Abroad in Honduras: Alejandra Bejarano

 I was born and raised in Honduras, a developing country that is greatly affected by poverty, several social issues, and many public health burdens. Therefore, I decided to have my first global health applied experience there, a place that I hold close to my heart and I still consider home. One of the main public health concerns in Honduras is cervical cancer, which is the first cause of death among Honduran women. The high mortality rate is mainly due to the fact that diagnoses are usually made in advanced stages of the disease because most women do not have access to costly screening methods. Therefore, poor and less educated women are disproportionately affected in terms of both incidence and mortality.

The treatment and control of cervical cancer is highly dependent on the developmental stage of the disease; thus it is of extreme importance to detect and treat the pre-cancerous/cancerous lesions at an early stage. As a consequence, in low-resource countries such as Honduras, the high mortality of cervical cancer is attributed to the high incidence of the disease paralleled by severe limitationsin screening programs and treatment facilities. Less than half of Honduran women have access to a Pap smear, the screening method of choice for cervical cancer. In response to this, the Pan American Health Organization (PAHO) has developed a Regional Strategy and Plan of Action for

 Cervical Cancer Prevention and Control, which promotes the use of new technologies for cervical cancer prevention screening. In resource-limited environments such as Honduras, PAHO has highly recommended the widespread use of alternative low-technology, cost effective, safe, and feasible cervical cancer screening strategies, such as Visual Inspection using 5% Acetic Acid (VIA). In this regard, introducing VIA as an alternative screening method for cervical cancer into the Honduran standards of healthcare has become of vital importance. In an effort to detect cervical pre-cancerous lesions early to reduce high rates of incidence and mortality in Honduras, the Honduran Ministry of Health, the Medical School of Universidad Autonoma de Honduras (UNAH), and the Hospital Escuela Universitario (HEU), in collaboration with PAHO, are working on establishing adequate policies to improve the early detection and treatment of cervical cancer.

I participated in a large-scale research study titled “Implementing Visual Inspection with Acetic Acid (VIA) as an alternative method of preventive cervical cancer screening for women in Honduras”, conducted by the Department of Obstetrics and Gynecology (Ob/Gyn) from UNAH Medical School and its teaching hospital HEU. The main objective is to implement VIA as an alternative to Pap smears in low-resource areas nationwide so it can be used as the main method for screening and diagnosis of early lesions of cervical cancer, as part of the policies and guidelines of the Honduran primary healthcare system. During my eight weeks abroad, I assisted the Ob/Gyn Department in recruiting patients for the study, educating Honduran women on the importance of screening for cervical cancer, and collecting and registering data. Additionally, I learned how to properly perform a VIA test and correctly assess the result. I hope that the analysis of my study about the feasibility and effectiveness of VIA testing at HEU can provide support for the creation of a training center specialized in the study of gynecologic screening, which will serve to train Ob/Gyn residents in preventive primary care and as the main referral site for patients who need confirmation of a positive VIA test result that cannot be obtained in their local healthcare facility. in screening programs and treatment facilities. Less than half of Honduran women have access to a Pap smear, the screening method of choice for cervical cancer. In response to this, the Pan American Health Organization (PAHO) has developed a Regional Strategy and Plan of Action for Cervical Cancer Prevention and Control, which promotes the use of new technologies for cervical cancer prevention screening. In resource-limited environments such as Honduras, PAHO has highly recommended the widespread use of alternative low-technology, cost effective, safe, and feasible cervical cancer screening strategies, such as Visual Inspection using 5% Acetic Acid (VIA). In this regard, introducing VIA as an alternative screening method for cervical cancer into the Honduran standards of healthcare has become of vital importance. In an effort to detect cervical pre-cancerous lesions early to reduce high rates of incidence and mortality in Honduras, the Honduran Ministry of Health, the Medical School of Universidad Autonoma de Honduras (UNAH), and the Hospital Escuela Universitario (HEU), in collaboration with PAHO, are working on establishing adequate policies to improve the early detection and treatment of cervical cancer.

This experience allowed me to be part of an invaluable initiative that will provide a real improvement in the healthcare of women. Moreover, it has been a privilege to interact with physicians and medical students from a completely different healthcare system, from whom I have obtained essential and valuable lessons that will aid in my personal and professional development. At the same time, as part of my preparation in Global Health, having abroad field experiences is vital to personally observe and learn from different healthcare systems, about different cultures, and about different global health issues. This will allow me to start building a concrete background in discussing and evaluating global health problems in the developing world. This project represents the first stepping-stone in my personal effort of becoming a physician with an expertise in global health, a field that concentrates in the enhancement of health and the reduction of healthcare disparities.

Alejandra Toro Bejarano, WCMC, MD Class of 2016

Weill Cornell Medicine Center for Global Health 402 East 67th Street, 2nd Floor New York, NY 10065 Phone: (646) 962-8140 Fax: (646) 962-0285