Duke Ob/Gyn's Global Health elective program is a 4-6 week clinical experience at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania.
Time in Tanzania is filled with lectures, outpatient and inpatient experiences, a reproductive health clinic, cervical cancer screening clinic and high surgical volume.
Duke Ob/Gyn faculty member Emily Herfel, DO, MSc-GH, travels to Tanzania throughout the year in a clinical role and will be onsite at the start of the elective.
The partnership with the Duke and KCMC Ob/Gyn departments is longstanding and projects include mentorship in resident research projects, development of GYN tumor board, education lectures and capacity building of clinical and surgical skills.
Personal Perspectives: Global Health Elective Program
Global Health Elective Spotlight: Resident Nguyên Thảo Thị Nguyễn (Thao), MD
How did you become interested in gaining a global perspective on cervical cancer disparities?
I became interested in gaining a global perspective on cervical cancer disparities through stories from my mother about life in rural Vietnam, where limited access to health care meant that preventable diseases often went untreated, leading to unnecessary suffering and loss. This deeply resonated with me as I learned about the stark disparities in cervical cancer rates between the Global North and South, largely driven by differences in access to screening and HPV vaccination. The long latency period between HPV infection and cervical cancer offers a unique opportunity for intervention, which inspires me to work toward reducing these disparities through innovative solutions.
Why did you feel recognizing the diverse approaches to screening for and treatment of cervical dysplasia worldwide was a priority for your work in global health?
Recognizing diverse approaches to screening and treating cervical dysplasia is essential for adapting interventions to the specific challenges of low-resource settings. In these areas, barriers to receiving results and attending follow-up appointments become significant obstacles to completing the cervical cancer screening cascade. Tailoring approaches ensures that screening programs are not only effective but also practical and accessible within the constraints of the setting. Cultural norms further shape how care is accessed and accepted, which should be taken into account to ensure that screening strategies are culturally appropriate. Even for providers only caring for patients in the U.S., it is important to understand the diverse approaches to screening and treatment given the diverse backgrounds of our patient population.
How does limited access to screening and treatment contribute to disparities in cervical cancer morbidity/mortality in low resource settings?
Limited access to screening and treatment exacerbates disparities in cervical cancer morbidity and mortality in low-resource settings by creating significant barriers throughout the care continuum. These delays allow cervical lesions to progress untreated, increasing the risk of invasive cancer. The lack of accessible health care infrastructure and resources further compounds these challenges, leaving many women unable to access life-saving interventions, which contributes to higher rates of cervical cancer and poorer outcomes in these settings.
What are the highlights/benefits of incorporating mHealth (to overcome barriers to screening/treatment in low-resource settings?
Incorporating mHealth into cervical cancer prevention programs in low-resource settings offers several key benefits. It can be used to facilitate automated result notifications and treatment scheduling, ensuring timely follow-up for patients who test positive for HPV. mHealth platforms (use of mobile devices in the health care setting) can enable community health volunteers (CHVs) to track patients due for treatment, assist with scheduling or rescheduling missed appointments, and provide targeted follow-up. Additionally, mHealth can provide a case management system, allowing CHVs and clinics to sync information in real time, improving coordination and reducing gaps in care. These features collectively help overcome logistical and systemic barriers, ensuring more efficient and effective cervical cancer screening and treatment in resource-limited environments.
