News travels fast in small rural communities, and the word about the women's clinic is quickly getting around. Women from the community women's groups have been bringing their sisters, daughters and neighbors. Each patient exam has been taking about an hour, as it includes a full history and physical. The appointment also includes an explanation of female anatomy, how a Pap smear is preformed, and how it is used to check for the changes caused by human-papilloma virus (HPV) which can cause cervical cancer. Many of the patients have never had a pelvic exam or Pap smear so teaching has become a large part of every appointment.
Primeros Pasos's mission includes increasing education about methods of disease prevention. Though it is common practice that Guatemalans only come to the clinic once already very ill, Primeros Pasos women's education program is doing a great job promoting wellness and annual check-ups. Some patients have come in for symptoms of anemia related to heavy and irregular menstrual bleeding, however many healthy feeling women have come in specifically for their Pap smear and annual physical. Currently, the Primeros Pasos clinic has the ability to process a handful of laboratory tests in house. Unfortunately, the Pap smear is not one of them. Where as many of Primeros Pasos volunteers are being trained to identify intestinal parasites from stool samples, or run different blood tests, a Pap smear slide must be read by a trained cytopathologist. Therefore, the Pap smears are being processed at a lab in the city of Xela. Once a week I take my bundle of Pap smears to the lab in the city. Each Pap smear costs 25 Quetzales, which is about the equivalent of three American dollars. It's amazing how three dollars can make such a difference in the lives of these women.
Cervical Cancer has been the hot topic the last two weeks. Rightfully so, as it deserves a lot more attention than it ever gets. In the United States, we almost never hear of deaths from cervical cancer because we have so many methods of early detection already in place. However, according to the American Cancer Society global cancer statistics report (2002), cervical cancer is the second most common cancer among women worldwide. In select countries, such as Guatemala, cervical cancer ranks even higher as the number one cancer among women with a reported rate of less than 10% of women receiving regular screening (Ministry of Public Health and Social Aid of Guatemala, 2003). Many myths and misconceptions about cervical cancer exist in the rural communities. The last two weeks I have helped teach phase two of the women's education curriculum, which focuses on women's health issues such as uterine, ovarian and cervical cancer. In the past many, most women have lumped all the aforementioned together as the same "women's cancer" that is rarely spoken about due to fear and stigma. Through the women's education program, the myths around cervical cancer are slowly being unraveled and addressed.
The patients are not the only ones inquiring about cervical cancer. The buzz among the Guatemalan medical students prompted a lunch lecture dedicated specifically to the topic. Upon request, I will now be running a weekly lunch lecture on the essentials of obstetrics and gynecology. The new group of medical students is inquisitive and hard-working. They have already made huge leaps and bounds in their time at the clinic. I am working closely with the two female medical students to teach them to perform women's health exams. It is very culturally taboo for females to be treated by male healthcare providers for any issues related to women's health or pregnancy. So although I am foreign, my presence is accepted because I am female. Each day I hope to slowly build my patients' trust, which is the biggest thing that you can ask for as a foreigner in the Valley of Palajunoj, in a country like Guatemala that is still feeling the aftermath and distrust of a 36 year civil war.
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