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.

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