Friday, February 24, 2012

One Thousand Patients


In the middle of clinic Tuesday afternoon, Puja and I quietly celebrated another surprisingly anticlimactic moment: our 1,000th patient.  Coming into this project, our goal was to screen 1,000 women with pap smears, which (somehow) seemed reasonable.  A few days in, Puja and I worried with more than a twinge of disappointment that we’d be lucky to even reach 500.  However, increasing productivity combined with some huge patient loads in La Libertad and consistent clinics at the rest of our locations propelled us forward.  It must be mentioned that all of this was made possible by the weeks of work by Ismael and Orfe, who visited the communities, educated the women, organized the accommodations, determined the schedule, and arranged transportation for women from more secluded locations – and that’s just the start of the list.  In talking to them now, it seems they also felt they would bear the bulk of the blame if things went awry at any step in the process.  I can’t begin to explain how instrumental they were in making this project a success.  The way they do their rather thankless job with quiet confidence and dedication is humbling.

I was doing pap smears Tuesday as I noticed we were approaching number 1,000.  When Puja ultimately passed that patient my way, I asked her to come in and help me.  She hid her annoyance surprisingly well as she glanced at the line of patients awaiting her attention – we had a pretty well-established system where we tried to help the other as much as possible, but only asked for help when we really thought it was important.  As she entered, I asked her to put the numbered stickers on the patient’s papers and she realized the significance.  She gave me a smile, and a quick high five, before slipping back out of the room to attend to the subsequent patients as I proceeded with the pap smear. 

At the beginning of the trip, my focus was pretty firmly set on reaching that goal of 1,000 patients.  It was an attractive goal: it seemed very tangible (again, not sure why it sounded so reasonable, but it did), and it would also give credibility to the research we were doing while making a significant difference in the communities.  Looking back now, however, that number seems less important.  I know that may be easy to say now that we’ve reached it, but I can’t help but feel that the other successes were more important.  I was talking to Ismael tonight about this, and it seems that the message we spread was of utmost importance.  This message was one of hope for these women – hope that they can receive the interventions they need, hope that there are people that value their health, hope that their local health care system can improve, and hope for curative treatment, if necessary.  More broadly, we tried to let the women know that we cared about hearing their stories and were pained by the countless injustices they have experienced.  The time we spent talking to patients about their lives taught us so much about our own and also how to effectively work in the communities here.  I heard repeatedly from patients who had never found someone willing to hear their pain from previous abuse, abandonment, and death.  We tried to empower the women to work toward a better future for themselves and their daughters by fighting against some of the things that have repressed them in the past (abuse, illness, uneven distribution of power).  I’m aware that it’s easy to speak against these things and rally around change, but actually affecting it is much harder.  At the end of the day, even making a difference in how one woman feels about herself seems worthwhile. 

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