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In late April, Dr. Barry Rosen, Head of Gynecological Oncology at PMH, and his family traveled to Eldoret, Kenya to work at Moi Teaching and Referral Hospital. The excursion was organized through the University of Toronto's Reproductive Health Program and involved working with local physicians and medical students to provide care to cervical and ovarian cancer patients."I was immediately impressed with my Kenyan colleagues' level of knowledge and clinical expertise. They routinely manage complex situations with limited resources in a setting that is not ideal," Dr. Rosen says. "When questioning the medical students, I felt their powerful commitment to learn, and their ability to discuss medical issues in English was remarkable."In Kenya and other parts of Africa, cervical cancer is designated as an "AIDS-defining disease," meaning those who are HIV-positive have decreased immunity to fight HPV infections and therefore are more likely to develop cervical cancer. As part of an ongoing study involving various U.S. institutions, Dr. Rosen helped set up a sustainable cervical cancer screening model using minimal resources.The study compared pap smear and colposcopy to a technique called Visualization and Inspection with Ascetic acid of the cervix (VIA) in 150 HIV/ AIDS patients. VIA was found to work well in this setting because of its low cost and the fact that a nurse can administer it.Dr. Rosen performed the first Loop Electrosurgical Excision Procedure (LEEP) in Western Kenya. The procedure removes precancerous lesions using a thin wire loop electrode that transmits a painless electrical current to quickly cut away affected cervical tissue. It is performed using local anesthetic on outpatients with a high rate of success."I brought my teaching expertise, as well as donated supplies in order to set up a program to treat those women with abnormal screening tests, both Pap smear and VIA," says Dr. Rosen. "I taught two doctors how to do a LEEP and with my help, they successfully completed 14 procedures."In addition to teaching physicians the LEEP, Dr. Rosen also worked with a group of Kenyan physicians to develop a treatment protocol for women diagnosed with advanced stage cervical cancer. In Kenya, radiation facilities are inaccessible. Therefore, an alternate treatment strategy using chemotherapy and surgery (if appropriate) was developed and implemented by Dr. Rosen and the hospital's medical team."For this treatment strategy to succeed, strong collaboration between several different disciplines approaching treatment with different expertise is required," says Dr. Rosen, who credits UHN's multidisciplinary approach for helping him to develop this strategy. "This collaborative approach is relatively new in Kenya, and the time I spent promoting dialogue among medical oncologists and gynecologists will help ensure cervical cancer patients are not seen in isolation."While working on the medical side, Dr. Rosen's family volunteered in a children's program attached to the hospital called The Sally Test Centre. The program was established to provide hospitalized children with day care and opportunities to learn and socialize with other children."My wife and children were shocked to see so many orphaned and abandoned children whose parents had died of HIV, or were victims of violence. It was a very difficult adjustment to see these circumstances face to face," says Dr. Rosen."There were days where the impact was almost unbearable, but the resilience and strength of the people we met living in these difficult circumstances were truly inspirational. It was our first experience in Africa and one that has had a lasting impact on all of us. The mutual support we provided each other was strengthening and made the experience much richer."