PINCC in El Salvador- A Developing Success Story

Photo: Two doctors brought all these women by bus to be seen and treated during their training in Nejapa, El Salvador

One of our greatest successes have been in El Salvador. PINCC was first invited to El Salvador in 2006 by a grassroots non-profit organization, ProVida, which works in villages and barrios to bring health care and clean drinking water to neglected communities. Their doctors and Director, Graciela Colunga, wanted to develop the skills to provide screening and treatment for cervical pre-cancer in their clinics serving poor and rural communities.  The government programs were too expensive and overloaded for women to access care, especially in rural areas. Also, the OB/GYN Society in El Salvador had ruled that only gynecologists could do the treatments, preventing women from accessing care unless they went to the overloaded government hospitals or private doctors. Women are waiting 6-12 months to get an appointment. Both were expensive, as the average amount earned per day is $3 or less.   Women told us stories of “free” care for which they were charged several days’ wages, and then sent home because it was too busy that day.  One mother said, “They told me I had a bad disease on my exam, and I should go to the hospital in San Salvador.  But who would take care of my children for 2 days, and where would I get the $25 it would cost? I am a widow, and only make $3 a day”.  PINCC performed a loop excision while training the clinic doctor, curing the woman the same day she was seen.  She was crying with joy and gratitude.  Her doctor is following her to be sure there is no recurrence, under the protocols we taught. And all her sisters, cousins and other relatives went in to get their exams as well!

PINCC began training at ProVida in 2007.  We trained in 5 different towns where they have clinics certifying 7 doctors and 2 nurses.  The doctors each work in a different area of El Salvador, so women in different areas of the country now can get screened and treated in their clinics.  Their nurses are doing education programs to inform and bring women to the screening clinics. In the past 3 years, they have screened hundreds of women and treated many cases of pre-cancerous dysplasia. Just during PINCC’s training visits in 2007, we screened 322 women and treated 79.

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IN 2008, a Peace Corps volunteer in the northeast mountain communities around the Honduran border heard about PINCC from a friend at ProVida.  She decided to make this cancer prevention program her project during her final year.  She talked to the doctors in the 4 mountain villages she served, and the head of a clinic program in La Palma, the largest central town in this border area, where HIV is much higher because of the amount of trucking that passes through.  The Director of the clinic asked PINCC to train the staff and the gynecologist who comes regularly to donate consultation time.  We have now trained this facility’s nurses and doctors, and donated treatment equipment, so the women of these remote villages can get screened and treated.  There are also many women who come across the border from Honduras to be seen in these clinics.

PINCC always makes sure that the staff treating HIV positive women are trained, and that they educate women to get their screening examinations every year.  Because of their reduced immune system, HIV positive women progress to cervical cancer much faster, and anti-HIV drugs don’t inhibit this growth.  The simple process of screening and treating early dysplasia will give these women a longer life, allowing their anti-viral drugs to keep them healthy.

Word of PINCC’s trainings continued to spread when The Medical Leader of ProVida, Dra. Iris Arevalo, told her colleagues who worked in the Clinica de Alcaldia de San Salvador about PINCC. The clinic is located in a giant market spanning a mile; people come here to sell their produce and goods from all around the central area of the country. They asked PINCC to train their staff of 20 doctors and nurses.

We had completed 2 training visits over a year’s time, when the 2009 National election took place, and the Mayor in San Salvador changed.  The conservative new mayor decided to go back to the old way of having women go to gynecologists, and fired the gynecologist head doctor we had trained!  However, in the same election, the liberal party won the Presidency, so the leaders who work with PINCC were promoted to the National Health Department (MINSA), and many of the doctors we trained are now employed there as well.  This training is never wasted, as doctors go on using it wherever they work, and convert new facilities to using the method.  Dra. Iris Arevalo, several other ProVida doctors, and Dra. Claudia Pintin, the gynecologist, have been involved in the continued training of doctors and nurses by MINSA.

PINCC has now been asked to collaborate with MINSA to train and equip many clinics and hospitals in El Salvador.  This is a wonderful opportunity to assist El Salvador in building capacity country-wide.  We have begun training with MINSA in 3 clinics in San Martin, San Jacinto, and Zacamil. Twenty-five (25) doctors and twenty (20) nurses are attending the trainings, including members of the Health Information and Training staffs of MINSA.  All of these clinics are committed to providing very low fees (about $0.50) for women to come for screening and treatment.  Their health education program is bringing large numbers of women to be screened during our training, and will continue to provide outreach to the communities.   PINCC’s goal is to help MINSA spread this important screening and treatment nation-wide.