El Salvador Day 5

Our Last Day in El Salvador

Today we began our last day together in El Salvador. As we climbed into the van I found myself feeling a bit sad, as we have made such wonderful friendships in such a short period of time. We traveled to a local clinic not too far from our bed and breakfast, in San Miguelito. I am always in awe when we walk into these clinics because there are always mothers and babies who have walked a long way, and have sat patiently waiting for hours. Our PINCC group quickly separates into our delegated areas and get to work. Our Spanish speakers begin their interviews with patients, the Doctors meet up with the local medical staff and my co-worker and I begin our data entry on the computer. In addition, you can always find one of our staff sitting quietly with a patient while they await their procedures. Although we planned to leave early today, the reality was there were far too many patients to be seen for that to happen. The Doctors diagnosed and performed procedures that had lifesaving benefits. It is always a wonderful feeling! After our week of work it was time to recognize the doctors and trainees at their formal graduation ceremony. The head director of the Metropolitan Region was there to speak and honor these Doctors. The national anthem of El Salvador was played, certificates were received and a warm heartfelt feeling of gratitude was experienced by all. They were kind enough to have appetizers and soft drinks for us afterward. We proceeded on to Santa Techa a new upcoming part of El Salvador. We strolled through a beautiful corridor of many Artisans while music played and sweet aromas filled the air. We dined at a favorite little paposa restaurant and had some nice conversation and drinks with the head director and her lovely family. 

Our night culminated back at our hotel Tazumal where PINCC had their closing meeting. They thanked us graciously and recognized us all with official PINCC certificates for our service. It was a most rewarding week. One that will be remembered by us for a very long time. 
 
Cherie Ackman
Fontana, WI

El Salvador Day 4

At the Clinic

Today we worked at the clinic in San Jacinto, about 45 minutes outside of San Salvador. The doctors saw about 45 women.  Once again, I was given the opportunity to do interviews.   Nearly half of the women I interviewed had experienced some form of sexual abuse.  They never included those experiences when they gave the number of their sex partners.  There were psychologists on hand to counsel these women. 

The younger women had fewer children, and many used a form of birth control.  In this way, they were more modern, and apparently better educated, than the women of Comasagua whom we met last week.   Two of the older women were reluctant to sign their names at the bottom of the form.  With some encouragement, they managed to print the letters of their first name, with the concentration and careful strokes of a first grader.

There were more children today, a number of them school age.  They waited uncomplaining for long stretches.  Each child had one small toy to keep them amused, and they played quietly without disturbing any of the adults.

We gave a cosmetic bag filled with sample size shampoos and lotions to the cook and cleaning lady of the hotel.   We received effusive thanks.   At a visit to the park, we were entertained by a lively soccer game of girls vs. boys.  The girls played in their white school uniform dresses, barefoot except for their white socks.  They were great players and highly competitive.  At the park we also met a charming young couple who chatted with us, delighted for an opportunity to practice their English.   The Salvadoreans are warm and welcoming.  So far, there have been no signs of any of the violence of which we have heard.   

Patricia Spross

El Salvador Day 3

Our Second Clinical Day with PINCC

Today was our second clinical day with PINCC, in a location they have yet to have the opportunity to work. We traveled to Soyapango, a distance outside of San Salvador, to work in another clinic that strongly served women´s and community health and was an urgent care facility at night, thus giving 24 hour care. The teams of teachers and students are getting more cohesive and the day overall was smoother and more productive. We didn't let a little earthquake slow us down, as we felt only a small shake compared to what Mexico and Guatemala experienced in the late morning. Some of us even saw El Salvador's national bird, the torogos, outside a window where it sat on a tree limb for the length of two different patient visits.

In all we saw 65 women today. For some this was their first screening although they were in their mid 60s. Some patients had been sexually abused before the age of 10. After their screening, many received the good news of "adequate and negative" (meaning cancer-free), and left with the self-confidence to take a step toward taking better care of themselves, and ultimately their families.

I know that all of us on this trip are happy to be here to lend PINCC a hand with their amazing work and yet also equally grateful for our own health care options back home. Peace!

Ruthann Marquis, Portland OR

El Salvador Day 2B

Reflections of our first day at the clinic

Today is Wednesday and I woke with a migraine.   So I stayed home to sleep in my dark room until it passed.  Waking in the early afternoon, I take this time to reflect on my first day at the clinic.  Nearly 60 women were treated in an energetic setting of Salvadorean doctors whom PINCC has trained to teach the screening procedure (maestras).  Also present were about 15 to 20 doctors and nurses being trained by the maestras to perform the vinegar procedure.   Clinic support staff, PINCC MD´s, PINCC/DFW volunteers, patients, and their small children added to the mosaic.  Carol coordinated the PINCC team, watching, listening, directing, to make sure that the goal of training the maestras to become trainers themselves was met.  In a previous life, Carol may have been a battlefield general, perhaps Joan of Arc…

Once more, what struck me most about our day were the women.  I was delighted to have the opportunity to conduct PINCC´s medical screening interviews for 5 women before the exams took place.  Sitting with each woman for 15 minutes, interviewers were obliged to ask the usual questions, name, address, etc.   These were followed by a series of probing questions on sexual history.  Affirmative responses to any question on sex abuse steered these women to a session with a psychologist that same day.  The crowds made it difficult to find a private spot for the interviews, but in tropical El Salvador, every building has a large patio or courtyard where a quiet conversation can take place.  

The screenings required a fair bit of Spanish, and it was a challenge.  Yet, each woman was patient and kind, and we both persisted until all the questions were answered.   The faces of the women were serious as they revealed a history of abuse, or anxiety over an abnormal PAP result.  Two women spoke of financial dependency on their husbands, which prevented them from leaving.  This reaffirmed that the micro businesses we saw last week can truly give a woman hope and an opportunity to free herself from abuse. 

All of the patients with whom I spoke were grateful for the high quality medical care they have received for years from this PINCC-supported clinic.  Some of the women awaiting a procedure to remove abnormal cells were frightened to tears.   When asked whether they had come to the clinic every year for screening, all responded affirmatively.  It was wonderful to be able to honestly assure a tearful woman that the doctors would most likely be able to resolve the problem that day with a minor procedure.   PINCC, with donations from organizations like DFW, has supported these women in obtaining consistent, high quality care to prevent cervical cancer. 

Of all the economic and social stresses that poor Salvadorean women experience, their health can be an area where they enjoy some peace of mind.   It has been extraordinary to see first hand that our donations have helped make this happen.

Patricia Spross

El Salvador Day 2A

First Day in Action!

Our first day in action with PINCC sped by! Severe traffic delayed our

start which added to the frenzy. We worked at a Pro Vida clinic in Nejapa,
where women had already been screened for the services offered today.
There was an entire courtyard of women waiting when we arrived! Work
stations were established, rooms were stocked, paperwork was stacked and
patients were seen.

The role of PINCC on this trip is to monitor the nurses and doctors that
are serving as teachers to the students who are learning the procedures
and guide them in assuming their full roles as educators. That means that
many sets of eyes are looking at that patient while in a most delicate
position. Yet always the needs of the patients are prioritized. There is
someone ever-ready to hold someone's hand. There is both uncertainty and
fear in the eyes of many of the women awaiting treatment and all efforts
are made to help them relax and know that those procedures are taking care
of an issue that could otherwise turn into a more serious condition.

In all 54 women were seen today and thankfully that means 54 women have a
chance at a better and healthier life. PINCC in action!

Ruthann Marquis, Portland OR

El Salvador Day 1

Training Day

An early start to our first day with the PINCC team included a hearty breakfast at 6:30 and filling two vans that headed out of San Salvador to the town of Nejapa.  There we joined 33 doctors and nurses for a day of training.  The nurses and some of the doctors (this week known as students) learned about the disease process of cervical cancer and the visual inspection procedure with acetic acid (AKA common kitchen vinegar) known as VIA.  This is the low cost, very transportable, visual screening that PINCC takes on the road to low-resource countries.

The remaining doctors and nurses spent the day learning to be trainers or maestras to the students.  They will be the extra set of eyes and voice of wisdom that will guide the students in their learning experience this week. Many of the physicians have already been certified in the VIA screening technique, as well as some in the two areas of treatment.  True to PINCC´s vision of developing a self-sustaining program, these participants are an example of the trained becoming the trainers.  Remember the proverb about giving a man a fish to feed his immediate hunger versus teaching him how to fish?  This is exactly what PINCC is doing!

Knowing that the training that is happening now is going to contribute to the health and wellness of the women being screened gives me the chills!  Since cervical cancer is so preventable what is being done has such great importance!

Seeing the enthusiasm of the participants today and hearing their thoughtful questions (okay...through some help with interpretation!) made me proud to be here to support PINCC.  Watching their gentle and compassionate bedside manner as they acted out the various scenarios convinced me that their patients will be in good hands!

Tomorrow we´ll get to see all of this hard work put into action.  Stay tuned!  

Ruthann Marquis, Portland OR

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.