Cancer treatment

Two decades ago, David Walmer went on a volunteer mission 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.

“And it’s easy to detect. It develops on the outside of the cervix, which you can see,” Walmer says.

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. 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. Confirm the presence of disease with a biopsy. Then freeze or remove the abnormal cells, the New York Times reported.

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.

By 1997, he told his boss he was closing his lab, effectively putting an end to a nearly two-decade-long academic career in biochemistry. He started traveling to Haiti more often and joined the boards of nonprofits that were active there. The urgency of his previous work paled in comparison. “If people are dying of a treatable disease,” Walmer says, “how important is understanding the biochemistry of the uterine lining right now?” 

Word of what Walmer was trying to do eventually reached Bob Malkin, a Duke professor of biomedical engineering who develops medical instruments for third-world hospitals and clinics. (He teaches a course at Duke called Design for the Developing World.) The field is a small one. “When I started in 2001, it was a group of one — and that was me,” he says. But it has grown: In addition to Duke, the University of Michigan, M.I.T., Rice University and others have begun adapting sophisticated medical equipment to address common diseases like asthma and diabetes in poor countries. In 2012, Malkin’s invention, the Pratt Pouch — it looks like a fast-food ketchup packet but contains antiretroviral medication to help prevent pregnant mothers from infecting their newborns with H.I.V. — was named one of the top 10 “innovative health technologies for low-resource settings” by the World Health Organization.

Malkin was intrigued when he heard about Walmer’s device

The problem was that the device was uncomfortable. “We had a working model, but it was too heavy,” Walmer says. 

One of Malkin's students, Theo Tam, and four students in his master’s program  from China, India and Pakistan proposed alternate challenges: a malaria microscope, an oxygen flow meter. One student volunteered to focus on marketing, another on finance. Tam took on the clinical research himself.

The first task was to settle on a name for the device, something catchy and descriptive but not too cutesy — they chose “CerviScope.” Next they sketched out a business plan. “Ending cervical cancer,” they wrote during a brainstorming session. 

They began by reaching out to gynecologists around the globe who had expressed interest in Walmer’s invention after he posted news of it online. In April 2007, the students won the CUREs competition, beating six other teams of undergraduates, grad students and even physicians. Suddenly they had $100,000 in prize money. They hired an engineering firm called Applied Technologies in Cary, N.C.,  to refine the device so it could be mass-produced.

Finally, at the beginning of September 2009, 13 years after Walmer put together his first makeshift gadget, 10 field-test models were ready. One scope was shipped to Malawi, another to Argentina and a third was earmarked for others landed in Pakistan and, hand-delivered by Walmer, in Haiti.

In 2012, the production of the first 200 scopes began. They are now sitting in Walmer’s office while he figures out where they will go.

Mother’s Day in Haiti is approaching — it’s always the last Sunday in May — and some women traditionally wear flowers that day: red if your mother is living, white or purple if she’s not. This year, Family Health Ministries wants to establish a new Mother’s Day tradition: cervical screening.

“Life has a way of detouring,” Walmer says. “Preventing cervical cancer was never my plan. And yet I think this was better than the plan I ever had for my own life.”