22 Days of Patients Later

Not sure where the last month went, but our project is officially done!  Everyone left last night (Wednesday) and this morning in a bit of a frenzy and I’m left here in the dust feeling a little lost.  I didn’t know what to do this morning without a clinic of pap smears waiting for me.  Actually, that’s a complete lie.  I still woke up early, but passed my time leisurely READING.  FOR PLEASURE!  More to come about my plans for the rest of my trip – I still have another almost two and a half weeks of my six total before I return to Toledo. 

The end of the trip was a bit of a whirlwind.  Our third week (in Poptun) went well and we were able to forge some relationships with the hospital there (I used the term “hospital” kind of loosely…).  Anne and I spent a day there doing LEEPs (basic explanation: using an electrocautery loop, you remove the end of the cervix as treatment in a patient with high grade dysplasia or carcinoma in situ).  I didn’t understand the importance coming into the trip, but sitting at the end I am so grateful that we had treatment options to offer the majority of patients with abnormal pap smears.  The way the system is set up in Guatemala, even if patients overcome the many barriers to actually getting a pap smear, they are often completely stranded if they receive an abnormal result.  Colposcopy, biopsies, and treatment are all very expensive, if they are available at all.  Moreover, women often don’t receive their results, and if they do they are given very little instruction of what to do next.  Over the last month I encountered numerous women that came in carrying abnormal results from pap smears up to a year ago that hadn’t pursued any follow up.  One day in the crazy La Libertad clinic I saw a nurse pointing a patient in my direction.  As she approached, she handed me a paper with a result of cervical adenocarcinoma from AUGUST!  Apparently she finally came in today to try to get her results after not hearing anything.  She was given that result, without explanation, and told she should probably check if we would see her.  Very fortuitous that we were there that day, but I know that this must happen regularly and those patients are left without such accessible options.  While giving patients abnormal results (and trying to help them understand the results) is really hard, we were so fortunate to have cryotherapy and LEEP as treatment options for the patients we saw.  The amazing thing is that these treatments are curative in the majority of cases.  Thus I was able to frame the discussions with all of this in mind, knowing that treatment was in the spectrum of the care we could provide.  Looking back, I can’t imagine doing the screening without being willing to offer the rest of it – in fact, it almost seems irresponsible. 

I think that what I saw in the last month only scratches the surface of the issues with the Guatemalan health care system.  It’s a system riddled of problems related to funding, access, facilities, and the workforce.  These are compounded by a litany of complicated social issues including the power dynamics within families and pervasive poverty – I just read in the daily newspaper earlier this week that over 80% of Guatemalans do not have reliable access to food, a figure that is even higher here in the Petén.  It was crazy to see the nurses line up in their clinic for pap smears with our team.  Employees from our hotel came in Poptun.  A trio of sisters that own stores in Flores came just a couple days ago after meeting us while we were shopping – none of them had received a pap smear previously.  Even one of the local cytotechnologists we worked with brought in her mother and wanted to be sure our cytotechs screened the paps – and we were working in her lab!  While this all may have had to do with the fact that our clinic was free or that we were offering treatment, it also seems to point to a lack of confidence in the system even by some of the people most involved – the nurses that perform paps and the cytotechs that read them.  While it feels good to be providing a very needed service to these communities, I can’t help but wonder if we are concurrently eroding faith in the local system rather than doing something to help it.