Reproductive Health Camp Bhaktapur

Today we attended a reproductive health camp with an emphasis on cervical cancer screening using VIA in a village in Bhaktapur. It was organized together with MIDSON, UBC Global Midwifery, the community health worker for the village, and the Family Planning Association of Nepal.

Sudal outside of Bhaktapur

Health Post in Sudal 

Some posters in the Health Post

VIA (Visual Inspection with Acetic Acid) is a method of screening for cervical cancer that has been proven to be very effective in low resource settings.

The procedure consists of a vaginal speculum exam, a cervical swab with normal saline, and then the application of 3-5% acetic acid solution to the cervix. This is followed by a visual inspection of the cervix using an adequate light source.In the presence of cervical cell abnormalities the acetic acid will cause the affected area to turn white with well define margins, attached to the squamocolumnar junction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4478664/

We arrived mid-morning and spent about an hour setting up the different spaces we needed. We had two exam rooms, a room for history taking, a room for dispensing the various medications MIDSON brought and a room for Mickey to hold an education session with the community health workers. Additionally we set up a registration area where the women registered, and had their weight and blood pressure taken.

After registration the women waited to have their history taken before being sent to the exam rooms.

As we were setting up the women started trickling in. They had expected 150 but we ended up seeing 83 women. Of the 83, 2 had a positive VIA test and one screened positive for cervical abnormalities, most likely HPV.

Many of the other women reported vaginal itching, discomfort and discharge. These women were given antibiotics and some of them were counselled to have their husbands tested and treated as well. In many lower income families the husband works outside of the country, and there is a rise in STI/HPV/HIV in Nepal do to this, as the men are visiting sex workers while working away.

We took turns observing the history taking and the exam rooms and had the opportunity to see a positive VIA test. The women who screened positive were referred to the local hospital for further testing.

It was very interesting to participate and learn more about the work that goes into organizing a health camp. 

After participating in our first reproductive health camp, from our observations these are the areas of women’s health care that still need improvement:

Getting informed consent

Making sure the women understand why certain procedures are being performed

Using sterile water or lubricant for speculum exams and pelvic exams

Adopting gentle but effective insertion techniques for speculum exams

Maintaining women’s privacy 

Maintaining confidentiality 

Following the VIA protocol accurately

Use of adequate lighting

We are grateful to MDSON for organizing this opportunity for us.