Clinic in the Mountains

Last week was our full week of clinic to provide pap smears and women´s health services to all those women we had signed up in the community. Each day of the week, we hosted a different community in Madrigales, a central small town among all the villages, where women would arrive for clinic, some having walked up to four hours to get in line starting at 7-8am.

Madrigales is up a winding steep dirt road leaving from El Corpus. There is a simple conference and education center there where we set up "exam tables" and homemade stirrups for the exams. On Monday morning, and every morning that week, we´d pile into the back of a truck owned by Pedro the husband of Juana, the community liason for our homestays and project coordination in El Corpus. Pedro would wind his wayup the dirt road, passing banana trees and plots of corn and beans nestled on hillsides so steep they towered over the road. The road was bumpy and uneven, and those riding in the front were charged with the duty to yell "branch" when it was necessary for everyone to duck.

For clinic we worked in med teams comprised of a second and fourth year. Together we would do the interview and medical history, and the we would take turns doing (or toward the end of the week, the second year would do most) breast and pelvic exams. Then we would present to one of our two attendings, and develop a treatment plan, if necessary. Among the normal complaints that correspond with urinary tract infections and STIs, nearly everyone had a headache or some sort of tummy pain. After seeing what life is like in those communities, and all the incredibly heavy work they do, I was not surprised. Things like ibuprofin and antacids are cost prohibitive to most campesino families, so the little aches and pains of life tend to add up after awhile.

Clinic was amazing in so many ways. I had so many "breakthroughs." Like hearing a heart sound that I knew was not normal, and starting to really understand S3 and S4. Or getting really good at visualizing a cervix and taking a pap smear without breaking a sweat. Or even the young woman who told me she had never had a sucessful exam- she always bled and had incredible pain. So we talked about it beforehand, I went really slow, and stopped whenever she needed a break, and eventually the exam was a complete success. She was thrilled.