Mysore activities January 02-10, 2012

John Adams

 

MYSORE --  02 – 10 2012

SUMMARY OF FOUR SCREENING TRAINING CLINICS IN MYSORE

 

DATE	HOSPITAL	DAYS	VIA	PAP	BIOPSY	CRYO	LEEP	CANCER		MD / RN TRAINEES
08/2010	St. Josephs	4	159	43	15	5	2	1		8
12/2010	Cheluvamba	4	202	47	31	2	2	2		7 (1 as co-teacher)
07/2011	JSS	4	263	46	50	14	5	7		5
01/2012	St. Josephs	4	198	57	50	8  (Broken Cryo gun)	7	1		8
TOTAL		16	822	193	146	29	16	11

We completed our fourth four-day VIA screening and training clinic in Mysore on 07 January. Once again, we were highly impressed with the organizational support provided by all the staff at the Public Health Research Institute of India. They provided a total of 21 staff for patient education, registration, informed consent, record keeping, nursing and patient flow management. We had to make a late switch from JSS Hospital to St. Josephs Hospital due to a government mandated polio vaccination program that was announce just before we departed for India.

 

During the camp, we saw a total of 198 women. 58 of the screenings were inadequate and Pap smears were sent to JSS Medical College Pathology Department. 53 patients were judged positive and 50 biopsies of the possibly affected areas of these women were also sent to JSS. Eight Cryotherapy treatments were performed for moderate lesions and seven LEEPs were performed for more severe lesions. We saw one "definite" case of cervical cancer and one possible case.

 

The original intention on day four was to bring in a large cohort of HIV+ women. Unfortunately there was a late glitch and so we only got to see a handful of HIV+ cases. As a result, Day four was shortened and we saw about half as many patients as on the other three days.

 

At the end of the camp, we certified five of the trainee doctors as qualified to perform and to teach VIA and Cryotherapy. We concluded that a fifth camp is necessary in order to certify any of the doctors in LEEP.

 

In our follow up meetings at PHRII after the camp, they reaffirmed their intention to continue to develop the VIA screening camps on a monthly basis in the Mysore area. We also held a "pluses and deltas" review of the camp with all staff at PHRII and identified several areas for clarifications and improvements. In another meeting of the PHRII management and clinical group (nurses, trainee doctors, administration), we focused on planning for the development of a longer-term cervical cancer screening and prevention program – with the vision of making Mysore the "capital" of cervical cancer prevention in all of India.

 

On 09 January, Dr. Rhoda Nussbaum, PINCC-India Medical Director, gave an excellent CME presentation on cervical cancer, which included an actual colposcopy demonstration on three patients back stage, with video coverage into the auditorium. A first for PINCC-India to be sure!

9 days and counting! Readying for Africa

The bags are (almost) packed! Shots and meds on Wednesday, first aide kit replenished, camera batteries and kindle charged, mosquito repellent and skin so soft purchased… got to pick up a mosquito net.

My name is Amelia, and this is my first trip with PINCC. I became acquainted with the organization last May, helped in the fundraiser in June, and waited until there was a trip that fit in my schedule. I will be going to Uganda and Kenya in two weeks. I am not a nurse or a doctor, I am a former teacher now nursing school candidate who will act as a community educator and all around support for the team while they train the host country medical staff on the identification and treatment of cervical cancer.

Today the team met in Oakland to prepare for the trip. At least 8 suitcases bigger than I have ever owned were packed with gauze, small cotton swabs, large cotton swabs, gloves, gloves and more gloves, pregnancy tests, LEEP machines and materials, exam kits that we put together, headlamps, alcohol solution, cytobrushes, pap sticks, syringes, loops, silver nitrate, lidocaine, and all kinds of instruments that I am only fairly familiar. Each suitcase had a packing list, each carefully thought out so that everything that was needed would be with us yet none would be over 50lbs, so no one would have to pay over sized luggage fees.

And what fun the day was! These are some terrific people going on this trip. Our fearless leader, Carol, has a Zen like quality that, regardless as to what is going on around her, keeps everyone calm and unfretted. Art, a retired OBGYN who plays drums and is studying Jazz piano has an elfish sparkle in his eyes, a joy of life seen in many people who are readying to embark on an adventure. Another Carol and Eva, two lively and cheerful nurses who have been to South America with PINCC, round out our team to Africa. The day went fast as we filled the suitcases, smiled and giggled at the stories and perused a book Barbara and John made of the last trip to Africa.

Many thanks to Kay, Pat, Carol, Art, Carol, Eva, Mitra, John, Barbara, Cheryl, Renee, Sujata and Karen for giving of their time in helping us prepare for this trip.

The bags are nearly packed. We are just about ready to go. For me, nine days and counting…

Amelia T. Hambrecht

Arrival of PINCC INDIA

John Adams

ARRIVAL IN INDIA: 02-03 January 2012

 

Our PINCC-India team of five departed from SFO new year's eve on time on an Emirates flight that is the longest non-stop flight coming out of San Francisco – nearly 16 hours! With suitable drug therapy we all got enough sleep to get off the plane in Dubai, walk around for an hour, and then board another three-hour flight to Bengaluru. For once, we actually arrived at our destination in India a few minutes early – unheard of in the annals of modern flight!

In the picture, from left to right, Janis Luft, Liz Armstrong, Joy Carlson and Rhoda Nussbaum, waiting for our car at Bengaluru Airport at 4:00 am Monday morning 02 January.

 

Our team consists of Dr. Rhoda Nussbaum, Medical Director, PINCC-India; Janis Luft, NP; Joy Carlson, and Liz Armstrong; and your trusty blogger and Administrative Director for PINCC-India, John Adams.

 

Our regular driver, Mr. Khan, met us at the airport and drove us safely to Mysore, where we arrived at 7:00 am on 02 January, and checked into our regular hotel. For Rhoda and me it is always like coming home! We spent the morning going to the bank to exchange money, shopping for room necessities, and getting our telephone SIM card charged up. We spent the afternoon at PHRII coordinating the week.

 

On Tuesday we had a wonderful meeting at the government hospital, where we worked during our second visit to Mysore, with the Radiation Oncology doctors, who are most interested in learning VIA and setting up clinics to screen for and prevent cervical cancer in the villages. They both declared they'd come to see our clinic set up on Wednesday to get an idea of what it takes. We may well be doing further PINCC camps in Mysore with new populations of doctors!

 

Next we went to the JSS Medical College and got a tour. During our July 2012 visit, the JSS Swamiji (Holy Man) blessed our project and invited us to make JSS hospital our home. When we were introduced to the JSS Medical College Principal, he told us that the Swamiji had spoken highly of our project. He invited us to submit a proposal for incorporating VIA, Cryo and LEEP training into their medical school curriculum. If it is successful, they would advocate to the National Medical Council, which controls all medical school curricula, to add VIA, Cryo and LEEP to all gynecology programs across the country. We continue to dream big and find progress!

 

Tomorrow we stat our fourth PINCC clinic hosted by The Public Health Research Institute of India and held at St. Joseph's Hospital (JSS not being available at the last second due to a government mandated national polio program – if only they'd take HPV as seriously as polio!).

209 728 9432

415 385 8388 (Mobile)

www.home.comcast.net/~jadams2212/

The rise of economics as a profession has not been accompanied by any noticeable improvement in the ability of societies to manage their economic affairs (John Michael Greer)

PERU!

Last Saturday we held classes for willing Salvadorenos that came in voluntarily on the national Bicentenial holiday to complete their training with PINCC. Dra. Patricia de Banos, the person who "put it all together in El Salvador" is pictured in the first attached photo. The PINCC team then dispersed and Kay, Carol, Samantha and Lyell continued to Lima and met up with Nancy Levine, Janet Wiese, and Natalia Tocino and headed north to Huaral at 5am Monday morning. Huaral proved to be challenging in many ways, but PINCC's training there will definitely benefit the women of Huaral and surrounding areas as there is MUCH need for cervical cancer screening there---sadly, we had to turn away women each of the three days we were there as there were still women waiting in line after 5 pm each day. The stats for El Salvador and for Huaral, our first 3 days in Peru are as follows:

El Salvador:

Total Patients seen for IVAA: 236

Cryo's: 22

LEEP's: 7

Huaral, Peru:

Total Patients seen for IVAA: 268

Cryo's: 6

LEEP's: 9

In order, the next photos show Natalia teaching women's health to the women waiting for their IVAA exams, photo 3 is Nancy teaching the midwives how to identify lesions, Janet teaching beginning students IVAA exam techniques, next is Noris, the midwife who coordinated the PINCC training, and, last but not least, the PINCC team shortly before departing Huaral. Tomorrow is the first of our 2 days working in Lima and we will try to blog one more time before heading home. All the volunteers send love to all their friends, families and supporters. Buenas noches, Lyell Fox

San Salvador

Saturday, 5 Nov 2011, by Kay Taylor, MD
Today we completed a terrific training week in cooperation with the El Salvador Ministry of Health. We have been working to train and certify teachers, who are already performing screening and treatment for cervical dysplasia in 5 health centers in the huge San Salvador metropolitan area. Each day, we drove for half an hour or more to a different clinic, some associated with hospitals. Our team of gynecologists, nurse practitioners and support people included two mid-teen girls, one of whom had her 14th birthday on Thursday. She received ice cream and cake from the health center with a lovely party after work was finished, then more ice-cream cake at dinner followed by singing and dancing at a local restaurant. She looked so cute in a huge caballero sombrero, with the MC leading singing of 'Felicidades' and Happy Birthday! They've been a great help, sorting charts and stocking exam rooms for us.

The rest of the team was kept very busy, teaching and proctoring examinations for 15 doctors, 4 gynecologists, and 25 nurse specialists, all of whom are in various stages of training, from just beginning to training their colleagues. We have certified 2 more gynecologists in all procedures, as well as 4 other doctors as trainers for examination and cryotherapy, and several more doctors and nurses certified to perform these techniques in their health centers. How proud they are of their certificates! The trainers will hold another training session in 3 months, so when we return, the remainder of these students should be ready for certification. There are 41 health centers in the metropolitan area. Now, 5 of them are equipped to perform treatments, and 14 to do screening and referrals. We hope to have this densely populated part of the public health system completely covered after May's visit!

We also trained 5 community health workers who lead health education efforts in the use of our new flipbooks for teaching women about their bodies and cancer prevention. They were very enthusiastic about the flipbooks we gave them, and are going to field-test them and train others with them. We'll get their feedback in May. We are told that only 1/3 of women have had cervical screening more than one time, because of lack of education as much as lack of opportunity. We hope to help change that!

Tired but satisfied, our team will be celebrating tonight with the Salvadoreans. Today is the 200th anniversary of their independence from Spain and Mexico, and the streets will be filled with music, dancing and fireworks. We really feel a part of their celebrations today!

(To watch Dr. Eve Yalom interview a patient that was treated by the PINCC team CLICK HERE)

Nejapa

Another special day with the pincc team alongside representatives from
the Ministry of Health and at least my favorite clinic yet.

Today we worked at a a clinic in Nejapa called ProVida. This was one
of the fist sites PINCC ever worked at and there{s a strong connection
and mutual respect.

ProVida is a community clinic, and those of us who{ve worked in then
even in the US know that there is a kinship in them that is different
from most other healthcare delivery sites. This clinic has worked
very hard to build itself from the ground up - literally as we arrived
to even new contruction since PINCC was there last.

Nejapa is a more rural community about 40 minutes outside of San
Salvador. Again, nurses and doctors from clinics and healh sites all
around San Salvador came to work today to learn VIA, sharpen their
skills, or become certified. We ran 6 rooms yesterday very smoothly
seeing patients for VIA exams while teaching new participants the
process and doing LEEP and cryo for new and prescreened patients.

Yesterday was extra-special. Soukeyna, my daughter, also turned 14
yesterday. The staff sang Las Mañanitos to her in the morning
introduction and, after clinic, we had a little party for her with
cake, singing and dancing with the clinic staff and participants. One
of the best days by far! Pictures to come...Michele Bunker-Alberts

day one El Salvador

picture from day one El Salvador

blogggg

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
 

day one El Salvador

we were off to a flyimg start in El Salvador with another stellar
PINCC group - all extremely hard-working and always maintaininh a
sense of humor. We spent our first day at a clinic in San Martin that
previous vounteers will remember as very busy with a BIG patient
volume. Alongside the Trainers and Trainees - the site is a new
´TrainñtheñTrainer´site, we saw 80-90 patients, 4 cryos and a LEEP.
-Lyell Fox, photos to follow