(This post was authored by Shreya Bhatt and Samita Thapa. Above, health worker Sharmila practices filling out an oral cancer screening report on a feature phone during a training session at RUHSA, Vellore in Tamil Nadu, India.)
The cancer epidemic has quickly spread across the world, disproportionately affecting developing countries. Today, non-communicable diseases (NCDs) like cancer claim more lives than malaria, HIV/AIDS, and tuberculosis combined. "More than 60% of world's total new annual cases occur in Africa, Asia and Central and South America. These regions account for 70% of the world's cancer deaths." Cancer has become a serious public health concern in India, but with only 11 health workers for every 10,000 citizens in the country, rural and urban populations experience vastly different health care.
Cancers in rural parts of India are rarely diagnosed due to lack of public awareness and health care services. Delays in cancer diagnosis pose challenges to treatment. With the increasing ubiquity of mobile phones in India, we can leverage mobile technology to improve access to health services, reduce costs, and strengthen health systems to meet the challenges of cancer care in remote communities.
Medic Mobile is excited to be a part of The British Council's Global Innovation Initiative and partner with University of Edinburgh, Weill Cornell Medical College, and Christian Medical College, Vellore, to strengthen cancer screening, early diagnosis and treatment of cervical and oral cancer in India.
(Health worker Lalitha fills out an oral cancer screening report on a feature phone after completing an oral visual examination during a cancer camp at the Veppaneri peripheral service unit in Vellore.)
While there are opportunities to use smartphones and other high-technology devices to support early detection and diagnosis of cancer, this project explicitly aims to study the impact that low-cost and low-technology tools can have on cancer outcomes in low-resource settings. With this mandate, we have built a feature phone-based application that will enable health workers and nurses to screen high-risk individuals, refer them to facility-based care, and follow up with them for treatment.
We will be implementing our mobile-phone based system in three sites: Padhar, Vellore, and Mungeli. Of the three sites, only Vellore's Rural Unit for Health and Social Affairs (RUHSA) currently has a paper-based early cancer detection system in place. Padhar and Mungeli have no early cancer screening or detection system and only provide facility-based care. Due to a nonexistent early detection system, Padhar and Mungeli receive many late-stage oral and cervical cancer patients with a low chance of successful treatment. (The most common cancers in India are cervical cancer, among women, and oral cancer, among men.) We will be training health workers, nurses, dental assistants and project coordinators, to use our mobile-phone based system to screen, record, and refer a patient during their journey to care.
(Nurses Devika and Valli (from left) practice filling out a cervical cancer screening report on a feature phone during a training session at RUHSA, Vellore in Tamil Nadu, India.)
In cases of oral cancer, health workers will be trained to identify lesions and refer the patients with precancerous lesions to the hospital. The health workers will create a profile for the new patient on our feature phone application and generate a unique patient ID. The health workers will also continue their follow-up and counseling in the community, encouraging patients with precancerous lesions to visit the hospital for treatment.
At the hospital, patients report to the dental department and receive a biopsy and further treatment as required. Dental assistants will use our feature phone application to create a biopsy report and treatment confirmation report for that patient.
Since cervical cancer screening requires a visual inspection with acetic acid (VIA), nurses (not health workers) will be screening women for cervical cancer by visiting community centers in the villages using a health camp-based approach. Women who test VIA positive are counseled by nurses to visit the hospital for further check-up. At the hospital, women visit the gynecology department and undergo a second VIA test and biopsy if needed, and are administered the appropriate medical treatment. Nurses will use our feature phone application to report on the second test results and treatment confirmation.
(Shreya Bhatt, our India Country Lead, with a team of RUHSA community health workers and their supervisors, Ganesan and Joseph (from right), outside the Veppaneri peripheral service unit at the end of the screening camp.)
We're excited about this partnership with Christian Medical College, University of Edinburgh and Cornell University, as we begin our work in cancer care. We have completed our training in Padhar, Madhya Pradesh and Vellore, Tamil Nadu, and are looking forward to feedback from our pilots there. Next, we will be training health workers in Mungeli, Chhattisgarh. Stay tuned for updates about this partnership!