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Vermonters Pitch in to Prevent Cervical Caner in Mexico

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 more women."

It's a fact made all the more poignant given the simplicity of its detection - through a simple PAP exam.

Grounds 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 farmers.

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 women," said 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 Pino.

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."

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