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Q&A with Dr. Groesbeck Parham

Posted by On September 27, 2012
Groesbeck Parham, MD, is a board certified gynecologic oncologist and Professor of Obstetrics and Gynecology in the Division of Global Women’s Health at the University of North Carolina at Chapel Hill. In Lusaka, Zambia, he is the Founding Co-Director of the Cervical Cancer Prevention Program at the Centre for Infectious Disease Research in Zambia (CIDRZ). He formerly served as the Zambian Co-Chair of HPTN 035, an international clinical trial designed to determine the efficacy and safety of two topical microbicides to prevent HIV infection in women. He is an Honorary Professor at the University Teaching Hospital of Zambia. Presently, Dr. Parham lives and works in Lusaka, Zambia where he is helping lead the development and roll-out of that country’s first national comprehensive cervical cancer control program. The screening component of the program targets HIV-infected women due to their extremely high rates of cervical cancer. Most recently, they celebrated the screening of the 90,000th Zambian woman for cervical cancer, a landmark achievement in the developing world. We asked Dr. Parham about his life and dedication to decreasing the impact of women’s cancers on the African continent. How did you become passionate about helping disadvantaged African women?
  1. My passion for working amongst dispossessed and disinherited women is an outgrowth of three things: my understanding of the inner essence of women, which is something I learned from my mother and other women in my community, as a young boy
  2. Observing how my father and mother interacted with the men, women and children in my community who were struggling to survive
  3. Growing up in the Deep South (Alabama) during its period of racial apartheid
What are the differences between treating women’s cancers in the U.S. versus a country like Zambia? There are four different variables that come to mind when considering this question, and they are (1) the cancer itself, (2) the patient in which the cancer has been diagnosed, (3) the caregiver, and (4) the context or environment in which all of this occurs. In general I would say that the majority, but certainly not all, women for whom I have been fortunate enough to provide care during my 27 years of working as a doctor on the African continent tended to be uninformed about cancer and thus had little understanding of the nature of the disease. Compared to diseases of an infectious nature, that are more prevalent on the African continent, such as malaria, TB and HIV, cancer is a new or “fresh” disease in the minds of most Africans and is thus surrounded by many myths and misconceptions. This factor, amongst many others, commonly manifests in patients presenting to health care facilities only after the disease has become very advanced and is causing symptoms such as extreme pain. In many instances patients are undernourished and full of fear and fatalism. These are very tough situations for cancer caregivers, especially the African oncologist, whose treatments fair better when disease is detected in an early stage. Lastly, because resources in Zambia’s cancer care infrastructure are sometimes limited, caregivers are not always working with the full complement of tools and services required to optimize outcomes. Examples are blood products for transfusions, sophisticated surgical equipment, pathology services, highly skilled personnel, etc. What have been some of your important research findings?
  1. HIV infection profoundly affects the course of cervical precancer and cancer, making it more common in occurrence and difficult to cure
  2. It is possible to build an effective cervical cancer prevention program in resource-constrained environments using nurses as primary care-givers
  3. Myths and misconceptions about cancer are deeply embedded in the culture and thus one must consider this when promoting screening services
In recent years, what have been the major events contributing to an increase in cervical cancer screening and treatment in Zambia?
  1. PEPFAR funding for cervical cancer screening of HIV infected women,
  2. The Pink Ribbon Red Ribbon (PRRR) initiative
  3. Advocacy by the First Lady of Zambia,
  4. The support of the Zambian government
  5. Advocacy activities of the Stop Cervical Cancer Conference,
  6. President George W. and Mrs. Laura Bush’s visits to Zambia,
  7. Community education by the CIDRZ Peer Educator, and last but not least
  8. The work and commitment of our nurses who perform screening and treatment in the clinics and the support staff.
Tell us the most memorable story or an “Aha!” moment from your time as a physician in Zambia. Once I was performing surgery, needed a particular instrument to control bleeding, was handed something that was not even remotely close to what I needed while simultaneously being told that what I needed was not available. I took the instrument, imagined it was what I needed, and did what I needed to do to control the bleeding. That was one of the great lessons in the transformative power of the human mind. What are your plans and expectations for the future of cervical cancer prevention in Zambia and sub-Saharan Africa and how can Pink Ribbon Red Ribbon (PRRR help?  To marshal the brainpower and technological expertise within PRRR and combine it with the creative power of African healthcare professionals to create a sustainable comprehensive cervical cancer prevention system. Do you have any key messages to Africa? Take the lead on solving your own problems.