Christine Campbell

I'm privileged to work with Malawian and Scottish colleagues in an ongoing collaborative project that seeks to reduce the burden of cervical cancer in Malawi. Working closely with Prof Heather Cubie, health care providers and the Ministry of Health in Malawi, and Scottish clinicians from Edinburgh, Glasgow, Dundee and Stornoway, I'm the co-lead on a Scottish Government-funded project that is providing sustainable cervical cancer screening across Malawi, with a focus on strengthening services for rural women. Malawi has the highest global mortality rate from cervical cancer, and since 2013 we've been partnering with Nkhoma CCAP Hospital to provide screening for this disease using a technique called Visual Inspection with Acetic Acid (VIA) - vinegar! - and treatment called thermal coagulation/ ablation, drawing on Scottish expertise in use of this treatment. Over 18,000 women were screened in the first project: results were published in the scientific literature and have contributed to updated World Health Organisation guidance on treatment of cervical cancer lesions in low resource settings. Our current project, the MalSoc Screening project, continues with Nkhoma CCAP Hospital, but has also widened to partner with additional hospitals and NGOs. We're working with partner hospitals and their associated health centres in Northern, Central and Southern Malawi to deliver screening and treatment where possible close to home through training many more nurses in use of 'screen and treat', helping equip consulting rooms where needed, and developing a mentoring programme for ongoing peer support and shared learning. The project is linked with the Scottish Global Health Collaborative and we also work closely with medical students visiting Nkhoma Hospital for elective visits, as well as with nursing students at Nkhoma Hospital. Over the course of many visits to Malawi over the past several years I've developed close working relationships with colleagues in Malawi, and have an ever increasing understanding of and respect for the dedication of Malawians to making a difference within their own communities. Here in Scotland I'm a health services researcher at the University of Edinburgh, where I also work on how cancer screening can reach as many people as possible, so it is always interesting to reflect on the similarities (as well as the differences) between reducing the burden of cancer in Scotland and Malawi - in both countries cancer can be a devastating diagnosis and families care deeply for their loved one: the skills and professionalism of nursing and clinical staff, and a health system that does what it can, are essential.

Close to 30,000 women have been screened to date, with plans to reach another 60-80,000. Over fifty staff have been trained, a mentoring programme is in place, and screening is being introduced in rural hospitals and health centres. Our project informed recent World Health Organisation guidance on treatment of early cancers.