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Optimism, Hope, and Satisfaction


Posted by Tara Hulbert, DO (a second year Ob/Gyn resident from Kaiser Permanente, Oakland serving a global health elective in Jalapa, Nicaragua with Prevention International:  No Cervical Cancer (PINCC)).

The first day is always chaotic.  That is what Carol, the Prevention International No Cervical Cancer (PINCC) director told us.  I felt myself relax and remembered why I love working abroad.  We come with goals and ideas of how we want to help and make a difference, but the local environment will ultimately dictate the work done.  And the environment is difficult to predict. PINCC has a successful track record of working in many different countries in a variety of settings, so this “chaos” is something written into their agenda.  I had come on the trip with Dr. Gupta, one of my own OB/GYN attendings who is fluent in Spanish and well-versed to international work.  So I knew whatever the day and trip would bring, there would be plenty of support.

Briefly, PINCC is a unique, truly sustainable educational NGO that focuses on bringing the World Health Organization’s “see and treat” method for preventing cervical cancer to different communities worldwide. In developing countries, cervical cancer is the leading cause of cancer mortality in women – which is in stark contrast to the rare incidence of this disease in developed countries which illustrates how preventable it really is.  This method is important where pap screening programs are not possible due to cost, resources, and access.  PINCC strives to bring these methods to local doctors and nurses with rigorous training and close follow-up over several years.  The volunteers on my leg of the trip had just returned from San Salvador where they watched a PINCC trained and certified local doctor training several other medical personal from around the community in a busy clinic.  Some of the volunteers had been to the first trip several years prior where that doctor was first being trained.  It was an emotional moment for them as they were truly seeing the sustainable nature of PINCC’s work.

The first day’s agenda included reviewing VIA (visual inspection with acetic acid), with the attendings and residents from the local OB/GYN residency program and then we would see about 40 of the pre-screened women with difficult cases from the community.  Some of these doctors had already been trained and certified from PINCC. This is what makes PINCC so unique and special – the follow through which ensures that the education and training is being practiced. Once we started seeing patients, I was assigned a few local doctors to work with. As a resident, my job was to observe how they went through the steps of VIA and chose the appropriate treatment and follow up. I surprisingly felt comfortable with my limited Spanish giving my opinion on diagnosis and plan. I worked closely with my own attending and medical director for any questionable cases. We worked with this same group of doctors the rest of the week, did cryotherapy and LEEPs (both treatments for cervical dysplasia), and put on educational sessions with the residents including simulation labs with the LEEP machine. The week ended with a wonderful evening out on the town with the PINCC volunteers and dancing with all the Nicaraguan doctors we had made friends with.

VIA training

The second week proved to be much more challenging.  We trained primary care doctors from outlying towns for the first time. The VIA method takes a lot of time and practice to become proficient, which became very clear with this new group of doctors.  I also learned how much misinformation the patients were getting about cervical cancer and HPV, the unnecessary worry and stress over vague lab results, the difficult situations and distances these women had faced coming to the clinic, and how challenging filling prescriptions and getting lab results was.

The rest of the week was spent doing lectures and seeing patients with this lively group of doctors.  Dr. Gupta and I were exhausted every night but we were rewarded by the motivation and progress of the group.  The PINCC volunteer group was amazing and absolutely devoted to the project which helped to make our work as providers seamless.

In conclusion, my global health experience with PINCC was everything I hoped it would be. Most work trips I have done in the past have left me wondering if I really made any difference at all.  This trip was different. I understood I was part of a process, a meaningful process that would help to transfer a specific life-saving skill to the hands of the local doctors that could and would help to save many women’s lives from a preventable cancer.  And I left with optimism, hope, and satisfaction that PINCC was truly doing something positive in every community they touched and I was honored to be a part of it.  My self growth was also very apparent throughout this trip and was very fortunate to accompany and learn from Dr. Gupta, who is an inspiring obstetrician/gynecologist devoted to global health, on this trip.  I look forward to being a future PINCC supporter and volunteer in the future.

Me, Dr. Gupta, and fellow PINCC volunteers

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