Today there were only about 20 patients waiting to be treated by the PINCC team. So the practitioners in training were able to devote more time to practicing biopsies on papayas, and LEEPs on raw cuts of meat. Meanwhile, the support people had to visit the pharmacy to stock up on home pregnancy tests. The teaching hospital in Leon does not have such tests, and our medical team will not risk performing a procedure on a woman who may be pregnant. So far, about four pregnancy tests have been administered, with one positive result for a woman who had had a tubal ligation. The other 3 women were able to be treated by the PINCC team.
Although many things about the US healthcare system can be improved, the basics that we take for granted are not easily available to the Nicaraguans. The teaching hospital in a major city seems to have no budget for pregnancy tests. Dr. Pam learned that women need to pay $1.25 to purchase a cytobrush if they want a more effective Pap test. The "free" test uses older technology, but is less effective in obtaining cells from inside the cervix. For these poor women, the price of a cytobrush can be daunting. Women have also told us that they have not been able to afford medicine to treat an infection. Sometimes these medicines are available at no cost through the government-subsidized hospital, but if supplies are depleted, the women will have to pay.
Since the support staff had fewer patients to interview, we had the chance to teach a small group of women about cervical cancer and how to prevent it. This group of 3 women shared their stories about the distance they need to travel to obtain medical care, and the limited number of facilities and practitioners available to provide it. These women were grateful for our fact sheet about cervical cancer. Though two of the women were unable to read, which is not uncommon among older women, they were happy to take them home so a family member could read it for them.
Today's lighter workload allowed us to accept the invitation from the owner of the Hotel Real, where we are staying, to visit his family's beach house. The Pacific is about 30 minutes from Leon, and we enjoyed a breezy drive through the countryside to the beach town, Poneloya. The Pacific was very rough, and the sand very dark from the high content of lava ash. But the lagoon where we bathed was warm, and the current strong. After our swim, we enjoyed pizza at the beach house.