The last one (no, really)

PINCC volunteer NP Christella Guzman celebrates with hospital nurse
Rosita Sifuenta Yanac at the end of our day today in Lima.

Penultimate trip post ... Really

Closing meetings and lunch today in Lima, where six gynecologists were
trained today.

The End

Hope you enjoyed following our progress throughout 3 countries.

If you're a new visitor, please read the older posts to get a sense
of our last three weeks.

We're back at the hotel, and this iteration of Team PINCC is
scattering to various places.

Please stay tuned to this blog for more PINCC updates.

-- Larry Shushan

How I got the blog posted today

You think this is easy?

In this giant, city-block-sized complex, I couldn't find a wi-fi
signal anywhere. But I knew there had to be a router somewhere. It's
just way too modern to not have one, I was certain. (My phone is in
"airplane mode" to avoid huge data roaming charges.)

With my miserable Spanish and my iPhone in hand, I wandered the halls,
courtyards and departments, trying to be sure to remember how to get
back to my little space where I'm processing patient info onto a
spreadsheet.

I was in a maze and on a mission.

I walked into a random office and managed to get the woman behind the
desk to understand that I needed a wi-fi signal.

She took me to another office, where a doctor was giving dictation to
an assistant. After I apologized for interrupting, the assistant
delivered me to another nearby office that looked like Mission Control.

This was clearly the communication nerve center, where the hospital
computer nerds kept everything humming. There were many computers and
all manner of high-tech equipment, including state-of-the-art
teleconferencing equipment for two-way audio/visual consults with
hospitals all over the country.

There, a young, sympathetic-looking guy watched my struggle to
communicate with an awkward combo of poor Spanish and pantomime before
asking me in English whether I was looking for a wi-fi signal.

:-)

He had me follow him up a narrow spiral staircase to a beautiful
conference room in the process of being mysteriously decorated with
orange and white balloons.

He walked over to the huge flat-panel TV, looked behind it, unplugged
the glue-gun that someone had plugged in to hang balloons, and plugged
in the router.

In seconds I had the signal.

Then the password prompt came up, and my new friend provided the
critical information I needed. Voilà! Blog entry posted!

-- Larry Shushan

Photos: The Institute's logo, and a group of nurses helping PINCC
today. From left: Rosa Sifuenta Yanac, Flor Guerrero and Carmen
Espinoza.

Our last day: Training the trainers at the Instituto Nacional Materno Perinatal in Lima

After an excellent but exhaustingly long day Thursday at Medisol
training six midwives and Pathfinder Medical Director Dr. Enrique
Guevara, and seeing more than 50 patients, we're back today at the big
national institute for our last day of work. (Pathfinder is the NGO
PINCC is working with in Peru.)

The Instituto is a big, hectic, medically sophisticated place, where
there are scores of patients waiting in long halls with rows of seats
facing the same way, three across.

Originally built in 1826, it's been updated and expanded repeatedly
over the years.

Our job here is to train several OB/GYNs in visual inspection with
vinegar (acetic acid) and in cryotherapy so they can, in turn, train
their OB/GYN residents and midwives to work in outlying clinics where
neighborhoods are poorer and often without resources for either
examinations or treatment.

The VIA technique (or IVAA, as it's called in Latin America) and
cryotherapy treatment for patients with exams showing smaller pre-
cancerous lesions caused by HPV, are techniques that haven't been used
here. In the former case, VIA will add a new, inexpensive and
effective examination tool. In the case of cryo, the doctors' arsenal
will be expanded to include a less extreme treatment method for minor
pre-cancerous lesions.

In six months, when PINCC returns, we hope to continue training
medicos and expand to a total of 3 outlying clinics.

-- Larry Shushan

UPDATED: Reader beware: This isn't a pleasant item

There's an invisible secret lurking around the poor, tough
neighborhood on the outskirts of Lima where we were yesterday and are again today.

It speaks of tragic consequences for its victims, and has caused
sadness for PINCC's American team visiting here to train Peruvian
medicos to prevent cancer.

In the United States, the generally accepted statistic is that
something like one in four women can recollect at least one episode in
their younger days when an older boy or man did something ranging from
inappropriate sexually to criminally abusive. It could be a family
member, a friend or a stranger, but all have been left with at least
unpleasant memories; some have suffered deep wounds.

Here in Lima, at the Medisol clinic in the Villa Maria district, our
patient intake people encountered women who at the slightest
provocation or simplest question would break down and tell of rape or
other sexual abuse as young children or young women.

In fact, of 25 women seen Wednesday, 12 told of abuse. (Thursday's numbers seem lower.). One, a 65-year-
old, said she had never been married because of her bitter experience
as an 8-year-old, attacked on the street. Scarred for life.

One interviewer had five of her first six patients tell such stories,
some sobbing at the opportunity to confide in someone they will likely
never see again.

It left us shocked, and we left wondering
how and why the numbers were so high..

All the women who acknowledged such things were offered counseling on
the spot through the clinic.

A sample this small can't be used to create a valid generalization,
but in our small group of patients Wednesday, the statistic was nearly
double what we find in the U. S.

This wasn't an expected revelation.

-- Larry Shushan

You think people drive "loco" where you live?

Picture big traffic jams everywhere you look. Now imagine that there
are no controls of any kind at almost any intersection.

That's right: no stop signs, no yield signs, no traffic cops -- zip,
nada, nothing. (And when there are controls, they're mostly ignored,
except for the occasional speed bump.)

Now take away any recognition of the pedestrian as worthy of
consideration.

Still with me?

OK, now imagine that every driver at every intersection is focused
entirely on psyching everyone else into thinking he (really, it's
nearly all male drivers) is going to seize the right of way no matter
what. And everyone actually follows through on that unstated threat
all at the same time, backing off only at the last instant -- but only
if absolutely necessary, with one car an inch or two from the one
alongside or crossing another's path. Gridlock means success, because
you, the driver, stopped the other guy from going ahead of you!

Now throw in constantly blaring horns and screeching, whining brake
sounds of widely varying pitch and dissonance that punctuate the air
for no reason other than that a car, bus or truck is in motion.
Sounds like an orchestra run amok with no conductor in sight.

Finally, remove any evidence of frustration or road rage: Everything
I've just described is just accepted as normal, and nobody seems upset
or stressed. Somehow, it all just moves, and people get to wherever
they're going. Even pedestrians take things in stride, dodging,
weaving, timing their next moves at just the right instant. And
they're always honked at.

That's Lima's traffic, especially in the morning, at lunchtime, after
work and, well, pretty much all the time except when people are
asleep. And then it's just fewer vehicles moving much faster.

And in four days, I haven't yet seen an accident. And, even more
interesting is that already, we're all de-sensitized to it even when
we're in our bus heading to a clinic. Amazing.

-- Larry Shushan

Three midwives from Medisol in Lima who have trained with us today

From left: Magali Nole, Patty Arroyo and Rosa Esteban

Medisol lat/lon coordinates

For you Google Earth fans:

S 12 09.986
W 76 56.833

Reviewing a difficult patient history

Volunteer Pepper Chastain (right) and CNM Carol Cruickshank talk about plans
to help a patient whose history includes sexual abuse from an early age.

Where we are right now

Anybody out there with $10,000 for a LEEP machine?

If you can contribute to PINCC to help buy a new LEEP machine to cure
women of pre-cancerous abnormalities of the cervix, please contact
PINCC at admin@PINCC.org.

Any contributions will be extremely appreciated! (Our new fuses got the machine we have to work, but it is still not working reliably).

Thank you.

Photo shows flyer distributed in the Lima area to attract patients to
PINCC's free screening at the Medisol clinic.

PINCC finally up and running in Peru

After some frustrating false starts on Monday and Tuesday in Lima, our team finally began its work seeing patients and training local medical personnel early Wednesday at the outlying Medisol clinic run by a Peruvian non-governmental organization called Pathfinders.  This is the group PINCC coordinated with to come to Lima in the first place.

Monday, we met with the head of the highly sophisticated and huge maternity and perinatal hospital, but ran into some surprises when we went to set up at the gynecology clinic, where specialists were already seeing their own patients, most of whom were not candidates for PINCC's visualization exams.  Most of the women were seeing their gynecologists for all kinds of reasons, and, in spite of arrangements having been made at the administrative level, we were clearly not expected.

Even without patients, though, our OB/GYN resident Dr. Emily Corrigan and our trip medical director and OB/GYN Dr. Melissa Miskell trained 6 senior gynecologists on the LEEP machine until it blew a fuse.

Then on Tuesday, we had another day that went somewhat awry because we had a few patients who wanted to be seen but no medical staff to train.  Nevertheless, the hospital administration took most of our group on a tour of the hospital while your correspondent went on a breakneck- paced search on foot for new fuses for the LEEP.  That search, led by a local doctor, was successful.

After the tour, we cleared out early, and that departure sparked an urgent meeting with hospital brass to make sure they understood PINCC's operating practice and how it can fit in with the hospital's setup. They had apparently not understood the difficulties we had encountered the day before and on Tuesday morning.

Wednesday and Thursday, as a result, have been designated as training days for midwives at the outlying clinic, and we'll be back at the hospital for another try on our last day here, Friday.

The stark contrast between two weeks ago in San Salvador versus Lima this week illustrates how things evolve with PINCC's model.

In San Salvador, it was PINCC's ninth trip, and the Health Ministry has become not only a huge supporter but a major partner as well.  (Please see my earlier blog posting.)

There, senior people from the government literally help us run the clinical operations, providing nurses and doctor for training, exams and treatment -- which results in hundreds of women being served and dozens of lives being saved.

Here, in Peru, PINCC -- while invited to come -- is an unknown quantity, and an adjustment period is needed as both sides learn each other's systems and look for ways to work together successfully.

In spite of the situation at the hospital, the team of volunteers had no problem shifting gears and setting off in all directions to explore, shop, eat Peruvian food, shop, sightsee, shop again, and even catch up on sleep.

The politics were left to be resolved by Melissa (who has now been on three continents for PINCC) and trip administrator Carol Cruickshank, whose local cultural understanding and eternal optimism and endless patience combine to move things forward.  (Carol has lived in both Peru and Nicaragua.)

-- Larry Shushan