Dear Diary,
Today I am compelled to face the serious business that is cancer prevention. The Inspeccion Visual con Acido Acetico (IVAA – Visual Inspection with Acetic Acid) clinic does just that. Specifically, the team aims to reduce occurrences of cervical cancer. They are able to do so through a quick test, the application of an acid allows them to visually identify pre-cancerous cells (i.e. cells that could develop into cervical cancer) and move on to treating them. It does require one to take the time to come in for the test.
Being on the ground I have the opportunity to accompany a local woman through the process, Nancy happens to be starting her visit when I show up, she is 39 and has come in today to take the test for the first time. About 7% of tests in the clinic result in a positive result. It sounds like a no-brainer, taking a cancer prevention test, but how often do we allow the day to day to take precedence over the important task of taking care of ourselves and our health? I am impressed with Nancy’s discipline. The local team takes the time to explain the test and the procedure that is performed to resolve positive cases. I sit in on Nancy’s test and sure enough, she is positive. She is taking it well, i.e. the news is that today we detected something that could have become dangerous to her health, and we will take steps to prevent that from happening. The test takes 5 minutes, she then has to wait 30 minutes for the pain killer to kick in, then the thermocoagulation procedure takes another 5 minutes. To put it into layman’s terms (which are the only ones I have), they use a tool that generates extreme heat to get rid of the cells and the patient comes back a year later to repeat the procedure. Beyond the medical service, the team provide detailed explanations and emotional support for Nancy, whom is here alone. Throughout the mission each clinic and the whole team go beyond providing medical advice, be it through emotional support, prayer, or gift giving of toys to the children. In this case, I believe Nancy needs it, though she does not show it. She left her 22 year old daughter with the 3 younger children, the youngest of which is 2.5 years old. She cleans houses to take care of her family and came in today because she “had a feeling”. I am relieved the team is taking the time to coach her through the process emotionally but, as always, I am surprised and impressed with her reaction. I.e. this is just another obstacle, it is not bad news, lets get on with it. She is so rational that she asks the doctor if there is anything she can do about her heart burn also. After a positive pre-cancer screening test, alone, and a cell “burning” procedure she is pragmatically seeking to take care of all the birds with this one stone. Now that is one level-headed lady! She is set up with her follow up appointment for the next year and is on her way, having reduced the risk she was unconsciously carrying around.
Antonia is also taking her health seriously, she and her family have put on their most beautiful traditional outfits to come in for her medical visit, she is 29 and has a cyst on her breast to get checked out. Her beautiful daughter (to the left), sister (to the right) and mother are with her (far right), though I find that my guess that they were both her daughters is pretty justified.
I am reminded that the women of Guatemala start raising families early and they do not always stop particularly young.
Teresa is 42 and has 4 boys and 1 girl aged between 25 and 14, she came in today complaining of nausea. I can tell you that since last giving birth 14 years previously she was not expecting the news that she is 13 weeks pregnant, after a (false) negative pregnancy test in the lab, nobody in the Ultrasound clinic was expecting it either, and they somehow managed to keep a straight face! Once again, the patient is more stoic than I anticipate. 42, with five kids, the oldest of which is 14, starting back from year zero. Children are absolutely a blessing, however this does represent an unexpected challenge, which she is willing to meet without making a fuss. It takes will power to face a challenge, and there is honour in facing it with a smile. All I’ve got to say is it had better be a girl!
We are shortly thereafter reminded that not everyone that wants children is fortunate enough to get their wish, Serena is 30 and has been unable to conceive. The same ultrasound machine that identified the unexpected pregnancy is put to use to determine if it can identify another’s cause for difficulty in conceiving. A reminder that each person carries their own burden, while it may be drastically different, or even opposite from our own or from others, it is there, whether we see it or not.
Taking on life’s difficulties is also Braulio, he is 6 years old and has delayed motor development. We are able to provide him with a wheel chair for his specific size and needs but he has started life facing adversity and unfortunately his path will never become easy. His mom is very excited about the chair, which the team explains will be able to grow with him. Braulio, on the other hand, is quite a bit more excited about the toys than the chair, though he seems to greatly appreciate how his new little table allows him an ample surface to play with said toys!
The last on the tour of today’s serious business is Pharmacy. They are the last line of defence, double checking any medication that has been ordered that day and carefully calculating dosages as needed. It is the last clinic patients visit in a day and the pose I have photographed is a typical one, each bent over their screen, analysing the information, challenging its accuracy, and making any necessary calculations. The team have to adjust to having less computerized support than they would back in the US, where the calculations are more system-driven. I have heard doctors admit they would be nervous handling the job assigned to Pharmacy. It is a task that requires discipline and careful attention to detail, it also requires some level of judgment as each individual is different.
Another key part of what they do, with the support of their wonderful translators, is to make sure the patients understand their instructions. Medication can be dangerous so it is vital that it be taken properly. Some of the instructions can be complicated, patients may not be able to read in Spanish or even be able to read at all. Today, the translator and Pharmacy team sat with the last patient of the day (while many of us restlessly waited on the air conditioned bus) explaining the instructions. When the patient was not able to repeat the instructions back to them, they patiently started over. As everyone, they take their job very seriously. They are also glad to be able to see almost every patient and to be the last ones to see them off, wishing them the best with their next steps in life and/or in their journey to recovery.
I’ll close today’s entry on that note, on the last line of defence.
Tomorrow is the last day, I’ve already been told “no quiero que te vas”, yeah, me either sweetheart.
Ciao for now (one more time).
Celestina
Team 884
