(For information about volunteering with PINCC click here)
I was a little apprehensive arriving in Lima, Peru as this was my first PINCC trip. Thankfully, Carol Cruickshank, our trip administrator, and Dr. Melissa Miskell, our medical director, greeted me with warm smiles and instantly eased my nerves. I joined the PINCC team for their third week in South America. While the rest of the team took a much needed break and explored the city, Carol and Melissa briefed me on what to expect as the only other physician over the next week. During this meeting, I learned about the PINCC procedures and my responsibilities but more importantly, I learned about the people I would be working alongside. Carol has exceptional organizational skills and an ability to understand the needs and strengths of each member of the team. She transforms a foreign country and a group of strangers into a home and a family working together. Similarly, Melissa's confidence, dedication and laid back yet adventurous attitude create an ideal work environment. Her passion for serving women is inspiring and keeps the team going when fatigued.
The first work day was overwhelming to say the least. We arrived at the clinic site and the team instantly flew into action, unpacking and organizing each exam room in a matter of minutes. After the rooms were ready, women were checked in and interviewed. During the initial interviews, I led a 30 minute basic class on Visual Inspection with Acetic Acid for midwives and physicians from the surrounding areas, focusing on how to identify the squamocolumnar junction and acetowhite changes. During this and other classes, I had the privilege of meeting midwives and physicians who had traveled great distances to learn from us. In fact, one woman had spent 16 hours on a bus ride the night before yet eagerly listened during our early morning classes. I'm honored to teach people who are excited to learn and can directly translate their knowledge into helping others. One of the trainees explained that in her clinic, a cryotherapy machine had been donated over a year ago yet no one in the area knows how to use it. She would see countless women with cervical lesions and few options for treatment while the cryogun sat collecting dust. Fortunately, many people and organizations recognize the health needs of the women of Peru and give financially. However, without the knowledge and skills to use the valuable tools that have been donated the benefit is lost. The mission and importance of the work that PINCC does became clear in that moment.
After the brief teaching session, we divided the trainees into exam rooms and began seeing patients. Despite facing poverty and sometimes physical and sexual abuse, the women we treated exuded strength and compassion. It became clear that the trainees were dedicated to improving their lives through cervical cancer prevention but also support and counseling. I was able to watch the skills of the trainees improve throughout the day and their confidence grow. At the end of the day, we would regroup and have another teaching session. This session would focus on specific questions that the trainees had, going over the pre-test questions and identifying low grade vs high grade lesions with the aid of flashcards.
For the more advanced trainees, we also taught cryotherapy and Loop Electrosurgical Excision Procedure (LEEP). The trainees would practice LEEP on a piece of raw meat at the end of a small paper cup. This exercise gave the trainees a chance to practice excising different size lesions. One of the trainees is actually a physician who teaches residents at the training hospital. Like the others, he was excited to learn new skills since unfortunately, LEEP and cryotherapy are not part of their regular curriculum. I was excited to have the opportunity to impart skills to someone with the passion and capability to teach countless others.
As a physician, we are indoctrinated in the see one, do one, teach one motto. Having only been on one other medical mission trip, I don't have that much experience. During the other trip, I acted as a provider, seeing as many patients as I could in a day knowing that after I left there wouldn't be access to care for these women. During the PINCC trip, I had the ability to not only provide my skills but teach local providers these techniques. Leaving Peru, my heart felt full with the knowledge that women will continue to receive the preventative care they need long after PINCC has left thanks to the dedication of the local providers.