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"So, did Grandma ever have a Pap smear?"

A strange question for a son to ask his mom, as I did last Thursday, but it came to mind because of careHPV.

The careHPV test is a quick, simple DNA test for the primary cause of cervical cancer — human papillomavirus (HPV) — could overcome serious obstacles to screening for cervical cancer in developing countries.

Rather than visit a doctor who prods the cervix and swabs it for tissue specimens, women conduct their own careHPV tests at home in minutes. Trialed in seven countries since 2007, careHPV eliminates the need to expose one's private parts to a stranger — a tremendous barrier in some cultures.

My mom's answer to my question was "no," primarily because she and her mother grew up in rural Nigeria. In developing countries like Nigeria, fewer than five percent of women go for screening for the third leading cause of cancer in women. Of the 500,000 women around the world who develop cervical cancer each year, 85 percent live in developing countries or rural settings.

Shots - Health News

Should HPV Testing Replace The Pap Smear?

In the U.S., by comparison, women are predominately screened by Pap smears — every 1 to 3 years — even though the test isn't very good at its job of finding cervical abnormalities. Pap smears only detect HPV or other signs of cervical cancer about half the time. Still, reliance on frequent Pap smears has helped cut U.S. cervical cancer rates in half over the last 35 years by identifying women who need treatment.

But "Pap just hasn't worked for developing countries," says Scott Wittet, an advocate for cervical cancer prevention at PATH, a Seattle-based nonprofit organization that worked with the biotech company Qiagen and the Bill & Melinda Gates Foundation to develop careHPV. A multicountry study published earlier this year found careHPV was more effective than Pap smears at detecting potential cases of cervical cancer. Vaginal careHPV caught 70 percent of cases across clinics in India, Nicaragua, and Uganda, while the accuracy of Pap smears ranged from 40 percent to 70 percent.

The problem with Pap in this study, is the lack of labs and technicians to complete error-free Pap smears. Even then, weeks can pass before results are available. For women in developing nations who live in villages far from health centers or hospitals, attending a follow-up appointment may not be an option. A 2008 study in Latin America and the Caribbean found that follow-up rates ranged from 90 percent (in Chile) to as low as 20 percent (in Mexico).

Another benefit of careHPV is that it tackles the cultural resistance that often surrounds Pap smears. In conservative regions, husbands may balk at the idea of their wives being examined by male doctors. One idea has been to send female health workers to rural regions, but they're often scarce in these countries.

"We've had this experience in Central America, especially with indigenous populations," says Jos Jernimo, senior adviser on women's cancers at PATH. Next year, PATH will send 110,000 careHPV tests each to Nicaragua, Guatemala and Honduras. The $5 tests will be provided free of cost.

While vaccination against HPV helps prevent cervical cancer, it must be done when girls are young. Women who've never been vaccinated must be screened.

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With the CareHPV test, women use the brush to take vaginal tissue samples, then put the specimen into a test tube. Patrick McKern/PATH hide caption

itoggle caption Patrick McKern/PATH

With the CareHPV test, women use the brush to take vaginal tissue samples, then put the specimen into a test tube.

Patrick McKern/PATH

In Kampala, Uganda's capital, gynecologist Carolyn Nakisige has field-tested careHPV at her clinic at the Mulago Teaching and National Referral Hospital. Most women reported a preference for self-testing rather than a doctor's exam. Nakisige used pictures and videos to show patients how to conduct the test: With three quick turns of a soft brush, they can collect vaginal tissue samples. "We allowed them to feel the brush in order to alleviate fears of hurting themselves," says Nakisige. Then the samples are dropped into a plastic test tube with a liquid that preserves the cells. A technician with basic training can deposit the specimen into a shoebox-sized machine that delivers results within in three hours.

The test can be deployed in far-flung places, too. "We envision a mobile clinic could drive to a rural village and collect 90 to 100 samples in just a few hours," says Wittet. So far it's been used by PATH in China, Guatemala, Honduras, India, Mexico, Nicaragua and Uganda. And the biotech company Qiagen, careHPV's developer, will provide the screening machine for free to any hospital or health organization that continues to buy the $5 specimen collectors.

Using CareHPV offers a chance to diagnose HPV, identify potential cancerous lesions and provide treatment all in the same day. Doctors can check for those lesions by using visual inspection and can quickly treat and remove the harmful tissue. By pinpointing patients with cancer-causing strains of HPV, as careHPV does, the test can help doctors devote time to the women who need care the most.

Like the Pap test, careHPV tests are most effective if they are repeated every year. But "even screening a woman one time can have a huge impact," says Leslie Bradford, a gynecologic oncologist at UMass Memorial Medical Center in Worcester. Studies have found that just one screening in a woman's lifetime can reduce her chance of dying from cervical cancer by 35 percent.

Shots - Health News

Older Women May Actually Be More At Risk For Cervical Cancer

My grandmother was lucky: she never developed cervical cancer. (In fact, she lived to be 95!) CareHPV may help other women in developing nations have a chance at a long life, too.

pap smears

cervical cancer

Global Health

For Republicans, Democrats in red states seem ripe for the picking in midterm election years, when the GOP usually has an advantage in voter turnout. One of their targets this year is Rep. John Barrow of Georgia, who faces one of the tightest races in the nation.

Barrow, often described as the "last white Democrat in Congress from the Deep South," is trying to hold onto his seat.

At First African Baptist Church in Dublin, Ga., a bronze plaque beside the front door reminds visitors that this is where a 14-year-old Martin Luther King Jr. gave his first public speech.

Pastor Keith Anderson stands behind the pulpit and welcomes Barrow to the service, while making a dig at Washington gridlock.

"I'm glad, Congressman Barrow, that I don't have to sit in the Senate or in the Congress and the only way my business gets done is if I get the majority to support [it]," Anderson says.

Even if Congress seems ineffective, Anderson assures his congregation, there is power in prayer to get things done.

Barrow tells the audience of about 60 people that even in Washington, he gets things done; he ticks off efforts to bring jobs to Georgia by promoting nuclear energy and expanding the Port of Savannah.

Barrow is comfortable here, among traditionally Democratic African-American voters. He describes himself as a Democrat in the tradition of his father, a judge known for helping to keep public schools open after desegregation. Barrow needs African-Americans to turn out on Election Day — they make up more than a third of his district. But they're not enough to put him over the top.

University of Georgia political scientist Chuck Bullock says that's why Barrow spends a lot of time trying to convince white Republicans in his district that he represents them.

"They see John Barrow and they go, 'Oh, wait a minute, yeah I'm a Republican but this guy Barrow, yeah he's pretty good,' " Bullock says. " 'He's been to our festival, I've met him. He came to our high school graduation. I'm going to make an exception.' "

At the Huddle House diner in tiny East Dublin, Barrow stops for a bite to eat in between church services. He chats with Jack and Dianne Conley, a white couple in their 60s. They say they normally vote Republican, but they tell Barrow — who's endorsed by the NRA — that they like his conservative positions on issues like gun rights.

"Thank you," Barrow says. "I take my Constitution neat; I don't water it down."

Barrow isn't just running against his Republican challenger, Rick Allen. In this conservative district, he has to distance himself from the national Democratic Party and the president. In this TV ad, he refers to an old political joke that says if you want a friend in Washington, D.C., you should get a dog.

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"Well, I wouldn't wish Washington on a dog," Barrow says, tossing a ball to a yellow lab.

Along with his homespun language and folksy demeanor, Barrow repeatedly portrays himself as an independent voice who has opposed President Obama on issues including health reform. Another ad touts his voting record, saying he has sided with House Republicans more than half the time.

But Barrow is up against a well-funded Republican effort to replace him with one of their own. The conservative American Future Fund, an outside group backed by the Koch brothers, has put nearly $1 million behind Barrow's Republican challenger. In ads and on the stump, Allen tries to paint Barrow as "two-faced" and a rubber stamp for Obama administration policies.

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But Democrats are hitting back with big money of their own — including more than $130,000 on a new ad this week. They're trying to keep Barrow in place, and dash Republican hopes that this will be the year Georgia's 12th Congressional district turns from blue to red.

"If someone you know is sick with sudden fever, diarrhea or vomiting, you should call 117 for advice."

"Healthcare workers who take care of Ebola patients have to wear protective clothes do not be afraid of them."

"People with Ebola who go to the health centre early have a better chance of survival."

In Sierra Leone, cellphone users are as likely to get a text about hand washing as about a social gathering. In an effort to contain Ebola, the International Federation of Red Cross and Red Crescent Societies (IFRC) has teamed up with local cellphone provider Airtel and the Sierra Leonean government to send health reminders via text message.

Since the Ebola outbreak began last April, the Trilogy Emergency Relief Application (TERA) system has sent out about 2 million text messages a month in Sierra Leone, reminding people to seek treatment early, avoid physical contact with others and not resist the efforts of community health care workers. TERA, a system created by Bolivian software company Salamanca Solutions and set up by the IFRC, can send a text to every phone turned on in a specific region. The texts are delivered free, so there's no financial burden to the recipient.

Texting isn't the only technology being used to combat Ebola. In West Africa, Twitter was abuzz with health tips and reassurance. Social media analytics firm Crimson Hexagon determined that since July, there have been 1.3 million tweets about Ebola coming out of Liberia, Nigeria, Sierra Leone and Guinea, the majority of them discussing treatment. For comparison, since September, 41 percent of tweets coming from the U.S. about Ebola discussed fear.

In countries where Internet access is not ubiquitous, cellphones play a vital role in communicating messages directly to a mass audience during health and other crises. Sixty-nine percent of Sierra Leoneans have a cellphone connection, but only 9 percent have a 3G or cellular Internet plan.

"Every mobile phone can do text messaging," says Ken Banks, mobile technologist and founder of kiwanja.net, a project that unites cellular technology with social change. "It doesn't matter if it's the cheapest model or the most expensive."

This isn't the first time TERA has tackled an emergency. The system was piloted in Haiti after the 2010 earthquake and was first used in Sierra Leone during a 2013 cholera outbreak.

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Almost 70 percent of Sierra Leoneans have cellphones, where they can receive text messages. This message, used in Haiti, recommends protecting important documents during floods. International Federation of Red Cross and Red Crescent Societies hide caption

itoggle caption International Federation of Red Cross and Red Crescent Societies

Almost 70 percent of Sierra Leoneans have cellphones, where they can receive text messages. This message, used in Haiti, recommends protecting important documents during floods.

International Federation of Red Cross and Red Crescent Societies

The interactivity is appealing. Recipients can text back with basic questions about Ebola and get an automated response with information about treatment options, cleaning tips and medical help. And since the texts are sent to specific areas of the country, the messages, which are drafted by the IFRC and the Sierra Leonean Ministry of Health, can be personalized with regional advice.

Even though the country has low literacy rates — 43 percent for adults — text-based services are effective ways to disseminate information. "In villages where there is low literacy, there might only be a few people with cellphones who can read these messages," says Christine Tokar, West Africa programs manager for the British Red Cross. Tokar says those who can read share the information with the town crier, who would distribute it through town meetings.

The texts are intended to reinforce similar messages delivered via posters, radio and television ads. But a text can be preserved on the phone, shown to a friend and referenced later — say, when Ebola comes to a previously unaffected area.

The Red Cross is hoping to have TERA up and running in 40 countries across the globe in the next five years.

"The challenge is getting countries to put the system in place when there isn't an immediate need," says Robin Burton, mobile operator relations officer for the IFRC.

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The TERA software shows the operator where cellphone towers are, not the individual numbers being messaged. International Federation of Red Cross and Red Crescent Societies hide caption

itoggle caption International Federation of Red Cross and Red Crescent Societies

The TERA software shows the operator where cellphone towers are, not the individual numbers being messaged.

International Federation of Red Cross and Red Crescent Societies

Using the Ebola outbreak as a catalyst, the Red Cross is hoping to expand the program to seven West African countries in the next few months: Benin, Togo, Ghana, Mali, Guinea Bissau, Gambia and Burkina Faso. This will require buy-in from the countries as well as from a phone company, which may be hesitant. While these texts are seen as useful during a health crisis, users might grow weary of regular "preparedness" messages.

The system has been built to appeal to both consumers and cell providers. TERA can only send text messages to phones that are turned on, so networks are not clogged with undelivered messages. In Sierra Leone, the text messages are sent at less busy times for the cell network so the company doesn't need to expand its capacity.

For consumers, there is no violation of privacy. No actual phone numbers are seen by TERA operators. And there's an opt-out feature. That's what some Haitians did when they tired of getting messages to wash their hands regularly.

Long after Ebola has subsided in West Africa, the TERA system will remain in place for times of conflict or natural disasters. It's currently being used in Nepal for earthquake preparedness.

"We hope this will empower people to help themselves," says Burton. "They could send a message back to us saying, 'Thanks for the rice, but we have no way to cook it,' or, 'We don't eat pork here.' We call it beneficial communications because it helps everyone do better."

Red Cross

Sierra Leone

ebola

texting

Cell phones

The anger of Illinois Republican state Rep. Mike Bost is spontaneous and raw.

In 2013, for example, he raged against a floor amendment to a concealed carry gun bill.

"Once again, your side of the aisle is trying to make ploys instead of dealing with the real issue!" a YouTube video shows him bellowing. "Keep playing games," he says. "Keep playing games."

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Now, Bost is running for a seat in Congress against first-term Rep. Bill Enyart, a retired general and Democrat, and Bost's anger has become a campaign issue.

Voters in the 12th Congressional District in southern Illinois are hearing a lot of another Bost rant, a furious harangue from 2012 about language inserted into a pension reform bill on the final day of the House session.

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"Enough! I feel like somebody trying to be released from Egypt! Let my people go!" he hollers. "These damn bills that come out of here all the damn time come out here at the last second and I've got to try figure out how to vote for my people!"

The video of those remarks went viral that year. In it, Bost is seen throwing the bill into the air. He whiffs at the pages as they fall, then picks up the papers and throws them again.

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Enyart is running ads that point to Bost's rant as proof that he doesn't belong in Congress. Using footage of the lawmaker's outbursts, the announcer says, "Mike Bost. Twenty years yelling. Twenty years being the problem."

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Bost has represented small towns in rural, conservative southern Illinois for nearly two decades. Many voters here see his fury as well-placed.

"I think this was appropriate," says Bost supporter Jill Bunyan of Bost's pension rant. "You can get angry, and that's OK. And I think at that time, for that few moments, that was an appropriate response."

Bunyan lives in the tiny town of Cobden, population 1,100. People in Bunyan's part of the district, which hugs the Mississippi River, are frustrated with the state's fiscal troubles and weak local economy.

But head north to some of the district's larger cities, like Belleville, population 44,000, and Bost's anger is embraced less and criticized more. Interviewed on Main Street, Richard Rockwell thinks "the rant" is all political theater.

"I'm hoping that's the reason, and not that he's acting the fool in a deliberative chamber," Rockwell says. "That would be rather disconcerting to me."

Bost, in his own ad, refers to a video of the rant and embraces it. He half smiles and explains in folksy fashion that he's angry about the direction his opponents are taking the country.

"What the Chicago politicians and Gov. [Pat] Quinn have done really made me mad," Bost says. "And what Bill Enyart and President Obama are doing to our country upsets me as well."

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