Message from the Secretary General - Walter Prendiville

Dear Colleagues

As we approach the half way mark in the term of this board it is perhaps a good time to reflect on where the Federation is going, what it has achieved and what it hopes
to do during the year and a half before the next IFCPC World Congress and our AGM in Rio de Janeiro in July 2011. The IFCPC has made a number of firm achievements.
Firstly our finances are now on a sound footing. As detailed in the President’s letter the Federation does not have limitless funds but it does have sufficient to meet its’ annual expenditure. Sincere gratitude to Jim Bentley and to Kathy Poole.

Meetings

Secondly a number of very successful seminars have happened in conjunction with coincident International events. These include two major Global meetings, the FIGO meeting in Cape Town last October and the Papilloma Virus meeting in Malmo in May 2009. The Federation has been very keen
to support regional colposcopy meetings and the IFCPC will have supported and held seminars at
several large regional meetings before we meet in Rio in July 2011. The Federation presented its’ aims and ambitions at a joint platform with the EFC at the Eurogin meeting in Monte Carlo earlier in March of this year, and hosted a seminar at the Asian sister to Eurogin which is the AOGIN meeting being hosted in New Delhi between the 26th and 28th of March 2010. Finally the Federation will be holding board meetings at the European Federation meeting in Berlin in May 2010 and at the Latin American Federation meeting in Cartagena in October this year.

Training

Ninety nine per cent of the world’s colposcopists live in the developed world and yet ninety nine

percent of the world’s cervical cancer occurs in the developing world. Those countries which have achieved real reduction in cervical cancer incidence and mortality rates have done so with the combined strategy of identifying women at risk using systematic screening programmes and managing the screen positive women in colposcopy clinics. If the IFCPC is to contribute to a reduction in the burden of cervical cancer globally it will need to find a role in one or both of these two strategies.

It is more difficult for the Federation to embrace a role in establishing screening programmes but maybe it should become a more politically engaging body and try to lobby governments and health strategists about the need to establish comprehensive and well organized screening programmes. As for colposcopy training the Federation does have a real role, and a real expertise, amongst its’ huge spectrum of members.

Almost certainly every colposcopist would like to help in training colleagues wish to be trained and in circumstances where training is needed. There is a difficulty in deciding which training initiatives are the most effective. For many years different member societies have run training courses in emerging regions in order to foster the evolution of colposcopy and pre-cancer services. Often this has taken the form of running a basic colposcopy course, either theoretical or hands on. These have, by and large, been successful in that they have been popular. It is less certain if these courses leave a lasting effect on the region in question.

Recently a number of newer initiatives have emerged. I am aware of some but not all of these. It would be very useful if members of the Federation could write or email me with details of those international training initiatives that they are aware of in their own countries or elsewhere. The Federation would like to establish a database of any training or research initiatives that are happening so that we may learn which ones are most effective and where the Federation might be able to help. I have listed three different projects that I know of, each of which are quite different. Two are in place, the last will hopefully start next year. Please let the secretary general know of any International initiatives that you are aware of at prendiville.walter@gmail.com

Peru : See and treat training programme

The US based organisation PATH had been involved in a number of health initiatives globally. It has successfully collaborated with the IARC and other international agencies and is adept at harnessing funds and personnel in order to achieve specific project goals. At Eurogin last month in Monte Carlo a number of presentations described a training project supported by PATH for a see/screen/treat initiative using VIA as the screening tool and cryocautery as the treatment modality. The training programme is based at the National Cancer Centre in Lima. It appears to be thriving. The see/screen/treat approach appears to have genuine support amongst a number of authorities.

Southern India : Video conference linked training

The project in Tamil Nadu arose out of discussions with Dr Sankaranarayanan from IARC who had undertaken several studies of Visual Inspection in Ambilikai in Tamil Nadu and elsewhere in India.

After visiting this rural and disadvantaged community in Ambilikai and making contact with an

interested dept of Gynaecology in Coimbatore a collaboration between Dublin and the two centres in Tamil began in 2008. After a basic course a dozen trainee colposcopists were recruited to become trainee colposcopists. The collaboration was supported by the Dept of Health and the Health Research Board in Ireland as well as the British Society for Colposcopy and Cervical Pathology. Initially the two centres were equipped with new colposcopes and video image and data storage computer systems.

The training continues by way of a regular videoconference of interesting cases presented from Dublin and Ambilikai and the hospital in Coimbatore. A number of theoretical and practical training courses have taken place over the last two years. At the end of this year an exit exam will take place and certificates of training awarded. This type of training is less expensive and disruptive than bringing trainees for a year or more’s preceptorship at a colposcopy service in established colposcopy clinics. It is still however relatively expensive, even if the equipment was already installed in the centre wishing to train. The ultimate ambition of this collaboration is to establish a training centre in Southern India so that when the screening programme begins (and it has been announced by the regional government) there will be somewhere to train colposcopists to manage the patients who need colposcopy. Although many of the screen positive patients may be managed at the site of screening in the community it is likely that not all will be suitable for a screen and treat approach. The project appears to have gone well and there are now several very keen and increasingly competent colposcopists in Coimbatore and Ambilikai.

Sub Saharan Africa: Distance learning project

Whether or not ultimately a see/screen/treat plan turns out to be the best way to deliver an effective cervical cancer prevention programme in Africa remains to be seen. It is likely that a proportion of patients will still benefit from colposcopy mediated management and there are very few trained colposcopists in Sub Saharan Africa. In discussions with both Prof Denny and Dr Sankaranaryanan it appears that a distance training programme may be the most efficient means of training colleagues in Sub Saharan Africa. The distances between colleagues who need training and training centres is vast, there are too many who want to be trained and too few centres of excellence that could offer the preceptorship / hands on individual training that is the model in much of the developed world. The proposal for such a programme is relatively embryonic but would run along the following lines

1. The course will be lecture based and will be delivered during 2011

2. The programme will be structured

3. A core curriculum will be generated (as with many National Society training programmes)

4. Each lecture will be video recorded and sent by email/internet or by regular mail in disc form

5. Each lecture will be accompanied by recommended reading

6. delegates will progress from one lecture to the next after satisfying an exam pertinent to the
    lecture and ancillary reading material
    a. i.e. Listening/viewing the lecture once or twice

    b. Reading the related reference material

    c. Answering a mini exam on the relevant subject

    d. Progressing to the next lecture

7. The lecture course will be preceded by a basic colposcopy course in January 2011

8. The course will finish with an advanced course in December 2011

9. There will be an exit exam, perhaps OSCE in form immediately after the advanced course

10. There will be a certificate of completion

11. There should be a practical component even if it is just model / simulated

12. Delegates must have a colposcope, a computer and a population of women who have been 
     or wish to be screened.

13. Ideally delegates will have or be provided with a videocapture system

14. Delegates will be charged a fee

15. The course will be undertaken in French and English

16. All lectures and course material will be vetted and passed by the Education Committee of
      the Federation

17. The faculty for the course will need to be large, with most faculty members contributing one
      or two lectures each

18. The full faculty should be drawn from as wide a spectrum of Federation members as
      possible

19. There will be a smaller core faculty

      a. to assess individual delegate performance and ability to progress through the course (i.e.
          to assess the individual lecture exam answers)

      b. to provide the basic and advanced course

      c. to sanction the choice of lecturers and core curriculum content

20. Funding will be sought from outside the IFCPC but some funding will come from the IFCPC.

21. The IARC have offered its’ audiovisual department facilities in order to record high quality
      lectures. Several of the board of the IFCPC already have a store of such lectures available.

Look forward to seeing everybody in Brasil next year

Walter Prendiville