The 4th quarter ends a great year and begins a bright future

Well it is blog time again. The fortune I am blessed with these days is that POI has a lot going on and much has happened over the past few months.

This past quarter started as you can see from the homepage with an amazing few days as guest of the Chinese government to receive the Friendship Award. Although the well-rehearsed protocols were in full evidence, I and the other 49 awardees from 18 foreign countries were treated like kings. The Friendship award is the highest honor China bestows on a foreigner and there was no question all of us recognized the specialness of the occasion. I met some amazing people from around the world with widely diverse contribution to China from oil exploration to roses, from cultural preservation to astrophysics. Most of all I felt very proud for POI and the recognition of our work and the work of all of our Chinese collaborators who truly shared in the recognition.

The SHENCCAST II trial which finished this summer has now moved to the writing phase. Our first manuscript “A Population Based Clinical Trial Comparing Endocervical High-Risk HPV Testing using Hybrid Capture II and Cervista from the SHENCCAST II Study”, has been accepted for publication by the American Journal of Clinical Pathology. Several more papers are being prepared. In addition SHENCCAST II provided important pieces to the self-collection story that in large part has charted our new direction.

Many years ago upon taking my first job at the University of Vermont, my wise chairman Dr Leon Mann told me to pick a focus. I remember him saying the focus will continue to grow and new doors will open. Well the energy at POI these days is like the birth of a child. After years of studying new technologies, and designing ways to improve the old, we have now decided to focus our energies developing methods so the people most in need can actually take advantage of the technologies that we now have. Not an easy task, but therein lies the mission of POI. No one ever described this work as easy. I can tell you it is so rewarding, and so self-fulfilling that if it were not so difficult the streets of discovery would be very crowded indeed.

A number of concepts have become progressively clearer to me as we work our way down our new path. First, I now believe it is not necessary to think simple and small to reach the earths needy. Certainly one size will not fit all, but a very high percentage of the world’s medically underserved now live in middle income countries. That says to me think high tech, high through put and the massive volumes possible with proper organization will control the per/patient cost. Second, think events, not continuous care. The medical model has always been a continuous care model. Designing the whole program to avoid lost to follow-up when only very few may actually need continuing care. Clearly continuing care is the only way to adequately provide the needed care for many problems. However, many interventions can be confined to events which organize large screening or vaccination days and only when positives are identified from the detection algorithm does the healthcare staff become involved for management. Third, for many conditions, we spend an enormous amount of the healthcare dollar identifying the majority of people who will ultimately test negative. We need to consider new paradigms to allow the healthcare workers to focus on the positives. Fourth, the more local the paradigms and the more involved the community in designing the program, the greater will be the participation and the lost to follow-up segment will shrink.

There are many gaps to fill, but we have enough filled to begin. Therefore in the 1st quarter of 2011 we expect to initiate a mother, child, screen, treat and vaccinate program in Manchay and Iquitos Peru. The primary focus will be the development of a preventive healthcare model using community based participatory research methodology. By the 2nd quarter in 2011 we hope to initiate a program with a similar primary focus in China, with the added elements to determine optimal management of the women who test positive. I personally have never seen the future so clearly. We obviously continue to work hard to generate the funding to allow us to continue this work. The message we believe is very compelling. We have the technology to prevent cervical cancer world-wide, now let’s develop the model to make it happen. The solution is more than money; it will be a well-designed, well-organized community based model that brings the people and the technology together.

Happy holidays to all of our friends around the world, we are a community.

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