CATHOLIC HOSPITAL, BATTOR.

CERVICAL CANCER PREVENTION AND TRAINING CENTRE.

ANNUAL REPORT - 2017.

The Cervical Cancer Prevention and Training Centre was officially opened on Wednesday, May 31, 2017 after a short ceremony by the Hospital Chaplain, Reverend Father Peter Kofi Atsu. Present at the ceremony were the Hospital Administrator, Mr. Donatus Adaletey, the Nurse Manager, Mr. Philip Diame, and some other senior staff of the hospital. The main staff running the centre are Nurse Ethel Tekpor (acting Nurse in charge) and Nurse Comfort Mawusi Wormemor. They are supervised by Dr. Kofi Effah, a gynaecologist in the hospital.
The activities/services offered at the centre are listed below.
Before the centre was opened to the public, cervical precancer screening was done at the Gynaecology Outpatient Department.
Activities/services offered at the Cervical Cancer Prevention and Training Centre:
A. Vaccination - With Cervarix.
B. Screening
1. Visual Inspection with Acetic acid (VIA).
2. Cytology (pap smear).
3. Primary screening with mobile colposcopy (EVA system).
4. HPV DNA testing with:
- careHPV.
- Genexpert.
[Self-sampling possible]
C. Follow up of screen positives:
1. Mobile colposcopy with EVA system.
2. 'Standard colposcopy' with stationary colposcope.
D. Treatment of cervical precancer:
1. Cryotherapy.
2. Thermal (cold) coagulation.
3. Loop Electrosurgical Excision Procedure (LEEP).
E. Treatment of (early) cervical cancer:
- Loop Electrosurgical Excision Procedure (LEEP).
F. Training of health workers to offer screening services and to treat premalignant lesions of the cervix
- For Community Health Nurses, General Nurses, Midwives, Physician Assistants, Doctors.
The nurses in the centre have been trained to offer screening (with VIA, HPV testing, pap smear, mobile colposcopy with the EVA system), to follow up screen positives with mobile colposcopy, and to treat women with cervical precancer with cryotherapy and thermal coagulation. The nurses are also trainers, training other health workers across the country to offer these services.
Below is a summary/statistics of the work done (vaccination, screening) in 2017:
2017 STATISTICS
Total number of women screened - 1,438
Breakdown:
CareHPV = 750
Genexpert= 186
VIA - 261
Pap smears - 31
Mobile colposcopy (EVA) - 120
Screening with mobile colposcope (Gynocular) and stationary colposcope during colposcopy courses - 90
VIA done during Module 1 training - 40* (*This is not included in the total number of women screened as all these women had already been screened with an HPV test before the VIA). Total number of screen positives - 211 Number followed up - 164 Breakdown: Mobile colposcopy (EVA) - 132 (35 had lesions) Colposcopy using stationary colposcope - 13 Pap Smear - 19 Total women treated -12 Breakdown: LEEP - 5 Cryotherapy - 4 Thermal Coagulation - 2 Simple hysterectomy - 1 Total number vaccinated: 37 (31 females, 6 males)
MAJOR ACTIVITIES OF THE YEAR
A. TRAINING PROGRAMMES
Modules 1 and 2 for cervical cancer prevention The Centre developed two training modules, each lasting two weeks to train nurses from across Ghana and beyond in cervical cancer prevention. Module 1 (Basic) involves training to set up a cervical cancer prevention unit to offer vaccination and screening (with VIA and HPV testing). Module 2 (Advanced) involves training to perform pap smears, (mobile) colposcopy (for screen positives and in primary screening), and treatment of premalignant lesions of the cervix using cryotherapy and thermal coagulation.
In 2017 eight (8) trainees (General Nurses, Midwives and Physician Assistants) from across the country were at the centre for Module 1. The list of those trained is below
1. September 4 - September 15, 2017 Ivy Tetteh (Sogakope District Hospital)
2. September 18 - September 29, 2017 Yvonne Agbozo (New Crystal Hospital, Ashaiman)
3. September 18 - September 29, 2017 Comfort Adobea Boateng (New Crystal Hospital, Michel Camp, Sebrepor)
4. November 13 - November 24, 2017 Cynthia Agyapomaa Adjei (Volta Regional Hospital, Ho)
5. November 13 - November 24, 2017 Jennifer Hlordzi (Volta Regional Hospital, Ho)
6. November 27 - December 8, 2017 Freda Agyemang Sarpong (Divine Grace Clininc, Kaneshie)
7. November 27 - December 8, 2017 Mary Frimpong (Peki Government Hospital)
8. December 11 - December 22, 2017 Josephine Nketsiah (Cape Coast Teaching Hospital)
Training in colposcopy by Dr. Theodora Pepera and team.
Dr. Theodora Pepera, Gynaecologist and Certified Colposcopy Trainer in the UK ran two of her colposcopy courses (Basic and Advanced for each) at the centre in 2017 with her team of trainers (Dr. Mirren Turner and Nurse Colposcopist Ms. Joyce Aburam).
Professor Margaret Cruickshank, co-chair of Training and Education, International Federation of Cervical Pathology and Colposcopy (IFCPC), and immediate past president of the British Society of Colposcopy and Cervical Pathology (BSCCP), was present during the second course in September.
The list of doctors, nurses, physician assistants trained is below:
First Colposcopy Course Monday,June 5, 2017 - Friday, June 9, 2017.
A. Basic Colposcopy Course Monday, June 5 - Wednesday, June 7, 2017.
1. Dr. Ernest Ameyaw (Holy Family, Techiman)
2. Ms. Ama Amoasi (Holy Family, Techiman)
3. Dr. Rexford Birikorang (St. Dominics, Akwatia)
4. Ms. Gloria Yankson (Cancer Connect GH)
5. Ms. Rebecca Bantey (Asiakwa Health Centre/Save My Mother Project)
6. Dr. Betty Anane-Fenin (Cape Coast Teaching Hospital)
7. Ms. Ruth Lorlor (Catholic Hospital, Battor)
8. Dr. Harry Agbley (Catholic Hospital, Battor)
B. Advanced Colposcopy Course
Thursday, June 8 and Friday, June 9, 2017.
1. Dr. Mary Amuah (Manhyia, Kumasi)
2. Dr. Kwaku Agyepong Doffour-Dapaah (Ada East District Hospital)
3. Dr. Rexford Birikorang (St. Dominics, Akwatia)
4. Nurse Ethel Tekpor (Catholic Hospital, Battor)
Second Colposcopy Course
Monday, September 25 - Friday, September 29, 2017.
A. Basic Colposcopy Course
Monday, September 25 - Wednesday, September 27, 2017.
1. Ms. Gertrude Mensah (Sinel Specialist Hospital, Tema)
2. Dr. Nathaniel Kofi Kyei (Oda Government Hospita, Akim Oda) 3. Dr. Alexander Boateng (Catholic Hospital, Battor) 4. Mr. Paschal K. Dah (Supercare Specialist Hospital, Ho) 5. Ms. Abena Agyeiwah Owusu (Frimpong Boateng Medical Center, Toase) 6. Dr. Benedict Boateng (Our Lady of Grace Hospital, Breman Asikuma) 7. Dr Hansen-Garshong (Eastern Regional Hospital, Koforidua) 8. Ms. Irene Yeboah (Eastern Regional Hospital, Koforidua) B. Advanced Colposcopy Course Thursday, September 28 and Friday, September 29, 2017. 1. Dr. Emmanuel Okine (Berekum) 2. Dr. Hayford Atuguba (Catholic Hospital, Battor) 3. Dr. Ibrahim Friko (Holy Family, Techiman) 4. Nurse Comfort Mawusi Wormenor (Catholic Hospital, Battor) Training in VIA and cryotherapy
The year started with training in Visual Inspection with Acetic acid (VIA) and cryotherapy for 11 health workers in the North Tongu District of the Volta Region from Monday, January 9 to Friday, January 13, 2017. The training was provided by ‘Save My Mother’ (SMM), a non-governmental organisation committed to maternal health care in SOS Villages. It was led by Dr Edward Dassah, who also worked with the Female Cancer Foundation, as well as Ms. Rebecca Bantey, a Physician Assistant at the Asiakwa SOS Village.
Dr Kofi Effah, Gynaecologist with the Catholic Hospital Battor, was also a resource person.
The Programme Manager, Non Communicable Diseases and focal person for cancers, Ghana Health Service, Dr. Dennis Ocansey, visited the team during the training. A cryotherapy unit was donated to North Tongu District.
Participants 1. Comfort Wormenor (Nurse, Catholic Hospital Battor) 2. Ethel Tekpor (Nurse, Catholic Hospital Battor) 3. Priscilla Dunyo (Nurse, Catholic Hospital Battor) 4. Anita Dugbazah (Nurse, Catholic Hospital Battor) 5. Stella Yengbe (Nurse, Catholic Hospital Battor) 6. Ruth Lorlor (Midwife, Catholic Hospital Battor) 7. Cynthia Badasu (Community Health Nurse, Juapong, North Tongu District) 8. Sarah Danso (Community Health Nurse, Battor, North Tongu District) 9. Theresa Nartey (Community Health Nurse, Afaode, North Tongu District) 10. Cynthia Dugo (Community Health Nurse, Fodzoku, North Tongu District) 11. Florence Agyeman (Community Health Nurse, Workpoe, North Tongu District) PATH/GHS training of trainers in VIA and cryotherapy
Ghana Health Service in partnership with PATH (Program for Appropriate Technology in Health) organised a Training of Trainers course in Visual Inspection with Acetic acid and cryotherapy in Accra from Monday, June 26 to Thursday, June 29, 2017. The training was for selected health workers across the country already involved in cervical cancer screening. Two nurses from the Cervical Cancer Prevention and Training Centre in Catholic Hospital, Battor were trained as trainers.
Training in use of thermal coagulation for SOS staff in Battor On Wednesday, September 13, 2017, three (3) SOS staff from Kumasi, Tamale and Asiakwa were trained in the use of thermal coagulation for treatment of cervical precancer at the Cervical Cancer Prevention and Training Centre in Catholic Hospital Battor. The resource persons were Dr. Kofi Effah, Ms. Ethel Tekpor and Ms. Comfort Mawusi Wormenor. The SOS team began using thermal coagulation at their centres after this. Before the training cryotherapy was the only treatment modality at the SOS centres.
Training in the use of the mobile mobile colposcope (EVA system) On Saturday, December 16, 2017, Nurse Ethel Tekpor, from the Cervical Cancer Prevention and Training Centre was flown from Accra to Kumasi (and back) to train nurses and midwives from the SOS team in mobile colposcopy - the use of the Enhanced Visual Assessment (EVA) system. The SOS team before this used only Visual Inspection with Acetic acid (VIA) for screening. In the last 6 years, the team headed by Obstetrician Gynaecologist, Dr. Edward Dassah, had screened over 36,000 women in their three centres in the country (Asiakwa, Kumasi, Tamale). They procured three EVA systems for their three centres, and brought nurses and midwives from these centres to Kumasi for the training.
B. NEW SCREENING TEST (GENEXPERT) On Wednesday, March 15, 2017, DCL, local representativesof Cepheid were in Catholic Hospital, Battor to train staff in the laboratory on the use of the Genexpert for HPV testing. Testing began immediate, allowing for same day screening and follow up of screen positives (with colposcopy) in Catholic Hospital, Battor. This is the first time the Genexpert HPV test is being used for cervical precancer screening in Ghana.
With over 110 hospitals in Ghana having the Genexpert platform because of the national tuberculosis programme, this offers an opportunity for a national cervical cancer screening programme using HPV testing.
C. OUTREACHES
1. Juapong, North Tongu District - January 13, 2017. Number of women screened with VIA - 122.
2. Musahamat Banana Farm, Aveyime, North Tongu District - June 29/July 5, 2017. Number of women screened (careHPV) - 39
3. Adenta, Accra - September 9, 2017. The founder of the Al-Hayaat Foundation, a non-profit organisation, Hajia Hanatu Abubakar, partnered the team from Catholic Hospital, Battor for this exercise. Number of women screened: 16
Breakdown:
Genexpert - 9
Mobile colposcopy (EVA) - 7
Number vaccinated: 7 (5 females, 2 males)
4. Kpomkpo, North Tongu District - September 14, 2017. Number of women screened with VIA - 43
5. God is our Light RHEMA Church, Tanokrom, Takoradi - November 30 - December 3, 2017. This was an innovative screening programme led by Reverend Paul Adu Mensah. Through a 'silver collection' organised by the church, 100 church members were screened without the women having to pay from their pockets on site, as is usually the case. We believe this is an innovation that can be adopted by other churches and institutions across the country in the fight against cervical cancer. This will make cervical precancer screening accessible to more women who cannot afford to pay for it.
Others who were not church members took advantage of the programme and paid to be screened and vaccinated.
Total number of women screened: 142
Breakdown:
CareHPV - 124
Genexpert - 7
Mobile colposcopy (EVA) - 11
Number vaccinated: 15 (13 females, 2 males).
D. CONFERENCES
Catholic Hospital, Battor presented its work on cervical cancer prevention/Human Papillomavirus (HPV) at the 31st International Papillomavirus Conference in Cape Town, South Africa from February 28 to March 5, 2017.
The topics (posters) presented were:
1. Introduction of primary HPV testing for routine cervical screening in Ghana – The Battor experience.
2. Raising funds through social media to subsidize cervical cancer screening with HPV testing in rural Ghana – The Battor experience.
They were presented by Dr. Kafui Akakpo from the Cape Coast Teaching Hospital, a pathologist who also works with the team from Catholic Hospital, Battor;
Three other posters presented included works done in Catholic Hospital, Battor together with its former partners from Charite Hospital, Berlin, Germany:
3. Trial on community health worker supervised self-sampling combined with decentralized HPV testing in Ghana
4. Community perception of self-sampling for cervical cancer screening in Ghana
5. Sexually transmitted infections prevalence in rural Ghana – The ACCESSING study.
E. SUPPORT
The hospital/centre runs a sustainable cervical cancer prevention programme not dependent on external support from outside the hospital.
The centre believes in self-support. This is evidenced by a crowd funding activity (which ended in May 2017) to buy a Liger Medical Thermal Coagulator at $1,500 for treatment of cervical cancer.
[This is the second time in the hospital that crowd funding has been used to buy equipment for cervical cancer prevention activities. The first was in 2016 when the crowd funding was used to procure and set up the equipment for HPV testing using careHPV bringing down cost for women screened. This is still running].
We are grateful to NGOs and individuals who decide to support us when they get to know about our work. In 2017 we had support from these groups and individuals and we are grateful:
1. Phoenix Resource Centre Global Aid Ghana, a Non-Governmental Charity Organisation, donated a $1,500 mobile colposcope - Enhanced Visual Assessment (EVA) system from MobileODT. The donation was done by the CEO, Dr. Koku Awoonor on June 29, 2017.
2. The University of Ghana Medical School Class of 1983 (UK branch) donated a $1,700 electrosurgical unit from Liger Medical. This unit is portable, has a smoke evacuator, and is battery powered (operates for many minutes without electricity when charged) making it possible for Loop Electrosurgical Excision Procedures (LEEPs) to be performed on outreaches.
3. The German Rotary Volunteer Doctors (GRVD) donated a steriliser.
4. Ms. Belinda Effah and her daughter, Ms. Michelle Tinkorang donated a Liger Medical Thermal coagulator for treatment of premalignant lesions of the cervix. The equipment was worth $1,500.
5. Dr. Stefan Seidl, colposcopist in Hamburg, Germany, donated teaching materials in colposcopy.
FUTURE (2018)
1. More staff for the centre As the centre grows and more work is being done, we shall need two more permanent nurses.
2. Paperless system
It is our desire to go paperless, to be able to capture and get access to our data electronically on the ground, even on outreaches in remote communities. This will enhance the care we give to our clients.
3. Vehicle for outreach services
We believe that the best cervical cancer screening strategy for Ghana is a decentralised system where there services are provided by health workers in the communities through the CHPS (Community-based Health Planning and Services). This may take some time to be realised.
In 2017, we demonstrated that cervical cancer prevention services (vaccination, screening with VIA, HPV testing with Genexpert and careHPV, follow up of screen positives with mobile colposcopy by trained nurses and treatment of cervical precancer by cryotherapy and thermal coagulation) can be brought to communities across Ghana, to the doorsteps of women, with outreach services.
The centre embarked on several outreach programmes in 2017 that took the screening team to remote villages and towns/cities like Kpomkpo, Juapong, Accra, Takoradi. There is currently no reliable vehicle for the centre. For the trip to Juapong in January, the team had to rent a commercial minibus. The hospital should invest in a bus for outreaches which will make travelling safe for the team as the team embarks on taking cervical cancer prevention services across the country.
2017 was a very eventful and successful year for us at the Cervical Cancer Prevention and Training Centre in Catholic Hospital, Battor. We made great strides in our vision to establish training programmes that will equip health workers across Ghana and beyond with knowledge and skills in the fight against cervical cancer.
We are grateful to the Hospital Management Team for the support and we express our sincere gratitude to all those who supported us in diverse ways. It is our hope that in 2018 we shall build on the successes achieved in 2017.