A Life Dedicated to Women's Health

RADM Kerry Nesseler, OGH, and Deputy Administrator Diana Espinosa welcomed Dr. Groesbeck Parham to HRSA on May 13. A professor at UNC-Chapel Hill, he is an internationally acclaimed gynecologic oncologist, credited with saving thousands of women's lives in Sub-Saharan Africa.
RADM Kerry Nesseler, OGH, and Deputy Administrator Diana Espinosa welcomed Dr. Groesbeck Parham to HRSA on May 13. A professor at UNC-Chapel Hill, he is an internationally acclaimed gynecologic oncologist, credited with saving thousands of women's lives in Sub-Saharan Africa.

 

In 2003, while Dr. Groesbeck Parham was making his rounds at the University Teaching Hospital in Zambia, he made a distressing discovery: eight out of 10 women diagnosed with HIV in his clinic also were suffering from advanced cervical cancer. 

"What struck me more than anything else was their age," he told some 200 attendees in a recent presentation at HRSA hosted by the Office of Global Health. "These women were in their 20s and early 30s" – dying of a treatable disease that does not usually affect women in the U.S. before age 50.

The cultural implications struck a chord in Parham, as the women who survived typically lost their ability to bear children, and with it their value in a heavily patriarchal, predominately rural, society.

The inferences were not lost on a HRSA audience well versed in health professions shortages in rural areas; limited access to preventive care facilities for the uninsured; and higher rates of vaccine-preventable diseases in underserved populations -- like the human papilloma virus in cases of cervical cancer.

In 2017 alone, noted Deputy Administrator Diana Espinosa, HRSA-funded health centers provided more than 700,000 women with mammograms and 1.8 million Pap smears -- saving the lives of over 200,000 women through routine screening and early detection.

As Parham looked further in Zambia, he discovered that there was not a single oncologist or treatment facility in the country of 18 million people -- more than half of whom live in the countryside -- and only 12 gynecologists, and 1 pathologist capable of diagnosing cervical biopsies.

Facilities were so limited, he observed, that only 10,000 Pap smears had been administrated in the southern-African country in the preceding four decades. Half were positive for cervical cancer. And 93 percent of patients succumbed to the disease.

Those findings would consume him for the next 15 years.

 

Dr. Groesbeck Parham is a U.S. board certified gynecologic oncologist. He is a graduate of Oberlin College and the University of Alabama  School of Medicine, where he was the first African American to complete a residency in obstetrics and gynecology in 1985; and a Fellow of the University of California, Irvine (1988). Widely published, he is recognized by the World Health Organization and the United Nations as a leading authority on building care systems in resource-poor settings ... from Los Angeles to Lusaka.
Dr. Groesbeck Parham is a U.S. board certified gynecologic oncologist. He is a graduate of Oberlin College and the University of Alabama  School of Medicine, where he was the first African American to complete a residency in obstetrics and gynecology in 1985; and a Fellow of the University of California, Irvine (1988). Widely published, he is recognized by the World Health Organization and the United Nations as a leading authority on building care systems in resource-poor settings ... from Los Angeles to Lusaka.

 

"In Zambia and Africa, it's as if you're on a battlefield," he observed. "Women are dying -- and you see what happens when women die, what happens to their children, what happens to the family. The majority of the children never finish grade school, and they're subjected to all kinds of abuse. So it's a far-reaching effect."

Worldwide, by far, breast cancer is the most frequent cancer among women, affecting 2.1 million people and causing an estimated 627,000 deaths per year HRSA Exit Disclaimer, according to the World Health Organization, while cervical cancer causes an estimated 311,000 fatalities HRSA Exit Disclaimer.

Parham stressed that adoption of a coordinated-care, "one-stop-shop" approach to healthcare has reduced the attrition rate among Zambian women in treatment. And telehealth and readily available technology -- like cell phone photo-sharing -- has vastly improved the ability of local clinicians to expedite diagnosis at a distance and speed up the start of treatment.

 

(From left) In 2005, Dr. Parham moved to the capital of Lusaka full-time and undertook a crash modernization program at the threadbare University Teaching Hospital with his Zambian colleague, Dr. Moses Sinkala, and others: simplifying screening protocols; conducting a massive outreach campaign to tribal chiefs and elders and faith healers; training scores of nurses. (Right) At the height of the AIDS crisis, death was as an omni-present feature of daily life. With a total population just five percent the size of the U.S., Zambia today has about the same number of citizens (1.2 million) living with the virus.
(From left) In 2005, Dr. Parham moved to the capital of Lusaka full-time and undertook a crash modernization program at the threadbare University Teaching Hospital with his Zambian colleague, Dr. Moses Sinkala, and others: simplifying screening protocols; conducting a massive outreach campaign to tribal chiefs and elders and faith healers; training scores of nurses. (Right) At the height of the AIDS crisis, death was as an omni-present feature of daily life. With a total population just five percent the size of the U.S., Zambia today has about the same number of citizens (1.2 million) living with the virus HRSA Exit Disclaimer.

 

The women's cancer epidemic in Zambia, Parham would learn, was not only a medical problem, but also had a societal component involving the "power relationships between men and women" – with men making the key decisions on how, where and whether women and girls would get screened and treated.

"The impact of forced early (child-bearing), gender-based violence, and also of deep poverty and low rates of education," were all impediments that had to be overcome through local intermediaries, he said.

In hard hit parts of the U.S., public health authorities have faced similar cultural barriers in their efforts to promote screening, vaccinations, preventive medications and treatment for conditions as varied as HIV, HPV, hepatitis and measles. 

"Our a-ha moment was when President Bush showed up wanting to do something in the area of HIV," Parham recounted, "and he brought all of these people from the United States, and he left us with $3 million" -- or 30 times more than the clinic's annual budget.

Now in its 16th year, the President's Emergency Plan For AIDS Relief (PEPFAR) would go on to train more than 190,000 new health care workers in 65 countries, cut the global rate of new HIV infections by half and afford prevention and treatment for a wide range of  communicable diseases around the world.

In Parham's case, the squat, non-descript University Teaching Hospital at Lusaka would soon become the African Center of Excellence for Women's Cancer Control -- the first and largest PEPFAR-funded cervical cancer program on the African continent.

Date Last Reviewed:  June 2019