Key to VIA Success: Vision and Vinegar

Sometimes it’s the simple things make all the difference.

Here at Grounds for Health, we use the Single Visit Approach to screen for cervical cancer. Applying a vinegar wash on the cervix allows us to make a visual confirmation of potentially cancerous cells. This is known as visual inspection with acetic acid (VIA). If the lesions match our treatment criteria, we freeze off the cells using an effective and safe procedure called cryotherapy.

All can be done in one 30-minute visit.

So maybe it’ll come as no surprise that four years experience in Mexico, Nicaragua and Tanzania has taught us that the success of the Single Visit Approach often boils down to two things: vision and vinegar.

First, there’s the issue of vision. Back in 2007 in Nicaragua, we found that some of the best students in the classroom, seasoned doctors and nurses in our training program, were missing clear positives when tested at close-range with VIA flash cards.

Someone offered one of the students a set of simple reading glasses. A-ha! Positives confirmed. These students were over 40, and although excellent health care providers, they didn’t know they needed reading glasses to see properly at arm’s length—the distance required to perform a visual inspection.

We now require that every clinician go through a simple eye exam before starting the training program.

… Then there’s the vinegar.

Our experience in Latin America taught us that positive VIA rates should range from 10-20%. But when we first began our program in Tanzania, in a remote region where we estimated that rates would be well over 10%, we found only 2% of women tested positive. At one point, over 100 women in a row tested negative using VIA. Something was wrong.

So we had a closer look at the local vinegar. Someone opened a fresh bottle, held it to her nose and took a taste. It seemed weak. We boiled the vinegar to concentrate it, and began experiencing more consistent results—close, but not quite normal.

When we returned to the States, we officially tested the Tanzanian off-the-shelf vinegar. It did not meet the 3-5% acidity level recommended for VIA.

On our return trip to Tanzania, we armed ourselves with Heinz-brand vinegar, and immediately saw a 10%+ positivity rate in the same population.

Grounds for Health now tests local brands for acidity levels before beginning any Single Visit Approach program.

Our experiences show that success is only possible when the simple things are done right.