Sunday, December 18th
At 1:00pm the volunteers headed to the health clinic for its grand opening. Having the opportunity to be a part of this was incredible. The community is excited to have the health clinic as a part of their community. Members of the community were encouraged to register their family at the clinic at it’s grand opening. Registration is only 1 sol per family; this equates to about $0.33 in American currency. The work put in by so many individuals to make the health clinic happen is so admirable. These are individuals that took their dreams and made them their reality. Katie, a co-founder of HOP with a masters in public health from the University of Pittsburgh, has a passion that is untamable. Rosa, the other co-founder of HOP, quit her job as a nurse in Peru to devote all of her time, energy, and resources to the clinic. Both of these women are truly inspirational.
At 6:00 pm we had our first medicine class followed by clinic orientation. The orientation was lead by a local doctor who went over the basics of taking vital signs: temperature, blood pressure, and pulse. Due to a difference in medicinal practices in Peru, it was necessary that we each learn these tactics, even those of us that thought we had it down pat realized we had room to learn and grow. In preparation for the first campaign, Women’s Health, we learned how to identify signs of cervical cancer as well as how to perform a pap smear. We also learned how to ask questions regarding women’s health in Spanish.
Monday, December 19th
At 7:45 am the volunteers took the local bus to the health clinic for its first medical campaign, a campaign for the women. Two obstetricians joined our team to give the women pap smears. Triage consists of blood pressure, pulse, temperature, height, weight, and a questionnaire regarding the women’s health. These questions include: when was your last period? how many children do you have? are you currently breastfeeding? do you have a regular period? etc.
During this first campaign, I got to observe three unique pap smears. Pap smears are a way of recognizing cervical cancer in women, the most common type of cancer in women in Peru. Cervical cancer can usually be identified during the Pap smear; however, swabs of cells in the inner and outer lining of the cervix were taken for testing. The women will get their results back in two weeks.
The first young woman’s pap smear that I observed was an individual that had two children. She had taken a pill for an abortion three years ago. A pill for an abortion in Peru is not necessarily a proper abortion pill, it is just a pill a woman finds that she can take and flush out her entire uterus. Therefore, these pills are not always healthy and can have serious repercussions. The woman came into the clinic because she recently had a miscarriage. This may have been a byproduct of the previous abortion, although it cannot be confirmed. It was interesting for me to be looking into the cervix during the pap smear, notice an abnormal area based on the information taught the night before in our medicine class, mention it to the obstetrician, and then learn that the inflammation I was seeing was due to the recent miscarriage.
The second young woman I got to see receive a pap smear was having an issue with her IUD, a method of birth control. After observing the pap smear, we concluded that her IUD was inserted improperly and as a result, became infected. The obstetrician explained some alternative methods of birth control that the woman can explore that will be much safer for her.
The third woman was older and was experiencing severe discomfort. Her discharge was also abnormally colored, which is a good indicator of an infection. Timothy, the volunteer coordinator for this trip, said something today that I’ll never forget. He said, “your five senses are your best tools in medicine.” This proved to be true during the pap smears, as we looked at the color and smelled the discharge as two main indicators of infection. Looking into the cervix, it was clear that there was an abnormal legion. The obstetrician cleaned the cervix out and then explained the abnormality to me and the woman.
I am so thankful that I had the opportunity to observe the obstetricians. They were great about explaining each part of the process to me as they went. They drew pictures, and answered the one million questions I asked. I am also thankful for Timothy who also answered a million questions for me and double-checked me on my initial blood pressure readings. Taking blood pressure non-electronically is harder than it seems (or at least it was for me, haha.)
After the morning shift of registration, triage, and examinations, we went to a community event a few blocks down the road. This was the mayor’s event. The mayor has supported HOP’s work and made an appearance at the clinic’s opening yesterday. He has supported all of HOP’s events, so we all wanted to show our support and recognition of his event. Afterwards, we went to our host family’s house for lunch. We then went to the local mall. Here we window-shopped, exchanged money, and got ice cream before catching a cab to our evening medicine class.
Our second medicine class was lead by Doctor Jose Elias Cabrejo Parades. He works at a family medicine practice. His presentation focused on health disparities, barriers to the public health feedback loop, and solutions to the issues discussed. I was curious as to whether or not certain demographics (ethnic, location, socioeconomic) in Peru experienced health disparities more than others. He confirmed that they did. In Peru, the medicine funding is divided into the different geographic locations. The variable quality of care maintained in the various regions leads to health disparities within the different regions. Dr. Parades has worked in 16 out of the 20 districts in Peru.
Dr. Parades believes that health centers must be catered specifically to their prospective area's desires and needs in order to be successful. It is essential for the community to sustain itself, rather than periodically shipping in doctors and nurses to clean up what could have been prevented through health education. Rather than encouraging the government to fund medicine, the government should be asked to fund public health initiatives and projects.
A main point in Dr. Parade’s presentation was the difference between health and medicine. Medicine is a reaction to a low quality of health. Health is a way of life.