Sunday, January 25, 2009


We spent the last two weeks working almost exclusively with the Women’s Foundation of Jalapa (FMJ), in anticipation of one of ISLA’s quarterly visits. ISLA (Interfaith Service to Latin America) is another NGO that works in Jalapa, and they do cervical cancer screening follow-up for Jalapeña women, as cervical cancer incidence is very high here, due to a largely untreated HPV epidemic. Cervical cancer is often preventable if women follow-up on abnormal paps. ISLA’s medical goal for the visit was to perform 500 paps, and administer care for women whose previous paps were abnormal.

To meet this goal, ISLA called upon the Women’s Foundation to mount an advertising campaign in 139 communities, some 20 km or more outside of Jalapa, on bumpy, washed out dirt roads, off of bus routes. The Foundation arranged ads with radio stations, and made and posted hundreds of posters (using their own $$ to pay for supplies and transportation) inviting women to come. They travelled by bus, moto, bicycle, taxi, and on foot, walking around communities, asking business owners to let them hang posters. Since the women of the foundation are all small business owners themselves, they must close their shops to do this work. Dan and Hannah decided to pause other FCP operations for the week to help out, so the women would only have to sacrifice 1-2 days each, as they would also be closed to work with ISLA the following week.

We also delivered normal results from ISLA’s October visit (See 10/19 blog for a full report) and “citas,” for follow-up to women with abnormal results, from both ISLA and MINSA, (the Nicaraguan Ministry of Health). Since addresses here are, “from the Catholic Church, 30 paces north,” etc. finding women can be tough, but it’s generally possible. If you ask around, people point you in the right direction.

When ISLA arrived on 1/15, we had a lovely dinner and meeting at Cafetin Mama Chunga. We created a work plan for the ISLA medical team, FMJ, and the FCP reps for the week. In addition to the pap drive, FMJ and ISLA coordinated a series of educational Charlas, or “Chats,” about cervical cancer screening, in hopes of mitigating the fear and embarrassment that prevents women from coming in. FMJ planned each Charla to occur before a captive audience- at Preindustrias, or tobacco processing centers, as women worked.

Beginning the 16th, part of the medical brigade worked at Jalapa’s hospital, and 2 other groups piled into the back of a big truck, with trunks full of gear, and headed to different community health centers to bring services to people who live out of town. FMJ women took patient data, answered questions, and checked people in. Hannah worked as a “floater,” so each day was different. She spent time alternately checking people in, taking patient data and translating for the ISLA doctors as they administered paps, and one day attended a Charla in one of the tobacco barns.

Hannah and Dan attended a Charla in San Judas, (about 10k south of Jalapa) with Heather Danckwart, a med student at The University of Minnesota. We arrived feeling lost, but we checked with the supervisor and he allowed us to enter and “do whatever we wanted,” as long as we didn’t interrupt the work. We wandered into the dark structure, lit by fluorescent lights and sparse, small windows, and were immediately stunned by the dense, musky, presence of mountains of dried tobacco. It was unlike anything we’d ever experienced-- though Dan is an avid smoker—there was a thick chemical quality to the air that penetrated one’s lungs, as if we were inhaling raw gasoline fumes.

From the middle of the room, Heather discussed HPV and cervical cancer. She encouraged women to come in to get screened. Hannah translated and afterword, they took questions. The women were shy at first, but they warmed up to us as we walked around. We were aware of how important it is to have someone from FMJ at these events, as women are more comfortable asking questions to people who share a common background and culture. Just the same, we felt like we reached a lot of women, many of whom had never had a pap before.

In the end, the brigade did over 475 paps, as well as many colposcopies and general consults. The ISLA doctors were very pleased with FMJ, and continue gaining confidence in their integrity and organization as a group, as this is a relatively new relationship. They noted that the trip’s success was largely due to FMJ’S work, and they were also very grateful for Dan and Hannah’s help.

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