FIELD EXPERIENCE

PHRII conducts regular field visits to rural communities and provides a wide variety of women and children’s health services. Many of the women and children they assess would otherwise have no access to healthcare, so PHRII’s services make lasting differences in the villages they reach. On June 2nd, 2017, I joined Dr. Vijaya and the PHRII staff on a visit to rural Ramanahali village, where the team organized an HPV and cervical cancer-screening site. Cervical cancer is the second most prevalent cancer in India. In Karnataka the rates of cervical cancer are lower than in surrounding states, but the averages range from region to region (National Institute of Cancer Prevention and Research, 2017). In the country, roughly 469 million women are at risk of developing cervical cancer, and at present, 20.2% of women in India have cervical cancer (Bruni et al., 2017). Annually 122,844 new cases of cervical and HPV related cancers arise in India, and approximately 67,477 women die from these cancers yearly (Bruni et al., 2017). HPV is a widespread epidemic, despite the fact that HPV is a preventable illness, but the implementation of screening sites is making notable reductions of infections in the country.

The staff began by counseling the women who attended on June 2nd. They stressed the importance of HPV screening for cancer prevention and then outlined the upcoming screening procedure, as many of the women at the camp had never been to a gynecologist and had little education on the risks of HPV infections. Only certain women were eligible to undergo the examination. First, because of the influences of Indian society, the staff could exclusively assess married women. The term “sexually active” is accepted and assumed solely for women in marriages. Second, the women either had to be over thirty years of age or married for over ten years because HPV in the female body is dynamic and fluctuating. Most strains of the virus, even some persistent strains, clear by themselves: only 1 to 3 percent of strains develop into cancer (Burchell, Winer, de Sanjosé, & Franco, 2006). Women regularly contract HPV viruses, particularly in their youth, but the few malignant strains exist in older women (Burchell et al., 2006). Third, the women could not be menstruating; their last menstruation had to have occurred seven to ten days prior to the examination. Fourth—naturally—the women had to have cervixes. Women who had undergone hysterectomies were ineligible. Fifth, the women could not be pregnant. Sixth, the women had to be in otherwise good health. The staff assessed the women’s height, weight, and blood pressure to further determine their eligibility.

Aside from assessing the reproductive health of the women at the camp, that afternoon a PHRII fellow began a comparative study on the differences between self-swabbing and physician swabbing for accurate HPV testing in women. Ultimately, the study seeks to determine whether women alone are as efficient in swabbing for HPV infections. The implications of this research involve expanding HPV prevention through home-kits and self-testing, thus reducing the necessity of trained medical personnel in preventative healthcare. Moreover, self-swabbing reduces the discomfort women associate with pelvic exams and is cost-effective. First the staff gave each woman a brush-like swab and instructed her to conduct the self-test. After the woman returned with the swab, Dr. Vijaya conducted the pelvic exam. She performed the physician swab, pH test, and VIA exam on each woman. If the VIA indicated signs of an HPV infection, Dr. Vijaya performed an additional Pap smear. Due to the cost of cytological testing and the lengthy follow-up associated with Pap smears, these tests were reserved for women whose cervixes exhibited abnormalities in epithelial colorations and cysts or exhibited obstructions. Finally, Dr. Vijaya prescribed vitamins and an appropriate medication if the woman was in need of any pharmacological treatment. The screening—vitamins and medications included—was free of cost.

The entire context of healthcare in Indian rural communities was markedly different than anything I formerly understood because never had I witnessed so much done with so little. PHRII’s staff thoroughly assessed over twenty women with only portable equipment and common, inexpensive medical supplies. The staff used no costly or technological medical gear. Moreover, the staff set up, carried out, and took down the camp in a matter of hours. Hyperbole aside, my experience at the camp was life changing. At first I was slightly overwhelmed by the stark differences between the healthcare styles of the camp and of the medical offices I had visited. Until I visited PHRII’s camp I had never witnessed newspaper being used as medical paper or the classroom of a local elementary school in a rural village being used as a medical office. My experiences with mobile clinics in the United States involved air-conditioned buses with computers and medical machinery, not vacant schoolrooms. As I saw the clinic in motion, however, I could not help but be overcome with admiration. My definition of healthcare was redefined that summer afternoon.

Previously I understood healthcare as something privatized, privileged, and almost luxurious. Before, medical offices were stereotypically white and sterile with cushion covered examination tables and medical posters hanging on the wall. Before, trips to visit doctors involved insurance companies, receptionists, and lengthy waiting times in silent waiting rooms. Before, I would not have been able to imagine healthcare trespassing these limited boundaries. Now, my appreciation and knowledge of the capacities of healthcare are forever changed. No classroom or lecture could ever have taught me what this experience taught me, as I saw firsthand what the motivations and initiatives of a group of women—the PHRII staff—yielded: healthcare that surpasses the boundaries of traditional approaches to medicine and preventative care to reach those most in need. As HPV is a rampant and widespread epidemic that plagues India, the efforts of clinics like PHRII have made unprecedented advances in reducing HPV infections. PHRII’s efforts make lasting differences in the community, as well. Obviously change occurs in the overall wellbeing of the community. But women who lacked previous exposure to preventative healthcare now understand the importance of regular screening, and word of mouth communication from one woman to the next is how empowerment and revolution begin in women’s health and in women’s identities. No issue is local. HPV is as much a burden on women globally as is it in India. And as the mobile clinic exemplified, with even the scarcest of resources a single person can make a difference.