A Nurse Practitioner’s Perspective on Volunteering with PINCC, November 2009

A Nurse Practitioner's Perspective on Volunteering with PINCC, November 2009

By Cheryl Brown

Having just returned from 10 days in Nicaragua (Ocotal, Jalapa and Achuapa), I am eager to share a few thoughts about my trip. I am a Nurse Practitioner in Women's Health, and this was my first trip as a medical volunteer. Although I have traveled quite a bit over the years, for me this was a real highlight. Experiencing a developing country is so much more meaningful when you actually can contribute something in the process.

Others have described in words and photos the physical environment and the living conditions of the women in the places we visited (see May 2009 PINCC Newsletter).Instead, I would like to speak to the experience of being a healthcare provider on a PINCC trip. I have been doing women's health for 20 years, and have always loved connecting with women around issues that matter so much to us all, our health, sexuality, childbearing and relationships. This experience has been very direct and very gratifying. Healthcare as a business, however, is somewhat more complicated. The systems that have been created to deliver care, the legal and financial aspects, the demands of paperwork and insurance coverage, all of these conspire to create barriers to the direct connection. As a provider, going on a trip with PINCC offered an opportunity for me to just "do my thing". Someone else (in this case Dr. Kay Taylor and the fabulous trip administrator Carol Cruickshank) took care of the administrative issues and complexities of the system. (Carol also did a fine job of housing and feeding us, including midmorning snacks!) What a privilege to be able to treat (for free) these patients who so clearly need our services and were so appreciative of them. Beyond that was the satisfaction of knowing that we left behind Nicaraguan professionals with the training and equipment needed to continue this work at each site.

One of the most remarkable moments in the trip was just after our arrival in Jalapa, when the Foundation of Women from Jalapa materialized at our hotel. This remarkable group of women is taking charge of the health care of their sisters in Jalapa. Apparently some years earlier, a large number of Pap Smears which had been done were simply misplaced by the health system, and the results never communicated to the patients. The Foundation had been formed to prevent this sort of thing from happening again, to advocate for patients, and to assist those who might need to go to towns far away for treatment. These women "joined our team" for 2 days, and assisted us with interviewing many of the patients we saw in Jalapa, Their efforts and dedication were truly inspirational.

Finally, a few words for those who may be considering your first trip with PINCC:

Take your spirit of adventure. The electricity goes out, the water runs low, you can't always shower when you want to, and you may have to interrupt your busy workday and rush outside, because someone has deemed it necessary to fog for mosquitoes or wasps in the middle of your clinic….you are not in Kansas anymore!

Expect to be asked to do things you've never done: teach a class in a technique you yourself just learned yesterday, tactfully show a practicing MD how to do a decent breast exam, or set up 4 "exam rooms" from just supplies you have brought in a suitcase.

If you have any Spanish at all, expect to use it. The patients so appreciate it, and it really helps in establishing a collegial relationship with the local MD's and nurses whom you will be training in the technique of Visual Inspection with Acidic Acid (VIAA).

And for those of you who are not familiar with VIAA, there is a book which is recommended at the website <http://screening.iarc.fr/colpo.php?lang=3>: "Colposcopy and Treatment of Cervical Intraepithelial Neoplasia: A Beginner's Manual". My advice is to buy it or borrow it, or read it online before you go! You will be glad you did.

If you are looking for a challenge in the context of a committed team of people who are going all out to help each other and care for some of the most deserving and least privileged women on the planet, PINCC offers just that.

I guarantee you an unforgettable experience.

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