Dr. Sabrina Ramkisson Embarks on a New Kind of Smear Campaign

For most women, going to the gynecologist is seen as a mundane task. A check-it-off-but-I-don’t-actually-want-to-do-it appointment. But for some women, these routine visits can save their life.

Chances are, you’ve heard of the importance of getting a Pap smear done regularly, especially when you’re regularly sexually active, but do we really understand what this simple test means? Well, for most, it’s a routine ‘you’re healthy’ check-up, but for some women, it’s the difference between life or death.

You see, a regular Pap smear checks for presence of the Human Papillomavirus (HPV) in your cervix – an infection that can cause precancerous or cancerous cells to appear in the cervix. Simply put: a Pap smear checks for cervical cancer.

For gynecologist Dr. Sabrina Ramkisson, a Pap smear does more than just check for cervical cancer, it gives women their lives back. And as a woman herself, her scope of work means something more to her, because it’s more relatable. But whether it’s helping a patient through periods of trying for a baby, coping with a miscarriage, delivering a newborn, or sadly, diagnosing cervical cancer, the role certainly has its’ ups and downs.

“I love women’s health. I love reaching out to girls and meeting women on a daily basis,” she explained. “Taking a woman through pregnancy, a miscarriage, her cervical health, I’ve learned a lot about myself as I’ve learned a lot about other people.”

But for Sabrina, becoming a doctor felt like the natural thing. In fact, even when she was a child, she was always quick to play doctor with her mummy, paper and pen in hand to write prescriptions. But it wasn’t until she was doing her internships in medical school that she truly considered gynecology.

“I think I always had a little bit of doctor in me, but internship was when things changed. The doctor I worked with at the time allowed me to deliver the baby,” she said, recounting the first delivery she’d shadowed as an intern. “That thrill that I felt, to be the first person to touch the baby, to bring a whole new life out, to be the person who made that difference for that woman, that was when it all made sense.”

That moment she considers the turning point, and from then she was on a strict mission to become a gynecologist, and to experience that every day. And for the last twelve years, she’s been fulfilling that dream every day: even if it means flying home early from vacations to help patients deliver their babies, or racing from North to South and in between to see patients between her offices. These are just some of the many sacrifices she makes daily to do her job – but it’s a labour of love. And for Sabrina, there truly is love in it. She feels close to all of her patients, and treats them like family, because she knows if the roles were reversed, she wouldn’t be quite as friendly as her patients are.

“Doctors are the worst patients, I don’t think I know how to be a patient. I can relate to patients, and help them through everything, but the minute I switch that role, horrible,” she joked.

“I think that’s the human side of me, and I think that’s why I’m able to help people through, because I always try to put myself or my mom in the role of the patient. I manage everybody like I would want people to manage my mom, and that’s the level of care I give to my patients.”

And so, with this passion for caring for her patients and wanting the best for women’s health, she knew that there was more she could do in Trinidad and Tobago to promote cervical health, encourage screenings and educate women about why they should visit their gynecologists.

So when Sabrina discovered a ‘Smear It’ campaign in Nigeria that asked women to take a selfie of their lipstick smeared to remind women to get their Pap smears and raise awareness for cervical cancer, she knew she needed to bring it to T&T. With their blessing, she started Smear It TT, an awareness drive to encourage women to get regular screenings and Pap smears. But she didn’t stop there.

After months of building awareness, she realized there was a major gap that she could fill. Much like the walks and runs that occur every year for other causes, breast cancer included, she decided to host the first annual Smearathon in 2017. But beyond just a 5K, the event empowers women and offers fun for all ages. And most importantly, the event offers screening for a miniscule cost, with doctors volunteering their time to perform Pap smears on any woman who’s due for one.

Sabrina says that in her practice, she often sees women in their 30s who have never had a Pap smear, and come to see her when they’re trying to have kids. And sometimes, these women discover cervical cancer in their 30s.

“When I see that you could potentially save that 35-year-old years before when she was in her twenties, if somebody had told her that a Pap smear in her twenties would make a difference to her at 35,” she added. “To me, the power of that is self-explanatory.”

Most women put off doing Pap smears because there’s a negative stigma around it, stemming from decades-old tools that were large and made of metal, and would cause discomfort or pain. But Sabrina ensures that most doctors are finding ways to make it more pleasant for the women – including using a plastic speculum which is much smaller and less uncomfortable for the women.

But the scariest part for Sabrina, beyond just telling her patients that they might have cancer, is telling them the long-term effects it can have on their body. One of the scariest is that, because cervical cancer affects the neck of the womb, she can lose her womb and never have children. Should you do your regular screening yearly or every two years, it’s easier to pick up on changes, and that same 35-year-old patients might discover she had cervical cancer years before, and it would have made a massive difference on treatment and moving forward.

“That’s why I’m so passionate, because it is a preventable cancer.”

Unlike other cancers that don’t guarantee early detection, cervical cancer is something that can be screened for year after year with a very simple, easily accessible test, and that’s what Sabrina hopes the Smearathon will raise awareness on.

“Internationally, cervical cancer is the 4th commonest female cancer, and the 8th commonest cancer,” she noted. “It used to be a lot higher, but with Pap smears, screening and awareness, it’s significantly dropped in ranking. Cervical cancer is definitely becoming less and less common because of more awareness and screening tests.”

And this screening is available to everyone, regardless of race, class or financial status. Because cervical cancer and HPV affect women typically in their reproductive age, it affects a major part of our population, and therefore it’s made readily available to anyone, it’s just for them to inquire.

Pap smear services are considered a part of the family planning unit, so every tertiary care hospital that has a unit would have a family planning nurse who is trained to do Pap smears, and anybody can walk in and get their Pap smear done. It’s also readily available at local health centres, and through mobile clinics that the government sometimes sends out. And of course, it’s also available at the Smearathon, because Sabrina never wants women to feel like it’s out of reach for them, whether it be because of accessibility, funds or availability.

Sabrina’s passion for cancer screening is more than just because of her role as a gynecologist, but also because of her role as a granddaughter. Just two years ago, she watched her grandmother get diagnosed with cancer at age 87, and saw her battle through it, albeit unsuccessfully in the end.

“As a gynecologist, you help so many women on a daily basis,” she said. “But when you can turn to your family and help them with that same knowledge, and you can help at home, that’s what matters for me.”

And helping your family doesn’t have to limit to offering skills as a doctor, Sabrina says. Just by educating your family and friends and encouraging them to get screened regularly, or just visit their gynecologist, you’re helping them.

“Education is important. Moms educating their daughters, sisters educating their sisters, cousins educating their cousins. To me, that’s what it’s about,” she added. “You make a difference in one person’s life, whether it be your family, a coworker, whoever. That’s what we try to encourage. Remind them to do their Pap smear. Each of us makes a difference.”

At the end of the day, women’s health is the most important thing, and Sabrina and Smear It TT are committed to the cause.

“Women are, after all, the pillars of our society,” she said, with a laugh. “So if we aren’t healthy, what’s going to happen?”

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