and hospitals was so successful that it led to the founding of a regional, comprehensive emergency obstetric and neonatal care center at Bobo-Dioulasso, which serves to build the capacity of midwives and doctors.
Jhpiego’s work in Burkina has since expanded to include projects for the prevention of mother-to-child transmission of HIV, prevention and treatment of malaria in pregnancy, and a cervical cancer prevention initiative funded by the Izumi Foundation. The two-year cervical cancer prevention project, in partnership with the Midwifery Association of Burkina, seeks to expand access to cervical cancer screening by strengthening the skills of midwives and nurses to successfully perform the single visit approach and reach many more women. The project is under way at two university teaching hospitals in Burkina where 512 women have been screened between September and February of this year.
Most women in countries like Burkina Faso don’t have access to Pap tests, the routine way women are screened for cervical cancer in the developed world. With 80 percent of deaths from cervical cancer occurring in the developing world, Dr. Lankoande says he can’t emphasize enough the relevance and importance of the single visit approach in Burkina.
“This is the best method to boost our activity around managing precancerous cervical lesions,’’ said Dr. Lankoande, who has served as master trainer and consultant for Jhpiego in Guinea and Haiti. “There are
only four pathologists [in the country]. The single visit approach is the way to go and I’m convinced it can serve the population in Burkina Faso.”
An enthusiastic supporter of cervical cancer screening, Dr. Lankoande is a well-respected resource on maternal health issues and policies in Burkina, said Dr. André Yolland Ky, Country Director of Jhpiego’s Burkina Office. “A real advocate!”
As the chief of obstetrics and gynecology at Yalgado Ouedraogo Teaching Hospital, Dr. Lankoande began an early screening program there with Jhpiego’s support. On his own initiative, he did the same at two regional hospitals in Fada and Ouahigouya with donated equipment from a French nongovernmental organization and persuaded hospital administrators to commit to maintaining use of the cryotherapy machines.
During his visits to the cervical cancer screening centers, Dr. Lankoande says he feels keenly his mission to heal. “There are women who come in with very advanced cases [of cervical cancer], which unfortunately are seen very frequently during screening—cases of women without hope,” said the doctor. “There is a sentiment of loss, a sentiment of frustration and really that is what motivates me and reinforces my decision [to promote cervical cancer prevention efforts].”
The Ministry of Health has been supportive in helping provide these services to women in Burkina Faso, he said, but the need is great. He cited the example of a regional meeting of fellow obstetricians and gynecologists who volunteered to host a cervical cancer screening. “A lot of women came,” he said, “but we could only handle 800. There is a huge demand for the service.” Dr. Lankoande said he has sought additional help from international organizations to supply cryotherapy machines at facilities that lack them so more women can be screened and treated in the same visit.
Dr. Lankoande is heartened by the fact that midwives in Burkina Faso have begun providing cervical cancer screening of patients, increasing the capacity to deliver these services to women. “They are doing the screening. They are doing the cryotherapy. It is a huge addition. In the past, cervical cancer was taken care of by physicians. Now there is a huge commitment to take care of the women by the midwives,” he says.
That shift should make it easier for more women to receive such services once screening units are in place and a national cervical cancer prevention program established. As of 2009, the World Health Organization estimated that there were 10 physicians per 100,000 people, compared to 13 midwives per 100,000 people.
The benefits of early screening, diagnosis and treatment of cervical cancer prevention have been seen time and again. According to research studies, countries that have developed and implemented high-quality cancer prevention programs with high participation rates have seen their incidence of cervical cancer decrease by 70 to 90 percent.
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