David Walmer

Adjunct Professor of Global Health

Appointment:

Topics:

Countries:

David Walmer

Adjunct Professor of Global Health

David K. Walmer, MD, PhD entered the global health arena in June 1993 when he and Dr. Jean Claude Fertillien initiated a cervical cancer prevention program at Hôpital Saint Croix in Leogane, Haiti.

In October of 1996, Dr. Walmer began taking Duke undergraduate, medical and divinity students to Haiti, which led to the creation of a course entitled “Issues of Healing in the Developing World and Care of the Underserved: A Medical and Theological Perspective”.  The course became part of the medical school curriculum in 1997 (IND304C), the divinity school curriculum in 2000 (PASTCARE21) and transitioned to DGHI in 2008.

In 2000, Dr. Walmer founded Family Health Ministries to support the cervical cancer prevention efforts. When Dr. Merson arrived at Duke as the founding Director of the Global Health Institute, he invited Dr. Walmer to join the faculty where he served until he retired from Duke in 2021. In retirement, Dr. Walmer has continued his participation in DGHI as a member of the adjunct faculty.

Duke students (undergraduate, graduate and medical) have conducted their research under the mentorship of Dr. Walmer through the FHM/DGHI collaboration in areas related to cervical cancer prevention, maternal child health and hypertension. An overview of those research findings and milestones are listed below.

  • Cervical cytology was ruled out as a primary screen for cervical dysplasia in rural Haiti because it missed 85% of treatable dysplasia due to the presence of obscuring inflammation.
  • Visualization of the cervix was found to be superior to cytology in the presence of inflammation and a portable, inexpensive colposcope was invented.
  • HPV testing became the preferred primary screen in Haiti because virtually cervical cancer is preceded by HPV cervical infections.
  • HPV genotyping revealed 5 genotypes associated with the progression of cervical dysplasia to HSIL (>10%) HPV16 - 26.30%, HPV35 - 19.20%, HPV52 - 13.10%, HPV18 - 11.10%, HPV31 - 10.10%
  • Haiti’s first HPV laboratory was opened in 2013.
  • Thermoablation of the cervix was found to be a better option than cryotherapy for a national cervical cancer prevention program because Haiti does not have the capacity to manufacture enough nitrous gas to support cryotherapy.
  • NGOs can together with the Ministry of Health and the Haitian Ob Gyn Society to create the infrastructure for a collaborative health care effort to expand cervical cancer prevention efforts in Haiti.
    • Haiti sans Cervical Cancer was formed in 2016
    • A pilot program enrolling 5000 women is due to be completed in 2022 to screen women for HPV with self-collected vaginal swabs, treat all positives with cervical ablation, retest them 1 year later and to enter all data into a cloud-based RedCAP registry.
    • Partnerships are being developed between the HsCC consortium and organizations treating HIV positive women (Caris Foundation, Zanmi Lasante) and other women’s health organizations (Fonkoze).
  • Future plans
    • Research is underway to identify the best secondary screen because ~20% of HIV negative and ~70% of HIV+ Haitian women are colonized with an oncogenic variant of the HPV virus.

Women’s health care efforts have been expanded to include maternal child health care at the Carmelle Voltaire Women’s Center in Tom Gato.

  • Ground-breaking 11/20/12
  • Women’s outpatient clinic opened 2/20/16
  • 24/7 labor and delivery services began 3/1/2020
  • Family Nurse Practitioner nursing students began doing clinical rotations at the CVWC 10/15/21
  • Future plans
    • Introduce Helping Babies Breathe program
    • Construct operating room, funds already raised
    • Participate in development of Nurse Anesthesia program