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Concerns for Women's Health

'The Epidemiology and Political Economy of Cervical Cancer in El Salvador'


Juno Obedin-Maliver
Within the next two minutes a woman will die of cervical cancer. One dies approximately every two minutes, with 240,000 such deaths occurring globally each year, 80 percent of them in developing countries, with Central America among the highest in frequency. Most are preventable deaths. In its pre-cancerous stages, the disease is curable, and proper medical screening and care could save these women.

May graduate Juno Obedin-Maliver is committed to that possibility.

Her work as a pre-med student at Hampshire College has prepared her well to meet the challenges that lie ahead. An internship funded by a grant from the Civil Liberties and Public Policy program enabled her to spend summer 2002 in Mexico as an administrative assistant to a physician training local midwives to do cervical cancer screenings. During January Term 2003, she was one of 10 Five College students enrolled in a course on health issues facing women in developing countries, co-taught by Hampshire health science professor Elizabeth Conlisk and alumna Meriam Cremer (87F), an ob/gyn who leads medical missions to El Salvador.

In the January Term course, students traveled with Cremer and her organization, Basic Health: El Salvador, to the region of Chelatenango, where they assisted physicians conducting health screenings by taking care of such tasks as obtaining informed consent, chaperoning patients through the process, cleaning equipment, and keeping records.

For her Division III, Obedin-Maliver examined nutritional correlations to cervical cancer in another region of El Salvador. She first immersed herself in the literature, identifying three critical nutrients that may be essential to prevention - vitamins A and C and folate - and worked with her Div III faculty committee to develop a food frequency questionnaire to determine the presence of those nutrients in a woman's daily diet.

She returned to El Salvador in December 2003, where in San Sebastian, "with amazing assistance from members of the Red Cross," she refined the questionnaire by interviewing women in Spanish in their homes, asking about specific foods and portion sizes in an attempt to quantify the presence of the three nutrients over time. In January, Dr. Cremer, other physicians, and Five College students arrived to set up a temporary clinic. Obedin-Maliver completed diet surveys of the 500 women examined and treated, seven of whom were found to have pre-cancerous cells.

She spent spring semester analyzing data and charting how levels of daily intake of the three nutrients being studied may affect development and
Juno Obedin-Maliver
prevention of cervical cancer. A poster of her findings has been accepted at the 132nd annual conference of the American Public Health Association, to be held in Washington, D.C., in November.

Her 240-page Division III paper, titled "The Epidemiology and Political Economy of Cervical Cancer in El Salvador," included a social science component, exploring why so many women continue to die from a curable disease. "The lack of medical infrastructure is the number one reason," she said, "but political, economic, and social structures and historical attitudes play important roles, too." She also included a section analyzing the ethical considerations surrounding international research, including her own.

The Hampshire faculty committee guiding Obedin-Maliver's Division III work consisted of Conlisk (chair), director of the Population and Development Program Betsy Hartmann, and quantitative instructor Fatemah Giahi. Other mentors important to the project included Dr. Cremer, Mt. Holyoke College anthropology professor Lynn Morgan, and Paula Stamps from the School of Public Health at the University of Massachusetts.

A native New Yorker, Obedin-Maliver came to Hampshire already certified as a holistic health practitioner, and plans a career after medical school that will enable her to continue working in hands-on healthcare and community health. She plans to spend the upcoming year continuing her research in El Salvador.

For more Basic Health: El Salvador


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