The journey by canoe to Tocomacho

Our PINCC team was 4 this trip: Amelia Coplan, who arranged this Nicaragua trip last year; her father Dr. Ben Coplan, a pediatrician from Kaiser in Fremont, Pat Sax, our therapist and logistics person, and myself, Dr. Kay Taylor. On April 30, Lillian Hall of ProNica, coordinator for our Nicaraguan visit, met us in Managua. She took us to the Acahualinca clinic, in a barrio of Managua next to the town dump, where the very poor scavenge a living. It's run by 3 amazing women, Norma, MariaElena, and Silvia, who work 6 days a week, frequently without pay when funding runs dry. Women from their programs for families, HIV prevention, prostitutes and a gay/lesbian group were waiting to see us. Dr. Rosa Olivia Mendez, a volunteer there, worked with us all week to train in VIA/Cryo, and brought a gynecologist who observed as well. We also met our 3 interpreters, Ben Rushwald, Jaime Contois, and Erin Cox. Erin is a 4th year medical student at Albert Einstein College in the US, doing a year of volunteer work; she trained in VIA/cryotherapy too.
Dr. Ben set up his pediatric clinic with Ben 2 as interpreter, and saw over 100 kids in 2 days! Here, Erin interprets.

After 2-1/2 very busy days in Managua, we packed up and headed for the hills. In Esteli, we stopped to meet Mama Licha, a nurse/midwife of 80 who has set up a women's clinic and birthing center. She trains local Parteras (Midwives), and teaches health education. She and her staff were eager to have us help add a gynecology screening program. We committed to working there on our next trip, and training staff.
(Pictured below left, Flor and Gladys in Archuapa Clinic Pictured below right - Kay and Erin seeing pation by headlamp)

Bumping over dirt roads for several hours more, we arrived in the village of Achuapa. The next morning, we met Flor Espinoza and Gladys Benavides, who have an acupuncture and naturopathic clinic.

They had offered their clinic for ouruse during our 3-day stay. Again, women and children arrived in greater numbers than we could see, and we worked till darkness closed us down. On Saturday, we did one last LEEP procedure when the electricity returned, and headed back to Managua, tired but satisfied, having seen 121 women and almost 200 children .
All told, we saw 161 women during our week's stay in Nicaragua, treated 11 precancers and trained 3 people. Dr. Coplan saw over 300 children. We met some incredible, devoted people, and greatly look forward to working with them again in November. It was a very rewarding and successful week!

On Sunday, April 8, as dawn painted the Nicaraguan volcanoes, we boarded a plane for Honduras. There we were met by Dr. Luther Harry, our Garifuna Honduran friend and Brigade leader. A graduate of the Cuban Medical School for Latin America, he had organized a large team of Cuban and Honduran doctors and interns to accompany us and our teammates, CHIMES and Birthing Project members. We caravanned in a bus and 3 trucks to La Ceiba for our seminar with Honduran health personnel that evening. Early the next morning, we loaded up and left for Limon, our first village Clinic. We worked here for 2 days, and the Birthing Project held their first seminar with local Parteras (Midwives). These were repeated in each village.

The following afternoon found us on another rutted road to Ciriboya. Here, CHIMES, in cooperation with the local community and the Cuban Medical Brigade, is building a clinic similar to Limon. It will serve 9 more remote villages, and will have an Emergency Room and Surgical suite. In the half-finished building, we set up 2 exam rooms for PINCC upstairs, and the medical and pediatric clinics downstairs. I mentored 3 Cuban-trained doctors in doing VIA/Cryo over our week's stay. (Photos Above Left an improvised examining table Below Right -Ciriboya Clinic)

It's an arduous journey to Tocomacho. We loaded our medical equipment onto our 4WD trucks for the drive along the beach, which must be made at low tide. The trucks were ferried over on a raft on the last leg of their journey. The rest of the Brigade piled into dugout canoes, traveling the 3-hour trek along the inland waterway to its limit near the vilage. In Tocomacho, we set up our clinics in people's homes. Again, we spent 2 days seeing as many people as we all could accommodate, from early morning to dusk. The women turned out food for our 40-person group on a combination of wood stoves and propane stoves: lots of beans, rice, and hand-made tortillas, and a special crab and fish soup!

On our last night in Tocomacho, the Mayor and school teacher gave speeches thanking us, and handed out certificates of appreciation. Everyone danced and sang, from children to elders. It was a wonderful sendoff! We caught the low tide at 8 the next morning, and made the day-long journey back to La Ceiba, arriving for a late dinner.

The showers and air-conditioning were wonderful. We had a farewell party with the Chief of the Cuban Medical Brigade and other dignitaries. Dr. Luther announced that in one week, we had seen and treated over 2,600 people along that coast! PINCC saw 90 women in those 3 communities, and treated 7 precancers.

After the brigade went home, Pat and I remained for 5 days, to work with our friend and nurse specialist, Zoila Mejia, whom we trained to do PAPs in November '05 . In La Ceiba and in 2 small villages beyond the pineapple plantations, we saw follow-up patients as well as many new ones. We found a 36-year-old woman with our first case of cervical cancer; fortunately, it was very early. With Dr. Luther's help, we got her set up for treatment. (Photo Right - Zoila in the class room which we turned into an examining room.)

We have returned tired but excited about the success of PINCC's mission in saving women's lives from cervical cancer. It really works! Our rate of positive screens is about double that found in the USA, because of the lack of available care (see Table). About one fourth of the women we saw, from age 20 to 76, had never had a PAP or gynecology examination.

We will return in November to both Nicaragua and Honduras with a larger team of PINCC volunteers. There are 5 Honduran and at least 2 Nicaraguan doctors/ health workers waiting to train with us then.

**T.G.W.W.T. Table: Spring '06 Results ( **Thank Goodness We Were There )_

Precancers Treatment:

*data pending pathology results

Your support and contributions were the key to providing our services to the needy women of Central America. I want to thank every one of you for your generosity and open hearts. We had received enough donations to cover all but about $500 of our expenses, and it only cost about $15 to screen one woman! And, the trained health workers we mentor will continue the work in their public health clinics, so that one day we won't be needed...at least here... and dying from this preventable disease will hopefully become a rarity, as it is in the USA.
We have lots more pictures and stories to tell. If you'd like to have us come to your home to talk to friends, or present our program at a social club or other gathering, please give us a call. Reaching out to more kind people is how we will continue to be able to expand our work. Missions to Africa and to Haiti are in the planning stages! We also need volunteers who can help us here at home, if you have a few hours a month you could give. My email is kaytaylor@pincc.com; or you can call me at 510-452-2542. Donations can be sent to PINCC/ MITF, P.O. Box 13081, Oakland, CA 94661. Thank you again for your support!

Yours in peace,

Kay Taylor, MD

Director, Prevention International:

No Cervical Cancer (PINCC)