As a medical student in Madison, Wisconsin, in 1997, Miriam Cremer traveled to Madison's sister city, a small town in El Salvador, as part of her education. There, Cremer met a woman in her late 20s who soon died of cervical cancer. Not only was there no cervical-cancer treatment available for this woman in El Salvador, there were no PAP smears to test any other women and no HPV vaccinations to prevent the disease.
"They didn't have anything available," she recalls. "It's the leading cancer killer of women in El Salvador. I was appalled that women could die of this very treatable disease."
In fact, it's the fourth leading cause of mortality for women aged 15-64 in El Salvador; worldwide, a woman dies of cervical cancer every two minutes and it's the top cause of cancer deaths in the developing world.
In the U.S., doctors can detect the disease up to two decades early by spotting pre-cancerous lesions, and it has an effective treatment. The HPV vaccine is also preventing new cases here.
Even if PAP smears were available in El Salvador, their effectiveness would depend on the ability of the women to be seen multiple times by caregivers to take the test, receive the results and follow up with needed treatments. And HPV vaccines are too costly.
So when Miriam Cremer began practicing medicine in New York City, she founded Basic Health International
(BHI), which has been working with the Ministry of Health in El Salvador since 2003 to create a countrywide cervical-cancer program that will screen and treat 30,000 women in three years. In the past seven years, BHI has trained more than 100 clinicians in El Salvador, Guatemala, Nicaragua, Dominican Republic and Haiti, providing free screenings to almost 8,000 women.
After becoming an assistant professor in the Magee-Womens Hospital of UPMC's department of obstetrics/gynecology, Cremer moved BHI here. "I was very young and naïve in my career when I started all this," she says. "It's been my life's cause."
At first, BHI trained El Salvadoran health-care providers to administer a low-cost cervical cancer test involving vinegar to detect symptoms internally, then to provide an inexpensive treatment. But that PAP alternative was creating too many false positive test results and causing overtreatment.
Now a new low-cost HPV screening method is available, so for the last year and a half BHI has focused on implementing this screening method.
Cremer also takes medical students on her trips to El Salvador. Hiking out to villages to screen women, the students found that "they're doing their exams on people's beds and on tables in schools." So they designed and constructed a portable exam bed that can be folded and worn as a backpack. At first, they used bicycle tires, but now they have created a sturdier model and plan to mass produce them.
Cremer, of Pt. Breeze, says her organization is always looking for volunteers and fundraising help (email here
.) Look for a new documentary about BHI in May on Al Jazeera-English.
Looking for an additional way to help women's health? Let them know about Be Well Pittsburgh
, a resource for women without insurance.
Writer: Marty Levine
Source: Miriam Cremer, Basic Health International