The Netherlands

Indonesia

Surinam

- Lobi Foundation

- People

South Africa

Related links

  Home > Who are our partners > Surinam

Surinam: building on strong contacts

South America is the continent where cervical cancer is most predominant. Unfortunately, Surinam, in the north of this continent, is no exception to this rule. Partly because of close cooperation with the LUMC, a health care system that enables prevention, early detection and treatment, is gradually emerging.
In the 17th century the Dutch were forced to make a swap after a defeat against the English: the Dutch colony in North America (currently Manhattan) was handed over to the English and in return the Dutch received a much bigger area in South America: currently Surinam. the colony was seven times the size of The Netherlands and very sparsely populated with its original inhabitants, the Indians.

In subsequent centuries, the Dutch exploited this country by using slaves from West Africa. Some of them managed to escape and settled in the vast forests. When slavery was abolished in 1863, there was a shortage in the workforce on the plantations. Asian laborers were brought to Surinam on a large scale. First the Chinese arrived (1858-1870), followed by people from what was then British India (1873-1916) and finally another Dutch colony sent laborers - from Java to Surinam (1890-1939).

Diversity: Genetic and Cultural
The current population of Surinam - approximately half a million people - reflects these migration patterns from the past. About 40% of the population is from India and Pakistan and 38% is Creole, descending from the West Africans. 10% of those are "Bosland Creoles" as they descend from the slaves who managed to escape into the bushy lands. 15% is originally from Java (Indonesia). There is a small minority of the original inhabitants (3%), the Indians, similar to the Chinese (2%) and the descendants of the Dutch colonists (boeroes: 2%). The various sections of the population are still relatively homogenous. They stick to their own cultural traditions and mixed marriages are quite rare. A population of this kind is extremely interesting for medical research, because the influence of genetic and cultural factors can be studied.

Each year, approximately 25 women are treated at the LUMC within this arrangement. Surinam's problems since its independence have resulted into an exodus of parts of the Surinamese population to The Netherlands. More Surinamese people live in Holland than in Surinam at the moment. Women with cervical cancer from Surinam who are treated in The Netherlands, benefit from this, because they usually have family in The Netherlands who can look after them when they come out of the hospital.

Health Care in Surinam
The majority of the Surinamese population lives in the capital of Paramaribo. It has four hospitals: University Hospital Paramaribo, 's Lands Hospital, The Diaconessen Hospital and The St. Vincentius Hospital. The fifth hospital is in Nickerie, the second largest city in the country.
The academic Hospital, which is affiliated with the Anton de Kom University, is the largest and most advanced hospital in Surinam. It has the only department of pathology in the country. Professor Anton Vreede is the head of this department. The hospital aims to fulfill a central role in the Caribbean. Surinam has to contend with a shortage of doctors, especially medical specialists. There is a sufficient number of general practitioners in cities. However, rural areas are difficult to reach because there are hardly any roads or railway lines. Some 100,000 people have to rely on aid from public health organizations. These public health activities are organized by the government (State Medical Service) and by medical missionaries. They are coordinated by The Diaconessen Hospital. The Lobi Foundation, a private organization that is interwoven with Surinamese society, has done a lot of work in terms of prevention and early detection of cervical cancer. This foundation, funded by the WHO-PAHO (Pan American Health Organization) is also active in subjects such as family planning, prevention of AIDS and birth control.

Cervical Cancer in Surinam
Cervical cancer is the most common type of cancer in Surinam, like elsewhere in South America. Unfortunately, the disease is often diagnosed when it is at an advanced stage and when the chance of full recovery is slim. In the last ten years, Surinamese gynecologists and pathologists have started to work together with their colleagues in the Netherlands, mainly at the LUMC. This cooperation does not just include the arrangement that was mentioned earlier in which Surinamese patients can be treated in The Netherlands. Work has also been done on prevention, screening and furthering the expertise of local gynecologists. Prevention can primarily be achieved by giving advice about life style and by increasing the awareness of the population. The Lobi foundation has contributed to providing this information in a way that fits in with the cultures of the ethnic groups in Surinam. This foundation is also closely involved in setting up a NAtional Pap Smear Project, in which every woman aged between 20 and 60 will be examined. This screening process is supervised by Leiden, which means that attention is paid to quality control and several scientific aspects such as which types of the HPV virus occur.

It is vital that when women are screened for or treated for cervical cancer, their wishes and perception are taken into account. If possible, treatment is chosen that does not affect fertility. Otherwise there is a risk of women backing out of the screening. Especially in sections of the population where people have little knowledge of how the body functions, a lot of understanding is needed to explain that a radical operation could be necessary even if the patient does not suffer from any pain yet. Surinamese gynecologists are equipped to treat the early stage of cervical cancer. Patients that need extensive surgery or radiotherapy are referred to the Netherlands after a medical committee has considered their case. The Surinamese national health service organizes this in cooperation with Intercare, which is part of the Dutch health insurance ZOA. The close collaboration between the LUMC and the Surinamese health care in respect to cervical cancer, is an excellent basis to introduce new ways of treatment and prevention like vaccination. However, this is only possible because every party is working together to help prevent cervical cancer and to take care of Surinamese women with cervical cancer. Regular personal contact between all parties involved is essential for the success of this project.

Recent research: Screening for cervical cancer in Surinam
The Lobi Foundation organizes in co-operation with the PAHO (Pan American Health Organization) and their financial aids and the Leiden University Female Cancer Project a study concerning screening for cervical cancer in Surinam.
The limited impact of cytology-based cervical-cancer screening programs in developing countries is widely recognized. Screening programs based on cytology need technical support, a good transport system, communication, follow-up and trained personnel.
Often this is difficult to organize in developing countries. As a result, new potential screening tests are being proposed, among them VIA (visual inspection with acetic acid), which is quite appealing for low-resource settings. The objective of the VIA is solely to be able to recognize clinically normal (VIA negative) from the abnormal (VIA positive) cervix.
Strengths of VIA are that this method is simple, easy-to-learn and relies minimally upon infrastructure. Costs are expected to be lower in beginning and the long-run than a program based on cytology. Another benefit of this method is that it can be provided by many types of health care providers. The test result is immediately available, that means that only one visit is required.
Unfortunately there are limitations too, the specificity results seem to be moderate. Because it is a new screening method, there is a need for developing standard training models and quality assurance measures. Still, VIA is a promising new approach.
The study that takes place in Surinam is a comparison between the Pap smear and the VIA. The hinterlands of Surinam are visited several times for one to two weeks by a medical team. The women living here are Creoles from the hinterlands and Indians. They are getting a Pap smear and are inspected with the VIA procedure.

The Pap smear is judged immediately by an analyst, who is a member of the medical team. If the result of the VIA is positive, a biopsy is taken and the patient is treated by cryotherapy. This treatment is easy to learn and it only needs nitrogen and no electricity so it can be used in the hinterlands. Another benefit is that it takes only 12 minutes to complete the procedure. The women can go home immediately, with minimal side effects. A program in which a women is screened and treated is called a 'see-and-treat' program. The most important benefits of such a program is that it takes less time for a woman and the rate of loss-to-follow-up is very low.
When women are suspicious for invasive cervical cancer they are referred to the hospital in the capital, Paramaribo.
Besides the Pap smear and VIA, HPV testing is done too. The intention for this part of the research is getting more information for developping HPV vaccination in future.