Two decades ago, David Walmer went on a volunteer mission with his church to Haiti. He was sent to paint walls at a hospital in the seaside town of Léogâne, but when the people there learned that Walmer was a doctor — he was a fertility specialist at Duke University — they asked him to spend the week with a local obstetrician-gynecologist named Jean-Claude Fertilien. Walmer was shocked by what he saw: Fertilien finishing a hysterectomy with the aid of a flashlight when the hospital generator failed to restart, for instance, or when an anesthesiologist wasn't available for an emergency C-section, the doctor just numbing the skin and cutting. At one point, Walmer was called to the bedside of a young woman in her mid-20s with undiagnosed cervical cancer who had gone into septic shock. There was nothing to be done for her, and she died right in front of him. Walmer was appalled. In the United States, cervical cancer is considered a preventable disease.
"You have 10 years to detect this disease before it becomes untreatable," Walmer says. "And it's easy to detect. It develops on the outside of the cervix, which you can see."
At the end of his week in Haiti, Walmer, who is a boyish 61, put a question to Fertilien: "I'm a busy guy. But if there's one little thing I can help you out with, what would it be?"
"Cervical cancer," Fertilien said.
Walmer had no expertise with the disease — he divided his time between seeing patients and doing lab work, analyzing the biology of the uterine lining — but he told Fertilien he would do his best.
Back at Duke, he pressed colleagues to let him work alongside them and learn about the disease. He knew that an effective screening program would be the biggest single fix he could propose. In the U.S., screening is typically done with Pap smears — a quick swab of a woman's cervix to screen for the cellular changes that foreshadow cancer. If abnormal cells are found, a doctor will usually perform a colposcopy, in which the cervix is examined using a specialized magnifying lens, a colposcope, to see if disease is visible. Before the widespread adoption of Pap smears in the 1950s and '60s, cervical cancer was the top cancer killer among women in the U.S. Now, when caught in time, the diagnosis and treatment are pretty straightforward: Paint the cervix with acetic acid — essentially vinegar — which turns abnormal areas white. Confirm the presence of disease with a biopsy. Then freeze or remove the abnormal cells.
Thanks to early detection (and helped by the vaccine for HPV, or human papillomavirus), the mortality rate for cervical cancer in the U.S. is relatively low. Not so in developing countries, where it kills almost 250,000 women every year. Haiti has one of the highest rates of cervical cancer in the world. Walmer knew that a national screening program would save countless lives, but deploying colposcopes across the impoverished nation was not feasible. They're expensive, they require reliable electricity and they're too big to be easily carted around to the ramshackle clinics throughout the country. A battery-powered, portable and affordable alternative was needed.
At the time, in the mid-1990s, Walmer was teaching young doctors how to reverse sterilization surgeries by repairing women's fallopian tubes. He used loupes, or surgical glasses, to see the tubes properly. "I realized, I've got these magnifying lenses right here, and they don't require any electricity," Walmer says. A solution began to take shape in his mind. He bought a halogen headlamp at a bike shop and a green filter at a camera store. He figured that by switching back and forth between green and white light he would be able to provide the contrast needed to identify precancerous lesions on the cervix and the pattern of blood vessels that indicate something suspicious.
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