by Ann LoLordo

As a young girl in Ethiopia, Tsigue Pleah knew that she wanted to be a doctor, an ob/gyn who would take care of the women and mothers of her country and safely deliver their sons and daughters into the world. Her choice of profession was driven as much by the lack of choices faced by most women in her part of the world as her desire to make a difference.

“I’m from East Africa,” the soft-spoken doctor and mother of three says, “where women don’t have any access to health services. Even though I was young, I knew maternal mortality was high. I knew [women] were dying. I knew that from the beginning.” The fifth of six children, Tsigue Pleah was always encouraged to be a doctor. Her older sister had married at age 16, but her two university-educated brothers prodded their youngest sister to follow her dreams.

When asked as a high school student why she wanted to be a doctor, Tsigue’s impassioned response—“Women are dying and I want to help.” —so impressed a college interview panel that she won a coveted spot to study medicine in the former Soviet Union. But the education of Tsigue Pleah began before she ever arrived in Russia.

After the 1974 overthrow of Ethiopia’s long-serving emperor, Haile Selassie, the rulers in Addis Ababa decreed that all students must be sent to the countryside to teach rural Ethiopians how to read and write, or tend to the sick or work in the fields, Reminiscent of a Soviet-style re-education campaign, the order meant that the 17-year-old Tsigue would join other students in Gondar, a village about 500 miles from the capital. This was her introduction to the Ethiopia beyond Addis Ababa, and the lives of women there convinced her that her decision to pursue medicine was the right one.

“I saw how hard it was for these women. We lived nearby the village hospital,’’ Dr. Pleah recalls. “I remember a woman was dying and they called us to give blood—three of us and that woman didn’t survive. I said I had to do something.” She eventually went to medical school in Russia, and when she graduated in 1983, she moved to Mali, her husband’s native country, and went to work in the ob/gyn ward of Gabriel Touré Hospital in Bamako, the capital city. This was a large, public teaching hospital with all of the problems typical of such institutions: shortages in staff, equipment and medicine, as well as poor infrastructure.

After 14 years there, Dr. Pleah decided to pursue a degree in public health at The Johns Hopkins University, arriving in the United States in 1997. If she could promote prevention of disease and disability in countries most in need, she felt she would have a greater impact on saving lives—including the thousands of women dying from cervical cancer in Africa and the developing world.

Today, as a master trainer for Jhpiego, Dr. Pleah is able to teach other health providers skills and techniques that they can use to improve care and subsequently share with others. In this role, she has taught health care professionals in 14 countries, provided technical assistance to hospital administrators all over the world and helped strengthen national health policy guidelines and standards in Madagascar. Most recently, she traveled to Côte d’Ivoire to lead a training on screening for cervical cancer—a major public health problem among the country’s estimated 10 million women.

This is Dr. Pleah’s passion today. “When you have this cancer, you are sentenced to death,’’ she says, of women with cervical cancer in the developing world. Cervical cancer is asymptomatic until it is at an advanced stage, she adds. “There is no symptom to tell you to go now [to be tested].”

Cervical cancer is the second most common cancer among women, and the leading cause of cancer deaths in women in developing countries. Early detection is critical to treating the disease and saving lives. Cervical cancer screenings and Pap tests are routine for women in the United States and Europe. But more than 95 percent of women in developing countries have never had a Pap test because health facilities are inaccessible or screenings unavailable.

But as Dr. Pleah knows, a safe, effective and low-cost method of testing for cervical cancer—developed by Jhpiego—has proven successful in averting this cancer in women in Ghana, Malawi, Thailand and other countries where Jhpiego works. With a small bottle of acetic acid (commonly known as vinegar), long-stemmed cotton swabs, a goose-neck lamp or flashlight, a trained health care provider (often a nurse or midwife) can test for precancerous cells.

If these cells are found on the cervix, the provider can—in the same visit— freeze those cells using cryotherapy to prevent cancer. HIV-infected women are at increased risk for cervical cancer. And given their numbers in Africa, this innovative screening method, known as the “single visit approach,” could help save thousands more lives if it were more widely in use.

“Advocacy is key,’’ says Dr. Pleah, who spent two weeks in October training health care professionals in Côte d’Ivoire in the single visit approach. To get health policies changed, she explains, “You have to raise awareness and focus on the number of women dying in a country.”

In Côte d’Ivoire, for the first time in the country’s 49-year history, the Ministry of Health has created a unit to fight cancer. Recognizing the need in this country of 21 million, Jhpiego is leading a new cervical cancer prevention program that will focus on HIV-infected women at 10 hospitals. The program’s results could help lay the groundwork for a national prevention and screening program, which if adopted, says Dr. Pleah, could serve as a model for others in the region.

“Now, I’m helping to institute a cervical cancer screening program in Burkina Faso,” says Dr. Pleah. “When I go to these countries and you are with the service providers, the physicians and nurses, they make you feel that you are helping them to make this difference. You know that you are giving them what they need….You put that liquid vinegar on. You see the precancerous cells—they are whitish—and you freeze them and you save somebody’s life. Very quick. Very cheap. Very effective.”

Dr. Pleah’s commitment to improving women’s health has been long-standing—today, she has worked in reproductive health and family planning for more than 25 years. Recalling how her brothers encouraged her to follow her dreams and become a doctor, she says “At one moment I felt I was doing good at school to make them happy. I finally understood it was for myself.”