by Robin Mahaffeyby Bruce Milletto
for Health: Coffee with Care
Vermonters Pitch in to Prevent Cervical Caner
by Monica Mead, Times Argus
In developing nations, cervical cancer is the number
one cancer causing death of women. "There's more breast
cancer," said August Burns, "but cervical cancer kills
It's a fact made all the more poignant given the simplicity of
its detection - through a simple PAP exam.
for Health works to detect and treat cervical
cancer in coffee-growing nations through screening campaigns.
Since 1996, it has seen over 10,000 women, mostly small coffee
Some make the journey on foot for days, sleeping on mattresses
outside the clinic until dawn. For many, the non-profit becomes
their first link in the healthcare chain. No one is turned away.
"We will see 1,000 women in a week," said Burns, Grounds
for Health Executive Director. "It's a sea of women."
"We believe that a healthy community starts with healthy
Marcela Pino, Program Coordinator, pointing out that in emergent
countries, 50 percent of children under the age of five who lose
their mother will not survive.
It was a fact unknown to Dan Cox, who spent time in coffee-growing
countries purchasing beans for his coffee extraction and testing
business, Burlington's Coffee Enterprises.
In fall of 1996, Cox invited long-time family friend Dr. Francis
Fote along to Mexico for the ride. "I basically told him,
'Look, I'm going to be there on business, so you're on your own.'"
Fote, a retired gynecologist, was naturally drawn to the local
hospital. A seasoned medico, he was appalled at the lack of resources
and follow-up for PAP exams which detect cervical cancer's earliest
indicator, HPV, or human papilloma virus.
Grounds for Health was born.
Back home, Cox and Fote enlisted medical volunteers, conducting
clinical trips into rural Oaxaca using their own funds for four
years. They set up the organization's first clinic in Pochutla.
Sites in Veracruz, Guatemala, and Chiapas followed.
The specialty coffee industry has since been especially generous
to Grounds for Health with a donor list that reads like a coffee
world "who's who."
"It's rare to find an industry that is so excited and interested
in bringing health to the community they work with," said
Cervical cancer detection through PAP exams had been rote in
Mexico for 20 years, yet the mortality rate remained unchanged,
said Dr. Emma Ottolenghi. Exams were conducted, but tissue samples
were ignored or thrown away.
Working with the Mexican government as much as possible, Grounds
for Health empowers coffee cooperatives - non-profit organizations
comprising small, regional coffee growers - to train medical
staff and improve quality of care.
"We can't just stop at the PAP smears," Ottolenghi said. "You've
got to see that they have follow-up," a piece of the puzzle
for which she credits Grounds for Health.
Born in Italy and Ecuador-raised, Ottolenghi's focus on women's
health with international organizations includes work with the
World Health Organization. Modestly, the retired Waterbury physician
admits to being one of the self-described "mothers" of
the Vermont Women's Health Center.
In Oaxaca, she conducted workshops for doctors, nurses, and auxiliary
staff, focusing on practitioner-to-patient communication.
Ottolenghi also performed hundreds of examinations in makeshift
exam rooms, using headlamps for light and putting paper over
windows to keep out the curious.
"It's not such a complicated thing to take PAP smears," she
said, "though PAP smears by themselves will not cure cancer."
Specialized volunteers like Fletcher Allen Health Care cytotechnologists
Tim St. John and Susan Warren (trained to detect abnormalities
in tissue samples on slides) were needed to read slides on-site.
With microscopes in tow ("baggage checkers had a hard time
understanding what they were," said St. John), they endured
12-hour days fueled with water and Power Bars, targeting 600
to 800 slides over five days. In spite of the grind, they found
the work rewarding.
"Here in the hospital we don't always know what happens
(after we read the slide)," Warren said. "This was
totally foreign and new."
Both technicians now develop lab procedure for the Mexican sites.
St. John also screens and organizes volunteers while Warren is
self-described "supply master" for future trips.
With what Burns calls a revolution on the horizon, Grounds for
Health will employ new World Health Organization protocol for
cervical cancer detection.
A low-cost, low-tech version of an HPV test already used in the
U.S. is in final testing. With partial funding by the Gates Foundation,
the swab test, due in 2008, should supplant PAP exams as the
first indicator of HPV.
The majority of PAP exams will be eliminated translating to a
less stressful, less costly procedure - a boon for women and
developing countries with limited resources.
With a 15-percent rate of lost follow-up for every step of cervical
cancer care in Mexico, Burns hopes the new test will make exam
and diagnosis a one-step process.
Until then, Grounds for Health will keep educating, building
on the pride of small farmers, and expanding their health network.
Nicaragua, which has the world's third-highest rate of cervical
cancer, is their next target.
"There are so many problems in the world and we ask 'how
do we fix this,'" Burns said, hands spread in exasperation. "We
can fix this - it's important to fix and it's worth fixing."