"Few books have mastered such a breadth of complex issues and done so in such clear and readily understandable prose. ...essential reading for every medical student and resident in the country, as well as anyone else who cares enough to address directly the health inequalities that plague so much of humanity."

-Robert Sparks, MD, Dean Emeritus Tulane University School of Medicine, President Emeritus and Senior Consultant for the W. K. Kellogg Foundation, former Chancellor of the University of Nebraska Medical Center, member Institute of Medicine.

Addressing Women’s Health Needs in Guyana

Back in early 2004, we asked our Guyanese colleagues to identify the priority women’s health issues in their country. Their answers: cervical cancer and complications associated with gestational hypertension. But, rather than come in with preconceived notions of what should be done, how it should be done, or what we wanted to do, we listened – to health care providers, government officials, and community members and leaders. From that and our own observations, we worked collaboratively with our Guyanese friends to develop innovative programs that are responsive, practical, culturally sensitive, and provide a high standard of medical care aimed at reducing the unnecessarily high levels of suffering of women in Guyana.

Outreach clinic in Moruca, Guyana.

Guyanese doctors and nurses at completion of training course at Georgetown Public Hospital for providing comprehensive cervical cancer prevention services.

Inequitable distribution and outcome of cervical cancer Women in Guyana continue to die painful, agonizing deaths from cervical cancer due to lack of access to high quality cervical cancer prevention services. Merely being born and living in Guyana, especially the more remote and poor areas, dramatically increases the risk of developing and dying from cervical cancer. Informed by the principle of social justice, we work collaboratively and in solidarity with the communities to eliminate this health disparity.

The inequitable distribution and outcome of cervical cancer is illustrated by the fact that each year, there are nearly 500,000 new cases and 275,000 deaths, 85% of which occur in developing countries. Guyana, a heavily indebted poor country, suffers one of the highest cervical cancer burdens in the world. In 2002, cervical cancer incidence in Guyana was 47.3 cases per 100,000 women, with a mortality rate of 22.2 per 100,000 women, both of which are 60% higher than the Latin America and Caribbean region. In addition, Omni Med’s work in Guyana reveals that the Amerindian women living in the remote areas suffer a markedly higher cervical cancer burden than the country as a whole, with rates 7.5x higher.

While numbers help give a broad view of the health disparities, faces exist behind these numbers. You see them on the crowded wards; women in their 30s to 50s lying in beds, some sharing a bed head-to-toe with another patient, bleeding from far advanced, untreatable cervical cancer, tumors eroding to the outside, essentially just waiting to die. Yet, this is unnecessary, as cervical cancer is almost completely preventable.

The inequalities in the distribution and outcome for cervical cancer are the biological expression of a disease that is largely socially determined. Political economy, poverty and inequality, and inhibited personal agency all work to marginalize populations and increase their risk for developing cervical cancer, primarily through lack of access to cervical cancer prevention services. Large social-historical and geopolitical forces have helped create and maintain this disproportionate burden of disease. Yet, effective clinical interventions, while not addressing the underlying forces of social inequalities, can often eliminate the biological expression of social inequalities. Effective cervical cancer prevention services can help address immediate health concerns of marginalized populations and empower them, while the longer-term structural interventions take place.

Ward rounds at Georgetown Public Hospital, the main teaching hospital in Guyana.

Maternal Mortality

Too often, women in Guyana die, or suffer serious disability, from complications related to pregnancy or childbirth. The maternal mortality ratio (MMR – number of maternal deaths per 100,000 live births) in 2004 was 132.2. While this figure is lower than several nearby countries (such as Bolivia and Peru), it is higher than the average for the Latin America and Caribbean region, and 15X higher than the U.S. Of more concern is there has not been improvement in the MMR in Guyana between 2000 and 2004. Preventing maternal deaths and serious disability is a high priority of our program in Guyana.

As in many developing countries, hemorrhage and complications from gestational hypertension/eclampsia are the leading causes of maternal mortality in Guyana. In addition, complications arising from miscarriage and abortion cause significant disability in the country. Our program works to target these problem areas through education and training, focusing on prevention, early detection, and timely appropriate management. Understanding the local context and working collaboratively in the country is critical to developing effective strategies to reduce these deaths and disabilities.

What we do

We work in collaboration with the Ministry of Health (MoH), Georgetown We work in collaboration with the Ministry of Health (MoH), Georgetown Public Hospital Corporation (GPHC), and communities to build local capacity and bring high quality health care services to the country. We do this through advocacy, community education, training and education of health care workers, and service provision. We believe that it is vital to develop programs that are feasible, sustainable, and locally owned.

See the report from our October 2007 trip.

Recently, two cervical cancer prevention grants for projects were approved: one a USAID funded Jhpiego-Omni Med project, the other a Rotary funded project. Together, these projects aim to provide a foundation for the scaling up of a national program. How you can help Volunteer or Donate – please see Contact Us - Get Involved section for details.

CFC # 10999

Guyana is a South American country bordered by Venezuela, Brazil and Surinam.

Population is 770,794; with average per capita income of $1,300; 35% live below the poverty line

Life expectancy is 66.4 years; one of every 33 infants dies before their first birthday; HIV/ AIDS prevalence is 2.5% of the adult population

The Ministry of Health invited Omni Med to Guyana in 2002. Since then, Omni Med has been a continuous presence in country. Omni Med’s Dr John Varallo started the Guyana Cervical Cancer Prevention Program (GCCPP) in 2004 in cooperation with the Ministry of Health and the Georgetown Public Hospital. Cervical cancer is the most common cancer associated with AIDS and Guyana has one of the highest cervical cancer rates in the Western world. The Omni Med program has screened hundreds of women, detected and removed many pre-cancerous lesions, and become the basis for Guyana’s national cervical cancer prevention strategy. President Bush recognized Dr Varallo and Omni Med in the White House’s September 2008 report, “Answering the Call to Service.”