We met with Drs. Vijaya, Bhavana,Reshma, Poornima and our team at PHRII. Dr. V had evolved her thinking over night and seemed to accept our strong recommendation that "See and Treat" was the only choice in this environment.
We brainstormed any barriers to carrying out See and Treat in a village. Drs. Bhavana and Reshma are so astute and have the ability to think about the larger system. They pointed out that a women who had received biopsy or cryo and had some complaint thereafter would go to the PHC. If the DHO and PHC staff were unaware that PHRII was doing Cx CA See and Treat prevention and a women showed up at the PHC, that might cause a problem. They strongly recommended that we talk to the DHO and get his permission
The second barrier identified was getting consent for procedures from the women. It was suggested that women be counseled during the awareness program that Biopsy and Cryo would be recommended if a precancerous lesion was found. They could bring their husbands to screening or call them if needed but by setting the expectation that these simple procedures might happen for at least ⅓ of the women screened, issues of refusing treatment because the husband hadn't consented should be minimalized.
We went to see the DHO this evening. He is aware and gives his acceptance that biopsies and cryo will be done in the villages. A process for letting the local PHC staff understand what was done and why and what post procedure side effects are expected will need to be worked out.
My eyelids are drooping as I write this email so I will say goodnight and will continue to let you know what is transpiring each day so that a sustainable prevention program will be well on its way and that a program for how to scale up is being worked on.