Cervical cancer is the third most common cancer among women worldwide and Mongolia has one of the highest incidence rates in Eastern Asia. Prevention and early detection programs are essential to counteract its prevalence, especially in developing countries.

However, women encounter barriers to knowledge and access to cervical cancer screening services in Mongolia – a country with low population density. The urban–rural divide, lagging healthcare reform, and cultural differences are cited as core factors leading to lack of awareness and treatment.

Gendengarjaa Baigalimaa

To address the rising burden, a national cervical cancer screening program was implemented in August 2012 by Mongolia’s Ministry of Health (MOH) facilitated by a grant from the Millennium Challenge Corporation.

Gendengarjaa Baigalimaa, the 2013-14 Developing Asia Health Policy Fellow at Stanford’s Walter H. Shorenstein Asia-Pacific Research Center in the Freeman Spogli Institute, has been evaluating the effects of that program. She serves as a gynecological oncologist at the Mongolian National Cancer Center (NCC). Her early findings show that awareness of cervical cancer has increased, and more women and girls are now getting screened. Gendengarjaa recently talked about her research, which she will present at a seminar on April 9.

What does your “typical” patient look like at the NCC and how has your work informed your research?

Patients typically arrive at the NCC with an advanced stage of disease – 70 percent of these women have progressive forms of cervical cancer. Of course it is not easy to work with patients who are this far along, especially if we are unable to offer full palliative services. As the only cancer center in the nation, just 10 gynecological oncologists are available to take on the high demand for treatment services. Healthcare providers and policymakers designed the Mongolian Cervical Cancer Program to address the alarming incidence rate. My research analyzes behavioral change before and after the introduction of the national screening program, bearing in mind my experiences with my own patients.

What does the national cervical cancer screening program facilitate? 

Local doctors and midwives received training on how to administer cervical cancer screening.

Before the program was implemented, regular cervical cancer screening did not exist in Mongolia. The program diffused and strengthened primary care screening services (Pap test) as well as prevention programs. Gynecological doctors from the NCC were systematically dispatched to the 338 soums or districts throughout the nation. They trained local doctors and midwives on how to administer the Pap test.  The program coordinated two initiatives: a pilot HPV vaccination program for girls aged 11-15 years from four select areas and a Pap test program for women aged 30-60 years. The women and girls who participated are urged to get screened every three years thereafter. Health education campaigns were also broadcast on select television and radio programs targeted at women and girls.

Comparing a survey taken at the program’s outset in 2010 to your survey at the program’s conclusion in 2013, what behavioral changes have been observed?

Our preliminary results have shown increased knowledge about risk factors and screening services. Women in both rural and urban areas are now more informed about cervical cancer risk factors. Awareness of the need for a Pap test increased from 15.3 percent in 2010 to 45.3 percent in 2013. The respondents also reported being more educated about the suggested frequency of visiting a doctor, and the availability of services outside of Ulaanbaatar. Due to increased knowledge, 54.2 percent of the women surveyed confirmed that they had attended cervical screening services.

What impact did the program have on younger generations?

We analyzed mothers’ attitude toward the HPV vaccination and their openness to their daughters receiving it. Awareness of the vaccine’s ability to prevent cervical cancer improved from 15.3 percent in 2010 to 45.3 percent in 2013. Our results show that 81.7 percent of mothers agreed on the importance of vaccination for their daughters once they become aware of the option. The same study conducted in 2010 showed only 28 percent of the respondents were aware of the vaccine’s existence and its connection to cancer prevention. Positive perceptions toward vaccination are very important because the vaccine can prevent one of the major causes of cervical cancer.

How were geographical divisions and local stigmas toward cancer considered?

An example of a poster that advertises cervical screening now found in local clinics.

Mongolia has 21 aimags or provinces further divided into numerous baghs or villages; each population has different priorities. Cultural relevance is key in advertising and implementing cancer screening and vaccination programs. For example, the program sought out input from local women’s and community groups in each aimag to inform about local customs. Cervical cancer screening was also linked to important events in a women’s life, i.e. becoming a mother or grandmother, to make it easier for the patient to validate resources spent. The program also set up a system of sending personalized invitations for screening during patients’ birthday months every three years.

What secondary reinforcements were used to campaign for cancer screening?

Media and targeted marketing were used to strengthen the message outside of the doctor–patient setting. Printed materials were placed in family practice clinics. The first lady of Mongolia generated media attention regarding the HPV vaccine for young girls. Beyond individual counseling, group awareness and other reinforcements can motivate participating women to follow treatment recommendations and reinforce satisfaction. The hope is that these women will then encourage other women to get screened.

Gendengarjaa will present her research with Naranbaatar Dashdorj, founder and chairman of the Onom Foundation and a 2014 Sloan Fellow at the Stanford Graduate School of Business, on April 9. The event is open to the public; more information can be found by clicking the link below.

In a March 22 interview with the Seoul Shinmun newspaper, KSP associate director David Straub discussed the U.S. role in bringing together South Korean President Park Geun-hye and Japanese Prime Minister Abe in a trilateral summit with President Obama to address the North Korea problem.

Anja Manuel and Lauryn Williams assess the impact of the India-U.S. nuclear deal, which is now in it's 8th year. They argue that it has been hugely successful for the environment and India-U.S. relations, but mixed on the issue of nonproliferation. 

Michelle Obama promoted study abroad programs during a speech at the Stanford Center at Peking University in Beijing on Saturday, then encouraged Stanford and local high school students sitting in Palo Alto to be "citizen diplomats" during a high-tech videoconference.

In her remarks before the conversation with students, the first lady said that study abroad is a "vital part of our foreign policy."

"Study abroad is about shaping the future of your countries and the world we all share," she said.

Studying in a different country gives students the chance to immerse themselves in another culture, she said.

"That's how you realize that we all have a stake in each other's success – that cures discovered here in Beijing could save lives in America," she said. "That clean energy technologies from Silicon Valley in California could improve the environment here in China; that the architecture of an ancient temple in Xi'an could inspire the design of new buildings in Dallas or Detroit."

Obama spoke before an audience of 170 students, scholars, and alumni at the Stanford Center at Peking University (SCPKU) in Beijing – her only scheduled public appearance during a trip to China with her daughters.

"Two great universities, two great countries. The symbolism behind this event is truly remarkable," said Xinkai Mao, MBA '14. "My wife went to PKU and I go to Stanford. What a connection!"

Mao attended the event with Stanford Graduate School of Business classmate Paul Chen, MBA '14. Both lead a China study trip for fellow students starting Sunday.

Max Baucus, Washington's ambassador to Beijing, and a graduate of Stanford and the university's law school, reinforced Obama's message of personal learning and diplomacy, recounting his own exchange studies in France.

"I am standing here because of my experience at a study abroad program," he said.

Thirty-five years after the normalization of relations with China, the U.S. is supporting more American students in China than in any other country in the world.

"We're sending high school, college and graduate students here to study Chinese," Obama said. "We're inviting teachers from China to teach Mandarin in American schools. We're providing free online advising for students in China who want to study in the U.S. and the U.S. China Fulbright program is still going strong with more than 3,000 alumni."

The largest group of foreign students enrolled at Stanford today are Chinese – 860 students, up from about 600 two years ago.

"You can't learn what the First Lady is talking about only through books," said Chien Lee, BSMS '75, MBA '79, a former Stanford trustee and SCPKU's lead donor. "You have to have an in-person experience. That's what helps you appreciate the subtleties and differences. The center provides a place for people to have that exchange."

Milestone for SCPKU

The first lady's visit came the day after the second anniversary of SCPKU's opening. The center made Stanford the first American university to construct a building for its own use on a major Chinese university campus. 

Obama's conversation with students sitting at Stanford's campus showcased the "highly immersive classrooms" at SCPKU and the Graduate School of Business. The rooms are identical, and use high-definition video technology to give participants in both locations the feeling that they are in the same room. The rooms will be used to conduct seminars between scholars at Stanford and PKU, and will also be used by the business school to expand the reach of its faculty.

Michelle Obama with Stanford students at the Stanford Center at Peking University in Beijing.

Michelle Obama with Stanford students at the Stanford Center at Peking University in Beijing. Photo Credit: Stanford University

The classroom features a curved wall of video screens and allows seamless conversation and real-time data sharing with participants on different continents.

"Through the wonders of modern technology, our world is more connected than ever before," Obama said. "Ideas can cross oceans with the click of a button. You don't need to get on a plane to be a citizen diplomat. If you have an Internet connection in your home, school or library, within seconds you can be transported anywhere in the world and meet people on every continent."

Sitting in the immersive classroom at SCPKU, Obama encouraged students to use all the resources at their disposal to become well-informed global citizens and decision makers, and to enrich the relationship between the U.S. and China.  

"The creation of a global citizen is a critical mission of the great universities in modern times," said alumnus David Chao, MBA '93, who manages a global venture capital firm and attended Obama's speech.  "When you have a global citizen with empathy, someone pushing the nuclear button is highly unlikely. It's especially relevant, when you see what's going on in Ukraine right now with people refusing to talk."

From neurology to energy and art

Stanford and Peking University have a long and growing collaboration that began with scholarly exchanges in the 1970s and student exchanges thereafter. 

In remarks welcoming the first lady, Mariano-Florentino Cuéllar, the Stanley Morrison Professor of Law at Stanford Law School and Director of Stanford's Freeman Spogli Institute for International Studies, spoke of SCPKU's mission and its relationship to China's elite Peking University, also known as Beida.

"Stanford scholars – like their counterparts at Beida – are constantly seeking a deeper appreciation of different societies and their histories," Cuéllar said. "That leads to stronger relationships –geographically, politically and culturally. We are striving for a world that is ever more capable of transcending its differences. Stanford's special relationship with Beida is a shining example of these ideals."

Nine Stanford teaching and research programs, including the School of Medicine's Asian Liver Center, the Bing Overseas Studies Program, and the Graduate School of Business, have located operations at SCPKU. Seventeen faculty fellows from departments as diverse as neurology, art, bioengineering and music, have conducted research at the center. SCPKU has also hosted 32 workshops or seminars on topics as varied as "Leveraging PCs to Advance Learning in China's Rural Schools," "Energy in China," and "New Urban Formations: Comparative Urbanization."

The first cohort of 20 Stanford undergraduates to study at the center will arrive for their 10-week program March 31. The center already has been home to a meeting of U.S.-China officials discussing North Korea's nuclear program and a conference of electrical engineers reviewing Technology Standardization. China 2.0, a forum on venture capital and entrepreneurship organized by the Graduate School of Business, will be held at the center April 11.

The future

Looking ahead, SCPKU aspires to tackle intellectual questions that address not just the political economy and culture of China, but also the challenges that arise as China engages other parts of the world in trade. China's geopolitical interests and actions in Latin America, Africa, South Asia and Southeast Asia are all important questions that Stanford faculty want to address. "The center can and should be a research destination for Stanford faculty whose work touches on China but is not necessarily solely focused on the country or region," said Jean Oi, professor of political science, director of SCPKU, and a driving force behind the center's creation.

As SCPKU activity and scholarship continues to evolve, technology also will allow its intellectual content to reach a wider audience beyond the Beijing campus.

Barbara Buell is the communications director for Stanford's Graduate School of Business.