Medical guidelines

Contraception guidelines

Guidance on contraception changes frequently, and I find the attached UKMEC guidelines really helpful to assess the risk of each contraceptive.

My take home messages are

  1. start contraception as soon as possible to prevent pregnancies. Please don’t wait until the patient’s next menstruation (which was previous advice). None of the hormonal contraceptives will adversely affect a pregnancy but delaying starting contraception places a woman at risk of an unwanted pregnancy.
  2. any type of migraine is now a potential contraindication to COCP. Previously only migraine with aura was felt to be high risk.UKMEC


Hi everyone, I am Francis M. Chilufya a Clinical Officer General based at Chipapa Rural Health Centre Kafue District Lusaka province. I am honoured to be part of this very important program.
Let’s go guys and improve the quality of health care we provide to our people.



Hello everyone, My full names are Chongo Ng’ona Kabungo, a clinical officer general based at Matua rural health centre, in Siavonga, southern part of Zambia.
I have a very brief testimony to give about the virtual doctors, though brief, I feel it’s important I go ahead a write it.
About March earlier this year, my late aunt, alive then got very ill. We had tried to take her to a number of clinics and hospitals, but nothing satisfactory was been done. So i decided to create a case for her on the virtual doctors application. Some options where given on the possible solutions to our patient. She later past on with non hodgkin’s lymphoma and other seconding factors. My testimony is the doctor on virtual doctors advised to do some scans, others for cancer, though we did it late,it was a worth while call.
So the virtual doctors to me is more of a learning and exploration tool on how I can manage the patients that I see and in the long run would help reduce on the cases of referring to the district hospital as the management of some case would have been discussed and known the management to heart.
Thank you for your time, best regards ????


Hello Vdrs

My full names are Chongo ng’ona kabungo, im the last born in family of all five men. I,just like many others, am a clinical officer general based at Matua rural health centre. My job at this facility is to make clinical judgements of the patients that we receive at our facility and treat those cases that are of to my knowledge. In this regard, VDRS come very handy as I get to learn and explore other options that I can take to manage certain cases that I find interesting to share. In a nutshell, this is what I can say about myself,
Best regards all ????

Case for discussion


ASCO: Alcohol Is Cancer Risk

First-time Statement

Nick Mulcahy
November 08, 2017
For the first time, the American Society of Clinical Oncology (ASCO) has formally stated that alcohol drinking is a risk factor for multiple malignancies and is potentially modifiable.
Furthermore, the organization believes their new “proactive stance” to minimize excessive alcohol intake has “important implications for cancer prevention.”
“Even modest use of alcohol may increase cancer risk, but the greatest risks are observed with heavy, long-term use,” write the ASCO statement authors, led by Noelle LoConte, MD, from the University of Wisconsin-Madison.
“Therefore, limiting alcohol intake is a means to prevent cancer,” Dr LoConte said in a statement. “The good news is that, just like people wear sunscreen to limit their risk of skin cancer, limiting alcohol intake is one more thing people can do to reduce their overall risk of developing cancer.”
ASCO’s statement, published online November 6 in the Journal of Clinical Oncology, has received widespread coverage in mainstream media.
“The message is not, ‘Don’t drink.’ It’s ‘If you want to reduce your cancer risk, drink less. And if you don’t drink, don’t start,'” Dr LoConte told The New York Times. “It’s different than tobacco, where we say, ‘Never smoke. Don’t start.’ This is a little more subtle.”
ASCO encourages oncologists to join their efforts: “Oncology providers can serve as community advisors and leaders and can help raise the awareness of alcohol as a cancer risk behavior.”
However, the organization also says there is “low physician knowledge of alcohol use and cancer risk.”
The general public also has low awareness. In a recent poll conducted by ASCO, 70% of Americans did not recognize drinking alcohol as a cancer risk factor, as reported by Medscape Medical News.
“People typically don’t associate drinking beer, wine, and hard liquor with increasing their risk of developing cancer in their lifetimes,” said ASCO President Bruce Johnson, MD. “However, the link between increased alcohol consumption and cancer has been firmly established.”
In its statement, ASCO notes that alcohol consumption is causally associated with oropharyngeal and laryngeal cancer, esophageal cancer, hepatocellular carcinoma, breast cancer, and colon cancer. However, alcohol may be a risk factor for other malignancies, including pancreatic and gastric cancers.
In total, ASCO estimates that 5% to 6% of new cancers and cancer deaths globally are directly attributable to alcohol.
A variety of causative mechanisms may be at play, depending on the particular cancer. Perhaps best known is the effect of alcohol on circulating estrogens, a pathway with relevance to breast cancer.
The American Heart Association, American Cancer Society, and US Department of Health and Human Services currently recommend that men limit intake to one to two drinks per day and women to one drink per day.
However, the ASCO statement authors observe that a meta-analysis found that one drink per day or less was still associated with some elevated risk for squamous cell carcinoma of the esophagus, oropharyngeal cancer, and breast cancer (Ann Oncol. 2013;24:301-308).
Defining risk-drinking can be “challenging,” say the statement authors, because the amount of ethanol in a drink varies depending on the type of alcohol (eg, beer, wine, or spirits) and its size.
Conflicting data about the impact of alcohol, especially red wine, on the heart is an “additional barrier” to addressing its related cancer risk. But recent research (Addiction. 2017;112:230-232) has cast doubt on those positive health claims studies, revealing multiple confounders, including frequent classification of former and occasional alcohol drinkers as nondrinkers, say the statement authors.
ASCO says that it joins a “growing number” of cancer care and public health organizations that support strategies designed to prevent high-risk alcohol consumption. Its statement offers evidence-based policy recommendations to reduce excessive alcohol consumption, as follows:
Provide alcohol screening and brief interventions in clinical settings.
Regulate alcohol outlet density.
Increase alcohol taxes and prices.
Maintain limits on days and hours of sale.
Enhance enforcement of laws prohibiting sales to minors.
Restrict youth exposure to advertising of alcoholic beverages.
Resist further privatization of retail alcohol sales in communities with current government control.
Include alcohol control strategies in comprehensive cancer control plans.
Support efforts to eliminate the use of “pinkwashing” to market alcoholic beverages (ie, discouraging alcoholic beverage companies from exploiting the color pink or pink ribbons to show a commitment to finding a cure for breast cancer given the evidence that alcohol consumption is linked to an increased risk for breast cancer).

Case for discussion


Hi. I’ve been referred a few cases of scabies over the past year, so thought some information on it may be helpful.

You should all be able to open this document on your mobile phones. If not, please WhatsApp me




Good morning vdrs.
My name’s are Michael Phiri working at an urban clinic of Siavonga(kariba).i love virtual doctors it helps me reduce on cases dat I regere to the district hospital. One of the challenges I gave is I usually receive few cases to send as pipo with very difficult cases can jst walk to the hospital.i look forward to receiving a lot of cases so dat I can learn more and be able manage complicated cases from this forum.
I thank you.




Hello everyone my name is Tony malagisha a clinical officer at kasinsa rural health centre in luangwa district. Using the VD app has been a great experience so far, hope that together we can continue improve the app to provide better services to our clients


Francis Hamuleya – COG

Francis Hamuleya is a Clinical Officer General in Lower Zambezi Area in Chieftaincy Chiawa area in Kafue distrct

Am one of the users of the VDRs app and it has been of great help in managing some cases.

It has been great to have a family of you guys that are keen seeing a health rural Zambia..

Am humbled and grateful to be one of those using this app, please continue supporting and how I wish it will spread to whole country..




I am Grader Sialwiindi, Clinical Officer operating at Chikupi uHealth Centre under Kafue district. CO
It’s indeed been a pleasure and full of interactions on the Virtualdoctors forum. I look forward to more of the sharing.