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Friday, February 10, 2012

CerviCusco

So for the last few weeks I've been volunteering with a new organization, CerviCusco. Its a women's clinic started by some doctors in Georgia who were doing genomics research on cervical cancer. They now do thousands of papsmears every year on women in Cusco and the surrounding villages. I don't care much about genomics research, but the pap smear part is pretty impressive seeing as cervical cancer is the #1 most common cancer in Peruvian women.
When we go out to the villages we bring everything- brushes, lubricant, gloves, drapes, etc in suitcases. Sterilized speculums in canisters. Back-up plastic speculums. Folding tables for the patients to lay on (obviously no stirrups or anything). We use headlamps for lighting.
Many women come with general medical problems hoping we can help them cause there is no other doctor to talk to. Almost every woman over the age of 70 has significant osteoporosis- you can see it in their spines and shuffles. We write a lot of prescriptions for ibuprofen. For the majority of women this is the first time they have ever had a pap smear. They'll come back in two months to get their results.
Many women speak quechua and there aren't enough translators to thoroughly explain the procedure. We get by with a few essential phrases and a lot of hand gestures. At one point we needed a woman to move down the table and she just wasn't getting it. So I put my hands on my own butt and did exaggerated hip thrusts until she got the idea. She found my demonstration quite amusing. Better than being terrified by the weird gringa sticking a piece of metal into you.
In the campos and at the clinic I explain every day that cramping with your period is normal, that whitish discharge between your periods is normal, and that once you haven't had your period in over a year you are in menopause.
We had one woman who took three buses into town to be told she was going through menopause. She was afraid she had cancer because she hadn't been getting her periods. She reasoned this must because there was something (ie a tumor) blocking her period from coming out. We did an echo to confirm. She had to drink water to fill up her bladder to make the echo easier to read. She looked so uncomfortable from being bloated with water and needing to pee by the time we did the echo. She was really sad to hear she was in menopause because she really wanted to have more kids. The doctor told her to focus on grandkids instead. She was only 42.
A 19 year old girl came to us for her first pap smear. She was really nervous. She had been pregnant four months ago but had gotten into a car accident. A month later she had a miscarriage. Apparently this is a common type of story you hear to cover up an illegal abortion.
An 18 year old came to us for her first pap smear. She had been having sex with one partner, but without any type of birth control. I tried to explain to her to importance of condoms if she didn't want to get pregnant. Also that some guys might not always be so clean or faithful and therefore using a condom could also be a good idea in terms of disease prevention. She left looking totally unconvinced.
There was a woman who was referred to us from the campos because she was 38 weeks pregnant and the baby was in a transverse lie (not good). We did an echo and found that the baby had flipped and was now vertex (very good). We were able to show her the head and the profile of the face and the heart beat. We printed pictures for her to take back to her OB and to keep. We told her she was having a girl and she cried she was so happy and grateful.

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