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!

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. 

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

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.

Unprecedented!

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

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!