Just five years ago, if anybody had told us about what we are currently doing at the Cervical Cancer Prevention and Training Centre (CCPTC) in Catholic Hospital, Battor, I would have said it was science fiction. Yesterday I performed a Loop Electrosurgical Excision Procedure (LEEP) at the CCPTC) for a 35 year old woman using Cure/Liger Medical's portable Electrosurgical Unit (diathermy machine with with an inbuilt smoke evacuator). This is not the first time we have performed a LEEP at the CCPTC but it was the first time we used the new version of the portable Electrosurgical Unit from Cure/Liger Medical. It completes our list of portable devices that make us like a mobile clinic/hospital when we move with only bags around the necks of our nurses, even to remote communities.
- This case is interesting because
1. She was referred by a nurse trained at the CCPTC when she screened her with HPV DNA testing using the Genexpert and the result was positive for HPV 18/45. She performed Visual Inspection with Acetic acid (VIA) which was positive.
A pap smear she took was reported as 'moderate dyskaryosis (High Grade Squamous Intraepithelial Lesion'.
Technology: HPV DNA testing.
I am happy that other institutions in Ghana are using HPV DNA testing in cervical screening. The Genexpert, AmpFire HPV platforms allow quick HPV DNA testing (and results can be available on the same day) and can be adopted across the country.
2. When she reported to the CCPTC in Battor, one of our nurses performed colposcopy with the mobile colposcope (the EVA system) and discussed the findings with me.
Colposcopy was adequate. Transformation zone type 2. There was circumferential thin acetowhitening around the cervical os.
We settled on treatment with LEEP.
Technology: Colposcopy by trained nurses (using mobile colposcopes).
With few specialists available to perform colposcopy in Ghana, we believe this is the way to go and our nurses have demonstrated this successfully. It is possible to carry these mobile colposcopes to the remotest areas for primary screening (or follow up of screen positives). Images can be shared with experts anywhere in the world when a second opinion is needed.
3. She was treated in the outpatient setting with LEEP. The cervix was infiltrated with xylocaine (with adrenaline) and the LEEP performed with the portable Cure/Liger Medical Electrosurgical Unit with an inbuilt smoke evacuator.
Technology: treatment of cervical precancer with portable devices
Portable thermal coagulators are replacing bulky cryotherapy units that require large and heavy oxygen cylinders. The CCPTC has both the portable Liger Medical thermal coagulator and the portable WISAP thermal coagulator. These allow a 'see and treat' model in cervical cancer prevention. Treatments can also be performed quickly in remote communities. The portable Cure/Liger Medical Electrosurgical Unit with an inbuilt smoke evacuator makes it possible to also treat cervical precancer (especially those not amenable to ablative treatment) quickly and in remote settings (if cases are well selected, and backups provided in case there is bleeding).
Ghana and other low (middle) income countries should take advantage of new technologies in cervical cancer prevention to reach out to more women. These mobile devices (colposcopes, thermal coagulators, electrosurgical units) are relatively cheaper than the 'traditional equipment' that have been used in the past. These new technologies make it possible to decentralise cervical cancer prevention. In Ghana, it makes it possible to offer cervical cancer prevention services at the basic unit of healthcare - the Community-based Health Planning Services (CHPS).
Dr. Kofi Effah
The author has no conflicts of interest.
Dr. Kofi Effah is a gynaecologist and head of the Cervical Cancer Prevention and Training Centre in Catholic Hospital, Battor in the North Tongu District of the Volta Region of Ghana.