The value of tinkering

David Walmer was a fertility specialist at Duke University who went on a mission trip to Haiti in the early 1990s. While there, he was shocked to learn of the high rate of cervical cancer among Haitian women. A disease that is highly preventable was killing some 250,000 women a year in developing nations, and Haiti led the world in deaths from cervical cancer. Walmer knew he had to get involved.

Walmer returned to work in North Carolina and learned everything he could about cervical cancer, mainly that it can be detected for a decade before becoming untreatable. Detection is easy because unlike many cancers, it grows in a visible spot: on the outside of the cervix. Routine screening via Pap smears is the norm; before Pap smears became the de facto screening tool, cervical cancer killed more women than any other form of cancer.  Since the adoption of Pap smears, the death rate from cervical cancer has dropped by 70 percent. The CDC reports that in 2010 in the United States, 11,818 women were diagnosed with cervical cancer. Of those, less than 4,000 cases were fatal. Compare that to the CDC’s breast cancer stats for the same year: 206,966 women and 2,039 men were diagnosed with breast cancer. Of those, 40,996 women and 439 men died from breast cancer.  Therein lies the inherent value of a highly visible cancer

If a Pap smear detects abnormal cells, the next step is to examine the cervix via a special magnifying lens called a colposcope. Walmer realized that outfitting underdeveloped nations with colposcopes could make all the difference in preventing cervical cancer deaths, but that getting colposcopes into the hands of doctors in those nations would be unrealistic because of cost, size, and dependence on electricity. Undeterred, he opted to get creative.

He realized that a common surgical tool — the loupe — could provide magnification without electricity. To provide the contrast needed to detect suspicious cellular activity on the cervix, Walmer bought a Halogen bike headlamp and a green filter for a camera and began to tinker.

Giulia Forsythe

Giulia Forsythe

A colleague at Duke who taught biomedical engineering got wind of Walmer’s pet project and lent some muscle: namely students in his Engineering World Health club. One of those students, Theo Tam, recruited four other students to work on Walmer’s portable colposcope. These four young men were some of the brightest minds in the sciences and engineering student world, yet they were freaked out by the prospect of working on something so closely tied to the most intimate part of female anatomy. Tam says the other guys were willing to take on a multitude of projects designed to improve medical conditions in third-world countries, but not the portable colposcope.  “Anything but the V-word,” Tam says. “Imagine the horror.”

Tam also got creative, and convinced the guys to get involved with the parts of Walmer’s project not related to “the V-word”: marketing, finance, and other “safe” parts. Once they got past the horrifying idea of the female body part, the guys got to work. They assembled a prototype colposcope using lenses from a $2 pair of reading glasses, magnification from a $10 pair of binoculars, and lights from a $16 battery-powered LED. The first portable colposcope, named the CerviScope, was born. After a few more tweaks, it was ready to go. With help from a grant from an investment bank, the CerviScope was ready for mass production.

Walmer created a nonprofit, called Family Health Ministries, from his North Carolina home, to get the CerviScope into healthcare facilities in impoverished countries. FHM’s goal is to screen for and prevent cervical cancer. An integral part of achieving that goal is advocating for the HPV vaccine. The American Cancer Society also advocates for the HPV vaccine; read more about it here. The CDC provides compelling evidence for the HPV vaccine: A 2013 study shows that in the 8 years since the vaccine’s introduction, the virus has decreased 56 percent among girls ages 14 to 19. CDC Director Tom Frieden estimates that two-thirds of American girls aged 13 to 17 have not been vaccinated, and that the 2013 study proves that “the HPV vaccine works well, and the report should be a wake-up call to our nation to protect the next generation by increasing HPV vaccination rates.” Frieden warns that the low vaccination rates in the United States will equate to 50,000 new cases of cervical cases; cases that would be prevented with the vaccine.

There are many take-away messages from David Walmer’s story. That easily-visible cancers are much preferred to those that burrow deep into the body’s nooks & crannies. That even the most brilliant scientific male minds are rendered powerless by the female honey pot. That one finds one’s calling in the most unlikely places. And that tinkering definitely pays off. In a very big way.


6 Comments on “The value of tinkering”

  1. Fascinating story. Tinkering pays off, for sure. ~C

  2. Amy H. says:

    Another takeaway is that American parents are “fingers in their ears LA LA LAing” their children’s health by not getting them vaccinated because why? That “someone” might “think something bad” about their teenager? That’s got to be part of the reason why….I would venture to think…

    PARENTAL A.P.B.: Just because you get your child vaccinated for HPV doesn’t mean you are condoning irresponsible sexual behavior NOR does it mean your child is having sex or that your children think you are giving them permission to have sex before they ready. Take responsibility for your children’s health while they are still minors, Parents…seriously…

    And have the conversation about why they need the vaccine in spite of the status of their current sexual activity….

    If the guys “tinkering” on this lifesaving device faced their fears and jumped over the “va jay jay” discussion hurdle and got down to the business of saving lives no matter how uncomfortable it made them feel perhaps some American parents can use that example to get some strength to focus on the health of their children vs. the moral statement that the vaccine may erroneously imply about their kids getting them or them as parents insisting that their kids get vaccinated. Whoever “they” are thinking “that” about a vaccinated kid and their parents are not going to matter much when a child’s life is on the line before their time. Being proactive and ensuring your child is vaccinated means that you were responsible and proactive and you have your child vaccinated against a preventable disease. No more meaning should be taken from this simple action.

    Have the conversation. Get the vaccination for your kid. A long life because of a proactive approach and a secure self assurance that you are protecting your child no matter what the sexual behavior circumstances are TRUMPS a life cut short by a preventable death due to any fear based parental irresponsibility over having a difficult conversation with your kid and wondering what “they” might think. “They” don’t matter. Your children do.

  3. Lauren says:

    How intertwined our worlds are…Dr. laura guttman was also on the HPV wart project and many of our sexually abused kids were involved in that wart typing process, to isolate the strains of HPV that lead to cervical cancer and esophageal cancers….Unbelievable that anyone won’t vaccinate against any disease…

  4. […] The Pink Underbelly: This blog documents the life and ongoing battle with cancer of a wonderful woman in Texas.  The author’s honesty, wit, and insights inspire me to value life in all its complexities and to fight for survival no matter what.  She is a survivor! […]

  5. David Benbow says:

    I’m a strong believer in the HPV vaccine. Thanks, Nancy (and Amy H) for sharing this.

  6. […] and that the exams do more harm than good. Pap smears are still recommended, however, because they do in fact detect cervical cancer. It’s the “no known cancer risk” part that really galls me. How do we know what […]

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