Even The Best Laid Plans…

My mom and sister may beg to differ, but I’m kind of a big planner.  I like to know what’s going to happen and I feel like the best way to deal with something potentially overwhelming (like walking into a clinic of over a hundred women that speak another language and all want your attention) is to come up with a systematic way of handling it.  This week of clinics hasn’t been as crazy as last week, but we’ve still been seeing over 50 patients a day in addition to the colpos and treatments Anne is doing.  This week we are at a Clinica de Salud where they actually have a functioning lab.  Mani and Chetti (our current US cytotechs) were so excited to find room to set up, refills of chemicals, and a cytoprep person to do all of the staining for them!  They also have a Guatemalan cytotech that works in the lab and they are helping improve her pap-smear-reading skills.  It’s great they have the opportunity to work with local lab people, even though them trying to communicate with all of the Guatemalans in the lab is hilarious – they all speak Spanish and Chetti and Mani only speak English.  Every time I walk into the lab with new samples both sides are quick to grab me to clear up their most recent “communications.”  Hopefully some of the training can have a lasting impact, because one of the huge issues we’ve run into is that many of the women with severely abnormal paps (even ones coming back as carcinoma) had pap smears that were read as “normal” in the last few years – clinically it is highly improbable that these paps were actually normal (some might even say impossible).  Improving the pap smear program is a huge goal of ours, and this clinic seems like a great place to start.  Anne has already had some encouraging meetings with them (in all of our free time between patients) about helping improve the skills of the current techs and the system in general.  We may also stay Saturday to do some surgeries at the hospital here! 

Getting back to the planning.  Chetti and I both agreed that our days were starting out too crazy when we arrived at the clinic and there were already large swarms of women clamoring to be seen, asking for results from the prior days, etc.  Tuesday was pretty stressful and we were all feeling worn down, so we proposed to start Wednesday as a group with breakfast and a brief meeting to ground us for the day and get an early start.  At 6:30 on the dot I arrived to find Chetti sitting alone.  In response to my quizzical look, she informed me Mani was still in bed, not feeling well.  I, in turn, informed her that Puja was so sick she was going to have to stay home for the day.  (Won’t go into all of the details, but poor Puja was SO sick, as evidenced by the fact that she barely even protested when I told her she needed to stay home.  Not surprisingly, she dragged herself out of bed by mid-afternoon, and managed to find her way to the clinic asking to help.  Here’s that by tomorrow she’s back to 100% because I need her!)  I hurried back to find Anne in her room to let her know about Puja.  Somehow in the midst of this, our breakfast (for all 8 of us) arrived at the table with only Chetti sitting there – so much for early breakfast as a group!  She has a great picture of the scene, which I will hopefully post soon (I know I keep saying that, but there’s no way this internet will handle it – it only lets emails go through about a sixth of the time). 

Eventually, our diminished group made it to breakfast, and then to clinic.  We had to limit our patient load to get through the day.  This will likely make for a busier Friday, especially since it’s our last day of clinic here in Poptun.  Hopefully we’ll have restored health and strength in the group!  Each person is so integral to the everyday workings of our clinics that it is painfully obvious when one link is missing.  By now, Puja and I have created quite a science of our clinic, but we’re really running with just enough hands to make it work.  Actually, whenever Anne asks if there are things we need for the coming weeks (meaning supplies), we reply with a request of one to two people to be our med students.  However, I can’t help but feel lucky for the group that has been a part of this trip.  Every person has a wonderful attitude and is very in tune with why she is here.  It makes a huge difference to have motivated people that truly care about the work that we are doing.  The injustices we see daily (and the tiresome hours we spend seeing them…) wouldn’t be endurable without everyone’s support and dedication.