Saturday, May 29, 2010
Friday, May 28, 2010
demonstrates the LEEP procedure to Nicaraguan doctors and nurses;
PINCC OB/GYN Dr. Kenya Numan performs a LEEP with CNM Lyell Fox
assisting; and PINCC Director Dr. Kay Taylor performs a LEEP procedure
with NP Cheryl Brown assisting.
working this October with one of just two medical teaching hospitals
The new program will be at the Hospital Escuela Oscar Danielo Rosales
Arguello (HEODRA). Leon (which has an accent over the "o") is the
country's second largest city.
Beginning with a 7 a.m. shift change lecture by PINCC Director Dr. Kay
Taylor for 30 residents and attending physicians about cervical
cancer, visual inspection with acetic acid (vinegar), and PINCC, our
team then moved on to a clinic to treat 9 patients hand-picked by the
Of the nine, six needed LEEP procedures and one needed cryotherapy.
So in just one day with very few patients, seven lives were saved
because the womens' pre-cancerous lesions were properly treated.
The hospital relied on the PINCC LEEP machine today because they're
missing two important parts for their machine, and their cryotherapy
setup is broken. So they have been treating patients with an outdated, more radical procedure in the meantime.
The future program will train dozens of doctors and nurses to examine
and treat Nicaraguan women, saving lives by using the simple protocol
PINCC uses. Increasing the number of in-country medicos skilled in
this technique -- and donating needed equipment -- will particularly
help women in outlying areas where help is often nonexistent and death
rates from cervical cancer are among the highest in the world.
(Watch for an upcoming post for photos of today's procedures.)
-- Larry Shushan
stop a major volcanic eruption.
Legend has it that the eruption stopped.
Ever since, in times of crisis and on August 15th and in December,
altars are set up for prayers to "Santa Maria."
Now is one of those times of trouble, with extremely heavy rains
plaguing the surrounding countryside right now. (The resulting
flooding has wiped out homes, killed animals and ruined highways like
the one we were on yesterday!)
This altar is in the hospital maternity ward.
Thursday, May 27, 2010
successful. Not only does he get us from one place to another safely,
he also looks after us when we're walking in strange places and don't
have the cultural "street smarts" we need. Carlos is always with us
in Nicaragua, and we can't imagine anyone else playing his role.
Team PINCC safe in Leon after slogging through a flood! Front page national news in Nicaraga; road no longer passable
for small fish to the left of the flooded highway. (And catching
After 48 hours of heavy rains, a nearby river overflowed its banks,
flooding houses, farmland and orchards to our right.
Here you see the lead van all the way over on the wrong side of the
highway pushing through the high, rushing water.
That turbulence to the left of the van is water rushing over the
highway's edge like a waterfall. We had no idea how deep it was to
the right so we stayed on this course until we were through it.
-- Larry Shushan (driver of the following van!)
helping women, I think about how this trip helps me recognize what we
have back home and what "standard of living" really means.
We Americans tend to have so much. And we get frustrated when our
paved streets have potholes. Or when the bus is five minutes late. Or
the car has a flat. Or the drain is clogged. Or the cellphone drops a
call. Or Safeway runs out of Cheerios and we have to settle for one of
the 102 other cereals on the shelf.
People here have no opportunity to have such worries. Because they
have so little. They walk everywhere or share a bike because there
are no cars or public transportation.
In this village near the Honduran border, I take pills to ward off
malaria, I apply mosquito repellent frequently to try to avoid Dengue
Fever, and I complain because Ultrathon with 30 percent Deet is greasy
and can stain my clothes and damage my plastic gadgets (like the
iPhone I'm writing on).
Our hotel here in Jalapa has only cold water, and only every other
day. I have to fix or fill the tank on the toilet from a bucket every
time I want to flush it. At home, I'd run to the hardware store and
replace the broken flapper; here, no such luck.
Staying in a "hotel," though, at least we HAVE a toilet. Many here
The "paved" streets are strewn with rubble and huge rocks, marred by
holes, muddy ruts, horse manure, and running creeks, prowled by
skeletal dogs that people treat like vermin. Some former streets just
aren't useable anymore. Money for repairs is out of the question, so
now they're footpaths.
When I hear the charming clip-clop sound of the donkey-drawn cart with
mismatched, bald tires, I have to remind myself that the cart driver
and his son would much rather be driving a pickup truck.
A scorpion in the bathtub, a mosquito carrying a deadly disease,
starchy food in meager quantities, walking or biking to every
destination -- all part of everyday life for Jalapa residents.
Food you want because you actually like it? How about just whatever
there is, whenever it's available? Dinner the other night was red
beans, chunks of boiled banana (plantain), half a hard-boiled egg each
and a slice of white bread. (I realize there are many hungry people
back home, but this is different: I'm not aware of entire communities
of thousands of people living in utterly impoverished conditions, with
no hope whatsoever for effecting change.)
Plenty of people here have extremely limited access to health care,
and the access they have is to care that even poor Americans would
find simply unacceptable. Imagine walking into any American emergency
room and finding that the place has soiled sheets, broken or missing
basic equipment, few staff, and certainly none of the specialists we
take for granted.
Need a gynecologist? Sorry, but she has been transferred to another
place where the need was deemed greater. Something like 10 of the 12
health centers in this province are shuttered because there aren't
enough doctors or nurses to go around.
Cardiologist? Neurosurgeon? Orthopedist? Allergist? Endocrinologist?
You're kidding, right?
Women may have a pap smear here but never get the results. Their kids
may die of diseases we never see in the U.S. because they've been
eradicated. Sometimes parents can't afford the vaccine. Sometimes the
vaccine simply isn't available. I could go on and on and on.
The next time I'm home, I hope to be able to have my sense of
appreciation deepen and last longer, and I hope my memories of the
warm, wonderful people I've met here -- and the struggles they face
all the time -- remain more indelibly a part of my ongoing awareness
of what the world is like in so many places beyond the small part of
it where I live a very comfortable life.
-- Larry Shushan
Wednesday, May 26, 2010
Kenya Numan review flashcards showing cervical abnormalities revealed
by the visualization technique using ordinary vinegar that PINCC is
teaching doctors and nurses in nine developing countries on three
continents. (See www.PINCC.org ond www.facebook.com/PINCC for more
arrived before 8 o'clock.
PINCC volunteers swung into action:
Nurse practitioner Jane Stringer trained Jalapa nurses (second photo
from top); physician assistant Nikki Chokshi takes a patient's
history; nurse practitioner and certified nurse midwife Lyell Fox also
interviews a patient before examination; and nurse practitioner
Christella Guzman sets up PINCC's cryotherapy equipment for those who
will need that type of treatment.
Tuesday, May 25, 2010
Monday, May 24, 2010
mayor) Dr. Elvia Violeta Menjivar held an award ceremony and news
conference to thank and recognize PINCC's service to the women of El
Salvador as we wrapped up five days of clinical work in that country
before moving on to Nicaragua on Saturday.
PINCC Director Dr. Kay Taylor awarded certificates to several local
doctors and nurses, and Vice Minister Menjivar gave certificates to
each member of the PINCC team.
PINCC also donated two cryotherapy sets and a biopsy tool, equipment
that can be pressed into service immediately by the newly certified
Afterwards, the Vice Minister spoke to the media, thanking and
praising PINCC's work effusively. The interview appeared extensively
in El Salvador in print and on radio and television.
have begun our work in Jalapa, a tiny town in the Department (state)
of Nueva Segovia in Nicaragua. (For those who love Google Earth, the
lat/lon coordinates of the actual clinic are N 13 54.030' and
W 086 07.437').
We arrived at the clinic this morning and got set up, dealing with the
usual first-day issues of coordinating with the local doctors and
nurses. By tomorrow, we'll be running more smoothly, and we'll see
far more patients than today (18).
-- Larry Shushan
Photos: (from top) A little girl of about 6 or so refuses to smile
broadly lest she show her missing teeth. She laughed and smiled
constantly, but as soon as the camera turned anywhere near her, she
locked eyes on the lens, but clammed up. Charming, nevertheless;
PINCC volunteer Rajaa Numan, daughter of PINCC OB/GYN Kenya Numan,
interviews a patient prior to an exam; and a three-generation family
await their turn to be called so mother and grandmother can be
examined by the clinic doctor being supervised by a medico from PINCC.
Sunday, May 23, 2010
early at the same clinic where PINCC's team first visited last November.
The roads were good all the way, but toward the end were filled with
pedestrians, bicycles, dogs, chickens, the occasional horse or donkey
-- all in the dark with no lights but our headlights. Slow, but safe,
We're here at Hotelito #1 for four nights. Everybody is in the
combination dining room / karaoke bar enjoying chicken soup and
tortillas while local townsfolk sing their hearts out.
I will still be writing about last Friday in San Salvador, where the
Ministry of Health held a big press conference and recognized PINCC's
team (and, of course Dr. Kay), awarding certificates of recognition to
each of us. PINCC, in turn, donated two cryotherapy sets to save
womens' lives for a long time to come.
Please pass along this blog address to your friends and relatives, and
spread the word about the amazing things PINCC is doing in 9 countries
on 3 continents.
More later ...
-- Larry Shushan
Saturday, May 22, 2010
A 33-year-old woman with five children was found to have stage 2
cervical cancer by one of our team members. In our nurse practitioner
Cheryl Brown's 13-year career, it was only the second cancer she'd
found during an exam.
For all the preparation we have before traveling with PINCC, it still
felt like I was punched hard in the stomach when I heard the news. I
choked up. And for some reason the weather turned dreary for the only
time in the week, with a brief period of lightning and loud thunder.
The patient's tumor has grown slowly, probably for about 20 years. Do
the math as to when she was infected with the virus that causes
The patient took the news stoically at first, then burst into tears.
The news for us was especially frustrating, and exemplifies why
PINCC's work is so critically important.
The patient told us she had a pap smear 7 years ago, but never got the
results. The medical professionals on the trip tell me her pap would
have almost certainly shown pre-cancerous tissue on the cervix. This
cancer could have been prevented, and that's why prevention is the
first word in PINCC's name.
She was referred yesterday to the country's ONLY gynecological
oncologist. Even with a fast-track referral from our high-profile
visit (more about that later), her future looks challenging. She may
see a cure, but it'll be a tough road in any event.
In the U. S., there are at least hundreds of specialists in
gynecological oncology. Wealthy Central Americans fly to L.A., Miami,
Houston, New York or elsewhere for treatment. No such luck for our
patient. She has one option, and we can only hope for the best for her.
Our 319 patients in El Salvador yielded 3 cancers. That's just a
hair under 1 percent.
In the U.S., there are 2.2 cervical cancer deaths per 100,000 women.
In El Salvador the comparable statistic is 37 per 100,000.
In Nicaragua, where we're flying as I write this, the stats are even
We're going from a gritty, crowded city of 2 million to a rural area
with maybe 12,000 in the town we'll start in -- Jalapa (HA' LA PA).
El Salvador has limited resources for everything, but Nicaragua is the
second poorest country in the Western Hemisphere. We'll see what we
find in Jalapa, where PINCC has been before.
More later ...
-- Larry Shushan, PINCC Volunteer
Thursday, May 20, 2010
the cervical exam process with nurses at the San Martin Clinic (top
photo); RN Nora Sheedy explains what to expect to patients waiting to
be seen; OB/GYN resident Dr. Emily Corrigan walks through the LEEP
process with nurses; and PINCC Director Dr. Kay Taylor talks about
the finer points of cervical visualization with clinic doctors before
leading them in a quiz using flashcards.
Tomorrow we visit our third clinic in the San Salvador area -- San Jacinto.
Today we completed our second day at our second clinic (San Martin), and after an extremely busy day yesterday -- 107 women -- we're already up to a total of 275 women seen.
Just as impressive to me is the amount of training I've watched, with members of our team instructing local clinicians throughout the day in each exam room as well as sitting down in groups before patients arrive, after the day's over and every other chance they get.
You can watch confidence levels rising in the El Salvadorean doctors and nurses as they become more familiar with the visualization technique PINCC brings. Beyond confidence, though, you see expertise growing not only in performing examinations, but in providing cryotherapy or LEEP treatments, as needed.
275 women, 8 LEEP procedures, 18 cryos. Many more lives saved.
-- Larry Shushan, PINCC volunteer
Tuesday, May 18, 2010
131 women were seen at the Zacamil Clinic in two days, and all
experienced the simple visual, cervical examination relying on
ordinary vinegar that PINCC is using and training local medicos to
perform in developing countries on three continents.
One 38-year-old woman was found to have cervical cancer, but it was
caught early enough that she has a good chance for a cure. She has a
chance she simply could not have had without today's exam.
Another had a precancerous lesion serious enough to require removal
with a LEEP machine, which, in trained hands, delicately cuts out the
abnormal tissue while cauterizing at the same time. This one would
have become a life-threatening cervical cancer without today's exam.
Another 16 women had precancerous abnormalities serious enough to
require freezing with cryotherapy equipment, which was purchased with
donations and brought by PINCC from the United States for this mission.
That's 18 lives altered in mid-course in a way likely to have averted
My job on the trip includes processing the paperwork for each patient,
entering details into a spreadsheet that ultimately includes post-exam
results. I see every name and every result, and I see women coming
and going all day. As a non-clinician, though, I am never in a
position to put a name with a face.
But I'll always remember that 18 of the women I saw today and
yesterday -- along with the children many brought with them to the
clinic -- literally had their destinies changed because of this
medical mission I have the good fortune to be part of.
And many more will have their lives changed for the better because so
many of the local doctors and nurses now have skills and techniques to
save lives that they didn't have before.
And starting today, the clinicians at Zacamil will be able to perform
cryotherapy on their own after we've gone because PINCC donated a cryo-
gun, along with the training to use it.
-- Larry Shushan, PINCC volunteer in Latin America
(Photos: A nurse takes medical histories while women wait to be called
for their exams; another nurse distributes literature about what to
expect; and El Salvadorean gynecologist Dr. Julio Rosales performs
cryotherapy on a young patient at Zacamil Clinic this morning)
After wrapping up a second day of dozens of exams and treatments at
the Zacamil Clinic in the heart of San Salvador, PINCC staff and
volunteers spent time with their hosts and partners, teaching and
While PINCC Director Dr. Kay Taylor held a seminar with a group of
doctors (attended, as well, by some fellow PINCC volunteers), RN Nora
Sheedy and others on the trip talked with several local nurses about
what they'd learned throughout their two days of clinical work. The
nurses had just completed a multiple choice test to help stimulate
Monday, May 17, 2010
assistants and even a director from the national Ministry of Health to
provide free exams and treatment for 71 local women at the Zacamil
Clinic in San Salvador. Many of the women -- ranging in age from 15
to 81 -- had never before had a gynecological exam.
While most of the patients had normal exams, many -- including an 18
year old -- required cryotherapy treatment with a special "gun" that
uses nitrous oxide gas to freeze abnormal cervical lesions caused by
the human papillomavirus (HPV). The treatment dramatically reduces
the chances of the patient developing cervical cancer in the future.
In the photos (from top): volunteers and staff attend early
morning orientation; a young mother arrives with her son at the
Zacamil Clinic; and patients are interviewed for their medical
histories by Clinic staff prior to being seen.
Want to help support PINCC's work in Latin America, Africa and India?
Please go to www.PINCC.org, where a link to PayPal makes making a tax-
deductible donation easy.
Want to help by joining a future trip? Please email admin@PINCC.org.
-- Larry Shushan, PINCC volunteer