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QUALITY IMPROVEMENT CERVICAL CANCER SCREENING

QUALITY IMPROVEMENT CERVICAL CANCER SCREENING. BACKGROUND.

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QUALITY IMPROVEMENT CERVICAL CANCER SCREENING

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  1. QUALITY IMPROVEMENTCERVICAL CANCER SCREENING

  2. BACKGROUND • This service was not rendered to clients by Eshowe Mobile Clinics until August 2006; we never thought it was possible to perform pap smears in Mobile Vans because we thought it was too small, mobile Vans were not meant for this service. We soon realized that like any other consulting rooms, Mobile Vans can offer complete privacy, they have couches, lights and water, the problem was our attitude that we soon corrected. • We then came together as Mobile Clinic staff to discuss this further especially as to how are we going to acquire skills to perform quality pap smears.

  3. WHAT LED TO INITIATION OF THIS SERVICE • Over the years, we have seen clients experiencing pains due to terminal cancer of cervix, emotional trauma of the loved ones as they experience the excruciating pains their loved ones undergo because there is no turning back, the person will soon die. Whereas if that cancer was early, detected all the emotional, physical and psychological trauma could have been avoided. • Recently, because of HIV & AIDS pandemic we have seen a lot of young ones (under 20’s) also at risk and some found to be already infected, so this was a massive challenge as well. • Since it was a Women’s month, we also wanted to Honour women to do something  that could save their lives.

  4. ACTION TAKEN • Thanks to our PHC Manager, PHC trainer and the experienced Clinical Nurse Practitioner who has been exposed to the services for training us step by step until we were confident and ready to perform quality pap smears • We that felt women would not be comfortable to do pap smears on a usual clinic days because men would also be around (Father In-laws, husbands etc – cultural backgrounds. • We then decided to use free Fridays when there is no clinic  • We liaised with our CSSD for equipment needed for this services including  vaginal  speculum (different sizes) – sterilized, sterile speculae and sterile per vaginal packs • After motivating through health education, the community was willing and happy to come for pap smears.

  5. OUTCOME • Our first ever pap smears to be performed in Mobile Vans was on the 18th of August 2006. We performed the total of 23 clients. 8 clients were from Ncemaneni area and 15 from Mhlathuzana area. Fortunately none had abnormalities. • When the Minister of Health Dr Sibongiseni Dlomo introduced “Phila Ma” Project, Eshowe Mobile Clinic was already running with the project, we even had more clients coming forward for pap smears having heard the Minister over the Media talking about importance of cervical cancer screening. • To date we have performed 699 cervical cancer screening  with 94 abnormalities • 75 low grade squamous intra-epithelial lesion encompassing C1N1 / HPV (LSIL) • 19 high grade squamous intra-epithelial lesion encompassing C1N2/3  - need urgent referral for colposcopy and or biopsy • 6 clients are still awaiting their results • 5 slides were broken on transit

  6. IN COLLABORATION WITH NGO’S AND OTHER INSTITUTIONS • We have worked together with CANSA at Ufasimba area in Ndlangubo in 2009 where 79 pap smears were performed • In the Premier’s event at Mabhokweni area, we performed 27 pap smears in 2008 • 20 Pap smears done with Khanya Africa at Ekuphumuleni Clinic in 2009 • In the Premier’s event held at Uhologo in 2009, 13 pap smears were preformed • At the recently opened Siphilile Clinic, 76 pap smears were performed on the 17th of September 2010 and still awaiting results.

  7. CHALLENGES • Our clients voiced out the fact that they wished that only female nurses perform pap smears, they were not comfortable with male nurses. Their wish was considered and pap smears are done by female nurses, which is unfair on our male colleagues because of the experience they are deprived of.   • Some clients do not have a reliable contact numbers for emergency results, some give contact number for boyfriends who work in Durban or Johannesburg, when  they are needed urgently, boyfriend will say he will only see the girlfriend at the end of the month, which pose a problem because of time being delayed.

  8. RECOMMENDATION • All clients at child bearing age or those who are sexually active should be done pap smears routinely not only 30 – 59 years due to the burden of diseases • Reliable traceable addresses to be taken for tracing purposes should urgent results be found.

  9. October 2010 29 pap smears were done at Saron. • November 2010 65 pap smears was done , 43 at Sidipha mobile point and 22 at Mhlathuzana. • February 2011 39 were done at Mpumazi during MMC campaingn. • March 2011 43 done , 22 at Ndlanguboduring MMC campaign and 21at Phaphana mobile point. • All clients with abnormal results were referred and managed accordingly.

  10. CONCLUSION • We aim at helping other facilities e.g Nkwalini Clinic and King Dinuzulu Clinic.

  11. THANK YOU

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