Friday, August 27, 2010

The Adventure Begins...Kisii 2010

As of now, we have been in Kisii for four intense, long, tiring,exhausting, crazy, hectic, chaotic....magical days. At this point, the team has (almost) seen it all. Visual Examinations, Cryotherapy, LEEP...HAIL IN name it, and we have already checked ( I mean, ticked) it off our list. Arriving from various jet-setter destinations around the globe, we met in Nairobi on Saturday, August 21st.

Our Team: Kenya, Carol, Monica, Rashmi, Raji, Renee, Rajaa, and Anu

From the get-go, trouble and his pal misfortune stared us in the face. One of our medical bags, which contained important supplies like batteries, gloves, and swabs was missing; probably stuck somewhere in Cairo! But of course, Carol, with her everlasting supply of patience and good will, kept calm, while urging Mike (the driver) to check up on the bag' progress. (Thankfully, on Tuesday morning, we had our bag and all of its sorely missed contents). On Sunday, we left Nairobi in a van, packed tightly with bags, equipment, suitcases, and, lastly, ourselves. And, after this 4 hour drive of picturesque views and varying weather patterns, we arrived in Kisii at the Ufanisi Resort, a place of untold comforts. Now, when you think of Africa, you probably think mosquitoes, dirt, no electricity, no running think that we all must be roughing it big time, reeking of bug spray, going without showers, and what not! The future may or may not hold that in store, but for now, we are enjoying the wonderful Kenyan food, hot water, and wonderful lodging. On the night of August 22nd, I know, many of us slept unsoundly...not because of a lack of comfort, but due to the agonizing anticipation, the excitement, and the uncertainty we were facing. Since this was PINCC's first visit to the area, we were unsure of what was in store for us on our first day.

Kisii level five hospital is used to seeing high risk cases: it didn't get that level five status for nothing. Standing resolutely in the hustle and bustle of kisii life, the hospital is fairly large with several floors and passageways galore. Here, in the Gynecological Clinic, we set up our supplies and the equipment. With 5 rooms for examinations and procedures, the team set to work on the long list of women who always appeared promptly in the morning, forming a line outside the door. The first day, Dr. Kenya and Dr. Rashmi practiced basic examination practices and worked with the nurses and Dr. Mutiso, the resident doc, to develop the skills that would transform these fledglings into lean, mean cervical cancer fighting machines. Though the first day saw very little of the more advanced procedures, the nurses were tested and lectured by Dr. Kenya, who handled the training with a masterful prowess that takes years to cultivate.

The place was hopping with activity as Carol sought to project her expansive calm across the area, Dr Kenya and Dr Rashmi coached the nurses, Raji stood in for whatever job had to be done in the procedure rooms, Renee flitted around like an energetic social butterfly, and Rajaa and I reigned as the Data Entry Queens (you may address us as such!). Almost 100 women were registered that day...and 40 were examined. You can imagine the heartbreak we felt when we had to start turning away some of the women. Judi, who handled registration, near begged us to admit more and more:

"This woman is old...almost ancient. And she walked and walked and she had surgery last week and she is on crutches and her daughter won't ask her husband for the car so he can drive her and she's so so so so so ill! We have to put her first on the list!"

As we worked...we developed a routine. We arrive at 8am. The medical professionals join Dr Kenya for a powerpoint lecture that was delivered to the nurses. And Renee, Rajaa, and I would head to the clinic, where we would set up the registration and data entry station. I have to add, just as a little rant of my own, this data stuff would get so convoluted and well...silly! Every person had a unique PINCC number and a hospital number. Thinking we were these brilliant hotshots, we made the PINCC number the same as the hospital number, so things wouldn't be so random.

Little did we know, that almost all the time, people would be assigned the same hospital Rajaa and I would stomp over to the med students doing the number (hands on
hips, frowns on faces) and demand the mistake be fixed...well maybe that's an exaggeration...Rajaa and I are far too nice :)

Anyways, after working for some time, the 10 o'clock tea arrived. Now this's a godsend. I'm pretty sure it was the wafting,enchanting scent of the chai that prevented any impatience and squabbles. The sight of this tea sent all the nurses into a sighing frenzy. And as soon as they cleaned the last speculum of their last procedure, they ran to the

tea and circled the canisters like zebras at a watering hole (Like the African wildlife analogy?). Soon, even we started awaiting the arrival of the buttered bread and the red and blue canisters.

On Tuesday, directly after the tea, Dr. Kenya oversaw the first Cryotherapy. Dr Mutiso and the nurses clustered around her (oohing and ahing when necessary) and eagerly watched Dr. Kenya perform the freezing treatment. It would get so crowded during each procedure that Dr Rashmi and Raji would literally be swatting some of the nurses away: "THERE'S ANOTHER PATIENT ON THE OTHER SIDE! YOU CAN'T JUST LEAVE THEM THERE!" I guess this behavior is a testament to their dedication to their profession, and really, these nurses are incredible. In the next post, I'll give you a closer look at some of them.

Thursday was crazy. Crazy, crazy, crazy. Carol says that the week worked out perfectly though. Monday was very slow, almost sluggish, as everyone tried to gain their bearing. Tuesday and Wednesday had few procedures, but there was enough to allow the doctors and nurses to practice. But Thursday, oh Thursday. On Thursday, this super blend team of PINCC and Kisii volunteers and medical staff finished 8 LEEP procedures and 3 CRYOS. Though we only saw 35 patients, almost all the major procedures ended up being on that day. Only the sheer will power
and energy of all present could have made this possible.

Right now, it's Ramadan. And Kenya and Rajaa are fasting. I felt it necessary to add, after that bit about that insane day, how amazing they have been, even without eating during the day!

Today is our last day in Kisii. In the morning, we examined and treated 25 patients...even though today is a holiday. Today, Kenya's constitution is getting a makeover. So now, the president has a term, there are checks and balances...and it's more democratic. It's a happy day for the most part, and people really believe that the passing of this bill will bring more rights for more people. Anyways, while people were in their house watching the proceedings or having little parties around transistor radios in street corners, the PINCC team and the Kisii nurses were hard at work. But, after all, it's not all work and no play. As a sincere thank you, PINCC treated the nurses to a lunch at the Ufanisi resort where we are staying. With enough ugali ( a mushy, corn based, rice-looking lump of stuff, which Carol and I love) and chicken for all, we dined together as one happy, content, successful team.

More about these festivities later! Food calls!

Thursday, August 12, 2010

SSSMH Training is Complete

From John Adams


Greetings all from Puttaparthi, Andhra Pradesh, India


Today we completed our fourth and final day with the Sri Sathya Sai Mobile Hospital -- our third training session here. Dr. Narasimhan wants four or more really outstanding doctors trained to full competence in VIA through LEEP. That way he can have VIA and LEEP (and all the rest) available 12 days every month, in the 12 nodal villages.


Dr. Ruth and Maddy are probably arriving at Bangalore airport about now, and Dr. Rhoda and I have a week to relax and to partake of the other joys available in Puttaparthi.


During the past four days we screened 126 women and found that the degree of pathology is already seeming to be lower after the first two rounds. We carried out two LEEPS and two Cryos and did a slew of biopsys and paps. Thing is, at the SSSMH sites, the mobile hospital has built such trust in the villages it serves that it is easy to get women to return for pap and biopsy readings and so we are using "see & treat" sparingly -- only when the need is obvious.


At our closing village today, Chandrayunipalli, Dr. Narasimhan thanked us profusely and told the whole village and all the volunteer doctors of his commitment to PINCC and his desire to have us do a four day camp every time we are in India to build and build and build an outstanding and highly effective program.


The two camps were tiring but exceptionally rewarding for all of us. We are already plotting our return in December -- when it is likely we will open another site, as well as carrying out #2 with PHRII inMysore and #4 with SSSMH in Andhra.

Tuesday, August 10, 2010

Greetings from the land of six syllable villages!

From John Adams

10 August, 2010

Yesterday we were in the village of Veldurthi, and today if was Mylasamudrum. The SSSMH VIA program is rolling along smoothly and we are mostly involved in enhancements and training a few new doctors in LEEP. Soon, the mobile hospital will have four or five LEEP certified doctors to cover each month's cycle of twelve nodal (and almost 400 nearby) villages. Presently there are three.

Dr. Narasimhan has received word from a subsidiary of Honeywell Computing that they will be donating a mobile machine that can upload medical notes to a protected server data base from any village that can make cell phone calls -- which past PINCC volunteers will recognize as "All" villages in the "less developed" parts of the world -- unlike in the 'developed" USA. He hopes to have all data, including VIA data, in digital form within a few months.

One of the doctors we are training at this camp has already started talking about bringing VIA to her hospital in Hyderabad, and numerous new site opportunities presented themselves in the final days in Mysore with the folks at PHRII. 

Another doctor here in Andhra Pradesh, that we certified in LEEP last December, has volunteered to be the second MD trainer in December at PHRII / Cheluvamba Government Women's Hospital! An exciting new feature in our work with the doctors here -- solidify their skills by having them come along and teach!

And good news for all those who want to volunteer in India!  We've been developing a key inside the curtains role for a woman volunteer in each site, thanks to the diligent work of Dr. Ruth Shaber's daughter Maddy. The hard part is developing a meaningful volunteer role for husbands on the outside of the curtains. We are working on it -- should have no trouble in Mysore in December for a volunteer couple -- although not sure if there is a role for the husband in Puttaparthi though. We'll be working on it!

Saturday, August 7, 2010

First PINCC PHRII Collaboration a Huge Success

August 7, 2010
Mysore India

From John Adams

Today we wound up four days of screening and training in Mysore, coordinated and "staged" by the wonderful people at PHRII. This is a collaboration that we will pursue for a long time to come. Every detail was meticulously planned, the PHRII staff members took care of every detail from beginning to end, and the women screened were very grateful for the work we did.

In the course of four days, we screened 159 women (43 paps, 15 biopsies, 5 Cryos, and 2 LEEPS for those who want the details).

This morning, before the fourth day of the session, we toured the Cheluvamba Women's hospital in Mysore, the venue for our second training. Two of the trainees are doctors at this government hospital, and are very keen to establish VIA screening within their institution. The head of the OB/GYN department at this hospital is also very supportive. We really liked the facility (see picture of central courtyard) and all the people we met there.

In the evening, we went to dinner with the core PHRII team that worked with us (see picture) and had a very warm celebration of the successful experiences herre in Mysore. Tomorrow morning early we are off to Puttaparthi, where we start another four days of screening and training -- our third round -- with the Sri Sathya Sai Mobile Hospital!

Thursday, August 5, 2010

First Two Days a Huge Success!

From John Adams

We have now completed two days of screening and training for PHRII, at the St. Joseph Hospital in Mysore. 

We are working with five doctors and two nurses. Some of the trainees are from a hospital that is connected to the Mysore Medical College.

The first day of the training / screening, we opened with a traditional lighting of a lamp (see picture) to invoke blessings upon our endeavor, and then received a nice welcoming speech from the Director of the hospital and also from Dr. Vijaya. After Dr. Rhoda and Dr. Ruth completed a first didactic session with the trainees, we screened 27 women. The second day, we screened 41! So far there is less pathology here than has been our experience over in Andhra Pradesh, so we have been finishing a little earlieer and having more time for resting or sight seeing or shopping.

We still are in love with Mysore and still are blown away by the level of organization and preparation that has preceded our arrival. 

Wednesday, August 4, 2010

Packing Day for India Trip

Packing Day for India Trip, July 2010- A Student Intern's Perspective

On July14th, we were packing up all the medical equipment for the India trip leaving at the end of July.  First we tested the LEEP machine to make sure everything was in good working order, to cut down on the possibility of malfunction when the PINCC volunteer doctors are thousands of miles away! And then there are the rest of the medical supplies that PINCC takes on every trip- the speculums, the medicines, the q-tips, cotton balls, the gloves, and all the other supplies for the exam rooms. Before we put the equipment into the luggage, we count everything and make lists of all the supplies we have. It will help the team keep track of the equipment and help them estimate how many patients they can treat each day.

I was glad to be able to help out today. It was a great opportunity for me to learn and understand the preparation process before the volunteer team goes to India. I've been taught how to operate a LEEP machine, and the difference between the Thin Pedersion speculum and the Graves (medium, large) speculum. I had a lot of fun and I hope the team will enjoy the trip and be able to help lots of women in India.

Best of luck,

Kitty Wang  
UC Berkeley Public Health Student Volunteer

Tuesday, August 3, 2010

Presentation to Mysore area Gynecologists

From John Adams
August 3, 2010

On the afternoon of August 2, Dr. Rhoda presented the PINCC VIA process to a group of about 20 gynecologists, including most of those who will be trained, and several interested others, at the PHRI Headquarters (see picture). Everyone seemed inspired by the presentation and it appears that it helped to heighten the resolve of local gynecologists to eradicate cervical cancer in the Mysore area. The rest of the day was spent preparing for the upcoming screening and training at St. Joseph hospital. We are just blown away by the extent and sophistication of the groundwork planning and preparation that has already taken place -- mostly under the leadership of Dr. Vijaya and Dr. Purnima (See picture of these two planning details with Dr. Rhoda). We are now expecting a wonderful four days of screening and training.

August 3 was spent going through the PINCC suitcases, the materials on-hand at PHRI, and a quick shopping trip to buy some basic stuff like a hand held vac that we will "Rube Goldberg" into a smoke evacuator.

Monday, August 2, 2010

Pictures from arrival in Mysore

From John Adams

Ready to go in Mysore

Dr. Ruth Shaber and her daughter Maddy arrived in Mysore at 4:00 am today and we all have spent most of the day at the Public Health Research Institute's headquarters getting ready for the first ever PINCC clinic in Mysore. We have also toured the St. Joseph's Hospital in Mysore, which is by far the most modern and cleanest and best equipped venues we have seen in our PINCC work anywhere. 
This afternoon, about 30 local docs will come to PHRI to hear Dr. Rhoda's introduction to PINCC and VIA talk. We are already getting the vibe that we may be busy in Mysore for a very long time. This would be really nice, since we have close friends living here, and Mysore, as a city, is so far superior from our Western perspective, to all other Indian cities. It is a real joy to be here.
Dr. Purnima Madhavanan has also arrived, just after hurriedly moving into her new home in Ann Arbor. She is the one who created PHRI and asked us to bring the PINCC program to Mysore. This morning she introduced us to all her research staff, lab workers, and interns. The range of research they are doing here on women's health across the boards is sooo impressive and definitely world class. What a remarkable place we are in!
I will send some photos with my next post. We left the camera in our sleeping quarters after lunch! Nuts! 


Sunday, August 1, 2010

Blog for India July 25-August 1, 2010

John Adams


July 25-August 1:


            Rhoda and I left San Francisco on the afternoon of July 25 on BA flights to Bengaluru via London Heathrow. We were so blessed to be the recipients of two of the BA grant tickets and so we were able to sleep significantly on both flights. When we arrived on time at Bengaluru airport, our usual driver, Khan, met us and whisked us up to Puttaparthi in under two hours. The National Highway that has been under construction for years is finally complete so the final leg of the journey is now a piece of cake. The entire trip was smooth as silk!

            We spent the first three days in India recovering from jet-lag, getting patient information, registration and clinical impression materials photocopied, and making phone calls to both of our clinic sites for this trip, to coordinate plans and make final arrangements. John also made arrangements for his involvement at the Sri Sathya Sai University in Puttaparthi during the latter portion of this trip, after the two PINCC clinics have been completed.

            We begin with the inaugural training at a new clinic in Mysore called the Prerana Women’s Health Initiative, 4-7 August. We have had numerous conversations with the lead doctor at Prerana, Dr. Vijaya. Dr. Vijaya also came to Puttaparthi last December to observe the PINCC VIA screening process at the Sri Sathya Sai Mobile Hospital and managed to get herself up to speed enough to begin doing VIA in January in Mysore (although we didn’t know initially that this was going on). The Prerana Women’s Health Initiative is a clinic established by Dr. Purnima Madhavanan, MD, MPH, PhD.

            Dr. Purnima, who is now on the faculty of the nursing school at The University of Michigan in Ann Arbor, has also journeyed to Mysore for this new PINCC initiative, to ensure that we get off to a highly successful start. Several Mysore doctors, and a few nurses, will be joining the training in addition to the Prerana medical staff. Dr. Ruth Shaber, a Kaiser Permanente gynecologist and former Director of Kaiser’s Women’s health Program, and her Daughter Maddy, will join us in Mysore on August 2

            On 8 August, Rhoda and I and the Shabers will be driven back to Puttaparthi, where we will carry out the third training at the SSSMH on 9-12 August. So far, three of the SSSMH volunteer gynecologist doctors have been certified in LEEP. At least one of these three is coming back for additional experience this time. Dr. Narasimhan, Director of the SSSMH, has already welcomed us most graciously back to India and has also indicated that he would like all of the SSSMH volunteer gynecologists trained by PINCC – so this could be a long term engagement!

            Since many of the SSSMH gynecologists are very senior and long-practiced physicians, it is our hope that someday, perhaps a few of these women will be capable of serving as trainer-doctors to work with Dr. Rhoda at future PINCC-India clinic sites.