Thursday, November 10, 2011

PERU!











Last Saturday we held classes for willing Salvadorenos that came in voluntarily on the national Bicentenial holiday to complete their training with PINCC. Dra. Patricia de Banos, the person who "put it all together in El Salvador" is pictured in the first attached photo. The PINCC team then dispersed and Kay, Carol, Samantha and Lyell continued to Lima and met up with Nancy Levine, Janet Wiese, and Natalia Tocino and headed north to Huaral at 5am Monday morning. Huaral proved to be challenging in many ways, but PINCC's training there will definitely benefit the women of Huaral and surrounding areas as there is MUCH need for cervical cancer screening there---sadly, we had to turn away women each of the three days we were there as there were still women waiting in line after 5 pm each day. The stats for El Salvador and for Huaral, our first 3 days in Peru are as follows:
El Salvador:
Total Patients seen for IVAA: 236
Cryo's: 22
LEEP's: 7
Huaral, Peru:
Total Patients seen for IVAA: 268
Cryo's: 6
LEEP's: 9
In order, the next photos show Natalia teaching women's health to the women waiting for their IVAA exams, photo 3 is Nancy teaching the midwives how to identify lesions, Janet teaching beginning students IVAA exam techniques, next is Noris, the midwife who coordinated the PINCC training, and, last but not least, the PINCC team shortly before departing Huaral. Tomorrow is the first of our 2 days working in Lima and we will try to blog one more time before heading home. All the volunteers send love to all their friends, families and supporters. Buenas noches, Lyell Fox



Monday, November 7, 2011

San Salvador

Saturday, 5 Nov 2011, by Kay Taylor, MD
Today we completed a terrific training week in cooperation with the El Salvador Ministry of Health. We have been working to train and certify teachers, who are already performing screening and treatment for cervical dysplasia in 5 health centers in the huge San Salvador metropolitan area. Each day, we drove for half an hour or more to a different clinic, some associated with hospitals. Our team of gynecologists, nurse practitioners and support people included two mid-teen girls, one of whom had her 14th birthday on Thursday. She received ice cream and cake from the health center with a lovely party after work was finished, then more ice-cream cake at dinner followed by singing and dancing at a local restaurant. She looked so cute in a huge caballero sombrero, with the MC leading singing of 'Felicidades' and Happy Birthday! They've been a great help, sorting charts and stocking exam rooms for us.

The rest of the team was kept very busy, teaching and proctoring examinations for 15 doctors, 4 gynecologists, and 25 nurse specialists, all of whom are in various stages of training, from just beginning to training their colleagues. We have certified 2 more gynecologists in all procedures, as well as 4 other doctors as trainers for examination and cryotherapy, and several more doctors and nurses certified to perform these techniques in their health centers. How proud they are of their certificates! The trainers will hold another training session in 3 months, so when we return, the remainder of these students should be ready for certification. There are 41 health centers in the metropolitan area. Now, 5 of them are equipped to perform treatments, and 14 to do screening and referrals. We hope to have this densely populated part of the public health system completely covered after May's visit!

We also trained 5 community health workers who lead health education efforts in the use of our new flipbooks for teaching women about their bodies and cancer prevention. They were very enthusiastic about the flipbooks we gave them, and are going to field-test them and train others with them. We'll get their feedback in May. We are told that only 1/3 of women have had cervical screening more than one time, because of lack of education as much as lack of opportunity. We hope to help change that!

Tired but satisfied, our team will be celebrating tonight with the Salvadoreans. Today is the 200th anniversary of their independence from Spain and Mexico, and the streets will be filled with music, dancing and fireworks. We really feel a part of their celebrations today!

(To watch Dr. Eve Yalom interview a patient that was treated by the PINCC team CLICK HERE)

Friday, November 4, 2011

Nejapa

Another special day with the pincc team alongside representatives from
the Ministry of Health and at least my favorite clinic yet.

Today we worked at a a clinic in Nejapa called ProVida. This was one
of the fist sites PINCC ever worked at and there{s a strong connection
and mutual respect.

ProVida is a community clinic, and those of us who{ve worked in then
even in the US know that there is a kinship in them that is different
from most other healthcare delivery sites. This clinic has worked
very hard to build itself from the ground up - literally as we arrived
to even new contruction since PINCC was there last.

Nejapa is a more rural community about 40 minutes outside of San
Salvador. Again, nurses and doctors from clinics and healh sites all
around San Salvador came to work today to learn VIA, sharpen their
skills, or become certified. We ran 6 rooms yesterday very smoothly
seeing patients for VIA exams while teaching new participants the
process and doing LEEP and cryo for new and prescreened patients.

Yesterday was extra-special. Soukeyna, my daughter, also turned 14
yesterday. The staff sang Las Mañanitos to her in the morning
introduction and, after clinic, we had a little party for her with
cake, singing and dancing with the clinic staff and participants. One
of the best days by far! Pictures to come...Michele Bunker-Alberts

Tuesday, November 1, 2011

day one El Salvador


picture from day one El Salvador


blogggg


Train-the-Trainer is in my life for good, I think.

After just completing a series at work in the US, I was looking forward to
seeing what this one would be like here.  From last week, teaching and
collaborating with health workers of various levels to do VIA, biopsy,
cryo, and LEEP every day, it was a nice contrast to focus on
Train-the-Trainer.  Each first day starts out chaotic, as Carol has said in
setting that tone in he usual infectiously calm way, but it's always fine.
Yesterday, we started with a new trainee in VIA, an experienced examiner,
and a trainer.  I started with a group of una medica, who was the trainer,
y dos enfermeras. who were learning VIA.  My part was to answer questions
and support the trainer.  Pretty quickly, we started talking about "tough"
cases, incorporating biopsies with treatment and the role of a Pap here.
More to come there...

El Salvador is so beautiful! -Michele Bunker-Alberts

Tonight after clinic, we said goodbye to another one of our group.  It's only been a little over a week, but, after a few days of this, the group actually becomes pretty familiar and ours works really well together.  I'm going to miss Eve.  We taught her final session this trip together this afternoon, but it has been really fun to have been here with her, learn from her, and get lost walking in Leon with her and Jaynia. Next trip, when she brings her daughter too, my daughters can show her daughter "the ropes" of PINCC support...

Today we had another busy city clinic.  Things are very well-organized in El Salvador in terms of our group sessions and the support it requires for municipal clinics without many resources to encourage their doctors and nurses to both learn and practice IVAA.  Further, our participants are all enthusiastic about womens' health and providing appropriate care.  Our groups today did many exams - about 75 patients and several cryotherapies and LEEPs. During the patient sessions, the examiners educated women about HPV and cervical cancer, the importance of screening, and more generally about their health, contraception, breast care, negotiating safer sex with partners, about reducing sexual violence and how to connect to support around all of those issues.  El Salvador's epidemiologic data, including cases of Dengue by neighborhood - which there's been an increase in this year with the rains, immunizations, even morbidity reports are posted throughout its clinics and in every exam room are posters about breastfeeding, nutrition, hypertension, and the steps of prenatal care by gestational age.

Okay, so back to us.

Today we did more Train-the-Trainer and each of us worked as "group advisors" and were there to both offer additional learning and to support the trainers as they taught IVAA. The group I worked with asked lots of questions about Pap diagnoses, cytobrushes, biopsies, and distinguishing lesions - all very rich discussions with a lot of detail. 

Tomorrow is Dia de los Muertos.  We're heading out to a few cemetaries and then to the beach for a few hours.  Again, El Salvador is an amazing country and it's nice to be doing work that people are really excited to be learning.  More to come, keep reading. -Michele Bunker-Alberts
 

day one El Salvador

we were off to a flyimg start in El Salvador with another stellar
PINCC group - all extremely hard-working and always maintaininh a
sense of humor. We spent our first day at a clinic in San Martin that
previous vounteers will remember as very busy with a BIG patient
volume. Alongside the Trainers and Trainees - the site is a new
´TrainñtheñTrainer´site, we saw 80-90 patients, 4 cryos and a LEEP.
-Lyell Fox, photos to follow

Saturday, October 29, 2011

Saludos de Leon!

We are getting ready to leave Nicaragua, everyone but myself is going on to El Salvador. It has been a wonderful week here in Nicaragua.

Monday and Tuesday we were in El Sauce at a hospital that's been up and running for 1 year. There was a full waiting room when we arrived at 7am with many women coming from far away homes to be examined. In total, we saw 50 patients over the 2 days, all very grateful for us being there.

Tuesday night we headed back to Leon, and have spent the rest of the week at HEODRA, the hospital here. We had wonderful trainees and worked with wonderful people that helped coordinate the program. I got to see a few exams and procedures and it was very clear that every single one of the women that we saw were extremely grateful for us, even when there are several people crowded around and looking at their cervix. One thing we made sure to do was to get the patients who had a history of sexual abuse an opportunity to speak with a psychologist, this was very important as many of these women don't get a chance to do this and many of them have had such difficult lives. It's great to actually see all of the wonderful things PINCC is doing for these women.

It was a successful week for PINCC and an incredible experience to have.

A video of the trainees singing the Nicaraguan birthday song to me, which was so sweet

http://www.youtube.com/watch?v=-ybdn6ZHwp8

A video of Carol's longtime friend Carola singing at her restaurant La Olla Quemada where we had dinner on Friday night

http://www.youtube.com/watch?v=wz39I8T-vIQ


Jaynia Anderson

Friday, September 30, 2011

PINCC at Mills College Health and Wellness Fair


Yesterday PINCC happily participated at Mills College Health and Wellness fair! Although it was so windy our banner was almost carried away, the women at Mills had a spirit of community involvement and concern for the conditions of women extending across the globe. Several students from Mills Nursing Honor Society eagerly greeted me with excited voices proud to have been a part of fundraising and participating in PINCC's walkathon.

Wednesday, September 28, 2011

New York Times

On September 26, 2011 The New York Times published an article entitled “Fighting a Cancer with Vinegar and Ingenuity. The article discusses how doctors in Thailand use the same method as PINCC to save women from dying of cervical cancer and praises them for their resourcefulness and cost effective methods. To read the full article Please go to http://www.nytimes.com/2011/09/27/health/27cancer.html?_r=1


Dr. Kay Taylor sent the following letter to the editor:

"Donald McNeil’s article (Sept. 27: A little vinegar and ingenuity) on cervical cancer prevention services shed an important light on a hardly-covered issue. The cervical cancer epidemic in the southern hemisphere has been given little support or attention, despite the death rate in Africa and Latin America being almost as high as maternal mortality. Yet cervical cancer – unlike other cancers -- is completely preventable.

PINCC (Prevention International: No Cervical Cancer) is an organization that brings American volunteer doctors to train local medical personnel in Africa, India and Latin America. We then donate the needed equipment to create self-sufficient centers for diagnosis and treatment. The unsung heroes of this movement are the many doctors, mid-levels, and lay people who pay their own way and donate their time to help the poor and high-risk women ignored by many countries’ health systems. However, funding for this work is difficult to obtain, unlike maternal/ child health or HIV/AIDS.

I applaud the George W. Bush Presidential Center for its recently announced “Pink Ribbon/ Red Ribbon” program to help defeat cervical cancer in Africa and Asia. They will work with PEPFAR programs, so that cervical screening will finally be included in HIV/AIDS care. At last, public health programs are recognizing this neglected public health epidemic. We can save so many women from a terrible death, with such simple tools and the great hearts of our volunteers! "


PINCC encourages our supporters to send similar letters of their experience with PINCC to New York Times' editor at letters@nytimes.com

Monday, September 19, 2011

An African Urban Pilgrimage





Our fall East Africa Campaign is over, and all our great volunteers are off on safaris or heading home. It's been so heartwarming and thrilling to watch our 3 continuing sites grow and become independent! The biggest thrill, though, was going out to a small rural hospital on the lower slopes of Mt. Elgon, in far western Kenya, to start a training of health workers from 5 very rural sites. This group was recruited by three of our trainees in Kitale and Kapenguria, They have gone out to these sites, doing one-day screenings and bringing women with abnormal results in for treatment. The doctors, nurses, and clinical officers were very excited about the techniques, and asked to be trained. We had 12 new people begin training, and 3 observers from other programs, as well as 4 of our graduates there to help start the new ones out. They came from many miles away, traveling since dawn in small buses called matatus. All had read the material sent, and were most enthusiastic students. The word had spread among the communities as well, and every day the waiting room filled to overflowing in the morning. We could only see about half the women; but the others were booked to come back to our centers during the next weeks. We left screening kits for the 5 hospitals and dispensaries to continue screening women during the 6 months until our return, when we will see and treat any positive cases. The wonderful outreach team is organizing a non-profit to continue spreading this work over the entire area, and we are assisting them to find funding and equipment, and donating much of it ourselves. We'll be showing a map of how much of the country is now getting care at our Walkathon on Sept. 24, and will then have it on the website. Watch for more great pictures as well! Today, Monday Sept. 12, Pat Sax and I (Kay Taylor) took a walking pilgrimage towards fulfilling a dream held since 2006, when we first came to Kenya. Ever since our first visit to the Kibera slums, second largest slum in the world, we have wanted to establish a cervical cancer screening and treatment site for these women who struggle daily for the bare essentials of life. One million people live in 700 acres here, on unimproved dirt in squalid mud rooms with tin roofs. Each little cubicle holds a family of 2, 3, 4 or more, with an open window and door covered by a piece of cloth. There is no water, electricity, or sewers; the rutted paths are strewn with garbage and plastic bags used as toilets. Small fires burn between structures and along the fronts, for heat, cooking and trash destruction. In a misting rain, we carefully picked our way through the mud and rocks for about half a mile from the dirt road which ended at defunct railroad tracks, along with hundreds of other people carrying food, water, bags, pushing wheelbarrows, or just kids going to and from school in uniform. We kept our eyes mostly on the path to keep from slipping into the streaming gutters of oily filth. At last, we reached our goal: Shining Hope School and Clinic, on the far side of the slum from the road. This will be our third clinic in Kibera to attempt a permanent program. The previous ones failed to stay in business. The enthusiastic group of Kenyans and Americans who built this 2-story clinic of cement, rock and wood greeted us happily. We were shown around the facility, meeting teachers, nurses, lab workers, a clinical officer and Dr. Henry, who tend to men, women and children from this desperate camp every day. They proudly tell us of their HIV screening program and the soon-to-be-established ARV treatment program; the 400 women they have in prenatal and family planning; and the immunization program for the babies and children. It only costs 150 shillings (about $1.60) for a person to receive all health care services for a week, including lab tests, procedures and medicines. We discussed our cervical cancer screening and treatment training program with Dr. Henry and two administrators from the USA, explaining our goal of helping them to have a cervical screening and treatment program independently functioning and fully equipped within 2 years. We all knew there would be problems to overcome, but felt they could be worked through, and left with the intent to start training in February of 2012. We were waved off by some of the 64 primary schoolgirls who attend school here. As we walked back across the crowded, slippery paths, I thought about bringing our team of American doctors, nurses and other volunteers along this walk twice a day, and moving in our equipment suitcases on the carts and wheelbarrows navigating the trails around us. Would they tolerate it? It reminded me of the famous pilgrimage in Spain through the Pyrenees to the sea in Portugal: self-denial and deprivation of our comfortable, clean way of life for the week of work, if not the months that journey requires. We will need to prepare our team carefully. But when I see a mother welcome her neatly uniformed children back from school with a smile, I'm awed by the amount of planning, work and love that this daily routine requires. I think our group will thrive on the challenge, and be invigorated by the hope and healing our training will bring. These are mothers and grandmothers motivated not only to survive, but to help their children to rise to better things. Surely we can spend a few uncomfortable days to give them the chance to avoid this silent killer, and live to see the children graduate and thrive. The gratitude we receive is certainly its own reward!

Tuesday, August 30, 2011

PINCC at Bishop O' Dowd


Today I did a presentation at my alma mater, Bishop O' Dowd for one of their clubs called "Sisters of Success" (SOS). It was my first PINCC presentation, and went better then I could have asked. SOS supports the young women at Bishop O' Dowd by discussing goal-setting, self-esteem, etiquette and other topics of interests to young women including PINCC.
The SOS girls were engaged and enthusiastic about our organization and our upcoming walkathon. They are planning to get a team together to fund raise for "Walk For Women Of Africa". It is really encouraging to see young women excited and getting involved in their community. Go Dragons!!!
By Tenay Woodard, Assistant Administrator for PINCC

Monday, August 29, 2011

Update from Africa

As usual, Africa is somewhat chaotic, and we struggle with spotty electricity, overworked staff, inability to hook up the cryotank, scant resources; but we have made major strides despite all this in our Gombe, Uganda clinic. The health workers are very excited and enthusiastic, both clinical and community workers. The Chief Medical Officer, Dr. Lule Haruna, has been given responsibility as District Health Officer as well, and 2 of his doctors were sent for further training, so they were really tight on doctors. But he is so committed, he found time to study the techniques in the evenings, and came for training in LEEP; he scored only one part wrong answer on our post-test, and is excellent at teaching. The community health team has started insisting the HIV+ women come for screening, and we did 5 LEEPs, saving these lives. There were 4 other LEEPs as well. I think Gombe will be a very successful program!

Wednesday, July 13, 2011

PINCC - India in Mysore

Lighting the lamp to open the third VIA camp in Mysore

PINCC India in Mysore

July 14 2011

John Adams

We have seen a huge number of women here in Mysore – over 200 in the first three days – with pretty much the same percentages of positives and pap smears as usual in India.

The big news here is that last evening (Tuesday, July 12) we were taken to meet the Swamiji (god-man) of the JSS system. He is head of many health care and educational institutions all over the greater Mysore area, and is reputed to have a huge amount of power and ability to get things done. Our host hospital for this visit is JSS Hospital, by far the largest hospital in Mysore. The connection was made by Mr. V. Bhat, who is a leader in the local Rotary and a devotee of the Swamiji.

Our visit with the Swamiji seemed to be very successful, and he told us we should meet with the Karnataka State Minister of Medical Education. He also acknowledged how important our work is. We then went into a small dining room inside the ashram and were given dinner and tea. As we ate, Mr. Bhat called the Minister and set a meeting for Wednesday at 5:00.

During the night, Dr. Rashmi became quite ill and had to be taken to a nearby hospital emergency room. There are not easy ways to get transport at 2:00 am in India, so the young man on the hotel desk woke up another guest with a car and got the owner to take us. The young man also came along because he knew where to find the hospital. With Rhoda and Rashmi and her mother Mytree that made a really full car!

This hospital had an excellently stocked and fully staffed emergency room and no waiting patients, so Rashmi got seen immediately. Unfortunately, they could not find the cause of her pain and nausea, but gave her an injection to ease the cramps. In the morning, Rashmi and Mytree left us and returned to their family in Bangalore. Later in the day we found she was feeling better, but still unsure of the cause.

So Rhoda was on her own with the volunteer docs, and as luck would have it, we had 81 women to see, and carried out 2 LEEP, many cryos and biopsys, and worked over an extra hour to get everyone seen. It's hard to turn women away when they've been bussed in from a remote village for the screening. Dr. Shobha Krishnan, a Columbia Univ. professor with her own HPV NGO in Chennai and Gujurat, is visiting to explore collabortions, and she pitched in with background stuff in the medical area. I was inundated with registrations, clinical reports, and a spreadsheet that crashes every few minutes – but we got through it all!

Unfortunately the minister could not meet with us, so we are carrying on with whatever connections we can make and focusing on building a network of solid relationships for the future. Given all this, we were glad the Minister of Health Education was unable to see us!

One more day of camp and then we head for home – quite happy with the progress in both our sites, appreciative of the great organizational support both sites present, and confident that we will be able to scale up our operations in the Mysore


Friday, July 8, 2011

One of Infosys's buildings in India

July 7 2011

Reporter filming the press conference

July 8 2011

Dr. Vijaya introducing Rhoda at the press conference

July 8 2011

Dr. Vijaya is our lead trainee in Mysore


Dr. Rhoda Delivers a Wonderful Message in the Mysore Press Conference

July 8 2011

Mysore Report

John Adams
July 8 2011

We departed Puttaparthi at 7:00 am yesterday and were in the offices of the Infosys CEO Kris Gopalakrishnan in Bangalore by 11:00. Kris spent a full hour with us and was highly interested in what we are doing. We proposed that Infosys support our intention to scale up our PINCC efforts in India, through our collaboration with PHRII, to establish a Centre of Excellence for Cancer Prevention in Women. We are expecting that Infosys will send a manager of the Infosys Foundation to our clinic here in Mysore during 11-14 July.

Initially we would create a more established centre for our work in India, with Indian management and an Indian lead trainer (whom we would train). As growth occurs we would anticipate establishing VIA screening and training collaborations with other NGOs who are working at micro-scale around the country.

We are also working on a proposal for the Tata Family Trust to support our work here. Since PINCC has no legal basis in India, the proposal will come through PHRII.

With 25% of global cervical cancer cases and 27% of cervical cancer deaths world-wide, India is an overwhelmingly large and intense place for the present PINCC model to make a difference. Fully 10% of the global population lives in Indian villages! The government continues to ignore this disease and its prevention, so we will have to shame them into attention through Public Private Partnerships to get our work to scale. PHRII continues to be an extremely reliable, competent and committed partner in this venture. When polio re-appeared a few years ago, the Indian Government proved it could mount a nation-wide universal vaccination program overnight, so it is just a question of challenging the society's will to save 73,000 lives a year (one every 7 minutes) that are lost needlessly. Presently only 2.6% of Indian women ever have a single screening (2.3% in villages, 4.6% in cities). The opportunity is huge for harvesting this low-hanging fruit!!!

Dr. Rhoda just completed a press conference here at PHRII headquarters, attended by about 20 local reporters. We will be looking for great coverage in the local English language and Kannada language papers tomorrow! Also tomorrow, Dr. Rhoda will be presenting a CME lecture at JSS Medical College, which is also our venue for next week's VIA clinic. JSSMC will be sending some new trainees and so far appear to be eager to become a central partner in the Mysore PINCC work going forward. Rhoda and I are scheduled to meet the spiritual leader of the organization that sponsors JSS to pray for his support next Thursday at the end of our fourth day of screening / training.

More to come!


Tuesday, July 5, 2011

Kay may remember this woman from two years ago when she gave padnamaskar following her LEEP procedure



PINCC India completes fifth clinic at SSSMH

A typical SSSMH clinic scene: Arithmetic, English, Telugu, the Goddess Lakshmi, and the Gynecology section!

July 5 2010
John Adams

We were overjoyed at how excellently the SSSMH team of gynecologists have developed and made this program their own. Duirng the six months since our last visit in December, they racked up the following numbers:

VIA -- 1276
Pap -- 16
Biopsy -- 260
Cryo -- 40
LEEP -- 8

They also referred 12 women with cervical cancer to various cancer treatment centers.

We had two wonderful visits from earlier patients. A woman who was referred with cancer two years ago stopped by to thank PINCC and to get rescreened -- she is completely healthy! Another woman who had a LEEP done two years ago also stopped by for rescreening and expressed her gratitude as well. 

During the just completed five day camp, we saw 225 women, performed 4 LEEPS and 6 cryos.

We will not need to bring PINCC-India back to this site. When we come to be at the ashram, we may go along for a day or two, but only to check in and exchange greetings. 

Sunday, July 3, 2011

Amidst the rewards, some sadness, too

LEON, Nicaragua -- Working with PINCC in Central America has always been richly rewarding and fulfilling, especially since the screen-and-treat protocol being taught serves mostly poor women who otherwise would have no care at all.

But sadness and frustration come with the experience as well.

For me, having just returned from my third trip, two things have affected me profoundly.

The first is the realization that I get to drive away from Jalapa, Nicaragua -- a profoundly poor place -- and escape the misery I see around me. Not an option for the people we serve there.

The second is the unexpected and completely shocking experience we just had in Leon: while her mother was being examined, we played with a little girl of about 7 years old, who seemed entirely happy and normal. But I'll always feel helpless when I think of her. We learned that she has been treated repeatedly for a common sexually transmitted disease, apparently from abuse by her mother's husband or boyfriend.

In the United States, we would have called the authorities. She would have been protected somehow.

No such thing in Leon. We had to watch her leave with the adults in her life, and there was nothing we could do to intervene.

-- Larry Shushan, PINCC volunteer in Central America

Friday, July 1, 2011

PINCC-India at Sri Sathya Sai Mobile Hospital

SSSMH Patient Record Format

PINCC-India at Sri Sathya Sai Mobile Hospital

Dr. Rhoda preparing to begin the day's screening

PINCC-India at Sri Sathya Sai Mobile Hospital

From John Adams
July 1, 2010

We opened our fifth camp at the Sri Sathya Sai Mobile Hospital, based in Puttaparthi, Andhra Pradesh, today. What we found when we got to today's venue, Rachuvarapalli Village, was most heartening. The gynecology section administrator presented us with summary statistics for their VIA work during the six months since we were last here.

During their regular 12 day camps each month January through June, they have conducted 1276 VIA screenings and carried out 40 cryotherapy and 4 LEEP procedures. Three LEEPs were brought back to be done while Dr. Rhoda is here.

Their record keeping is very good and the lead VIA doctors are performing with confidence and competence. We introduced our QA materials today, and these were heartily welcomed, along with the idea of making one improvement every day. Our primary focus now at this location, in addition to reviewing quality items and procedures is to work towards increased "bench strength" of doctors who can capably carry out LEEP.

Wednesday, June 29, 2011

Unprecedented!

Two PINCC campaigns are underway simultaneously, one in India and one wrapping up in Nicaragua!

Tuesday, June 28, 2011

Re: PINCC-India At work Again

An Indian child waiting for her mother to be screened

PINCC-India At work Again

From John Adams
June 29, 2011

Rhoda and John arrived back in India on June 26, and immediately began preparations for the two very important cervical cancer initiatives here in Puttaparthi (Andhra Pradesh) and in Mysore. It is a little strange to be in Puttaparthi, now that Sri Sathya Sai Baba has left the body (April 24). There are very few people around and the shopkeepers, porters, and others who rely on a steady coming and going of devotees are becoming desperate! The owner of Sai Towers Hotel tells us that his bookings are picking up again from about the middle of July, when Gurupurnima, a major Hindu holiday, takes place. By then, the tomb being built for Sai Baba's remains in the main darshan hall will be completed and the theme of "continuity" will ensure that all programs and rituals will be carried out as before. We all assume that the ashram, Prasanthi Nilayam, will become a major pilgrimage site for spiritual seekers of all kinds.

The Sri Sathya Sai Mobile Hospital gynecology section has already been certified in the PINCC VIA protocols and in use of Cryo and LEEP procedures. During this camp (1-5 July) Dr. Rhoda will be reviewing and helping the certified physicians to "brush up" on their knowledge and skills, and also begin the training for some additional SSSMH volunteer physicians. John will be inaugurating a quality assurance process for this program, so that they can self monitor and engage in continuous learning and continuous improvement.

On the drive down from Puttaparthi to Mysore for the third PHRII (Public Health Research Institute of India) cervical cancer camp, we will be stopping in Bengaluru to meet the CEO of Infosys. We hope to get his company's involvement and support in the "The Centre of Excellence for Cancer Prevention in Women" that we want to create through our collaboration with PHRII. During our stay in Mysore, we will also be meeting with the local Rotary club for the second time, seeking their support. We are also attempting to get the Rotary Wives Club involved to advocate for cervical cancer screening for all women in the area. Less than 5% of all Indian women (2.3% in the villages) ever have a single cervical cancer screening in their lifetimes.

While Rhoda is engaged in the third clinic with our Mysore trainees, John will begin rolling out our QA process here as well. (Contact John if you would like to see the items we are going to be investigating for quality assurance). This third camp is to be held at the JSS Hospital / Medical College -- our third venue in Mysore. By the end of this visit, we will have carried out PINCC clinics in a catholic hospital, a government hospital, and a private hospital. More networking for the future!

Also in Mysore, we will be meeting with the District Health Officer and other key stakeholders at the various Mysore medical colleges and teaching hospitals and will once again be hosting a Stakeholders' Dinner on our last evening in town. Our vision is to create a network of involvement that includes the local medical colleges, civic associations, and health-related government agencies.

Our volunteers on this trip are Dr. Rashmi Murthy, who volunteered previously on a PINCC Central America camp, and her mother Mytri Murthy. Dr. Shobha Krishnan, a professor at Columbia University, will also join us in Mysore. She has been engaged in VIA screening through her own program in northern India and also in Chennai. We are looking forward to also finding ways to synergize our programs with hers during this trip. India is so huge, and the need is so great, that we need to rapidly find ways to scale up before the cost of coming here becomes too high! 25% of all cervical cancer deaths in the world each year are in India (Globocan 2008), and there is at present no coordination of efforts and no center for rapidly building local capacities to address this huge challenge.

So all in all, we have a lot on our plates beyond running two PINCC-India camps. We will be much clearer by the time we leave about the future directions of PINCC-India! Progress reports will follow! Everyone who reads this -- please send good thoughts for successes!

Waiting room outside our exam rooms

At the hospital in Leon yesterday morning. Training is going great.

View from our hotel roof last night

This was before the spectacular lightning show that we had walking home from dinner in Leon!

Parking outside the hospital in Leon

No hitching post for the horsecarts, and no parking lot for the few cars. Main transportation: feet or two-wheeled vehicles (or buses).

Team PINCC on a day off on Sunday

At a nature preserve near the beach outside Leon. A much needed break!

Friday, June 24, 2011

Some of Team PINCC right now in Leon

Lunchtime in Leon! From left: Hayley Miller, Dr. Tara Hulbert, Dr. Pratima Gupta and Emily Riggs.

Guess what this is?

A bottle of orange soda left for the occupants of this house (which is in Leon en route to the hospital)? No! But if you said "a papaya", you're right!

Thursday, June 23, 2011

Desvios, Puentes y 'Policias Acostado', Oh My!

SOMEWHERE BETWEEN JALAPA AND LEON, Nicaragua -- So I found myself yesterday engaged in one of the more adrenaline-pumping, sometimes-terrifying and certainly adventurous drives I've ever performed from behind the wheel.  With a vanload of innocent people relying on me to get them to their destination safely.  (Why me?  Because I volunteered to drive when our usual Nicaraguan driver was unable to join us for the trip. We later joked that he chose not to join us because he checked on the road conditions for the portion of the trip I'm about to describe.)
 
We got out of Jalapa later than expected, which meant we'd roll into Leon -- at least a 6-hour drive -- after dark. That's never good in an underdeveloped country, especially one where pedestrians (or groups thereof), loose livestock, bicyclists, motorcyclists, trucks and dogs all occupy major highways at unpredictable times and locations, and, depending on which of these you're talking about, without warning, lights, reflectors, consideration, caution or apparent concern.
 
The first part of the trip was predictable.  Jalapa to Ocotal is a known quantity.  It's a trying, winding road with the usual asortment of men on horseback, small children playing on the shoulder and -- best of all -- a series of "puentes," narrow bridges across rushing water where the approach is partly washed away, the ability of the bridge to carry our vehicle safely is questionable and the width of the bridge is just enough to drive across.  But it was during daylight hours; in other words, no big deal.
 
We got through without incident. 
 
Then we got to the highway (loosely termed) where you turn toward Leon.  Of the options to Leon, we had been told that this was the best one in terms of road conditions.  And the presence of major commercial trucks confirmed that.  In other words, if there was a better way to go, they'd surely be going that way.
 
Very quickly, we encountered a "DESVIO" -- known in the United States as a "DETOUR".  Detours where I live consist of a sign with an arrow followed by a series of signs keeping you on the right route.  Here, however, a DESVIO simply signifies that you don't go the way you thought you'd be going.
 
If it's dark (which it was by the time we saw our first DESVIO sign), you look to the right or left for a very bumpy, lumpy dirt road down in the gully alongside the highway where your vehicle MAY be able to pass if it's not raining.  And if there's no major truck (or herd of cattle) either coming the other way or stuck. 
 
We got used to this because we encountered at least a dozen of these always interesting one-way DESVIOS.  That's right: one way.  Nobody handles the duties handled in the United States by a person with a flag and radio, signaling someone at the other end to either stop traffic or let people pass.  Here, you take your chances.  Part way through, you may encounter someone coming the other way who also has taken their chances.  There's nowhere to turn around.  There's no way to back up. 
 
Once, the pavement abruptly changed from old pavement to new in our lane (with an 8-inch change in elevation) without warning.  Coming the other way, in my lane, was a huge truck.  When we got close to each other we both stopped.  The driver of the big truck leaned out of his window and motioned for me to drive off the edge of the new pavement onto the old pavement in the oncoming lane so he could pass.  I quickly thought this through.  He couldn't do what he was asking me to do because of the kind of vehicle he was driving.  So I veered gently down to the oncoming lane.  Fortunately for all of us, nobody was there.  The big truck passed and honked his air horn in kind of a "Spanglish" thank you.  I returned the signal, got back into my own lane and continued on to the next DESVIO sign I knew must lie ahead.  I wasn't disappointed.
 
Of all the DESVIOS we encountered, only one was so deeply rutted that the entire undercarriage of our van scraped along the center part of the dirt road with a pronounced sort of grinding sound, punctuated by abrupt stops and more pronounced sounds.  It felt and sounded really awful.  We envisioned u-joint parts, the oil pan and other essentials being ripped from beneath us. 
 
After many more DESVIOS, we finally concluded we were through the section being worked on.  Not because there were signs indicating "End Construction Zone," but because of the lack of any more DESVIO signs.
 
But now we faced a new phenomenon.  We called them "random strips of missing pavement."
 
These were sections where, apparently, new, huge concrete culvert pipes had been installed across the road, with the opening then filled in with dirt and rocks to be paved later.  No care had been taken to ensure the level of the unpaved space was anywhere near that of the highway. So, at 80 or 100 kph (that's kilometers per hour to those who have never left the mph world), you'd come to one of these strips and struggle to slow down enough to keep the car intact as you passed over the patch.
 
We got through all of these, as well.
 
Soon we were in total darkness, but with ominous lightning occasionally flashing in the sky to our right or just ahead.  Now came the really fun part.  Apparently, in Nicaragua, the place for people in tiny villages to hang out just after dark is along the side of the road. Once in a while, they hang out by themselves.  Mostly, though, they hang out in groups ranging from 3 to 20.  The custom I was most surprised at was the one where they hang out as close to the pavement as possible, or, in many cases, on the pavement where vehicles are traveling at what we in the U.S. would describe as "freeway speeds." 
 
Sometimes, they'd be sitting or even lying down perpendicular to the pavement.  One young man remained in this position, with his body from the waist up on the road and the rest of his body on the shoulder.  As I came speeding along, just about when the limit of my high beams brought him to my attention, he did a very slow and controlled situp -- just in time.
 
One of my favorite experiences, though, involved my encounters with people on bicycles, motorbikes, horsecarts and other vehicles with no lights or reflectors whatsoever. They weren't moving along on the side of the road.  They were in the road.  In the dark. Mostly, if they were people either on foot or on bikes, they wore very dark clothing.  Sometimes, I'd catch a momentary glint of a reflector strip on the pedal of a bike.  These made me feel lucky.
 
I also felt lucky to have Carol Cruickshank, our trip director and a one-time Nicaragua resident, as my co-pilot and navigator.  From time-to-time, she would quietly alert me to a barely visible pedestrian or bicyclist.  Carol's voice is almost always perfectly calm.  Her voice remained so as the rest of the passengers sat behind me in abject terror.
 
And then, once we got to Leon and my body had more adrenaline coursing through its veins than blood, I learned about "policias acostado."  In the United States, we call these "speed bumps."  Here, they're called "sleeping policemen."  If they're really large and challenging to drive over, they're called "policias acostados con su mujer," which means they're nearly twice as high.  I'll leave it at that since this is a family blog.
 
After nearly seven hours, we rolled into Leon without incident.  In fact, there actually were no true INCIDENTS on the whole drive.  Only the constant, nagging sense that an INCIDENT -- or worse -- would happen at any second.  There are a lot of seconds in nearly 7 hours.  What if we had a flat out there in the middle of nowhere and had no way to drive to a non-existent shoulder?  What if the oil pan had truly been pulled from the bottom of the engine on that one DESVIO where the center section of the dirt road was higher than the van's clearance?  What if a child on a bike had randomly chosen the moment we were careening past to cross the road? What if, what if, what if (fill in the blank)?
 
My mind reeled as to what may have happened but -- thankfully -- didn't.  We got to the hotel safely.  The longest, toughest part of our trip was finally over. 
 
-- Larry Shushan, PINCC volunteer in Central America