Another "usual" day in the clinic....We arrive to find a long line of anxious looking women tightly in a line so no one get ahead of them!
As Ismael is opening the gate, I'm standing there and they are all looking at me with serious faces. Instead of saying "Good Morning", I smiled and said "You all look afraid! I would be too!" Then they all break into rolls of laughter and off we go...
Sr. Pam quietly runs around making sure we all have water and all our needs are met while she makes all the patients feel they are entering a place of love and peace. Today is baby Katerina's first birthday but instead of having a birthday party, she and her parents are here tending to the most in need.
Tracy and Dina sprung into action and had to bypass residency and just function as "attendings". Their Spanish knowledge soared under the pressure and I can only say to their 2 moms whom I hope are reading this "You would be so proud!!!"
We triaged as best we could - tried to be as thorough as we would be with our patients at home - and as always I longed for my "right hands" at my office in Toledo who make my life so easy there. The women came with many of the same issues I deal with at home but sometimes the answers are a little different.
"Do you have high blood pressure?"
"Only in the summer!"
"Do you get bladder infections?"
"Only when I drink coffee!"
But in the midst of the controlled chaos, a quiet 34 year old woman came in complaining of a discharge for the last 3 days. I imagined a yeast infection or something similarly benign. But when I sat down on my stool, I was hit with that smell that I have sadly become too familiar with here - the smell of Cancer. In seconds, as I placed the speculum, my worst fear was confirmed - another advanced cervical cancer. And in just seconds, my mind raced through all the memories of Flori and all the hopes we have had for an answer to this tragedy. Sometimes I wonder if I exaggerate the problems of Cervical Cancer that the women in this country face. I sometimes ask myself if it is really as bad as it has seemed. No, here again in a random group of women is ANOTHER statistic - another young women who will leave motherless children behind shortly. I began asking her the questions for which I already knew the answer. When did you have your first baby? "13". Have you had a pap before? "No".
And then the stories of her life unfolded....a life of sexual and physical abuse....an alcoholic husband....and now she will face a premature death. She told us she was afraid to tell her husband about this cancer because he would say it was her fault.
She had absolutely no idea that there was a serious problem. She had gone to the local "Centro de Salud" 3 weeks ago with complaints of back and thigh pain and this smelly discharge. She showed me the "lab orders" they had given her - knowing full well that she would never have the money to get them done. They never examined her and just give her some "pills" - she didn't know what.
The stink, the stories, the "fungating" tumor filled me with hopelessness and despair. We say we are fighting this fight and yes, there are so many people fighting along with us - but for this woman it is too late.
Orfe and I talked with her at length although I don't think she understood anything. She will come back tomorrow with her husband. As I write this, I wonder what she is doing. Is she sleeping? Can she sleep? Has she told her husband? Did he hit her in his anger? Or can he show love? What will happen?
As always in Guatemala, such a sense of the surreal! What an inspiration to work with medical students who are so eager to learn about how they can contribute to ending the great global inequalities in health. To say "I am old enough to be their mother" is an obvious understatement and yet, we can share laughter and so clearly learn from each other. Dina and Tracy arrived right on time at 3AM this morning and in trying to set the tone of the trip, Dina pulled out her "Band Kit" - she believes we'll be doing lots of Yoga and muscle building this month - hmmmmmm......we'll see how that's going in a couple of days! Travel went without a hitch and we were promptly picked up by Isabel's body guards and brought to her very splendid, loving and welcoming home. Of course, a joyful reunion with Sr. Pam who is already accomplishing so much more than we could have anticipated! In just 3 short months, she is mastering the language and already greatly expanding our mission here.
Tonight, about 40 people gathered in Isabel's home to have the official signing of the paperwork to initiate the foundation for Cervical Cancer Prevention. This is a partnership with Guatemala City Rotary, Dr. Dean from the NIH, the Guatemalan Ministry of Health and SewHope. What a privilege to join with leaders in this effort as we became founding members of this new Guatemalan Foundation committed to ending the alarming rate of cervical cancer here.
Many of the Guatemalan leaders in this effort were there tonight so we had an opportunity to set plans for immediate efforts to expand our current project. Felt strange having my hair down, not sweating and not wearing scrubs!! In the midst of the scrumptious food and elegant surroundings, I so deeply admired these Guatemalan leaders who are committed to changing the lives of their people. As I listened to Dr. Dean talk about the thousands of children who are left motherless here each year from this disease, I thought of so many of you who have made this work possible and how much there is yet to do. We pray that we always hear God's voice as He leads us in His work.