The partnership between Nottingham University Hospital NHS Trust, the Maternity Hospital in Kathmandu, the National Public Health Laboratory, PHASE NGO, and the Nepal Network for Cancer Treatment and Research NGO is attempting to reduce mortality rates due to cervical cancer in women in Nepal by training a strong team of colposcopists and supporting a country-wide cervical screening programme.

Preventing cervical cancer among women in Nepal

According to the WHO, cervical cancer is the largest cause of female cancer mortality in Nepal, with an annual death rate of approximately 2000 cases. The disease is preventable by screening. However, a screening programme to prevent cervical cancer would entail a coordinated effort from screening camps, to colposcopy (treatment of women who screen positive), to pathological interpretation of tissue that is removed from the cervix. The capacity of colposcopy services in Nepal is severely limited to two functioning clinics and there are only a small number of doctors trained in colposcopy. In addition, pathological interpretation of cervical tissue has recently been highlighted as a major problem with limited training of Nepali pathologists in the assessment of cervical tissue. The government of Nepal has agreed to launch a national cervical screening programme in the hopes of reducing deaths from cervical cancer with a goal of 50% of the population of women to be scored by 2016. However, the absence of quality and training in colposcopy and pathology will limit the national screening strategy.

Training and capacity development

This partnership hopes to increase the number of trained colposcopists, expand the capacity of colposcopy clinics, and increase the number of trained pathologists experience in cervical histopathology. The benefits from these outputs will be maintained with a sustainable quality assurance programme. The partnership has already delivered successful workshops; one for pathologists to be proficient in recognition of cervical histopathology and one to train medical personnel in colposcopy via hands-on ‘training the trainer’ approach.  Now, 25% of Nepal’s pethologists are trained to be proficient in recognition of cervical histopathology, and in total, the programme has resulted in 40 health workers trained to date. Bringing in a biomedical scientist for hands-on teaching became especially helpful in bringing about sustainable change to Nepali laboratory staff in the practice of tissue preparation prior to pathological review.

Delegates in course

One trainee remarks: ‘This cervical pathology workshop to pathologists was very fruitful to me, learn cervical biopsy and Pap smear slide, which are very beneficial for me for day to day reporting the slide. It will be very nice if such workshop to be held next year involving more pathologist.’

Supporting the use of new skillsets

With the completion of training, the hope is for the pathologists and health workers to put their new skills to practice and to ensure quality service is provided following training. Initial data collected through audits have shown concurrence in reporting colposcopy between UK and Nepali colposcopists to be 70%, an acceptable standard. However, many of the newly trained colposcopists are also doctors or nurses who have other duties besides colposcopy clinical services. Therefore, many emergency procedures take precedent over colposcopy services, making it difficult to reach the number of patients hoped by project partners. More still needs to be done to further build on colposcopy clinic capacity due to variable obstetric demands on staff.