PINCC in Latin America

La Ceiba, Honduras was our first stop. We worked in 2 local clinics, along with Nurse Specialist Zoila Mejia, whom we had trained to do PAP's and is now learning to detect dysplasia. We were also joined on day 2 by Dr. Dennis, a Honduran public health doctor trained in Cuba who started training in cervical cancer prevention. We worked until 7 pm to see all the women who had come, and were then treated to a lovely cake in thanks by the community's women. After collecting all our team members at the airport and buying supplies, we left the next day for the villages of Tocomacho, Ciriboya and Limon. It was an arduous trip, with several travel accidents: upset boat, injured elbow, truck stuck on a raft, and got hit by a drunk driver; but we soldiered on through. This was the largest team PINCC has yet fielded, with 5 doctors, 2 nurses, and 5 counselors and volunteers. It enabled us to see many more women, and do lots of teaching. We worked with a team of Cuban doctors who will stay in this area for 2 years, and trained them in VIA/ cryotherapy.

Before leaving Honduras, we did a day's clinic at the Women's Prison in La Ceiba at the request of their pastor, screening and treating another 20 women. All told, we were able to see 209 women and treat 7 precancerous lesions on this visit.

Our next stop was Havana, Cuba! We were invited as guests of the Cuban School of Medicine for Latin America and Africa (ELAM), which trains doctors from many countries to do public health work. We were given a detailed and informative tour of their medical care system, and were able to meet with many doctors and medical students, including a group from the United States. We also observed their Operation Milagro (Miracle) program, which brings patients to Cuba for state-of-the-art eye surgery, all free of charge. They are restoring the sight of thousands of poor people who could otherwise not afford the operations. The Secretary of State and the Deputy Minister of Public Health spoke to us several times, as well as the Director of the Medical School. It was a fascinating look into a culture with very different goals and standards than ours. They have done an amazing amount with very scarce resources, because of the USA's continued sanctions against trade with them. Their finest resource is the education and devotion of the Cuban people. After a week in Cuba, we flew to Nicaragua.

Nicaragua: Submitted by Ruth Fraser, RN, PINCC team and Board Member.

Driving to Mulukuku was definitely a challenge to the skills of each of us that drove. Yet we were lucky. Had there been recent heavy rain we might never have got there at all. Busses and big trucks have been mired for days during the rains. No wonder most people travel on foot or by horse! The women of this remote area in the Unincorporated Atlantic region have been served for over 20 years by a women’s collective which, among other things, has a health clinic. The saga of that Collective, the clinic and Dorothy Granada is worth a book in itself. Here we also met Sue Howe, who does quality control; she agreed to serve on our Advisory Board in this capacity as well. The clinic staff are able to screen women with Paps, but, having no gynecologist, were unable to treat them. Anyone found to need it would have to make a daylong journey to Managua by bus, to stay for maybe a week, or return several times for appointments and treatment. Arduous in itself, but it also meant expense, separation from family for a caregiver, and loss of income from work; this created difficult choices. We were the answer to their prayers, and it was deeply satisfying to give that treatment, supported by their caring and very competent staff. They had identified 50-plus women in need of treatment and notified them we were coming. That sounds simple, but the town is surrounded by hills, and the journey to town can be many hours on foot or horseback. Erratic post, few phones, FAX, or email and sometimes illiteracy meant personal contact by the outreach workers was often the only way people could be told. One worker reached a woman’s home, only to find her gone. Undaunted, she searched and found her and brought her to the clinic. Our housing was a simple accommodation, with mosquito- netted cots in a large, shared room, and composting latrines. We bathed in a stall, open to the trees and the stars, scooping water from a bucket. It is near to heaven, after a hot, sticky day slathered in sun screen and Deet, to feel that cool water cascading, hear the wind in trees, and watch the stars.

From Mulukuku, we went on to Achuapa, another long journey, with no improvement in the roads. It's a pretty town, with cobbled streets in the town center. There we worked with the women of the natural health clinic where we had visited before, seeing both returning and new women. Through ProNica, we had sent test results and identified women needing further examination or treatment. Again, huge efforts had been made to bring the women in. When we checked our list of women and found some were missing, staff went out to their homes and persuaded them to come and be seen. One 65-year-old lady had been treated in May for a very abnormal exam, and was found to have micro-invasive cancer; we removed it, and on recheck, there was no sign of recurrence. She had refused further surgery due to a heart condition, so was really grateful for the good news, as was her family!

On to Managua, where we had the pleasure to stay in Mulukuku's Managua House; women needing treatment stay here when they come to the city. We met and spent time with the formidable and inspiring Dorothy Granada, RN, who has given over 20 years of her life to the work in Mulukuku. We worked in the barrio clinic of Acahualinca, another reunion with staff and patients we'd seen in May, many of whom are HIV+ or sexual abuse victims. We were delighted to work with Dr. Rosa Olivia Mendez again; we completed her training in VIA-Cryo, and began LEEP training. There are moments that are truly humbling. A group of women gently and politely kept asking if we could see them very soon. Through our interpreter we learned that they came from the remote area of San Francisco Libre; they had got up at 2 in the morning, walked for 1½ hours, ridden the bus for 4 hours and walked across town from the bus station to reach us. They planned to take that journey in reverse once they’d been seen, so needed to leave to catch their bus! Altogether in Nicaragua, we were able to see 122 women, and treated 21 for pre-cancerous dysplasia.

How would we describe the time in Nicaragua? Challenging, tiring, physically demanding, sometimes daunting, are all words that come to mind. Above all it is the word ΄satisfying‘ that resonates. It is deeply satisfying to know we make a difference to women who seldom see care, and to support those struggling to give what care they can. Please help us to continue doing so by your contributions!