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

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.