PINCC: Cameroon – The Kathryn Gunnison, MD Experience

Posted by Kathryn Gunnison, MD  (a third year OBGYN resident from Kaiser Permanente, Santa Clara while on a global health elective in Yaounde, Cameroon with Prevention International: No Cervical Cancer PINCC).

I arrived in Yaounde, Cameroon late on Sunday evening after many hours of travel from the bay area.  I was exhausted but anxious to begin my work with Prevention International: No Cervical Cancer (PINCC).  PINCC is an organization that provides training of local health care providers in visual inspection with acetic acid (VIA) to identify and treat pre-cancerous cervical lesions.  Over the course of several trips to the same location, PINCC aims to certify local providers in VIA , cryotherapy and LEEP in order to provide cervical cancer screening and treatment to a previously unscreened population.   The goals of PINCC were of particular interest to me.   I loved the idea of passing on clinical knowledge and skills to local providers so that they would eventually be able to function independently.  This trip was PINCC’s first to Cameroon so there were many unknowns for our trip director, Carol.  We had no idea what to expect in terms of clinic conditions, trainees or patients.

On Monday morning we arrived at our first clinic site, Bethesda Hospital in Yaounde.  It was a small open air hospital on the outskirts of town.  The grounds were well kept and the staff was friendly and welcoming.  We were given 3 small rooms to run our training clinic.  Gyn beds were not available.  The three beds with foot stirrups for pelvic exams were to remain on Labor and delivery.  There was no running water that day and the electricity was somewhat temperamental   Our team, which consisted of three resident physicians and three support staff members, got to work unpacking supplies and setting up exam rooms while Dr. Miskell, our medical director, met and began teaching the trainees.  After several hours of set-up, including construction of “under buttock lifts” from folded and taped together surgical drapes, a blessing of our team by a highly regarded Baptist minister (we quickly learned that many Cameroonians were very religious and many organizations religiously affiliated), we finally met our trainees and began to see patients.

The trainees consisted of local nurses, a lab technician, several first year residents, a nurse’s assistant and two nurses who had traveled 12 hours from the northern region of Cameroon specifically for our program.  We quickly learned that many of our trainees were primarily French speaking and a vast majority had never done a speculum exam.  They were divided in to groups, each assigned to one resident physician.  My group on that first day was excited and eager to learn.  I guided them through their first pelvic exams, finding the cervix, identifying the squamo-columnar junction and reviewing the basic principles of VIA.  Our patients were extremely kind and grateful.  Most had never had a speculum exam before but were very calm and tolerant of any discomfort.  After we completed exams many patients thanked us for their screening but also thanked me for coming to their country to help their people.  It made me really appreciate the resources that we have in the United States for cervical cancer screening and reinforced my desire to provide cervical cancer screening for women throughout the world.

I had spent a lot of time with one of the nurses who had traveled from the northern region of Cameroon for the program.  I was particularly impressed with her clinical skills and kind way with patients.  She very quickly picked up the skills needed for VIA.  It was gratifying to know that I had played a significant role in training such a capable young woman who could provide screening to women in a rural area of Cameroon.

As the week continued the trainees made excellent progress.  When it came time to say goodbye, the PINCC volunteer group felt that we had established a strong foundation in Yaounde for the clinic to continue.  PINCC plans to visit Yaounde in January 2014.

Our next stop was a short visit to Kumba, a smaller town in the more humid, jungle-like area of Cameroon.   After an eight hour van ride, we arrived late on Saturday.  We began working in the WeCare women’s clinic in an area of Kumba called “Kumba 2” that Monday.  Conditions in the clinic were poor.  There was no running water, exam rooms were hot and poorly ventilated.   We worked hard with the trainees to establish screening at this clinic in just two days.  PINCC will return to Kumba in January of 2014 for a full week.

I thoroughly enjoyed my trip to Cameroon with PINCC.    I learned a lot about the people and the culture.  In addition I was able to share my own clinical knowledge with medical providers, which will eventually allow local women to be screened for cervical cancer.