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.

For More Photos, Go to:  http://primerospasoswomensclinic.shutterfly.com/

Pretty sure I have fleas. Jim found these two little guys buried deep in my hair and wriggling up itches everywhere. Now I learn that the previous neonatologist had also acquired some type of stow-away and so would not sit on the mom's beds or wear his white coat thru maternity. But what am I to do? The mom's wait longingly as I speak to the woman in front of them. The want attention for their babies and for their concerns. They delight when the blond mazungu doctor hugs them and stops to visit. Maybe if I were here long term it would be different, but for just six weeks, though its not very lady like - I guess I'll have fleas.
The past two weeks have been an absolute whirlwind. After overnighting in Antigua I took a small bus for five hours up the winding mountains into the western highlands, finally arriving in Quetzaltenango. Quetzaltenango was and still is a principle center of Maya Ki'che and is often referred to by its Ki'che name Xelaju and abbreviated to Xela. Xela is a large city seemingly disconnected from the surrounding cities but by small winding dirt roads which the revamped and repainted yellow school buses ride along. Most women in the city still dress in traditional Mayan clothing, which becomes even more prevalent as you head out into the country side. Every morning we take the unmarked school bus from the bus stop at the Calvario Church into the mountains of Tierra Colorada Baja. Outside the church, venders sell flowers freshly cut from the mountains and beans and eggs out of street charts.
Today, Charlie Peacock moderated a panel on How Artists Can Help Charities, especially given the current economic climate -- when money is tighter than ever. Panelists included Billy Cerveny, Brite Revolution; Kenny Alphin, Love Everybody; Jenny Dyer, Hope Through Healing Hands; Andrea Howat, Hanson’s Walk/Tom’s Shoes; Derek Webb, Blood:Water Mission; and Barrett Ward, Mocha Club.
Global Health Leader Amelia Wood arrived a couple weeks back at Kijabe with her husband Jim and baby Josiah. She is serving as a neontologist there, bolstering health care delivery and training.

We have now been in Kijabe a full week. We arrived to homemade zucchini bread and an invitation to watch "So you think you can dance" from the wonderful Davis family (our neighbors just below in the Sitaplex guest house). Not having a TV at home, we were way less in the know than some of the long term missionaries here. Kijabe is like summer camp for doctors. And although there may be some sacrifices in being in Africa (like broccoli free of aphids) our overwhelming sentiment is, "man, don't we feel at home!"
September 30, 2009

by Jenny Eaton Dyer, Ph.D.

Last night we had a really fantastic Global Health Gathering at the Frist home. Welcoming all Nonprofits who were dedicated to Global Health issues (or Millennium Development Goals) in Tennessee, we had an array of groups who attended who had traveled from as far away as Johnson City or Memphis.

These great groups, all who have joined the Tennessee Global Health Coalition, provide aid and service around the world. They provide beds, shoes, education and clean water for the world's poorest. Some offer leadership training, mental health services and a haven for child soldiers. We have groups who fight trafficking in all forms, and we have groups who train community health workers to provide better health care in forgotten corners of the world.
September 23, 2009

This morning I participated in an Action Network Workshop that focused on Health Systems. This past month, I wrote an Op-Ed for the Boston Globe, "Global Healthcare Needs More Than a Pill." In that, I argued that we need to consider a "systems-approach," looking at health systems as a whole - beyond just preventing and treating infectious disease. This would include considering the renovations of health clinics, providing good roads for transportation to those clinics, access to clean water, treating chronic disease, addressing child survival, and partnerships across governments, NGO's, and the private sector to make this work. Given this framework, a discussion followed about how to move forward horizontally and vertically with infectious disease, chronic disease, and maternal and child health.
September 23, 2009

P&G Dinner: The Procter & Gamble Company (NYSE:PG) honored partnerships that have helped the company achieve three life-saving commitments at their "Live, Learn and Thrive" Awards event. Held at a VIP reception in conjunction with the 2009 Clinton Global Initiative (CGI) in New York City, the Awards recognize partners CARE, PSI, UNICEF and World Vision for their help in improving the lives of more than 40 million children, by providing vaccines and safe drinking water to help those in need.

Senator Bill Frist was one of four who presented awards to the partners. While there, we took several photos featured below.
September 22, 2009

This afternoon, the 5th annual Clinton Global Initiative commenced with the Opening Plenary led by President Obama. It is such an exciting event for global issues with the world's elites--governmental, nonprofit leaders, private sector leaders, and celebrities to name a few--who are committed to health, infrastructure, women and girls, development, and the environment.

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