Bringing Better Health Care To Women In Africa

Ideas in Action with Jim Glassman is a new half-hour weekly series on ideas and their consequences.

A discussion about innovative programs designed to reach more women in Africa to improve their health care, with a particular focus on cervical and breast cancer detection and prevention. Taped during the Global Health Conference sponsored by the Bush Institute in September 2011.

Transcript

IDEAS IN ACTION with Jim Glassman

Bringing Better Health Care to Women in Africa

JIM GLASSMAN:
Welcome to Ideas in Action a television series about ideas and their consequences. I'm Jim Glassman. This week: bringing better healthcare to women in Africa. Women in Africa suffer disproportionately from poor health yet the fate of the continent is linked to advancing the health of its women who often shoulder much of the burden for caring for and supporting their families. A recent global health conference hosted by the George W. Bush Institute profiled some innovative programs that help improve the healthcare of women in Africa. I had a chance to talk to some of the participants including; Nancy Brinker, founder and CEO of Susan G. Komen For the Cure, an organization devoted to finding a cure for breast cancer; Dr. Groesbeck Parham, director of the Cervical Cancer Prevention Program in Zambia; Dr. Eric Bing, director for global health at the George W. Bush Institute; and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. The topic this week: improving women's health in Africa. This is Ideas in Action.

ANNOUNCER:
Funding for Ideas in Action is provided by Investor's Business Daily. Every stock market cycle is led by America's never ending stream of innovative new companies and inventions. Investors Business Daily helps investors find these new leaders as they emerge. More information is available at Investors.com.

JIM GLASSMAN:
Women in Africa die from cervical cancer at a rate 24 times greater than those in the United States. Four organizations have joined together to try to do something about it; Susan G. Komen for the Cure is the renowned breast cancer research and advocacy organization. It has joined the George W. Bush Institute, the Department of State, and UNAIDS to launch an innovative program called The Pink Ribbon, Red Ribbon Campaign to fight breast cancer and cervical cancers in Africa. Ambassador Nancy Brinker is the founder and CEO of Susan G. Komen for the Cure.

NANCY BRINKER:
It is extremely important for us to be engaged because breast cancer and albeit women's cancers don't stop at our borders. It's an important-- it's important for us as Americans to lead when it comes to global health, to lend our knowledge, expertise, and this is certainly the case with the fight against breast and cervical cancer in order to get to a place where people are not dying from these diseases routinely at young ages. We need to be able to detect them, treat them, and allow people to live lives without these kinds of threats.

JIM GLASSMAN:
Welcome gentleman to Ideas in Action. Eric can you just describe why the Bush Institute is getting involved in fighting cervical cancer and breast cancer in Africa?

ERIC BING, M.D.:
Well thank you Jim. I think it's a great question. The president has long been concerned and interested in Africa-- invested a lot in Africa during his administration and has built a platform such as PEPFAR which has saved millions of lives. Cervical cancer's an opportunistic infection, which many women with HIV get, and it's a natural extension of the work the President has previously done in HIV as well as in Africa.

JIM GLASSMAN:
And when you say platform you mean there are clinics in Africa, there are trained people-- that sort of thing?

ERIC BING, M.D.:
Yes in many countries initiated by president Bush and, as a cornerstone, the current administration's global health initiative, have clinics, have support systems, have trained nurses and doctors, and many people are now getting their care there.

JIM GLASSMAN:
Tony, let's just talk about the link between HIV/AIDS and cervical cancer. How are these two connected?

ANTHONY FAUCI, M.D.:
Well, when you have an infection that is directly linked to a cancer, i.e. HPV and cervical cancer, and then you have in an HIV infected individual immunosuppression and that means that the immune system that generally can tone down or control HPV from flaring up-- that mechanism is diminished in people who are HIV infected. So then you have the capability much easier for HPV to lead in a chronic way as it does to cervical cancer. So the link is extremely strong there.

JIM GLASSMAN:
And Groesbeck what do the prevention and cure of these two diseases have to do with each other?

GROESBECK PARHAM, M.D.:
Women who have cervical cancer are at much higher risk of developing HIV but women who have HIV are also at higher risk for developing the Human Papillomavirus. Let me just give you an example; we have a very large cervical cancer screening program supported by PEPFAR--

JIM GLASSMAN:
And where is that?

GROESBECK PARHAM, M.D.:
In the country of Zambia. We started in 2006 and we have almost screened 70,000 women, one third of whom are HIV infected. As a result of these services women who did not know their HIV status also started coming asking for cervical cancer screening. We began to test these women for HIV and found out that one third of them are HIV positive and we were then able to link them-- even though they came in for cervical cancer screening-- we found out they were HIV positive and we were able to link them for HIV care and treatment. Also women who come into the HIV care and treatment clinics are referred to the cervical cancer treatment clinics.

JIM GLASSMAN:
And Eric is this the model that Groesbeck just described that you and the partners want to extend to other countries in Africa?

ERIC BING, M.D.:
Absolutely. One of the things that we know is that this works. That we're able to find cancer in women with HIV as well as find women who have the virus and also have HIV as well. So one of things that we're planning to do is to strengthen the systems that are currently there to make sure they work really, really well, and then to scale it up to other parts of the country in the countries where they're currently operational as well as to other countries as well.

JIM GLASSMAN:
You know Groesbeck, I forgot to ask you also about treatment. Is it relatively easy and quick to treat cervical cancer if you catch it in the early stages?

GROESBECK PARHAM, M.D.:
Well, that's the goal. The goal is early detection-- screening and early detection. It is much easier to cure a precursor to invasive cancer and so the goal is to try to detect these precursors before they develop into invasive cancer particularly in women who are HIV infected who are severely immunosuppressed. Once that type of women develops invasive cervical cancer it becomes very difficult to actually cure her of that disease.

JIM GLASSMAN:
And Tony, cervical cancer of course is a killer in the United States as well but nowhere near to the extent as in developing countries, especially in African countries. Why is that?

ANTHONY FAUCI, M.D.:
The incidence of HIV infection in many of these developing countries, sexually transmitted disease, and the link between HIV and HPV, but it's also a question of the access to healthcare. When you go for a regular exam, a pap smear, you go to a gynecologist, you have anti-natal, prenatal, postnatal examinations, you have the access to healthcare and the kinds of very easy things that can detect the early precursors of cervical cancer, namely the dysplasia that you see on the cervix. If you have a setting in which economically the social infrastructure, the economic infrastructure, does not allow easy access to healthcare you have a double whammy against you. You have a high incidence of the infection HPV that actually causes cervical cancer superimposed upon the fact that you don't have the capability of getting the kind of early diagnosis that Groesbeck had mentioned where you can actually cure it very easily in its early stages. You put those two things together and you have a very high incidence of cervical cancer in the developing world.

JIM GLASSMAN:
And, Tony used the word dysplasia; may I ask you what that means?

ANTHONY FAUCI, M.D.:
Cervical cancer is one of those cancers that it starts off in a precancerous or not quite neo-plastic in the sense that it can be categorized as a cancer. We generally refer to that as dysplasia where the cell is abnormal but not yet cancerous. If you don't do anything--

JIM GLASSMAN:
Can you actually see that with the human eye?

ANTHONY FAUCI, M.D.:
Certainly. If you-- well if you take a pap smear, which is not readily available in many countries, you can look under the microscope and see it. You can do DNA testing but the thing that is applicable to the developing country, that Groesbeck has done so well in Zambia, is that you could just visually inspect and put acetic acid on there and the areas that have that early change come up white and it's just a sharp contrast to the normal tissue. So it's easy to do and easy to diagnose.

JIM GLASSMAN:
And acetic acid that's vinegar right?

GROESBECK PARHAM, M.D.:
Right.

ERIC BING, M.D.:
And I think that's actually the beauty of it is that this is so simple. You can put acetic-- you can put vinegar on there and then freeze it off with nitrogen, liquid nitrogen, and you actually can cure many of these women of cervical pre cancers so they don't develop cancer.

GROESBECK PARHAM, M.D.:
The other thing about this vinegar method that-- to which both of them have referred is that it can be performed by non-physicians. We're very short on highly trained specialists in the African continent. So we have been able to task shift the screening, the interpretation of the results, and the treatment to nurses. One single nurse is empowered to do all three of those things. It also empowers the patient to be able to accept treatment at the same time that she is being screened.

JIM GLASSMAN:
Now that's not true of all of the people that you see who do have the cancer-- some of it's more advanced correct?

GROESBECK PARHAM, M.D.:
Yesm, but by and large-- we recently analyzed the first five years of our data. We looked at the first 60,000 patients that we treated, about 85% of the patients who we screened who have abnormalities-- the type of abnormalities that can be treated with cryotherapy, with freezing the legion, the other 15% then need to be referred to a center that handles more complex cases. So the vast majority of those legions can be treated in the clinic and 90% of the women who are provided the option for same day treatment accept it.

JIM GLASSMAN:
And Tony once it's treated is that the end of it? In other words does this kind of cancer recur? Or pre cancer--

ANTHONY FAUCI, M.D.:
Well the pre cancer can recur if you're still infected which you likely are with Human Papillomavirus, HPV, so that's the reason why when you come in for the procedure that Groesbeck mentioned then you remove those superficial cells, you're good to go for a long time but you should get follow up to make sure since you already have a predisposition to get this kind of abnormal cell formation which can lead to cancer.

JIM GLASSMAN:
But what you were referring to earlier in developed countries such as this one where women get pap smears I don't know is it once a year?

ANTHONY FAUCI, M.D.:
All the time yeah.

JIM GLASSMAN:
Is that something that's going to have to happen as well in Africa?

ANTHONY FAUCI, M.D.:
Well you know it doesn't necessarily have to happen every year. I don't think you're going to transform the healthcare system overnight in Africa as it is in a developed country but just getting people periodically to the clinic to monitor the ones that you have treated I think will go a very long way to preventing the incidence of cervical cancer which is so disturbing in the developing world.

JIM GLASSMAN:
Eric you've worked in Africa and in Los Angeles, how much support are African governments giving to the kind of health and issues that we're describing here?

ERIC BING, M.D.:
I think part of it depends upon the country. You know some of them are giving a fair bit; some of them are giving very, very little. One of the things I think is important is that we do need to have government leadership but we also need to bring in the private sector as well. And these private and governmental partnerships I think is absolutely critical and it's one of things we're doing at the Bush Institute through our initiative. Over 60% of all healthcare in Africa is delivered by the private sector and 50% of all expenditures are going there. We also need to begin to help develop that sector so that the government doesn't have to do it all by itself.

JIM GLASSMAN:
Groesbeck, in Zambia what is the buy in of men to these kind of initiatives? I mean is this-- are there cultural problems?

GROESBECK PARHAM, M.D.:
Right. Men have a lot to say about the type of healthcare that women are permitted to seek. In many instances women have to ask their husbands or mates to allow them to seek screening and treatment which is why this screen and treat paradigm that we're talking about is so important. Women can come into our clinics and if they are offered treatment it can be offered and they can have it on the same day without having to seek consultation if they don't want to. It gets them around that. But men are very important. So in our program we make sure that we also talk to men, places where they go, their workplaces, bars, barbershops, wherever we think we may find them, in the markets, and make them understand that what we're trying to do is to keep the most important person in their family alive, which is their wives. And it may seem fairly crass to say this-- but it's true-- that one of the major concerns of men is the reproductive potential of their wives. Right? And so what we have been able to make them understand is that by early detection and treatment we are preserving the reproductive potential of their mates, the ability to them to have children. Once a woman develops invasive cancer she has no reproductive potential. The cervix, the entire uterus has to be either removed surgically or treated with radiation therapy, which prevents her from every having the opportunity to become pregnant again.

JIM GLASSMAN:
Tony let's talk about HIV treatment which is really the kind of the foundation of all this. In 2002, president Bush asked you to go to Africa to take a look at what was going on with the epidemic. What did you find there?

ANTHONY FAUCI, M.D.:
Well what we found-- several things-- that the prevalence and the incidence was extraordinary-- high. The thing that was very frustrating is that the African physicians and healthcare providers wanted to be able to treat their patients but drug was not available. There was skepticism-- unfounded-- that you would be able to actually galvanize the African community and get people to get on drug essentially for the rest of their lives. So when I went to Africa, I saw examples of groups that were actually doing it. Doing what people thought was undoable; going into the community, getting people diagnosed, and getting them treated. So what the president did is that he put together this program that was a program that provided both prevention, treatment, and care, and launched the largest public health program for a single disease in the developing world in history. And it has completely transformed in many respects, certainly in the developed world, the HIV treatment has. What the PEPFAR program, the President's Emergency Plan For Aids Relief, has done is that it has brought that to the developing world. So that right now there are over 3 million people receiving antiretrovirals. That's life saving. In other words these people essentially had a death sentence before, now it's life saving. If you combine that with the global-- the global fund for HIV, malaria, and tuberculosis, there are now close to 7 million people receiving antiretroviral. That's a phenomenal start. That is historic. What we need to do now is to expand that to the people who are infected and who need drug and are not getting it as well as to prevent infections in individuals who are not yet infected. The PEPFAR program has been totally transforming in that respect.

JIM GLASSMAN:
How close are we to a vaccine?

ANTHONY FAUCI, M.D.:
Well, I can't tell you. The reason I can't tell you is that we're still in the phase of scientific discovery. We've had a modest success with a vaccine in a study a couple of years ago in Thailand in which the efficacy was about 31%. That's not ready for prime time but we've learned some things for that. So we're starting to see the light at the end of the tunnel. We are right now as we speak planning a similar trial in southern Africa where we can see if the concept of this particular vaccine candidate can be applied to high-risk heterosexuals in South Africa. So unfortunately I can't answer your question 'when?' I feel something now today that I couldn't have told you five years ago that I think we will get a vaccine. I just can't tell you when. Whereas five years ago I wasn't even sure whether the concept would have proven that we could. I'm more confident of that now but there's no way you're going to put a date on it.

ERIC BING, M.D.:
And while we don't have a vaccine for HIV we do have a vaccine for HPV, the virus that causes cervical cancer. And what we hope to do is to be able to implore that to begin to prevent HPV infections so women don't come down with cervical cancer.

GROESBECK PARHAM, M.D.:
We recently performed a survey of a large number of women who were attending our cervical cancer screening clinics in Zambia to be screened as well as women out in the community and the question was; 'would you allow your daughter to be vaccinated with a vaccine that prevents cervical cancer?'. 95% of the individuals said yes, across the board.

JIM GLASSMAN:
Groesbeck are there-- what are some of the new ways that you've been training doctors and nurses in Zambia-- you pointed out earlier that this early stage treatment can be done by a-- someone who's certainly trained but not the level of a doctor.

GROESBECK PARHAM, M.D.:
Well I think the-- finding innovative ways to use appropriate technology has been and is the key to overcoming the-- some of the barriers that we face in sub-Saharan Africa related to shortage of highly trained specialists. One I said was training non physicians to perform this screening interpretation and treatment and this is the way it works; when a nurse in the clinic screens a patient and she sees something that she-- of which she is not quite sure--instead of having me or one of my colleagues to travel to those clinics, which we used to do when we only had two clinics, she takes that picture, that digital photograph and downloads it onto a laptop computer and then sends it to me or my other physicians that are on call for that day for pictures. We then look at the photograph, type in what it is that we see and send it back to her because along with her photograph comes a text message. So my phone goes off it says 'beep beep beep' and when I look at it it says nurse consultation. So we've been able to do that and what we'd like to do is to expand that across the country and out into rural areas. And the next phase would be training nurses, or even people who are not nurses, to take pictures of the cervix with cell phones and then take that picture and send it in to a physician who's on call that day and that physician actually could be anywhere in the world.

JIM GLASSMAN:
And this allows you to expand the number of clinics that you have-- with the same number of doctors.

GROESBECK PARHAM, M.D.:
Clinics-- and against-- across the number of physicians and nurses and we can even further task shift the screening to specially trained people who are not nurses because we're going to need a larger cadre of people; doctors are limited, nurses we have more, but then if we're going to expand we're going to have to do something that allows us to use people who are not nurses. But we have to have close monitoring and evaluation to maintain the excellence of what it is we're trying to do.

JIM GLASSMAN:
Good. I want to ask all of you what the next steps are. I'll start off with Eric.

ERIC BING, M.D.:
Well I think the-- one of the things I think is critical here is that we are focused. That we are focused on what the targets are, that we understand where we're going, and then we strengthen the systems that will enable what is currently there to be either stronger and-- to do more effective. Then we need to quickly scale up to other parts of the countries in places like Zambia and to other countries as well. I think we need to be focused; we need to strengthen what's there, and then scale up.

JIM GLASSMAN:
And as far as focus and targets are concerned do you have specific targets? Do you think you can reduce cervical cancer deaths by one third in a certain amount of time?

ERIC BING, M.D.:
No absolutely. I think through this initiative our real goal is to reduce the incidence of cervical cancer by 25% among those who come in for screen and treat. For those who come in, we hope to reduce cervical cancer by 25%.

JIM GLASSMAN:
And Tony what are the next steps? And not just for cervical cancer but to use this platform for other diseases.

ANTHONY FAUCI, M.D.:
Well when you have something that works go for it. PEPFAR works. We know the program that Groesbeck spoke about regarding HPV works. They were put together and you just have a real synergy of effect for health. We've got to expand that beyond HPV and cervical cancer to other disease where you can use the extraordinary program and infrastructure that was set up by PEPFAR in the developing world, particularly southern Africa, and integrate into that in a horizontal way other diseases that you can actually utilize to its best level what we already have with PEPFAR. We've seen a sig-- this is a great success story that you just heard about Zambia. We can do that in many other countries with many other diseases. That's what I see as the next step.

JIM GLASSMAN:
And you're not worried that the effort against HIV/AIDS is going to be diluted as a result of this?

ANTHONY FAUCI, M.D.:
No, I don't think so. I think it's a tag on. It really isn't. I mean when you're there in the clinic and you're coming in for one reason it isn't very difficult to take a look at something else.

JIM GLASSMAN:
And of course it works in the other way--

ANTHONY FAUCI, M.D.:
Right exactly.

JIM GLASSMAN:
People can come into be checked for cervical cancer and find out they have HIV/AIDS.

ANTHONY FAUCI, M.D.:
Exactly.

JIM GLASSMAN:
Groesbeck what do you think the next steps are?

GROESBECK PARHAM, M.D.:
I think the next step is us as American citizens realizing that there is a new Africa. There's an emerging Africa that wants to stand on its own feet and be able to sustain itself. That's the Africa we need to connect with. If we do that I think we can increase awareness of what it is we're trying to do; these various diseases, which will increase demand, and then tie into that new emerging Africa that desires self-sufficiency through public-private partnerships. I think that's the key. I have never been to a place in the world where I have seen an entrepreneurial spirit that is strong as the one I see when I'm traveling through the African continent. Everybody is selling something. All of my nurses when they get off work at 5 o'clock they have another business; they're selling chickens, they're selling quails, they're selling food, they're selling clothes. That's the kind of entrepreneurial spirit we need to tie in and maybe even give the nurses an opportunity to own some cervical cancer screening clinics.

JIM GLASSMAN:
And I want to just second that motion, my experience in Africa is exactly the same; tremendous optimism, great entrepreneurial spirit. I know Eric has written about the importance of sustainability. This is not simply a question of pouring in a lot of assistance and then leaving, it has to be sustained, right?

ERIC BING, M.D.:
Absolutely.

JIM GLASSMAN:
Good. Thank you all. Thank you Groesbeck, thank you Tony, and thank you Eric. And that's it for this week's Ideas in Action. I'm Jim Glassman, thanks for watching. Keep in mind that you can watch Ideas in Action whenever and wherever you want. To watch highlights or complete programs just go to ideasinactiontv.com or download a podcast from the iTunes store. Ideas in Action because ideas have consequences.

ANNOUNCER:
For more information visit us at ideasinactiontv.com. Funding for Ideas in Action is provided by Investor's Business Daily. Every stock market cycle is led by America's never ending stream of innovative new companies and inventions. Investor's Business Daily helps investors find these new leaders as they emerge. More information is available at investors.com. This program is a production of Grace Creek Media and the George W. Bush Institute, which are solely responsible for its content.


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Featured Guests

Dr. Eric Bing

George W. Bush Institute

Eric G. Bing, MD, PhD, MBA joined the George W. Bush Institute in December of 2010 as the Director for Global Health after nearly 2 decades at Charles Drew University of Medicine & Science (CDU) in Los Angeles where he was an Endowed Professor of Global Health. As Director, Dr. Bing will spearhead Global Health initiatives, including a program to raise awareness and improve the treatment and screening for cervical cancer and breast cancer in multiple countries on the African continent, as well as an initiative to provide integrated health services to pregnant women, new mothers, newborns and children.



Dr. Bing is a Psychiatrist and Global Health Services Researcher. He is the founder and director of multiple action-oriented researcher centers and programs including SPECTRUM, an HIV community services research program that has mental health, substance abuse, case management and social services to over 500 people per year since 1994. Dr. Bing also has directed Drew CARES/Institute for Community Services since 1998, an HIV research center that focus on health disparities in California and co-directs the NIMH-supported Center for HIV Identification, Prevention and Treatment Services (CHIPTS) based at UCLA, CDU and RAND. Dr. Bing has led international health efforts at CDU since 2000, developing HIV prevention, care and treatment programs in Rwanda, Angola, Nigeria, Namibia, Belize and Jamaica. For his efforts Dr. Bing was awarded the Alfred Haynes International Health Leadership Award (2002) and a Paul G. Rogers International Health Research Ambassador from Research! America (2006).



Dr. Bing has been a member of three Institute of Medicine committees and has published over 90 articles and abstracts. In 2010, Dr. Bing was honored to be selected by his peers as the Outstanding Professor of the Year at CDU. He received his medical degree from Harvard Medical School, an MPH and a PhD in Epidemiology from UCLA and an MBA from the Fuqua School of Business at Duke University.

Dr. Anthony Fauci

NIAD

Anthony S. Fauci, MD was appointed Director of NIAID in 1984. He oversees an extensive research portfolio of basic and applied research to prevent, diagnose, and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies. The NIAID budget for fiscal year 2010 is approximately $4.8 billion. Dr. Fauci serves as one of the key advisors to the White House and Department of Health and Human Services on global AIDS issues, and on initiatives to bolster medical and public health preparedness against emerging infectious disease threats such as pandemic influenza.

Dr. Fauci has made many contributions to basic and clinical research on the pathogenesis and treatment of immune-mediated and infectious diseases. He has pioneered the field of human immunoregulation by making a number of basic scientific observations that serve as the basis for current understanding of the regulation of the human immune response. In addition, Dr. Fauci is widely recognized for delineating the precise mechanisms whereby immunosuppressive agents modulate the human immune response. He has developed effective therapies for formerly fatal inflammatory and immune-mediated diseases such as polyarteritis nodosa, Wegener's granulomatosis, and lymphomatoid granulomatosis. A 1985 Stanford University Arthritis Center Survey of the American Rheumatism Association membership ranked the work of Dr. Fauci on the treatment of polyarteritis nodosa and Wegener's granulomatosis as one of the most important advances in patient management in rheumatology over the previous 20 years.

Dr. Fauci has made seminal contributions to the understanding of how the AIDS virus destroys the body's defenses leading to its susceptibility to deadly infections. He also has delineated the mechanisms of induction of HIV expression by endogenous cytokines. Furthermore, he has been instrumental in developing highly effective strategies for the therapy of patients with this serious disease, as well as for a vaccine to prevent HIV infection. He continues to devote much of his research time to identifying the nature of the immunopathogenic mechanisms of HIV infection and the scope of the body's immune responses to the AIDS retrovirus. In 2003, an Institute for Scientific Information study indicated that in the twenty year period from 1983 to 2002, Dr. Fauci was the 13th most-cited scientist among the 2.5 to 3 million authors in all disciplines throughout the world who published articles in scientific journals during that time frame. Dr. Fauci was the world's 10th most-cited HIV/AIDS researcher in the period 1996-2006. Through the years, Dr. Fauci has served as Visiting Professor at major medical centers throughout the country. He has delivered many major lectureships all over the world and is the recipient of numerous prestigious awards for his scientific accomplishments, including the Presidential Medal of Freedom, the National Medal of Science, the George M. Kober Medal of the Association of American Physicians, the Mary Woodard Lasker Award for Public Service, the Albany Medical Center Prize in Medicine and Biomedical Research, and 36 honorary doctoral degrees from universities in the United States and abroad.

Dr. Fauci is a member of the National Academy of Sciences, the American Academy of Arts and Sciences, the Institute of Medicine (Council Member), the American Philosophical Society, and the Royal Danish Academy of Science and Letters, as well as a number of other professional societies including the American College of Physicians, the American Society for Clinical Investigation, the Association of American Physicians, the Infectious Diseases Society of America, the American Association of Immunologists, and the American Academy of Allergy Asthma and Immunology. He serves on the editorial boards of many scientific journals; as an editor of Harrison's Principles of Internal Medicine; and as author, coauthor, or editor of more than 1,100 scientific publications, including several textbooks.

Dr. Groesbeck Parham

Cervical Cancer Program Zambia (CIDRZ)

Dr. Groesbeck Parham, MD is Director of the CIDRZ Cervical Cancer Prevention Program and Professor of Gynecologic Oncology in the Department of Medicine at UAB. A board-certified gynecologic oncologist, Dr. Parham completed his obstetrics and gynecology residency at UAB, urogynecology fellowship at the University of London and Khartoum Teaching Hospital in Sudan, and gynecologic oncology fellowship at the University of California, Irvine. Dr. Parham moved to Lusaka, Zambia in 2005 to establish the CIDRZ Cervical Cancer Prevention Program. Before moving to Lusaka he served as director of divisions of gynecologic oncology at Charles Drew University of Medicine and Science in Los Angeles, California and the University of Arkansas School for Medical Sciences in Little Rock, Arkansas.

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