Leon blog 6/3/13

Monday, 6/3/13

Today was our first day at HEODRA, the teaching hospital in Leon.   The doctors examined and treated about 38 patients, out of the 40 or so that we interviewed.  Most of the patients had been referred from their local health centers because of an abnormal pap result.    The patients waited quietly in the heat to be interviewed, and then had to wait again for their examination.   Thankfully, some of the exam rooms were air conditioned.  The PINCC nerve center also was also air conditioned.  There, the volunteers  attached the intake forms to the patients' charts, and input the information into the computer.   Data input involved lots of data cleansing, i.e. running around asking the doctors for missing information, or  interpretation of handwritten notes.    

Some patients bore the signs of their difficult lives, with faces aged beyond their years.   Many women have four children, but those whom I met stopped at four with a tubal ligation.  The interviews identified a number of women who had been abused sexually or physically.    The patient Reina returned to see Carol.   Dr. Pam performed a LEEP on Reina two years ago.  Reina has since given birth to her third child, a girl seven months old.   Miguel, Reina's 5 year old, accompanied her to the hospital.     

All in all, it was a long day.   We waited until all the patients had been seen until we had the lunch that had been delivered in takeout containers.

At Carol's late afternoon meeting, the reports were of a very satisfying and successful first day.  There were a few tough moments, but overall the job got done.  The doctors who are being trained in IVAA, cryo, and LEEP, have some experience and performed well.  Yet, they seem reluctant to ask questions.  Maybe we are more intimidating than we realize. 

After a dinner of veggie lasagna at the local restaurant, we will turn in early to prepare for another day of hard work, and hopefully the satisfaction of helping the doctors of Leon prevent cervical cancer among the local women.    

--
Patricia Spross
patricia.spross@gmail.com

PINCC team in Leon Nicaragua June 2, 2013

Saturday, 6/1/13

It's rainy season in Nicaragua, and the air is heavy with humidity.   Managua is quite sad, except for a park along the lake full of colorful restaurants and playgrounds.  A few 2-wheeled horse-drawn carts navigate among the cars.   Vendors move through the neighborhoods singing out their wares.  The cathedral has not been repaired since the devastating earthquake of 1972. 

 

Sunday, 6/2/13

This morning the PINCC group moved from rainy Managua.  We are now staying at the charming Hotel Real in Leon.    Sitting in rockers on the patio, we gathered around Carol as she explained the work we will be doing.  The clinicians broke off and spoke together while we support folks and interpreters reviewed the medical questionnaire.   Carol assigned a team of 2 to each of the medical suitcases.  We will be responsible for their contents, and safe return of the costly instruments and medicines.   Carol is well organized and very calm.  She reminded us that if anything goes wrong, it's her fault.   I feel very safe around her.

We broke for dinner after our training session.    We are a group of 16.  About half are in their 20's while most of the rest have passed our 40^th birthdays, some quite a while ago.   Dr. Pam's children are with us, charming us with their games and drawings.

We will turn in early tonight, so we can be fresh for tomorrow's adventure. 

--
Patricia Spross
patricia.spross@gmail.com

The PINCC Team with trainees, last day at Kiambu District Hospital.

Final day in Kiambu

What a difference a few days make.  After a rocky start the PINCC team dug in. With four improvised exam rooms in full swing, Anne Daly, Eva Bryer, Deborah Crabbe and Art Levit took on a constantly changing group of trainees ranging from MDs to Nurses to Clinical Officers (sort of like our physicians assistants).  Some had never done an a pelvic exam, others were quite experienced.  By the end of the week the group had more or less stabilized and enthusiasm and commitment grew.  Carol, Laurie Jones and myself manned the desk and as word got out about the free screening, people poured in.  Predictably, chaos ensued as we struggled to register, interview, screen patients, and restock supplies in some sort of coherent manner.  By Friday the desk was a well oiled machine (relative to Monday). 

And miracles do happen-- a malfunctioning cryo tip was replaced the same day by the company supplier in Nairobi.

By Friday afternoon, thanks to the finely honed diplomacy skills of Carol and Art,  the hospital higher ups were on board and eager for another visit and more training with the hopes of setting up Cryo and LEEP treatment centers.  What a difference a few days make.

Re: Day 2 at Kiambu District Hospital

On Wednesday, January 30, 2013, Nina Fletcher wrote:

On Tuesday, January 29, 2013, Nina Fletcher wrote:

For those eagerly awaiting Deborah Shaffler's fourth Kibera episode, you may be disappointed. Our Kibera super-blogger has moved on, as have we-- onto the Kiambu District Hospital for a first ever visit. In spite of prior arrangements with the hospital, our arrival was somewhat unanticipated.  There has been a nurse's strike at the hospital for the past month the the staff that remains have been pressed to the limit.  After an awkward start, four exam rooms were created from practically nothing, trainees were summoned, patients recruited and we began.  Given the difficult situation, the staff has been extraordinarily helpful and enthusiasm has been building among the trainees. 
We've had the usual equipment glitches, malfunctioning cryo tips, a blue tank that was provided labeled "oxygen"...the usual. However, we see smoother days ahead.  

Clinicians Deborah Crabbe and Eva Bryer and Anne Daly report that today was a noteworthy bad cervix day..Apparently they were  playing hard to get.  This too will pass...  Nina Fletcher

parting shot of Kibera trainees

this is our great group!!

Anne Daly
 

Kibera, Episode Three

We have completed our work in Kibera so this will be my last posting about this sensational - as in sensory overload - experience.

This has been a successful trip. We certified several trainees: Irene, Maureen, Adah and David in VIA and Cryo, and Richard in VIA. The three other new trainees were exceptional and we look forward to their certification in the future.  We will be posting photos of all the trainees. We performed two LEEPS and six Cryos. The flip books we donated on a prior visit are being used, among other things, as teaching tools for women waiting for their examinations. Our relationship with Carolina for Kibera is moving along. In part due to access issues - the CFK facility is further into the slum and down a treacherous hill - we have not been working there. Rather, community workers from CFK brought us several patients to screen at Shining Hope. One super friendly CFK woman assured us that she takes care that all her population receive necessary shots, vaccinations and tests. I'm sure she does!

By the fourth day our corner of Kibera was starting to feel like a neighborhood. A mural project we noted on the first day was completed. Sewer pipes were at rest along the main road, waiting for installation. The woman crocheting a blue blanket was busy with her project. The man frying donuts at the turn in the road was chatting with his friends. Hair braiding, a social as well as grooming activity, was going on everywhere. Chickens strutted and pecked. The popcorn, fish, charcoal and vegetable vendors were in their regular places. The exotic was starting to look normal.

Most of our patients are Christians, which is the predominant religion.  However, we saw many Muslim women as well, like in India, only there the mix is Hindu and Muslim. You will occasionally hear the call to prayer, and mosques are scattered about. There are reportedly 42 tribes represented in Kibera. More traditional Kenyans may have arranged marriages, marry within their tribe, and pay the bride price. Kenyan women tend to be somewhat shy and Kenyans generally speak softly. They have beautiful smiles and teeth, and dressed in tradition clothing women are truly striking. 

One of the benefits of staying at the Guest House is meeting inspiring people doing interesting things. We have met:

--  A young woman doing research on the contribution of hippopotami to nutrient transfer from soil to streams. Yes, it's exactly what you think. The animals graze on the land and poop in the stream, serving as vectors for the nutrient transfer, sort of like erosion. She's trying to figure out whether this is a good or bad thing.

--  A young British man proctoring a United Nations debating event.

--  A young woman designing products for production by a rural women's coop.

--  A surgeon here for volunteer work.

--  A Mennonite man here for mission work.

--  A retired couple from Denver doing teacher training at the Kibera Girls School next to our clinic. In fact, one of our team members, Deborah Crabbe, met them on the plane coming over and we all went to dinner together this evening.

And of course we met Esther, who has been so helpful to PINCC with travel arrangements and other things. She and her fiance Simon came to dinner with us one evening. They are lovely young Kenyans starting off life together.

Just a few words on security. A substantial portion of the employed population here must be involved in security work of one sort or another. As I mentioned before, most homes and buildings of any size have a wall and a guarded gate. The ATM we have used has a guard armed with a machine gun fitted with the size of magazine much in the news in the states lately. Parking lots at shopping centers are guarded and gated. At the upscale mall where we ate tonight the guards searched some cars before allowing them into the lot. On the other hand, there is no official security in Kibera. We were told that the clinic is guarded at night by men with bull horns. Should anyone approach the facility they will blow the horn and the community will come out in force. Another example of how the residents improvise services normally provided by government.

Perhaps one of the most fun things to do here is shop. There is a tremendous variety of affordable items. This morning we visited a shop selling attractive crafts made by disabled people. We were impressed with the well made, creative and even whimsical choices. Kay bought a bunch of things to sell at our spring event April 7. Later we visited the Masai market in downtown Nairobi. This is a not to be missed scene. If you're into it, you can have a terrific time bargaining. It's real life theater. Some of the vendors truly love what they do and are naturals at sales. Sometimes you can get a better price if you also agree to buy lunch from the vendor. Watch out for the items made in India or China, but mostly you'll find products from Africa.

Much has been written about Kibera. There is even a commercial tour of the area that gets five stars on Trip Advisor. Check it out. There is considerable controversy about how many people actually live in Kibera. For a contrarian viewpoint and some great pictures, check out 
http://www.guardian.co.uk/science/the-lay-scientist/2012/aug/01/africa-propaganda-kibera.

Sent from my iPad

Trainees last day Friday January 25, 2013

Kibera, Episode Two

We have completed 3 days in the Shining Hope facility, so it's time to tell you about it. Shining Hope is a gloriously successful NGO that sponsors many community projects in Kibera, one of which is the clinic in which we are working. Shining Hope is well known in Kibera, and there are many directional signs to its facilities, critical in an area without street signs, addresses (most of our patients have no address), or anything approaching a rational grid. The clinic is next door to the girls' school, which you may have seen in the lively You Tube video. Fhttp://video.msnbc.msn.com/rock-center/50502475.  On beaks from the clinic we can climb three floors to the roof of the school, which features views of about 30 percent of Kibera, and, after lunch, perhaps 40 little girls in plaid uniforms racing around colorful and imaginative play structures. The favorite game seems to be competitive rolling of painted tires. When you get bored with that you can hide inside three stacked tires.

We have four examination rooms, each the size of a large walk in closet. The lighting is from a single naked incandescent bulb and whatever natural light comes in the window, along with children's crying, playing and singing, and neighbors' chatting. The uneven walls are brightly painted, often decorated with informational  posters about child abuse and rape from US government agencies. Some of the floors slope noticeably. While the Shining Hope facilities seem to be made of concrete, the predominant building materials are corrugated metal, wooden poles and mud. It is warm in the exam rooms, but less warm downstairs where we do intake interviews and data entry, my jobs.

The employees of the clinic are competent, hard working and endlessly accommodating. They, like our trainees, speak English well, as do many, but not all, of the patients. Thus we have informational material in English, Luo, and Swahili. The clinic personnel have been helping us out with the non-English speakers. Interviewing the patients has been extremely interesting. I have learned, for instance, that women in this culture simply do not smoke or drink, although men can - and do - do both. One woman told me she would not drink because she is a Christian. In response to the question about smoking, the women tended to wrinkle their noses and shake their heads in distaste. Almost all women have been tested for AIDS, and a shocking percentage are HIV positive, which makes them more susceptible to cervical cancer.

If you are a volunteer, you may be interested in the lunch provided by the facility and the latrine situation. Lunch is simple, plentiful and hearty: greens, beans and a starch like congealed Cream of Wheat, or cabbage and beans. There is a tolerable squat latrine with 8 stalls donated by Newman's Own. There is water and soap outside to wash your hands. People line up to use the latrine. There are similar structures dotted throughout Kibera. There is also a water depot contributed by another donor, and there are similar water towers at points in the surrounding area. The slum is divided into neighborhoods, and it may be that these facilities are associated with different neighborhoods. Women line up throughout the day to collect water in yellow plastic containers, which they carry home on their heads. Sewers are open ditches on the sides of the road. Side alleys have no such ditches because they are too narrow. People sweep refuse into the ditches, little boys pee into them, and there are little bridges across them right up to the home entrance. I once saw water flowing in one of these sewers, but mostly they are stagnant. People use propane and charcoal for cooking. These, and cell phones, are some of the ways the slum dwellers compensate for the lack of the utility and city services we take for granted. 

Perhaps the most gratifying thing that happens during the day for me is recording the performance of a cryo or LEEP procedure on a woman who has dysplasia, or diseased cervical cells, meaning those cells will not grow into a cancer. We effectively have prevented her from developing a deadly condition. Teaching local providers to screen and perform these types of procedures is what PINCC is all about.

The largest and best constructed structures by far are the churches, of which we saw many. In this intensely inhabited area totally devoid of greenery, churches have surrounding open space. Some look like they predate the slum itself. Religion, mostly Christian, is pervasive in Kibera. Many business have religious themed names, such as the By God's Mercy Hair Salon.

Cell phones are ubiquitous. In fact, cell phone companies are about the only international businesses with a presence in Kibera. If you long for a place without Walmart or Starbucks, this the the one for you. Perhaps the reason there are all these tiny businesses is that they do not (yet) have competition from big companies. 

I do have to prepare you for the traffic, which is awful, and unpredictable. On our side of town people tend to drive nice Japanese cars and are generally courteous. Our amazingly patient and ever helpful driver Mike lives on the other side of town and reports that drivers there are aggressive and careless. There is a divided highway near us where traffic seems to flow, but all the other streets are two lanes and you can stand still for minutes at a time. It takes at least an hour to get to our clinic from the guest house. By the way, people drive on the left. It is not as chaotic as India, however, since here there are no cows, dogs, rickshaws, motorbikes, bicycle taxies, hand trollies, etc. competing for advantage.

Breakfast bell is ringing, so I'll sign of. Deborah



Sent from my iPad

Kibera clinic where PINCC is working

Note brand new steps, the only ones we saw.