Saturday, July 13, 2013

Results! Fiesta!

Zac and Rachel, our medical student leaders, returned to El Corpus on Thursday from Tegucigalpa with the pap smear results. We convened on Thursday night to go over the results and follow-up plans for women in each community. We had about 365 patients, about 270 whom received pap smears, and of those that received pap smears there were 28 abnormal findings that ranged the spectrum of severity.

Yesterday we traveled to our respective communities to give back results. One of the health promoters will organize all the women that had abnormal results to go to Ashonplafa in Choluteca, our local partner. At Ashonplafa the women will receive biopsies and be counseled on what treatment is necessary following the biopsy results. We will provide the transportation and biopsy fees as we have done in the past.

We all had a great time spending a final afternoon with our host families in community. It was so pleasant to be able to return to our communities to say goodbye after developing a relationship with them during the first week. The MS2s on the trip will have an opportunity to return to the same communities as MS4s and thus our goodbye was possibly more of a ‘see you later.’

After packing up the clinic and reviewing pap results Thursday and returning results on Friday, we only have one more day of work before returning to the states. We will meet this afternoon to have an evaluation of HHA. This is HHAs 10th anniversary and thus we feel a particular responsibility to evaluate how our program has grown and how to effectively provide services in the future. Finally, we will have a fiesta to celebrate our hard work!

This trip would not have been possible without the generous donation of family members, friends, physicians, alumni, and the medical school. We are grateful to be part of such a legacy of UNC medical students and faculty that have gone before us. We are excited to pass the torch for those returning next year.

¡Hasta en los Estados Unidos!

Christina and her host family.

Typical homestay.

Des organizing clinic breakdown.

Wednesday, July 10, 2013


We just returned from a fun trip in Amapala, an island about an hour south of Choluteca. It was a much needed rest after an intense clinical week. It was a beautiful island. We had plenty of time to explore the downtown area, which was like walking through a time capsule lined with old, colorful buidlings. There was also a lovely beach lined by shacks that sold delicious seafood that was served at colorful tables situated next to a number of hammocks. We had a great time relaxing and spending time with one another.
Tonight we will evaluate our charlas and make changes for next year. Tomorrow we will take down clinic, inventory supplies, and go over pap smear results with the leaders. Friday we will return to communities to return results. Saturday we will have time for evaluation and tos ay goodbye to our host families in El Corpus.

We are glad to get back to work and finish the trip well. Thanks for your continued support. More to come. 

Top of the volcano.


Saturday, July 6, 2013

Los Torreros!

Today we woke left El Corpus at 5:30am for Los Torreros, a rural, mountainous community about 2 hours away via chicken truck. We set up clinic in an elementary school and got to work by 9. It was an exhausting but fulfilling day as we saw over 60 patients while setting up and taking down a clinic. 

We are now in Choluteca before leaving for Amapala, the beach, for a relaxing few days while waiting on pap results. We will then return to El Corpus to review results and follow-up plans with the residents on Wednesday, inventory clinic supplies on Thursday, and return to community to give back results on Friday. 

This has been a very fulfilling as well as challenging clinic week. We have a number of women who likely have more than mild to moderate dysplasia and we have to grapple with how to ethically and sustainably define our role and scope of practice. We do provide follow-up for several women, 18 last year, who needed it at Ashonplafa, who can facilitate care for early cases. 

We have had meaningful and difficult conversations to our role as an organization with these difficult realities. 

We are grateful we are helping to prevent cervical cancer, provide family planning, and treat acute infections. 

We are proud to have served about 400 women this week and will work hard to close this trip well. 

Dr. Bliss leaves tonight. She has been such an enthusiastic teacher and engaged member of this trip. She has taken time to get to know all the students personally and we are so thankful for her guidance and support. 

More to come from the beach!

Line of women waiting to be seen.
Dr. Bliss and Jackie.
Jordy in a one of our makeshift clinic rooms (with a dirty speculum bin...)
Exam room
Taking a break.

Thursday, July 4, 2013

Guanacaste: 89 women + 4th of July

Yesterday was a big day. Between Monday and Tuesday combined we saw a total of 69 women and yesterday we saw 89 women in one day. We showed up per usual in a chicken truck donned in scrubs to a line of over 50 women that had been waiting since 6 in the morning. Needless to say, all a bit nervous, we hit the ground running immediately.

The MS2s that could speak Spanish fluently enough to work on their own took their own patients (without an MS4) with the oversight of our attendings. By 1pm we saw over 50 patients, which was a feat of teamwork. Kyle, our pharmacist of the day, ran around with a walkie-talkie handing out medications, taking vitals, and helping clean dirty speculums. The attendings took the time to teach us even in the midst of the bustle. We took all the time that the women needed to talk and ask questions while still moving along at a clip. It was such an exciting challenge to serve so many women. It will likely be are largest clinic day as the rest of the week we are expecting about 70 women per day.

We saw 5 patients with possible cervical cancer yesterday. Because of the extensive screening for and education about cervical cancer in the US, it is very rare to find frank cervical cancer on exam. Thus, this is a frustrating finding as we have technology available to prevent such advancement of disease. However, this reinforces the importance of HHA’s mission to screen and facilitate follow-up for mild and moderate dysplasia at Ashonplafa before cancer develops. We are grappling with how to best deal with more advanced cases that may e out of our scope of practice and funding capability. 

Today was a bit of a breather as we saw 57 patients. We are all getting into a routine and learning new things: how to insert and remove IUDs, remove cervical polyps, detect cervical cancer, detect STIs on exam, and how to counsel about a variety of ailments, for example. There was not a massive thunderstorm today, as there was yesterday, so all and all the day was much smoother.

 Liza went to Ashonplafa, our local partner, to attend the follow-up visit with the first lady who came with invasive cervical cancer on Monday. She will get an idea of how HHA can support her treatment follow-up and provide support and brief us on that process tonight. We will also have a little 4th of July celebration this evening after putting in patient charts.

We are really enjoying spending time with our attendings: Dr. Monica Selak, Dr. Mansa Sememya, and Dr. Susan Bliss. Drs. Selak and Sememyaare 3rd-year family medicine residents at UNC and Dr. Bliss is the OB/GYN clerkship director for UNC at the Charlotte campus. They have all brought of enthusiasm and energy to this trip and we are thankful for their intentional effort to teach us.

Tomorrow is our last clinic in Madrigales, about an hour chicken truck ride from El Corpus. We will travel to Los Torreros, one of our larger communities, on Saturday and set up clinic there for the day. After that, clinic time will be complete. Time is flying by.

Internet is a bit difficult to come by here so more to come as it’s possible. Cheers!

Our lovely attending and residents (all seated, from the left): Dr. Bliss, Dr. Semenya, and Dr. Selak.

Preparing pap slides and wet preps at the lab.

Monday, July 1, 2013

First day of clinic!

We had a lovely and very smoothly run first day of clinic. We served the community of Guansale, which totaled to 32 women. We will ramp up the pace quite significantly in future days but purposefully started out with a smaller community as we are getting used to things. We expect 300-400 women in the course of the week.

The very first lady we saw had invasive cervical cancer diagnosed elsewhere. We are able to provide follow up for women with mild to moderate dysplasia at Ashonplafa but have never dealt with this severe of a case before. Thus, we are defining our mission statement and scope of practice in light of this challenge. This beginning to clinical week really gave perspective to our work at preventing cervical cancer. 

At clinic, an MS2 and MS4 are paired together to gather a history and physical exam. This gives the MS2s a lot of hands-on experience and the MS4s ample teaching opportunities. The doctors consult with us about our assessment and plan and oversee our pap smears and pelvic exams. It is amazing how much the MS4s have learned and it is such a pleasure to have someone willing and excited to field questions throughout the day. We consulted women about birth control, STIs, UTIs, HPV, and bacterial vaginosis.

It is so fulfilling to see the clinic come together so nicely. We are all working well together in teams. Rachel and Zac, our med student leaders, did a wonderful job laying out our responsibilities beforehand so that everything ran smoothly. We have a well-stocked pharmacy with medications for the most common complaints as well as year-long supplies of birth control pills, depoprovera shots, and IUDs.

It has been peacefully raining off and on here. Everyone has been in a good mood as we are here doing what we have planned to do for months. More to come.

Jordy and Dan taking a patient history.

Check-in and lab.