In Puno the city in the sky

We arrived in Puno over the weekend and began working on Monday. Puno is a small city and overlooks Lake Titicaca. The weather is perfect sunny, 60-70s and crispy at night. 

On Monday we met close to 40 midwives called "obstetriz" and a few doctors who wanted to participate in the PINCC  VIA (visual inspection of the cervix) training. We were all overwhelmed to say the least. How were we going to possibly train all these highly motivated and interested students. We started with a didactic and sadly only saw a few patients.

Today Tuesday we got a system down. We have 6 US providers and 2 Peruvian providers who can train/teach the students. We buddied up 6 students per provider for the full day. That way we created a sort of buddy system and the provider could really get to know their group of students. It worked well and we saw 40 patients.

Our group of volunteers are really sweet. Carol our fearless leader has unbelievable patience and is an amazing leader. Linda is a family nurse practitioner from the Boston area who has done work in Guatamala and works part time at a Harvard affiliated public health clinic in Jamaca Plains. Virginia is an ob/gyn who was a solo practitioner in Monterey, California for 30+ years, closed her practice recently and now works part time for the Salinas Department of Public Health. Carol who goes by "Carolina" here is a recently retired public health nurse from San Francisco and is on her 5th trip with PINCC. Tara is in her final year of residency at Kaiser Oakland in ob/gyn. She was in El Salvador with Carol last week and was in Nicaragua on a PINCC trip in 2011. Jamie is a PA originally from Utah who lives and works in NYC, loves to travel and this is her first PINCC trip. Suzanne is a family practice doc who practices at Clinica de la Raza in Concord and this is her first PINCC trip. Eve is an ob/gyn from Kaiser Oakland and this is her 2nd PINCC trip.

Juana is our local midwife, was trained by PINCC a few years ago in Lima and is helping to get us started in Puno. Enrique is a local ob/gyn from Lima who was also trained by PINCC and is working to get things going in Puno as well.

We have an amazing group and we're working hard to get things going. The altitude is incredible 12,000 feet and when you walk up a small hill you get winded. The food is great here. Trout is fresh from the lake and the vegetables are awesome.

Wanted to get something started on the blog. the next entry will be mostly photos.

Final Screening / Training in Mysore

We concluded our fifth four day camp at JSS Hospital in Mysore on Friday afternoon, November 9. It was a very busy camp, with 242 women screened and numbers of medical students, faculty, guests from Biocon and Rotary coming to observe. We were up to the challenges however, as we had an incredible team of four volunteers -- Dr. Debra Levinsky, Dr. Ginger Ruddy, Dr. Marie Johantgen, and Lauren Sokolik, FNP. While Lauren and I did most of the out front work, Rhoda and the doctors kept the screening tables "turning over" throughout the four days. One vo;unteer had too return home suddenly on the morning our camp was to start, due to a death in the family -- an event that made us all very sad!

The reason for this fifth camp was to solidify a LEEP referral center at JS hospital, to further our contribution to the course work for Gynecology students, to foster planning for a large scaling up of the PINCC protocols over the coming years, and to continue to build on the collaborations that we have been establishing across Mysore.

On the first evening, we were treated to a second meeting with the Swamiji of JSS who continues to be committed to our program. We started out with him, along with two research pharmacists from Penn State, and then went for "prasadum" (gift snacks) in his special dining room. We (just PINCC) were called back for a further few minutes after the light dinner. Auspiciously enough, he and Marie Johantgen were on the same flight out of Bangalore Friday night!

Following two wonderful weekend days of touring local palaces, tomb, battle sites, temples and gardens, we went on Monday morning to help Inaugurate PHRII's (our main Mysore partner) new larger women's clinic. Then we went for meetings with the medical college principal to talk further about curriculum, and also about how to scale up these screening and prevention services.

On Tuesday, the three remaining team members, Dr. Rhoda, Lauren and I, go to Bangalore for a Wednesday morning site-visit with the Biocon Foundation clinic doctors. We have rising doubts that it we can create a screening program in Biocon, but will give it a great effort.

On Wednesday evening the three of us head for Puttaparthi for a 6 day (1 day for Lauren) "time-out" at our Ashram. Then we will do further site visits in Hyderabadand the Indo-American Cancer Hospital and in Siliguri at the Sunitha Cancer Society

John

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India report by Rhoda Nussbaum, MD

We had a great and auspicious first day of camp.  We saw 56 women, many returns from the last camp or between camps, did 4 LEEP and 2 cryo and many other biopsies.  Dr. Suma will be certified to do LEEP by tomorrow or the 3rd day and AP Chandrasekar has deported another OBG professor to learn LEEP, Dr. Somia.


Tonight we had a visit with Swamiji arranged by Dr Suma who's in-laws are very close to Swami ji.  We thanked him for his support and described our goals of screening 75% of eligible women by 2020.  He talked about brining training to other parts of Karnataka.

The Vice Chancellor was also at the visit with Swami and we talked a bit about our proposal.  So in the last few days we have met all the important decision makers at JSS expect the principal  land we expect that will happen later this week.

The woman who represents the wives club of Rotary stopped by and two men from Rotary as well.  We will try to get a few of our  California Rotary friends connected with these Mysore clubs and see if we can get buddy support from US and India Rotary for cervical cancer prevention.

So it was a good day.  We are exhausted and satisfied.

India November 2012

 We met with Drs. Vijaya, Bhavana,Reshma, Poornima and our team at PHRII.  Dr. V had evolved her thinking over night and seemed to accept our strong recommendation that "See and Treat" was the only choice in this environment.

We brainstormed any barriers to carrying out See and Treat  in a village.  Drs. Bhavana and Reshma are so astute and have the ability to think about the larger system.  They pointed out that a women who had received biopsy or cryo and had some complaint thereafter would go to the PHC.  If the DHO and PHC staff were unaware that PHRII was doing Cx CA See and Treat  prevention and a women showed up at the PHC, that might cause a problem.  They strongly recommended that we talk to the  DHO and get his permission

The second barrier identified was getting consent for procedures from the women.  It was suggested that women be counseled during the awareness program that Biopsy and Cryo would be recommended if a precancerous lesion was found.  They could bring their husbands to screening  or call them if needed but by setting the expectation that these simple procedures might happen for at least ⅓ of the women screened, issues of refusing treatment because the husband hadn't consented should be minimalized.

 We went to see the DHO this evening.  He is aware and gives his acceptance that biopsies and cryo will be done in the villages.  A process for letting the local PHC staff understand what was done and why and  what post procedure side effects are expected will need to be worked out.

My eyelids are drooping as I write this email so I will say goodnight and will continue to let you know what is transpiring each day  so that a sustainable prevention program will be well on its way and that a program for how to scale up is being worked on.

PINCC's Work in Kibera Aug 20-24, 2012

We just completed a most successful week's work in Kibera, Nairobi,
Kenya. Each day brought many patients, volunteers, Kenyan lunches,
and exciting work to screen women for cervical cancer.

The team was absolutely TERRIFIC. Congenial, to say the least. Two
women (mother and daughter) who worked in both Uganda and Endebess
joined our team for the first two days, then left for safari in
Tanzania. We were also joined by two local Kenyan volunteers, one of
whom had just recently returned to Kenya from having lived in the U.S.
for 16 years. She was accompanied by her aunt who is on vacation from
a government job teaching cosmetology. Both Nimo and Joyce were
incredibly helpful and delightful. And filled with information about
Kenyan life, marriage, Kenyan customs, and food.

We saw over 100 patients this week. For me, it was difficult at times
trying to understand responses from Kenyan women. They seemed very
quiet while waiting, sometimes for hours unfortunately, and never
complaining. Not quite like in the U.S.! I was impressed with the
amount of family planning practiced and the number of women taking
antiviral drugs for HIV + status. Of course, there were those who
didn't want to get pregnant and were not using any family planning.
Many women had 3 or less children and most lived in Kibera. Walking
into Kibera every morning was less crowded than leaving each afternoon
- lots of children wandering about saying, "How are you?" Kibera
seemed to come "alive" each afternoon.

The Kenyan clinical & administrative staff working in Kibera was
terrific. There were approx 8 trainees, and they worked vdiligently
and were very eager to learn and take direction from both the nurse
practitioners and Dr. Kay performing internal exams, PAP smears, &
colposcopies. Several were given certificates to carry on; some
needed more training but we are hopeful they will again return in
January when PINCC returns for another visit.

While this is not my first trip to Kenya, it was clearly one of the
best. I am taking away thoughts about how life exists in a very
impoverished area of the country. For me, I feel I have given my
administrative skills to a project that is very valuable to women's
health. The healthier a Kenyan woman can be, the more empowered she
will become in controlling her life and that of her family.

This has been a remarkable trip and I am planning to meet Linda and
Julie, mother and daughter, in Zanzibar next week. I also feel I have
made new friends whom I will definitely keep up with once back in the
U.S. PINCC volunteers seem to have so much in common with a purpose
of giving to those who don't have as much as we have in the U.S.

We should never forget that the greater population of the world is
impoverished and lacking health care.

Randy Weiss

Pics from Kenya

Previous pictures are from Gombe, Uganda and these are from Endebess
Hospital in Kenya

home at last

Unfortunately, we had almost no internet access in Kitale so I was
unable to update everyone on our progress there. The good news is now
that I'm home, I finally show everyone some photos!

Although Dr. Melissa had to leave on Thursday night, we were joined by
Dr. Kay on Friday and were able to certify many of our trainees in VIA
at Endebess Hospital and a few in cryo as well.

We then had a very long journey to Nairobi on Saturday and after many
transportation issues, Jaya, Priya, and I made it to the airport in
time for our flights back to the US. I won't go into detail except to
say that we rode in 4 different vehicles for a total of 12 hours.

I finally made it home on Sunday night and went back to work in the
Bronx today. I can't believe how lucky I feel to have an exam table
with stirrups and disposable table paper and drape sheets. I feel so
spoiled and grateful that every exam room has a sink with running
water and electricity. I truly have a different perspective about the
care that I give and also how much waste exists in our health care
system.

But on the bright side, everyone I encountered today who knew where
I'd been and what I'd been doing could not wait to hear about my
experience and was so proud of me and impressed with the work that
PINCC is doing.

I've heard the work in Kibera is going well and hopefully we'll hear
something from the rest of the group soon.

Thanks for reading and enjoy the pics!
Rebecca

Arrived safely in Kenya

After an easy border crossing but a long drive complete with a bit of
pouring rain and a loose fan belt, we arrived in Kenya yesterday. (So
far the bathroom in Busia at the Uganda/Kenya border, which costs 10
Kenyan schillings to use gets our vote for the worst of the trip).
After thanking Mike, our driver, for his fantastic driving skills, we
settled in at The Kitale Club. It's an interesting and pretty place,
set on a golf course. We were happy to be able to sit outside on the
patio and watch the sunset - which we did for a while since it took so
long for our dinner to be ready!

Today was our first day working at Endebess Hospital and we were happy
to set up and get working. We had many trainees with varying levels
of expertise so it will be interesting to see how they progress
throughout the week. Everyone seemed enthusiastic about continuing
their training and was eager to perform lots of exams.

Maria, an MPH student, joined our group here and is working with the
community health workers to educate them and some of the clients about
HPV and cervical cancer.

I'm looking forward to more work tomorrow (and hopefully a shower with
hot water).

Will try to keep writing and updating you on our progress. Sorry no
pictures yet but I am working on it!

Keep reading!
Rebecca

Uganda

I did not know exactly what to expect upon arriving in Gombe, Uganda. But the circumstances at Gombe Hospital were even more dire than I anticipated in terms of staffing, equipment and resources. We were shocked when Dr. Haruna, who not only runs the hospital in Gombe but is also the head hospital administrator for the entire district, told us that his budget was cut by 33%. He was also not allowed to hire new staff unless someone retired, even though the hospital was at about 50% in terms of staffing. Oh, and by the way, he came to greet us and deliver this news after completing a c-section for a woman who had placenta previa. The condition had been identified before delivery and the patient had been instructed to stay near the hospital. She and the baby made it out of surgery healthy and another woman's life was saved.

Despite all the challenges, the team of clinicians at Gombe was upbeat and motivated. Nurses, medical students, and anyone who knew we were there was eager to meet us and learn whatever we had to teach them. The patients, although nervous, were very grateful for the services that were provided and at the end of the week, 3 of the clinicians, Sarah, Penninah, and Carol were certified in VIA. Dr. Melissa was absolutely unrelenting in her quest to get the cryo machine to work and after some duct tape and chewing gum (I kid you not), she was successful and able to certify Penninah in cryotherapy.

Our team of PINCC volunteers has really gelled: me, Julie, Dr. Jaya and our fearless medical director, Dr. Melissa are the fabulous clinicians. Then there's our nurse extraordinaire Linda (also Julie's mom) who is willing to teach anyone who will listen. Our support staff members, Shelby (Melissa's daughter) and Priya (Jaya's daughter) are hard workers and mature behind their years. And of course, none of this would even be possible without the always calm and supportive Carol, making sure we have what we need and get where we need to go.
Today we had a day off in Jinja which we spent shopping and then on a sunset cruise on the Nile. We had a bit of rain but overall it was fun and beautiful.

We leave for Kenya tomorrow morning. Can't wait to see what adventure awaits us!

Hope we will be able to post some pictures soon!
Rebecca Donn
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Sent from my Android phone with SkitMail. Please excuse my brevity.