Our final weeks in Kisumu were bustling with travel to Siaya County. Our team is focused on leading the most effective CHP and provider trainings possible. Provider training introduces clinicians to their responsibilities as part of the R33 study and instructs them on treating HPV-positive women with thermoablation.
Perhaps the most fulfilling aspect of our time on the study has been leaving an imprint on the training materials. We’ve developed several iterations of training slides, assessments, and study guides to enhance the providers’ knowledge and confidence in conducting treatment. After the first training session, the team asked us, “Do you think you could perform thermoablation now?” That’s when we decided to clarify the anatomy and treatment details that left us confused. We approached the materials from the perspective of a busy clinician with several other services to provide and counseling scripts to remember. We created a succinct summary of the most important aspects of cervical anatomy and thermoablation instructions. The next day, we conversed with teams of providers as they practiced thermoablation, using the instrument on raw meat simulating the cervix.
A provider practicing a thermoablation procedure on a piece of meat to mimic the cervix
As students in the field, we often watch and diligently document study challenges. It was important for us to avoid passively recording implementation challenges and instead step into the shoes of a provider, CHP, or patient to experiment with the workflow from their view. After taking this leap into hands-on discovery at the provider trainings, we began to ask even more questions and hold thorough conversations about implementation with the study coordinators.
Many of these discussions led me to personal realizations about HPV and cervical cancer stigma. Clinicians and CHPs often explained how anticipated stigma colors their patient interactions. Women’s hesitancy to accept screening and treatment for fear of judgement remains a concern. Providers and CHPs continue to respond to stigmatizing attitudes and environments with open dialogue, collaborating to determine how they can best mitigate feelings of shame or fear among their patients.
In fact, the provider and CHP trainings were home to the most open and thoughtful group discussions I’ve witnessed about reproductive health. Of course, these conversations were often clinical and logistical, but they highlighted the group’s compassionate outlook and consideration for their patients’ emotional wellbeing during such an intimate and vulnerable screening process. During these conversations, the groups asked questions like, “How would a client who is menstruating experience the screening process differently? Would blood visible in her specimen tube be troubling for her? Who would see her specimen tube and how would this affect her decision to screen?” The ensuing discussions revealed a profound consideration for the women our study aims to serve.
At each training, eligible participants are asked to collect their own samples for HPV testing. We emphasize that completing screening can equip providers and CHPs to speak from experience and better connect with their clients. RAs Belinda Malongo and Merceline Alala document CHPs’ samples for tracking at the lab.
As our data team works to quantify and describe elements of HPV and cervical cancer stigma, we often overlook situations devoid of harmful stigma. The absence of stigma has no name or simple descriptor, but was tangible in so many interactions with my colleagues. My training experiences taught me to not only study stigma as a barrier to care when it abounds but to celebrate the work that has banished it from conversations in favor of empathy and understanding.
In my introductory reflection, I wrote that engaging critically with flawed systems is the heart of global health work. This remains my view. But after my first summer in the field, I now know it to be more involved than this. It demands a spirit of collaboration and an enthusiasm for investigating social determinants of health from all stakeholder perspectives. In short, global health work is about engaging thoughtfully and compassionately with people.
Study coordinator, Jenipher Ambaka walking through the HPV screening eligibility criteria with a group of CHPs
Thinking back to our first days in the office and out in the field, I am reminded of the learning curve we’ve navigated with the guidance of the team. I want to express just how grateful we are for their generosity and direction. To our gracious mentors and friends, Jenipher, Breandan, Evans, Florence, Merceline, Belinda, Javan, Amelea, Raphael, and Paul: Asante sana!