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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