Okay, hi, I'm, like I said, I'm a nurse practitioner, but I've been a nurse for about 47 years and a nurse practitioner for almost 32 years. So I've been around a long time taking care of women. I'm a women's health nurse practitioner, and kind of one of my missions in life is to, you know, try to promote the role of nurses, nurse practitioners, and midwives, and talk about what we can do to help to make the world a healthier place. So as we all know, cervical cancer is a preventable disease, and I know that you've all heard this before, but, you know, just to reiterate, you know, vaccinating boys and girls beginning at age 11 and 12, all these things are so important, educating medical providers and the public about the vaccination, we can't overemphasize that, of course, and teaching medical providers about screening for abnormalities on the cervix, looking for precancerous lesions, training nurses and midwives, because here in MD Anderson, at least, you know, nurse practitioners, we're allowed to do colposcopy, we're allowed to do LEAP procedures. We really can, with extra training and care, be an awful lot of help with all this. So we want to help, so we want to participate and help to prevent this disease. We want to encourage training, and once we're trained, we want to help train others. So, you know, training the trainer is a big part of our program. When you learn something, you know, please share what you've learned with others so that we can grow our net. So nurses, as we all know, you know, there's, we're about 59 or 60% of all the healthcare professionals in the world are nurses, so there's lots of us, right? We do lots of things and help doctors and help patients. In some parts of the world, though, you know, nurses are doing pap testing or even VIA. It's really important that nurses are educating patients, they're getting patients in for treatment, they're getting them in for follow-up. And there are about 28 million of us, so that's a lot, but it's still not enough. So we need to keep training nurses and keep promoting our profession, of course. So what do nurses do? We provide patient care and we're teachers by nature. So, you know, a lot of times doctors go in the room and talk with a patient and then a nurse comes in and explains what the doctor said. That's kind of a thing that we laugh a lot about, but it's true because, you know, it's just we try to communicate with patients on their level. Even in the United States, the average level for healthcare education is about an eighth grade level and that's in the United States. So, you know, just keeping things simple, trying to make sure that patients understand all the things because it's an awful lot of information, it can be confusing. We teach other nurses. So this was teaching nurse practitioners in Tyler, Texas, LEAP procedures. You know, Texas has many, many counties actually that don't even have a primary care doctor. So people think of, oh, Texas, United States, you've got so many things. We do in some areas, but we have many areas even in our own state where there is no doctor, where it's a nurse practitioner that is taking care of patients as their primary care provider. So really important that we're helping to train each other. You know, we teach other nurses. This was working, actually, this was the breast cancer clinic, but it was connected to a cervical cancer clinic in Nicaragua, but we were there training nurses and it was a wonderful experience. So again, teaching nurses, taking what we know to other places around the world and trying to improve the knowledge and grow our forces. We teach doctors. So this is, I know you're all probably familiar with the portable colposcope, teaching doctors how to do colposcopy and how to recognize abnormalities on the cervix. And it's just a wonderful invention and I'm sure you've all probably had some experience with that. Nurse practitioners, nurses, we can help with training, colposcopy, biopsy, teaching doctors and then they go out and help in their community. So this was just, here's Dr. Salcedo, a wonderful thing that I got to do years ago. We're students. So this was in Malawi, learning from the head of this Queens Hospital in Malawi when he was talking about, you know, the number one cause of cancer and related deaths in women is cervical cancer, talking about, you know, how they are trying to plan to reduce this burden in their country, very, very interesting to learn from others. And this was in Nampula. This was a group that we taught. We did lectures and we did colposcopy, biopsy and leak procedures and everybody got a certificate. And so wonderful sharing information. So nurses, how do we help? Well, for one thing, somehow we continue to be ranked the most trusted profession for about 22 years now. So patients trust us. We're happy to talk to them. We're happy to help and try to help them too with misinformation. There's a lot of misinformation, especially at least in the United States about the HPV vaccine. You know, is it safe? Who do you vaccinate? When do you vaccinate? Will my child go out and start having sex as soon as they have the vaccination? So nurses, we can talk with the patients and try to help with dispelling these myths and giving proper, complete information. But we can also help with barriers to cervical cancer screening. We all know, you know, increased age, I'm too old, I couldn't need a Pap test. Well, I don't know what the oldest person I've seen diagnosed with cervical cancer was, but I think she was something like 70 years old. So I mean, it's not common. Increased age doesn't mean you don't need to be seen if you haven't been seen in 50 years or have symptoms. Race, ethnicity, there's different education levels. There's problems with income. There's people that can't get a ride. They don't have any money. They are scared of being screened. They're embarrassed if something's wrong. It's their fault. Something's wrong with them. So lots of barriers that nurses and nurse practitioners, midwives, physicians, assistants, we can all help with. So what about nurse practitioners? What about midwives? I know that here we have, in the United States, many, many nurse practitioners. We have about something around 1,000 of us at MD Anderson now. Just like today, I was seeing inpatients in the hospital, helping with, you know, consenting treatment, you know, the whole spectrum of care that we help with here. I think maybe in Africa you have more midwives, but I believe that they practice similarly at a similar level. So nurse practitioners, we provide care to over a billion patients a year around the world. So there's a lot of us. We are trained with master's or doctoral degrees. We have more clinical training. We're allowed to perform and interpret tests and lab work and x-rays. Sometimes do different procedures, like LEAP procedures, if we have the proper training. We can prescribe medications. We can counsel patients. We can certainly educate patients. We can teach other providers. In the United States, there's over 385,000 of us now. So it's become a very popular profession. And again, like in Texas, where there's no primary care doctor, we can sometimes be their primary care person. So we're trying to help in any way that we can. Actually, I was reading that in Africa, four African countries have now formally adopted a nurse practitioner as a role. So hopefully it'll be a growing way to help more people in Africa as well. And midwives. As of 2020, there were about 2 million midwives globally. So there's lots of midwives out there that are out there taking care of mamas and babies. But they're also doing antepartum, postpartum screening, good times to look at the cervix and look for abnormalities, trying to get people into treatment, trying to encourage HPV vaccination, trying to educate. If the mom's with them, if the sister's with the patient, whoever's, educate everybody that you can, as well as performing, doing exams to look for abnormalities and knowing the proper thing to do, whether they need to be referred or treated, and go from there. So what is the role of nurse practitioners in midwives and cervical cancer prevention? Education of patients and providers, prevention, assessing for risk factor, performing routine screenings as recommended, treatment, providing care before, during, and after treatment, surveillance, so important, follow-up, treating side effects, looking for recurrent disease, encourage healthy lifestyles, policy. If we don't be involved, if we're not involved in policy, then sometimes things just stop. So we have to pay attention and be aware and try to be involved so that we can have policies that allow us to have the money and the funding and the things that we need to go forward to take care of these patients. And research. As far as all of us know, even if it's a small thing that we think might make a difference, keep up with, ask questions, try to keep information, try to find somebody that can help you with research if you think you have an idea that can help. So trying to get nurses more involved and midwives more involved in research is very important. Being in ECHO, like this project here today. So it's just so important. Everybody can participate. Nurses can present cases, midwives, PAs, everybody's welcome in ECHO. So this is such a great, wonderful way to share information and share knowledge and help each other. So hopefully that's going to grow as well and we can include all the nurses and midwives and nurse practitioners. Hands-on training. So we are teachers, so we're happy to help. We can teach nurses, we can teach doctors, we can teach fellows, we're happy to teach anybody. Educators and researchers. So again, this was a small project I had, but I got to work with the ECHO people and I learned a great deal just trying to figure out small ways that we could help to make things to work better. And I was reading about Africa. So there are a lot of midwives in Africa. About 205,000 were registered in 2022, and it looks like they've made a huge difference in reducing maternal mortality. And in Africa also, when you read about cervical cancer, it looks like about 34 out of every 100,000 women in Africa are diagnosed with cervical cancer. I hope I have those numbers right. 23 out of the 34 that are diagnosed die of the disease every year. So hopefully with more help, more hands-on people, more people spreading the word to get people in to be screened earlier so things can be caught when it's a pre-cancer and cancer can be avoided. Hopefully we can help with that. So sexual reproductive health, it was furnished, does include cervical cancer prevention, of course. I was reading something about Rwanda. You know, there's been a collective effort to train more midwives and it has really helped with reducing maternal mortality. There was one statement that said properly trained midwives can provide 90% of essential sexual reproductive health care, and that does include cervical cancer screening. So we need to be sure and always bring them in the loop, bring them to ECHO, bring them to everything where they can be trained along with everybody else so that they can help. And they can be at the front line. They certainly absolutely can. As recently as 2020, health care systems centers in Rwanda, and I hope this is correct also because I'm not there, but it sounded like nurses were very much at the forefront of taking care of patients. And if they were extremely at any level of training, they were important. They can educate. And it looked like there were different levels of nurses, but they can all be, they can all be educators. They can all talk to women. If they don't know the answer to a question, they can find somebody that does. Hopefully someday HPV DNA testing will be everywhere. I know that it's not now, but when it's available, you know, nurses can help with these things. They can help with education. Maybe they can help with sample collection. Maybe when women are allowed to self-collect someday, they'll be able to train the women. So there's many, many things nurses can do, again, working with education about HPV vaccination, giving the vaccination, going out into the schools, going out into the communities, talking with people, you know, teaching people that this vaccination is to prevent cancer so that we can do better. Following up for test results, nurses forever have been following, you know, what are the test results, notifying the patient, trying to help the patient get in for care. So so many things that we can all do anywhere in the world as nurses and healthcare providers. So nurses and midwives in Uganda, I know the cases today were from Uganda. It looks like you have about 1.6 nurses and midwives per 1,000 people. And in 2020, it looked like you had about 0.2 physicians per 1,000 people. So that's compared to 3.6 physicians per 1,000 in Mexico. And oh, this got cut off. It's 2.4 in Mexico and 3.6 per 1,000 in the United States. My bad. Sorry. But anyway, there's a shortage of physicians most places in the world, I believe. Shortage of healthcare providers, shortage of nurses, this may continue to get worse. So we need to be very supportive of the role and the people, try to help them with education, make sure they're taken care of and that they're treated well so they can help. So I think that's all I really have to say about that. But we do know that education saves lives. I can't say enough about education, educating each other, educating patients, educating the community, and dispelling the myths and the falsehoods about things like HPV vaccination, getting people into care, helping them with whatever their issues are. Why are they afraid to come? How can we help you? How can we get you here? So that's kind of my soapbox about nurses, nurse practitioners, and midwives is please always include us. We need a seat at the table. We're smart. We save lives just like the rest of you. We're out there to help and really, really, really appreciate you for your time and attention. But please do always remember to include us when you're making plans for cervical cancer prevention. Thank you.

nurse practitioner

women's health

cervical cancer prevention

vaccination education

nursing role in cervical cancer prevention