Emma Fox — Pearl Lagoon, Nicaragua
Of the 45 women we saw today, the oldest was 71-year old Emma Fox. She learned independence and resourcefulness at any early age- she was four when her mother died and she went to live with an aunt.
Emma and her husband worked hard to support their eight children, all of whom have lived to adulthood. "He was a good man," she said, "but he is gone now." To keep the family going, she "did a little bit of everything. I bought coal and lumber and sold it for more money. I dried shrimp and sold it." And she raised her children, proudly noting that three of her daughters are nurses.
Talking comfortably during the PINCC interview, Emma provided full information about her medical history. The interview questionnaire asks sensitive questions to help the clinicians assess a woman's risk of developing dysplasia that can lead to cervical cancer. Sample questions include "How old were you when you had sexual relations for the first time?" and "How many sexual partners have you had?" Many women wince as we ask these questions, but not Emma. She said, "You have to tell the truth to keep your health. If you lie, they can't help."
But when I asked her the final question, Emma lost her confidence and her eyes teared. I told her that she'd be having a breast and pelvic exam and that she'd be in stirrups for the cervical exam with vinegar. I explained that a local doctor or nurse would be giving her the exam, and U.S. nurses or gynecologists would be training them. I asked if she would sign the release form, but she didn't want to because she thought only U.S. doctors would be doing the exam. She didn't want people from Laguna de Perlas, people she knows, attending her. We offered to let her choose her own local nurse, she thought about it, signed the form, and then sat down to wait her turn. WHEW!
By Sallie Weissinger
Juliette is 51. She has beautiful blue eyes set in golden skin, which speaks to her ancestors who were the English conquerors and their freed African slaves. A second grade teacher here in Pearl Lagoon, Juliette has obtained a day off from work to be examined by the PINCC team. She is vigilant about her health because numerous members of her family have died from cancer. Her mother had endometrial cancer, and refused treatment after the diagnosis. But Juliette, her sisters, and her daughters will not allow fear to prevent them from visiting the doctor.
Cervical cancer is a horrible way to die, and some women may want to avoid the possibility that the PINCC tests may yield bad news. The bad news is real and very frightening. Three women with cervical cancer visited the Pearl Lagoon Health Center to see the PINCC team. One woman had already been diagnosed with cervical cancer, but 2 new cases were identified. These women still had young children at home. This cancer strikes women in their 30's and 40's. Three patients out of roughly 200 seen by the PINCC team in Pearl Lagoon may seem like a small number, but it is really quite large considering that this cancer has been been nearly eradicated in developed countries. Probably none of us have ever heard of a woman dying of cervical cancer, other than in stories told by our grandmothers.
In this small town, everyone seems connected by blood or marriage. We hear the same surnames again and again as we conduct the interviews. Many patients request to be seen by the PINCC trainees who are friends or family members. So, a case of cervical cancer is difficult to hide in this small place. Many women in Pearl Lagoon have seen just how horrible this cancer is, and how little is available to treat the patient.
Here in Pearl Lagoon the fear is understandable. So, we salute the brave ones like Juliette who overcome their apprehension and take advantage of PINCC's visit to their town. On future trips, we hope that the positive news about our visit will encourage more women to come in for their tests.
~By Patricia Spross
Socorro's story June 12, 2013
With a happy smile on her face, Socorro emerged from her visit with the PINCC doctor and the trainees in Pearl Lagoon, Nicaragua. Her VIAA examination showed that her cervix is free of precancerous lesions. Yet, a few hours earlier, Socorro had broken into tears during the interview that PINCC volunteers conduct with each patient before she sees the doctor. Socorro's mother, Andrea, is dying of cervical cancer. Andrea was initially diagnosed at the health center in Pearl Lagoon. The doctors referred Andrea to the regional Bluefields Health Center, which in turn referred her to the hospital in Managua. The hospital was also unable to offer treatment for this advanced case of cervical cancer. Ten months after the initial diagnosis, Andrea is back home, where Socorro and Andrea's other family members care for her. The family is treating Andrea with local remedies, in an effort to preserve Andrea's hope. But Andrea is enduring a lot of pain.
Socorro sadly reports that Andrea had been bleeding for three years before she revealed her trouble to her family. She had never gone for regular Pap tests, which may not have been widely available until recently. The VIAA technique is just now being introduced by PINCC in Pearl Lagoon. Once PINCC trains the local medical practitioners, VIAA will be available as a diagnostic tool. PINCC ultimately hopes to train the local team will to cure lesions with cyrotherapy or LEEP. That day is not here yet, but Socorro has hope. She walked several kilometers and was the first patient to arrive at the Pearl Lagoon health center on the first day of PINCC's first visit ever.
~By Patricia Spross
Most of today's patients came from Laguna de Perlas, right here where we are working in the clinic, or from towns nearby. But not Sofia Jarking, a 62-year old midwife ("partera") whose home in El Cedro is not a hop, skip, and a jump away. Sofia's trip took her ten hours - two by horseback and eight by boat - and part of that boat ride was in torrential rains. She spent last night at a "casa materna" (a maternity waiting home, where pregnant women from distant villages come to stay in anticipation of childbirth) and will spend tonight there as well. Tomorrow she will head back home, again by boat and horseback.
Sofia's visual inspection with vinegar was "inadequate", which means that the clinicians were not able to see the entire area that would tell them if there was any suspicious activity (low or high grade lesions) that could lead to cervical cancer. So they did a PAP smear to be sure they got the full story. Sofia said she has had many PAP smears in the past, but has never gotten her results. She has called the various clinics and labs to follow up, but has never been able to find out the results. This time, however, was going to be different. In Laguna de Perlas PINCC brought along a cyto-technologist, Fatima Figueroa, to provide quick turnaround results. We didn't have electricity at the clinic all day yesterday, but today we did. So the microscope went at full speed today, making up for lost time. By mid-afternoon we had her results - the results of the PAP smear were negative and all was fine - and two PINCC volunteers walked over to the casa materna to give her a copy of her results. Tomorrow she will head home on her ten-hour trip, her mission accomplished.
~By Sallie Weissinger
Eve Yalom, MD: OB/GYN and PINCC volunteer who is giving the interview
Patient: A young mother and wife that has just received Cryotherapy treatment for precancerous cervical cancer cells. She agrees to do a short interview about her experience with PINCC.
Art Levit, MD: OB/GYN and PINCC Medical Director who is filming the interview.
EVE YALOM: How are you?
PATIENT: Well, now after the visit…things are fine.
EVE YALOM: How did you find out about this program?
PATIENT: I was seen at San Jacinto health center, had a PAP, and when the results came back, thank God, that led me back here today, where I was just seen. (At first, I was going to be referred to a national hospital).
EVE YALOM: How did things go here?
PATIENT: I received a lot of caring attention today. They did an exam. They just did Cryotherapy, thank God I came, they also did a biopsy and they're going to give me the results. I never expected such excellent care.
ART LEVIT: - (to patient's husband) thanks very much for bringing her and thank you (to patient) for allowing us to have this interview.
PATIENT: (to Eve) - Is your group staying longer or leaving?
EVE YALOM: - Yes, we're leaving soon--heading for Peru. We've spent a week here in El Salvador.
PATIENT: - and you're returning next year, right?
EVE YALOM: - Yes, in six months.
PATIENT: - How will people know where you're going to be back, and when?
ART LEVIT - We'll be returning near the end of May. You can check here at the clinic for the exact dates.
PATIENT: - I'm asking because I want to take advantage of the next time you come.
EVE YALOM: - You can come here to San Jacinto anytime. They are participating in a training program, and they were involved in what we have done today.
Click here to watch the interview.
Lucy is a 45-year old mother of 8 and grandmother of 5 in Kenya. She had never had an examination of her cervix, but her mother had died of a cancer of her genital organs, and she knew how terrible it could be. She came to our teaching clinic from a village many kilometers away, arriving the night before and sleeping near the clinic to be sure she could get care. PINCC did find cervical dysplasia, and was able to treat her the same day. She has a 95% chance of being cured! She was very grateful, as she needs to care for her 3 youngest children and 5 grandchildren while their mothers work in the fields. "I am so grateful I will not have to suffer and die as my mother did!", she told us. She promised to return in 6 months so her cervix could be checked by the clinic doctor again.
Erlinda Guevara — El Salvador, Central America
Erlinda Guevara is 32 years old, and works in San Salvador’s Central Market. She nursed her mother when she died of cervical cancer, and so she knows of its terrible consequences. When she heard there was a screening and treatment program in the Market Clinic, she came right away. “I tell all of my friends and family that they must get examined”, she said. She was overjoyed to be told that her examination was normal.