Delegates from the following countries and organisations met in Suva, Fiji on 5-6
December 2019 and agreed the Call to Action below:
Delegates from Papua New Guinea, Vanuatu, Solomon Islands, Kiribati, Federated States
of Micronesia, Fiji and Samoa together with representatives of the Pacific Society for
Reproductive Health, Papua New Guinea Obstetrics and Gynaecology Society, Fiji
Obstetrics and Gynaecology Society, Papua New Guinea Institute of Medical Research,
Cervical Cancer Prevention in the Pacific, The Pacific Community (SPC), VCS Foundation,
Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Kirby
Institute at the University of New South Wales, Family Planning Australia, Australian
Cervical Cancer Foundation, Fiji Cancer Society, Fiji National University, University of
Otago, National University of Samoa and Victoria University. Also present were
representatives of the United Nations Population Fund and the United Nations Children’s
Fund.
We agreed to the following principles:

1. We support the global target to achieve elimination of cervical cancer as a public
   health problem, noting the current high burden of cervical cancer in the Pacific
   and the current lack of adequate vaccination, screening and treatment.
2. In line with the World Health Organization (WHO) draft targets for 2030, in the
   Pacific our targets are:
   1. a. 90% of girls are fully vaccinated against human papillomavirus (HPV) by
      15 years of age.
   2. b. 70% of women have had an HPV screening test between 30 – 39 years of
      age and a second HPV test between 40 – 49 years of age1.
   3. c. 90% of women identified with cervical pre-cancer and cancer have
      received appropriate treatment and care
3. We support the principles of equity in striving for the elimination of cervical
   cancer in the Pacific so that no woman or community is left behind.
4. We support the principle of meaningful collaboration between Pacific Island
   nations in planning, procurement and knowledge sharing.

We are committed to the following actions:

1. Raising awareness of cervical cancer in the Pacific and its impact on families and
   communities and strengthening advocacy for elimination.
2. Vaccination
   Exploring funding options including public-private partnerships for ongoing HPV
   vaccination in the Pacific.
   These two tests should be 10 years apart. Clinically validated PCR based tests should be used.
3. Urging Pacific Island governments to include HPV vaccination against HPV onto
   existing immunization schedules.
4. Screening
   Urging Pacific Island governments to transition to the delivery of effective cervical
   cancer screening with HPV testing and pre-cancer treatment services.
   Consideration should be given to self-collection of vaginal samples in order to
   facilitate scale up and acceptability.
5. Treatment:
   Urging cooperation between Pacific Island Governments to establish a treatment
   centre for cervical cancer, including radiotherapy, to act as a referral hub within
   the Pacific.
6. Workforce:
   Assisting Pacific Island governments and training agencies to develop an essential
   workforce for the delivery of HPV vaccination, cervical cancer screening and the
   management of cervical cancer.
7. Registry establishment:
   Assisting in establishing an adequate registry to record information about
   vaccination, screening and treatment for the prevention of cervical cancer; and
   with potential linkage to a cancer registry. This will facilitate follow-up of the
   young with incomplete vaccination and women through the screening pathway. It
   will also enable robust monitoring and evaluation of vaccination and screening
   program performance.

For more information, please email/call any of the following:
Professor Alec Ekeroma, HOD, Department of Obstetrics and Gynaecology,
University of Otago, Wellington, New Zealand. E: alec.ekeroma@otago.ac.nz; M:
+64212767975.
Professor Diana Sarfati, Head of Department, Public Health, University of Otago,
Wellington, New Zealand. diana.sarfati@otago.ac.nz
Professor Marion Saville, Executive Director, VCS Foundation, Melbourne, Australia.
E: msaville@vcs.org.au

Urogynaecology is part of gynaecology that is involved in the assessment and treatment of women with pelvic organ prolapse, urinary and faecal incontinence. It is a common problem but often hidden because of embarrassment and shame and a lack of awareness that there is anything that can be done to help. NZ MFAT has supported a project scoping the extent of the problem in Fiji and doing a needs assessment on how to upskill health professionals in this field. It is a multidisciplinary approach with upskilling of nurses, midwives, primary care doctors as well as O&G specialists.
I recently spent a week at Port Vila in Vanuatu with Drs Harry, Tungu and Damutalau assisting in prolapse surgery and teaching the midwives and student midwives about perineal suturing. I was very impressed with their surgical skills and enthusiasm and look forward to working with them again in the future to expand their services in quantity and quality.
If you are interested please contact meat Jackiesmalldridge@gmail.com

My colleague, Dr Louise Tomlinson, myself and others have been developing a program that we hope to launch at the next PSRH meeting in July 2019. This is in response to a need identified by Pacific midwives particularly from remote areas where referral can be difficult if perineal trauma is severe. We want to extend the scope of the perineal suturing workshops that we usually run at the PSRH meetings and across the Pacific at other opportunities. As well as improving knowledge and practical skills, we wish to provide some tools to help the participant going forward. We have developed a laminated flip chart with step by step information about how to identify and repair perineal trauma that can be practically useful on a day to day basis. We hope to provide a set of instruments and appropriate sutures to use. We are working on how best to evaluate this program as it unfolds and have engaged some partners to support us financially.
We also want to identify “champions” in each country who are interested in perineal suturing and can act as mentors and troubleshoot for the participants in their countries. We also want them to help us collect data on how the program is going and how they can become trainers in the future.
If you are interested please contact meat Jackiesmalldridge@gmail.com