Last Cacaopera blog entry, by Patricia Spross

Attached is the  photo of Dr. Garcia, the head of the Cacaopera clinic, with the cryo equipment donated by PINCC.

Last days in Cacaopera

PINCC doctors and nurse practitioners focus on training the local medical team on how to treat the patients.    When they guide the medical exams, their main focus is ensuring that the local doctors learn how to perform IVA, cryotherapy and LEEP's.   The sustainable part of PINCC's mission is to make another PINCC visit unnecessary because the local team is fully trained. 

Volunteers often say that they receive back much more than they give.   So for my final blog entry, I want to express thanks for the gifts that PINCC has given me:

·         Meaningful work, and the feeling of being needed

·         A motive to improve my Spanish

·         An opportunity to support the cause of women

·         The recognition that my life has been full of extraordinary gifts

                A PINCC volunteer without a medical background lives in a parallel world from the trainers.   We stay on the periphery of the medical and training process.   In fact, some of us are squeamish about getting close to a patient's nether regions.   We interview and comfort the patients, hold the babies, input data into the computer, set up the exam rooms, and perform unexpected tasks such as chasing runaway patients, visiting the local pharmacy to buy pregnancy tests, or using our best handwriting to create "graduation" certificates for the local medical team.    This is nothing like a normal day at the office, and is enormous fun!         

Having studied several languages, I rarely have the chance to immerse myself in a second language.   That love of languages gave me my first entry into PINCC's world.   They needed Spanish- speaking volunteers, so I took a risk and signed up in spite of my limited Spanish.    Two years ago, during those months of waiting to travel with PINCC, I read only Spanish novels borrowed from the public library.   Those first books were hard because my vocabulary was weak.   So I wrote down the many words I did not know, and looked them up in a dictionary.   The excellent telenovela "Pablo Escobar – El Patron de Mal", was my tutorial for spoken Spanish.    Language learners usually struggle the most to speak, especially adults who are embarrassed to make mistakes.  But I forced myself to speak Spanish in my neighborhood stores.   As I have always found, native speakers kindly endure the fumbling efforts of someone trying to learn their language.   And now that I have completed my third trip with PINCC, I enjoy simple chats with anxious patients about our families, our gardens, and food.   And my vocabulary of Spanish gynecological terms may exceed my English vocabulary on the same subject!

But perhaps the most important gift bestowed by traveling with PINCC, is the opportunity to support the cause of women.  I was a young teen during the 1960's, and the women's movement spoke strongly to me.    A phrase from that era, "We are all sisters" still resounds.   As a Catholic schoolgirl from a religious family, I ached to participate in the fight for equality.   And in my small way, I have always fought for the cause.  But a female professional in the banking industry needs to tread carefully because we are a minority.  Banks are hierarchical organizations where only in recent years have women begun to achieve a critical mass.   Only when we are present in numbers can we be our best selves, and speak freely of the challenges of trying to succeed in our professions, while having and raising our children.    I connect the experience of our struggle for equality in the US with the struggle now underway in El Salvador.

Patriarchy still reigns in the poor communities of rural El Salvador.  Women clearly have made inroads in the medical profession, and the majority of our trainees were female doctors.  Yet, silence among women has allowed patriarchy to flourish.  A critical mass of women needs to give voice to the things that impede them from being full participants in society.   While taking the patient histories, we PINCC volunteers ask the Salvadoran women about forbidden topics such as childhood sexual abuse and violence in the home.   When a patient minimizes her suffering by responding that she endures only verbal, but not physical abuse, a PINCC volunteer can observe that verbal abuse is also very painful.  This acknowledgement may be a seed of strength that can be nurtured through the psychological counseling that is now available to many patients.  Some Salvadoreans ruefully acknowledge their culture of machismo.  Acknowledgement is the first step on the long journey toward change.  The PINCC team was happy to see the poster in the clinic which offered support to victims of family violence. 

So I will keep coming on these trips as long as PINCC will have me.   The wonderful women I encounter will always pull me back.   The women may be illiterate, but the intelligence and courage often shines through.  Like all mothers, they think of their children and want a better life for them.   And sometimes they feel safe enough to open up about the pain in their lives, and we listen as tears fill their eyes.    But for the luck of birth, it could be one us speaking softly of lost children, abuse, or the grinding poverty of life in rural El Salvador.   We are all sisters.

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Patricia Spross
patricia.spross@gmail.com

NOT BY THE BOOK (OR THE PINCC MANUAL)

By Sallie Weissinger, PINCC Volunteer, June 2014

There's more to volunteering for a PINCC mission than doing our work by the book or, in our case, by the manual.  According to the manual, our mission is to train local doctors and nurses to diagnose and treat women for low and high grade lesions, thereby preventing cervical cancer.  But our real job description is far richer and rewarding than the official one.  On a PINCC trip, we are learners and students, as well as medical experts and teachers. We relish that richness, as we soak up information about the cultural, political, social, and familial structures in the regions where we work.  We're especially interested in learning about the health care resources that support (and, in many cases, don't adequately support) the in-country clinicians mastering PINCC techniques.  Meeting the clinicians' patients and learning about their histories, hardships, and challenges is always interesting and at times humbling.  The same is true of getting to know our clinician trainees' backgrounds.  Every day we work with them, we become more impressed with the dedication of the local doctors and nurses. They cope with personal and professional demands and pressures we simply haven't ­ encountered.  Their stories and experiences leave us open-mouthed and even awe-struck.

 Someone who fits this description is nurse midwife Selmira Aguilar, a mother in her 30s, who trained with PINCC in Kukra Hill, in the Kukra indigenous region on Nicaragua's Caribbean coast.  The day after completing her five-day, intensive training in diagnosing cervical lesions, Selmira did not go home for the weekend, to hang with her family.  She and five other health care providers left on a 14-day trip to visit 13 remote hamlets, places too small to have access to health centers for some of the 16,000 inhabitants of the catchment area in which she works.   They left on horseback and mules, packing their clothes, medical equipment and supplies.  They packed hammocks to string up on trees, but left prepared to sleep on the wet ground if trees weren't available.  Even so, they clung to the hope that, in the midst of the monsoon season after a day of trudging through mud on dirt paths, there'd be the occasional school or church for sleeping dry. 

Their plan called for eating food prepared by the villagers on the way and setting up the 13 clinics wherever possible:  in some hamlets, clinics would be set up in churches and schools.  In other places, Selmira told us she and her colleagues planned to improvise clinics in people's homes or, if necessary, hang sheets on ropes attached to trees.  One way or another, they would provide a full range of services:  PAP tests, HIV testing, routine vaccinations, pre-natal care, well baby care, and general medicine.  In time, once she becomes certified by PINCC in VIAA – visual inspections with acetic acid- she will add it to her medical repertoire, so women won't have to wait months and months to receive their results.  With VIAA, they will get their results within minutes.

Following her first week of training, the PINCC trainers were favorably impressed with her skills:  she's fast-moving, quick-thinking, accurate, energetic, and animated; most importantly, she's a good clinician and a good communicator.   And, in the words of one of the PINCC team, "she has a generous heart."   

As we write of her visit to the hamlets outside of Kukra Hill, Selmira should be returning from her 13-day trip.  On our next visit in November, we will be sure to learn more about her time on the road as a medical provider in this remote part of the second poorest country in the Western Hemisphere.  That's when she will once again be a PINCC trainee, and we will return as her trainers.  But we will also switch roles, learning from her about dedication in the face of discomfort, generosity in the face of scarcity, and  perseverance and commitment in the midst of pouring rain and omnipresent mud.  And all of this while riding horses and packing with mules.  For sure, the learning goes both ways! 

  

Cacaopera June 11, 2014

 

We just finished our third day in Cacaopera.   Many patients have traveled for miles to visit us for treatment.  There have been numerous LEEP's and cryo's which have enabled our doctors to train the local medical team.   The trainees need to observe many cases of diseased tissue in order to recognize it in their practices. 

The local public health employees have done a great job to improve the health of their communities.  One group arrived today with their doctor, their nurse practitioner, and their psychologist!   The doctor, like many here in El Salvador, was trained in Cuba.

Yesterday, we had a patient who had been deported from the US.   She preferred to speak in English, and overflowed with stories of her troubled life and the difficult living conditions in El Salvador.   The young woman seems to have no place in this world.  She has no documents for the US, and none which allow her to work in El Salvador.   This lost soul spent time talking with us while waiting for her cryotherapy.  She seemed grateful to have someone listen to her.

Today, the services of the PINCC support team, i.e. non-medical volunteers, expanded to include child care.   One young mom came with her 2 year old who sobbed pitifully during her exam in the ante-room.   His body was tense with fear, and nothing could soothe him.   He finally calmed down when his mother rejoined him after her exam.  But his young mother was very nervous at the prospect of the cryo treatment that the doctors had recommended.  Another PINCC volunteer supported the mother until her turn for treatment came.  During her cryotherapy, the little boy sat quietly in the waiting room watching the scene.  People delivered lunches in huge baskets.  Stray dogs smelled the food and roamed the hall until shooed away.  Doctors and nurses rushed to treatment rooms discussing their cases.  Patients chatted while waiting their turns.  Most entertaining were the young children who drew with the colored pencils that one of the PINCC volunteers had brought.  Sitting next to my young charge, I also enjoyed the bustle of the clinic at midday.      

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Patricia Spross
patricia.spross@gmail.com

First day in Cacaopera El Salvador

Off to a smooth start on our first day in Cacaopera, El Salvador!  The town is in the poorest region of El Salvador, and the region most impacted by El Salvador's war.   The clinic's team was well- prepared for us, and the trainees eager to learn.   Veterans of 7 PINCC trips, Carol and Cheryl, were very impressed with how well organized everything was.  We saw 20 patients, which allowed us to unpack the PINCC suitcases and sort things out without pressure.   Salina, a medical student on our team, had the time to teach the patients some anatomy.   Although the patients were quiet during the talk, Salina had an impact because several women approached her afterwards with questions. 

As always, the patients were lovely, and grateful for the care.   Among the older women there were harrowing stories of war experiences.   One woman delivered her baby two months early when a bomb detonated a few yards from her home.   The baby survived, but the mother was left deaf for several years.   Another woman had worked as a nurse for wounded guerillas.    Another woman had beautiful green eyes, a rarity in this country, but not in her village.  There must have been a European ancestor who brought those genes to this remote region.   It is an honor and a wonder to hear these women's stories during the patient interview.

It is rainy season here.   We need to be vigilant about using the stinky mosquito cream.   Our hotel is high in the mountains, surrounded by clouds in the late afternoon.   What a joy to be here with such a wonderful team of women, in this forest full of colorful birds and tropical vegetation.   Tomorrow is another day of adventure; we expect to see 40 patients, so there will be lots of stories to share.

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Patricia Spross
patricia.spross@gmail.com

photos from week in Pearl Lagoon

Captions for photos:
Top L: Volunteer Dr. Christine Newsom observing trainee Nurse Elcia Taylor with trainee Doctora Maria Ines Castilla behind. Decorations are up because of recent Mothers Day celebration.
Top R: Trainee Dr. Effie Fox (Clinic Director) using cryo-gun under observation by volunteer Dr. Nancy Reynolds.
Mid L: "Central-Supply" table with clinic specula, some donated by PINCC
Mid R: Cryo-gun and Nitrous Oxide Tank
Combined group of PINCC volunteers and five Pearl Lagoon trainees
Emergency Room interior
Emergency Room entrance

Pearl Lagoon, June 2014, Photos and text by Dr. Nancy Reynolds, Gynecologist

Today began with the news that one of our nurses' cousins had died in Managua. She was in her 30s and had been diagnosed a year ago on the first PINCC visit to Laguna de Perla. She left 4 children motherless. This sad news reminded us of the significance of our mission. 300,000 women are diagnosed annually with preventable cervical cancer worldwide. In my 35 year career in the U.S. I have diagnosed only 4-5 women. It is rare because we practice prevention. The clinic and patients from a village, Orinoco, who came by panga today for cervical cancer screening. Photographs of Nurse Elcia and  Doctor Maria Inez, that I worked with today. A truck parked outside the clinic. The cryo therapy unit was successfully repaired today so we treated 2 women with pre cancer.

Photos from Pearl Lagoon by Dr. Nancy Reynolds, Gynecologist

First day at work—7:30 til 4—curried shrimp and rice for lunch. Lots of bottled water. Hot sunny day outside. Inside AC when electricity was on. I worked with a Spanish speaking family practice doc—25 wks pregnant—Cuban trained. There are 4 docs here who went to Cuba at age 18 and trained for 10-15 years before coming home to Nicaragua.

Pearl Lagoon

This is the clinic in Pearl Lagoon and our Support Team (Sarah, Shana, Salena and Kate from left to right).

Last day in Pearl Lagoon...by Shana Wetzler

Well, the last day has now officially come…Friday. What happened to the time, the two weeks of the trip? This time here has FLEW by!!

The work here have been long days; some with sunshine and heat, others are humid along with down-pours. Regardless of the weather, every day our group has strived to work hard; to teach the clinicians in Pearl Lagoon to maintain cervical cancer screening without PINCC returning; educating members of the society about cervical cancer; working in rooms filled with many women with limited air conditioning; keeping up with all the paperwork, computer work and medical records; cleaning and stocking each room. Everything in the past 2 weeks has made the experience here be a total thrill!!

The local 'Pearl Lagoon' folk, the PINCC crew and the staff at each hospital have been totally amazing! I will miss each and every person…it brings tears to my eyes to think that tomorrow I will fall asleep in a hotel room all alone somewhere in Houston awaiting a flight back home to Wyoming. I have become so close with everyone here that it will be heartbreaking to leave.

The simplicity of the lifestyle here in Nicaragua is one thing that I will miss more than I can say.  People tend to walk slower taking in the beautiful day, sunshine and life in general. Once the locals get to know you, they will smile as you pass with a simple greeting. Children are riding their bikes, playing baseball, and running around their houses with friends. One thing that I have noticed is that children here seem very happy and content. The mothers are very attentive and the older siblings are second hands to help tend to the youngsters.  

On a regular day I have noticed that horses wander down the dirt roads. Cows wander in the fields. Chickens roam around each house. Dogs lay in the sidewalks. Hummingbirds feast on the beautiful flowers growing all over. The 'farm lifestyle' is one thing I will miss the most. Children walk to school each day in groups, dressed in classy uniforms. White shirts, green bottoms, skirts for the girls and pants for the boys. All carrying backpacks…smiles greet us each day.

Our day ends with our group separating prior to dinner. Some go back to the room to rest, others socialize. We all reconvene for dinner at a local restaurant…changes each night. The late night walks back to the hotel have been exhilarating. Cool breeze and calm…a perfect way to end each day.  The power has only gone out a few times this week, but overall we have been sleeping in air conditioned rooms throughout the nights.

Even though it is a goodbye for some of us, the rest of the crew will be continuing on to El Salvador next week. I have heard so many great things about El Salvador and in some way…I'm slightly jealous I'm not going!! I can't wait to hear all of the stories of next week. It will be a great adventure and I wish everyone safe travels! Thank you again PINCC for a great learning and travel experience. One I will never forget!!

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Live~Laugh~Love

Week 2 in Pearl Lagoon:Blog from Shana Wetzler

Well the second week has officially started!! The new crew is all settled into Pearl Lagoon-welcomed with a 'power outage' the first day. But so far, everyone is just wonderful! Sarah and I have 2 new running partners (Kate and Selena) for our morning runs prior to clinicals. This morning was a beautiful day to run, clear skies and a small breeze. Always a wonderful way to start off the day.

Coffee and breakfast to greet us after our run...always my favorite!

Today in Pearl Lagoon at the clinic, has been a little hectic. Although, as Carol will always say "its the first day, its supposed to be hectic!"

The staff here has been very helpful. Ellen (a nurse at Pearl Lagoon clinic), her mother made homemade 'PICO' a pastry filled with sugar and cinnamon...YUM!!!

The weather is beautiful with sunny days...leading to hot and humid-ness. Minimal rain yet so far since the week has started.

We have been seeing many returning patients that PINCC saw in the past 2 visits last year. The wait time for each patient is a little longer than last week, but we are working on our 'time factor'.
The lunches this week have been super delicious, homemade from a great cook named Warner, local man here.

So far so good on this second week!!!!

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Live~Laugh~Love