Tag Archive for: gynecology

Behind the Science: Enhancing Cervical Cancer Screening in Rwanda

Interviewee: Dr. Katherine Gray; UBC Obstetrics and Gynaecology resident, PGY-2 | Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators)

Published: July 5th, 2024

Can you tell me about your research?

I am a first year resident in Obstetrics and Gynecology (Ob/Gyn) at the University of British Columbia (UBC). I started doing global health research within the theme of women’s health in my fourth year of medical school. My research focused primarily on equity and care surrounding women’s health in Rwanda.

I initially delved into a project centered around enhancing access to cervical cancer screening for women in Rwanda. Since then, my endeavors have expanded to various projects within the realm of Ob/Gyn care in Rwanda. One noteworthy initiative I spearheaded was the optimization of cervical cancer screening and accessibility in Rwanda by gaining insights from healthcare providers. My study, which concluded last year, looked at the practices of Ob/Gyns, nurse midwives, and family doctors regarding cervical cancer screening, shedding light on the challenges they encounter.

Additionally, I’ve been involved in diverse research themes in Rwanda, including an exploration of preterm premature rupture of membranes and the existing guidelines, comparing them to Canadian standards of care. I’ve also investigated operative vaginal deliveries in Rwanda, and my current focus lies on various facets of cervical cancer screening.

Are there any findings from your research that you’d like to highlight?

From my study on healthcare provider perspectives, a lot of the findings did align with similar studies in other low-resource settings. One prominent theme that emerged is the significant barrier posed by patients’ knowledge and education levels regarding cervical cancer and screening. Many patients exhibit a limited understanding of either the disease or the screening process, which limited their engagement with screening initiatives.

Additionally, the training of healthcare providers in conducting cervical cancer screening emerged as another influential factor in accessing screening. A small subset of physicians and nurses receive formal training on how to conduct screening, leading to a shortage of proficient providers. This shortage of trained professionals was consistently cited as a barrier to screening by every provider interviewed in my study. Overall, the training landscape appears inconsistent, resulting in notable gaps in screening and subsequent care provision.

How did you get involved with this kind of work?

In my fourth year of medical school, I knew that I wanted to pursue Ob/Gyn and I have always been interested in global health. I was connected with my research supervisor, Dr. Marianne Vidler and got involved with her work and the theme of global health and maternity care in Rwanda. I have been interested and involved ever since! I am immensely grateful for the opportunity to continue my residency at UBC, as it enables me to sustain my research endeavors alongside my exceptional team, both in Canada and Rwanda.

What impact do you hope to see with the work you’re doing?

My research is dedicated to identifying and understanding the barriers hindering both patients from accessing care and providers from delivering it effectively. By comprehending these obstacles, we aim to take proactive steps towards enhancing screening accessibility. With a primary focus on understanding these barriers, my aim is to progress towards devising strategies and implementing them effectively.

Currently, my team and I are delving into the concept of self-collection for HPV testing in Rwanda. This method has gained prominence, particularly in British Columbia, primarily because of its heightened sensitivity compared to traditional Pap smears in cervical cancer screening. Our research will involve integrating this more sensitive and efficient approach, which allows individuals to self-collect samples, into Rwanda’s healthcare infrastructure.

Looking ahead, I hope that I can continue working on the integration of HPV DNA testing and self-collection methods in Rwanda. By doing so, I hope to shed light on how these innovations can significantly enhance access to and rates of cervical cancer screening in the region.

 

 

 

 

 

 

Beyond the Focal Points of Endometriosis and Chronic Pelvic Pain

Author: Danielle Perro, BMSc, PhD | Editors: Romina Garcia de leon, Shayda Swann (Blog Coordinators) 

Published: September 15th, 2023

*This article represents Danielle Perro’s views and not necessarily those of her employer.

Endometriosis is a chronic inflammatory condition characterized by the growth of tissue similar to the lining of the uterus found elsewhere within the body. Though typically such tissue is found within the pelvis, it has been found in many extra-pelvic sites. It is known to impact as many as one in ten women worldwide, and though data on the experience of endometriosis in transgender men, gender diverse and non-binary folks are more limited, they too experience the condition—this represents a hugely important area of ongoing/future research. 

Similar to endometriosis, chronic pelvic pain (CPP) is highly prevalent in women, affecting as many as one in four women of reproductive age. Furthermore, females living with either endometriosis or CPP experience similarly significant physical and mental health symptoms which impact their ability to go about their day-day life. According to the Royal College of Obstetricians and Gynaecologists, CPP is defined as ‘intermittent or constant pain in the lower abdomen or pelvis of a woman of at least 6 months in duration, not occurring exclusively with menstruation or intercourse, and not associated with pregnancy’. Endometriosis and CPP share many similarities, not only in their burden and commonality, but also in how they are managed. Unfortunately, in both cases, the treatments which are targeted at the pelvis or primary disease site are often ineffective or require a lot of trial and error to arrive at a suitable option. Examining years of work into endometriosis, CPP and other localised pain conditions (like migraine and low back pain), it’s important to shift the way we think about endometriosis and CPP by looking a step beyond the pelvis at whole body pain symptoms and their implications. Similar to the MaPP research group’s work on CPP, women with CPP and endometriosis have been shown to commonly experience pain outside of the pelvis, and with an increased number of regions affected by pain, there is a strong association with worse mental health and quality of life.  

Shifting the dial away from the pelvis

Endometriosis has long been described as a gynaecological condition, given that many do experience symptoms related to the pelvis and reproduction. In addition to CPP, people with endometriosis experience pain associated with their periods and/or pain during or after sex, as well as infertility. However, a recent genetic study has demonstrated that endometriosis-related symptoms are far more complex than being just a pelvic-condition. This study showed that endometriosis is genetically linked to inflammatory conditions like asthma, as well as body-wide pain symptoms, like migraine, back pain, and multi-site chronic pain (pain all over the body). Endometriosis is associated with systemic symptoms, so why do we still ascribe a gynaecological label, rather than calling it a systemic condition? Leaders in the field have put forward a strong case for considering endometriosis as a systemic disease. More work remains to be done to understand what the public health implications, and impact on individual care, of doing so would be. 

Reconsidering our current understanding of endometriosis

Earlier this year, I attended and contributed to the Reframing Endometriosis: Power, Politics and Potential Futures conference in Birmingham, UK. This conference was the first to truly bridge the biomedical and social science research divides, whilst creating a platform for people with lived experience of endometriosis and pain to equally contribute to the panels their own experiences with the condition. Similar questions to the ones above were raised, about why we still consider endometriosis to be a ‘gynaecological condition’, when so many experience system-wide symptoms. Everyone in attendance, myself included, was confronted with moments of discomfort, as our current understandings of endometriosis were challenged. It’s become clear that in order to move the endometriosis field forward and evolve both our definition of the condition and effective treatments, we need to continue breaking down barriers between stakeholder siloes. When I envision the future of endometriosis research, I envision one which strives for personalised medicine. To achieve this, we need to consider the entire person with endometriosis and CPP, as with these conditions there is often more than meets the eye.

To learn more about this work, follow Danielle Perro on Twitter.