Grounds for Health: Working in the Clinic

"Oye empayzamos vayendo moocheesimahs muheraays." - Laura Morales, our in-house jewish-gringa spanish speaker with a crappy spanish accent stated.

Today we saw women from the Coopante Cooperativa. The women today were more urban and educated, and had half the number of children (averaging 4, versus 10 kids) in the population we saw yesterday. The women we met on Monday were predominantly all agrarian workers and explained to our providers during their exams that they make, on average, one US dollar per gallon of coffee picked. They pick, on average, anywhere from 6 to 8 gallons each day.

We saw over one hundred women today from 8:30 AM to 4PM and completed/taught twelve cryotherapy sessions (cervical cancer prevention/treatment). It looks like all of the Nicaraguan providers will become certified in Visual Inspection and Cryotherapy by the end of the week. Yeah team!!

Our Nica providers debriefing after a long day
(from left to right: Thelma, Merling, Paula, Esperanza, Fatima, Janeth L., Jeanet Z.)





Waiting patiently to be seen








all photos of patients taken w their permission


The lab team has diagnosed pre-cancerous findings on some of the patients thus far and fortunately most patients have had normal results.

Kei staining pap smears



Yurit one of the great CECOCAFEN organizers of our cervical cancer screening program


Oh, and a whole box of condoms was stolen from the clinic last night -- we don't think it's a bad thing. We can sleep better tonight knowing that someone out there is being safe... But because of this robbery, we had to make a special trip to the pharmacist and ask, among a large crowd of folks all crowded around the counter, if we could have 100 condoms. Eve thinks she provided sufficient entertainment to the crowd, but if you ask me (Sarah), the joke was on her.



The view from our clinic

Random Photos of Matagalpa

Coconuts for Sale


Government Propoganda


Our Hotel

Grounds for Health Trip, Nicaragua Weekend: Getting Ready for 400 Patients

This weekend we awoke to very loud church bells ringing around 530am and we all went off to church, well not exactly. Some of us rolled over and some us roamed the city in desperate search of a caffeine fix. Everything was closed.

The Lovely Lab Team arrived on Saturday. We spent most of the weekend getting the clinic ready for the upcoming week.

Barbara, Kai, Ken, Cary, and Rob



All of us lugged lab and clinic supplies to the clinic (ie 5microscopes, chemicals, fans, etc...). We worked for 5 hours and lived on a diet of coffee (the good schtuff we finally found a decent coffee shop)


One of five clinic rooms


She works hard for her coffee...


The Lovely Lab Team set up all their microscopes and made potions of chemicals for pap smears. They LOVVVVEEEED mixing chemicals and came out of the staining room with goofy grins.

Ken the Master Mixer


Because chemicals are never good on an empty stomach, at the end of the day we headed to dinner at our favorite cafe, Cafe Artesana. We enjoyed delicious coffee, food and one anothers company.

We have a lon, hard but fun week ahead of us.
Off to sleep zzzzzzzz.... 400 patients, 399 patients, 398 patients....

Grounds for Health; Today We Saw Women in the Clinic

This morning involved a final overview of cervical visual inspection, logistics, and we got to play a family feud-like game to test our knowledge.

For the game, we divided into two teams and then LET THE GAMES BEGIN!!!!
Everyone got so animated. It really showed how much everyone had learned over 2.5 days




After spending a few hours schlepping around for supplies for the first afternoon clinic we were off and running.
Once we were got all our consult rooms ready, we ran like a well greased machine
We had four clinic rooms and saw 30+ patients in the afternoon. We had many normal visual inspections of womens cervices which was great.

Some of our providers getting ready to see patients


After a days hard work we all gathered for a photo op


The clean up and clean up crew Sarah aka Sarindella



5 little specs all in a row...


For more information on Visual inspection for detection of cervical cancer screening in low resource areas see link
http://www.guttmacher.org/pubs/journals/3514709.html

Grounds for Health Trip Photos of Nicaragua and Our Training

Here are some various pictures of the training at the coffee cooperative, the yummy produce, our hotel view, and random other pics

Gathering around during one of our training sessions



Today was our second day of training and everyone who showed up yesterday came back, which is progress. All the participants really got a grasp of the copious material we were taught. we drank more good coffee and practiced looking at cervices and looking at abnormal versus normal cervices w flash cards. The last time I did flash cards for anything was for the times tables in third grade -- who knew they made them for cervixes...?

More Teaching and Learning to be had by All




Our Lovely Commute Home



Tomorrow we will start seeing our first patients and doing Visual Inspection of the cervix to look for abnormal cells or cervical dysplasia. Should be interesting. We'll 10-4 you all manana. Oh, one quick addition -- the ice cream is just like in Israel. It's non-dairy -- a big hit with the Vermonters.

Lots of great fruits and veggies


Our hotel, A Room with a View

Our hotel's Attention to Detail

Grounds for Health Trip to Nicargua

Yesterday all the 5 volunteers 4 of them gringas arrived in Nicargua to begin our work with Grounds for Health
We are
Jeanne from Joisey a nurse midwife who has done the gamet from home birthing to now working in a womens health clinic
Sarah from Vermont currently residing in Cambridge who just finished a stint with the WHO/Harvard med school in improving utilization of pharmaceuticals in developing countries
Eve a new yawker now a long time resident of San Francisco an ob/gyn at Kaiser Oakland
Laura from Albequerque a physicians assistant, former Nicarguan peace corp volunteer in the 70s, who works with pediatric/adolescent sexual abuse survivors and does migrant health work per diem in northern california
and lastly
Yvette an ob/gyn hails from new yawk, of puertorican descent now practices in coneckticut and a veteran volunteer/trainer at Grounds for Health. Her 6th trip!!!

Our grounds for health staff from Vermont include
August who cowrote Where Women Have No Doctor and the executive director of GFH
Martha who is the project manager extraordinaire for all the Latin American sites


Grounds for health provides cervical screening and treatment to women
Their mission is to bring effective cervical cancer screening and treatment to women in coffee-growing communities. They currently work in Mexico, Central America and Tanzania. They use an innovative, affordable and community-appropriate method called the Single Visit Screen & Treat Approach, which has been endorsed by the World Health Organization.

Their work is made possible through partnerships with local coffee co-operatives, national and regional ministries of health, and specialty coffee companies. These partnerships have made it possible for them to bring better and sustainable health care to women in coffee-growing communities. For more details see www.groundsforhealth.org

Today we met the other providers which included 10 Nicaraguan nurses and doctors. The training took place at the coffee cooperative. It was fun, well organized, and intense. We were served about 3 cups of good coffee throughout the day and were wired and ready to go. The training included learning how to do visual inspection of the cervix and reviewed how to do a pelvic exam in a respectful manner. We will have 3 days of training followed by 4 days of seeing patients. We'll see over 400 patients whewww thats a lot of vag jay jays!!!

Our group

Drak Yurpa Monastery and Views of Mountains after Snow

We managed to interview over half the Amchi's, enter all the data into the computer and so took Friday morning off to visit the Drak Yurpa monastery. Its been raining at night which means while we get rain in the valley, the tops of the mountains get snow, making the views more spectacular. Sadly, at the Drak Yurpa monastery there were many ruins but it's slowly being rebuilt. The buildings are built into the mountain and there are tons of caves. This monastery is one of the holiest cave retreats in Tibet. Reini and Chris hung a prayerflag for their bean.
So our work and travels here are ending. Hope you had fun looking at the photos and learning a little about Tibet and our adventures.

Funny Signs and Cool bike fork made out of rebar

Click on photos to enlarge

Fields next to Tsurphu Monastery and Barley

Barley fields, by Tsurphu monastary. The barley is first roasted, then sifted and then ground

Tsurphu Monastery

We headed out to Dulong County to interview more Amchis. The interviews went well and then we gave one of the amchis a ride to her home. She had walked four hours to get to the township clinic for the interview. Since the Tsurphu Monastary was on the way we all headed there (including 2 amchis, ONEHEART staff member, driver, Chris, Reini and me).

The Tsurphu Monastary is where the Karmapa Lama (17th lama)is from. The 17th lama left the monastary and moved to India to practice in 1999. The history is very complicated/controversial and I cannot explain it here. The monastary was located at the end of a valley that was full of pristine rivers and fields of barley. Along the way we stopped at one villagers house along the way to taste some freshly "popped" barley and checked out how they used hot sand and fire to cook the barely and water power to grind the barely into a paste (tsampa). I cracked my molar on a not so cooked piece of barley.

We finally got to the monastery and it was beautiful. Because of the proximity they do not get very many visitors. There are about 300 monks at this monastary currently the majority are on vacation visiting their families for 2 months. We got a very individualized tour by the monks. It was great to have translation provided by one of the ONE HEART staff. The monastary was one of the more beautiful and magnificant ones we have seen. During the 1950s over 6000 monastaries were lost and now there are around 2000.