From Pork to Patients

            Another day done! The morning started with me rolling out of bed, still exhausted, and heading to the Desalegn Hotel. Luckily, there were no en route panicked phone calls and I relaxed for a little with my macchiato before Dr. Goedken came down in her usual blaze of bubbly energy. We chatted over eggs and toast and came up with a reasonable to do list and amendments to our schedule given our participants inability to be on time. Then we headed down to the lobby to meet Dr. Dawit who has been giving us rides to Black Lion. Dr. Dawit’s family actually owns the hotel, and he works there as a supplement to his income as a physician. Around 45minutes later, he pulled up in his car, sporting his Prada sunglasses, and off we went!

            Per usual, Dr. Goedken and Dr. Dawit worked on higher up details and talking with faculty while I ran around like a mad woman setting up the room, printing schedules and sign in sheets, and setting up the lectures. Luckily, we only ran 30minutes late this morning so I didn’t have to hassle people too much on time. We reviewed the steps of VIA and cryotherapy and then spent the rest of the morning practicing the two. We brought over two ZOE pelvic models and bought hot dogs, as I mentioned yesterday, to be used as pretend cervices to cryo. It actually worked remarkably well and the residents thought it was hilarious that we had little hot dogs on sticks stuck in the pelvic models. We had each resident walk through the whole process and spend extra time counseling the “patient.” Physicians here don’t really take the time to counsel or to make any sort of connection with the patient. Generally the patients are ignored and told what to do, so we spent a lot of time talking about choice, privacy and confidentiality. If you think things doctors have bad bedside manner in the U.S., you would be shocked here. I have seen doctors completely ignore crying women who have just been told they have cancer as they sign paperwork, so a little extra emphasis on how to talk to patients was definitely needed!

Hot dog's on a stick make excellent cervices apparently. Unfortunately, Dr. Dawit left them in his car over night so they smelled a little ripe. 

Dr. Goedken helping Mesfin adjust the speculum to show the hot dog cervix. 

            As the residents counseled, screened, and treated the hot dog cervices and rubber pelvic models, I was busy making copies of all the forms we would need for that afternoon. There were consent forms, patient follow up cards, education sheets, surveys, and VIA/Cryotherapy forms that all needed to be printed, copied and stapled. I’m telling you, I am mastering the art of being an assistant. Oh and the Ethiopian photocopy machine, which is finicky beyond belief. All of these forms have to be in Amharic, which can sometimes prove difficult with formatting. I’m not sure how to read it so can’t tell if the lines are in the appropriate place or what and was definitely admonished today by the attendings for my sloppy forms. Oh well!

Mesfin practicing VIA on Samson, OB/GYN Chief resident pretending to be the patient/obligatory hot dog in pelvic model holder. 

Practicing cryotherapy

Dr. Abdulfetah watching as Jalel practices cryotherapy.

            When the mini training and demonstration was over, the group heading to St. Paul’s, made up of 4 residents, one nurse, and one attending, quickly grabbed sandwiches and hopped in a cab. Well, really they all grabbed sandwiches, sat down and took their time eating, while I was standing, taking my lunch to go, tapping my foot and glaring at my watch. Oh habesha time…We eventually got there about 1pm and Nigussu, one of the nurses, and I, busied ourselves with setting up the clinic. It is even more noticeable to me how hierarchical the medical system is here. I am asked by everyone to do the most minor things simply because I am lowest on the totem pole. When asked something absurd, I tend to stand my ground, which the attendings don’t appreciate, but what can I say, my stubbornness usually wins out. Luckily, the clinic came together pretty quickly and we began to see patients within 30minutes or so. Half of the residents spent time in HIV VIA clinic that St. Paul’s already runs and the other half were with me in the non-HIV clinic. The hospitals here don’t really understand HIV transmission nor do they have good decontamination techniques so the HIV population is still heavily segregated in terms of procedural rooms where blood or bodily fluids could be involved.

Our little table filled with forms and patient charts. The OB/GYN residents would sit here and talk with the patients before performing the screening test. 

The other side of the clinic showing the patient table and our decontamination buckets. 

            Over the course of two hours we saw a total of 14 patients in the two clinics and all of the women tested negative for any precancerous lesions. As Dr. Abdulfetah, the OB/GYN residents and other trainees talked to the women and performed the screening, I was nagging everyone to obtain consent forms (preferably PRIOR to the woman undressing and putting her legs up in stirrups. This proved to be a difficult concept) and in my broken Amharic trying to have the women sign surveys. Of course, half of them didn’t understand the form, so I’m pretty sure my data will be horrendously skewed, but it all got done! We are surveying the women to assess the overall acceptability of VIA and cryotherapy. We basically want to see if women will tell others about it and view it as a positive experience, which is one of the ways we can hope to assure sustainability of the program.

            While we were busy at St. Paul’s, Dr. Goedken, Dr. Dawit, Dr. Hezkiel, and 5 OB/GYN residents were over at our other clinic in Black Lion Hospital seeing patients as well. Unfortunately, they only saw 4 patients over the course of the afternoon but were able to utilize cryotherapy to treat a precancerous lesion found. The rate of dysplasia in women is usually around 10-15% so unfortunately for the training, the residents won’t gain the experience in utilizing cryotherapy (the treatment modality) as often as they will the steps of VIA (the screening modality), which is done on everyone.

            Tonight I am busy preparing my lecture for tomorrow on infection prevention practices, which I am a little nervous about. Hopefully I don’t bore them to death and hopefully they take me seriously. I guess we will find out more tomorrow!