My Time in Africa

lisaobgyndoc September 16th, 2007

A little background… I am a second year resident in ObGyn at Albert Einstein in the Bronx. Since medical school I have been volunteering with an organization called PINCC (Prevention International No Cervical Cancer, www.PINCC.org). It is a nonprofit organization started by a Gynecologist from California who, after seeing the poverty and neglect of the women in Central America and Africa, decided to retire and start this amazing organization. They make trips twice a year to Central America and Africa to screen and treat women in order to prevent cervical cancer. I chose to spend my two week vacation in residency working with PINCC in Africa, helping to see and treat women in addition to teaching the healthcare workers how to perform the necessary protocols in order to sustain this as a screening method. Here are a few of my thoughts and experiences from my time on this incredible continent.

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lisaobgyndoc September 16th, 2007

After our 46 hour journey including a flight to London, then Nairobi, then Rwanda followed by a 4 hour drive across the border on horrendous roads, we finally made it to Kisoro, Uganda, the site of our first stop on the PINCC journey. I was very excited and nervous at the same time. Excited for the obvious reasons… I was going to be doing what I love - helping women by both educating and treating them. The nervous part came into play because I was taking on an intense goal on this trip. Working with PINCC and 2 dedicated medical students, Chavi Kahn and Eleanor Chung, we organized an entire training protocol to train the healthcare workers in Kisoro to do what PINCC does so that it would be a sustainable means for cervical cancer prevention. Most of these workers had never put in a speculum and did not know the first thing about what cervical cancer was, how you got it, or how you treated it. We had spent hours upon hours putting the training protocol together and I was so anxious about it going well… about finding people who were willing to be screened, were willing to be trained AND actually being successful in training them.

When we got to the clinic the first day I was completely overwhelmed. We could not even get to the clinic doors because there were so many women who had heard we were coming to the village. There must have been almost 600-700 women there in their phenomenally vibrant colored garb with babies either on their back or on their breast. Some of these women walked over 3 hours from their village, most without shoes, to see the “muzungu” doctors (white doctors). Chavi and Eleanor worked so hard to spread the word that we were coming and the turn out was amazing.

We spent 5 full days in Kisoro training doctors, nurses, midwives, and seeing patients. We were able to see over 550 patients in our time there. We treated over 50 women for pre-cancerous changes but diagnosed 3 advanced cancers. Unfortunately there is not much hope for the women that are diagnosed with advanced disease - the chemotherapy and radiation that is available in the states is nearly impossible to get there. But the hope is that with the implementation of this program, there will be fewer women that have to die from this nearly 100% preventable disease – that we will catch the early stages and treat them before it is too late.

Everyone in Kisoro was amazing. I was so floored by the incredible enthusiasm, dedication, knowledge, and excitement of the people who were being trained. They learned so quickly and worked so hard. And the village women were amazing. They would walk for hours in the pouring rain and even sleep in the clinic overnight in order to be seen by the doctors. Their faces would light up with a simple “warai” (hello in Rufumbira, the language in Kisoro). It was an amazingly uplifting experience and a fabulous way to start my first trip to Africa.

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lisaobgyndoc September 16th, 2007

After working our butts off in Uganda, we had a free day and went gorilla tracking in Rwanda. There are only 700 mountain gorillas left in the world and Rwanda is one of the 3 places in Africa to where you are able to actually go to see them close up in their natural environment. We went to Parc National des Volcanoes, the park that Diane Fossey worked/lived in Gorillas in the Mist. We paid an arm and a leg to go on the trip and were nervous that we would be disappointed. That is the absolute last word I would use to describe our experience. We were led by two experienced “trackers” who took us hiking into the forest where the gorillas lived. After about 2 hours of hiking, we came upon one of the most amazing sites I have ever seen… literally a foot in front of us was a mommy gorilla and her baby, rolling around and playing with each other. We watched them for a while until they decided to move away from us. But that wasn’t the end… we quietly followed her to the rest of the group and basically spent an hour just watching the gorillas play, eat, snuggle, and fall from trees. When I say we were close enough to touch them, it isn’t an exaggeration in the slightest. One of the blackbacks actually came so close, he almost sat of Jessie’s foot! It was an amazing experience and definitely a nice way to escape the craziness of the clinic.

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lisaobgyndoc September 16th, 2007

On Sunday, a week into our journey, we made our way to Nairobi, Kenya, where we stayed with Dan and his family, the man who arranged our visit to Kenya and the clinics we would work in. Dan is an amazing person… he is a perfect example of someone who came from absolutely nothing and is now quite successful. He lived in Kibera slums (see below) during his teenage years and would walk 3 hours to work and 3 hours back from work for a mere $1.50 a day. Yes, $1.50 PER DAY!!!! He was one of the lucky ones that worked extremely hard and met the right people and was able to advance in his job and find a way out. He now dedicates his work and money to improving the Kibera slums - he has created a school there, sports activities for the kids, and has a safari company whose proceeds go to bettering Kibera (http://helpinghandstours.org).

We spent a day walking through the Kibera slums. It is an area of 300 acres with 1 million inhabitants and it was one of the most disgusting experiences of my life. Houses are thrown up with clay and stones but have the potential for being torn down by the government as it is considered to be on squatter land. The “streets” are made of mud mixed with human feces that is nearly impossible to trudge through without wanting to vomit. The wretched stench that is all around only intensifies the nauseated feeling that was ever present throughout our journey. They have no clean water and no plumbing system yet all the people have huge smiles and big hearts. I can’t count the number of times that we were offered help by some of the local people in forging the rivers of excrement. At one point when I was slip sliding away down a hill made from unimaginable things, I felt someone grab my arm and help me balance the rest of the way down. I was half feeling grateful for not landing face first into human waste and half feeling incredibly guilty that I could be so grossed out in the home of these people. I wanted to hug him to say thank you but also to say that I was sorry. Sorry that he, along with 1 million other people, had to live like this. Sorry that I couldn’t do more to help. Sorry that I come from a place where opportunity is present and clean water and plumbing are not considered gifts. And sorry for wanting so badly to leave the slums, wash my hands, and breathe fresh air.

We worked in a clinic right outside of the slums to screen the women from there. We had gone on this tour before we started working so we had an idea of the types of patients we are seeing and where they come from. Side note: if any of you have seen The Constant Gardener (about drug companies testing their drugs on the innocent people/children of Kibera), the film was set in the Kibera Slums. Disgusting poverty and filth doesn’t come close to adequately describing the conditions of the Kibera slums.

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lisaobgyndoc September 16th, 2007

The trip was incredibly rewarding but I would be lying if I didn’t say that I had mixed feelings throughout the trip. There were some days that the extreme poverty and helplessness of the people just got to me. Was I here with this organization and merely attempting to “bail out the ocean?” In a continent that is full of political greed, incredible illness, destitution, and extreme need, was I making an ounce of difference? Was I wasting my time in trying to help a select group of people, a small community on a huge continent wrought with so many death sentences? If I save them from dying of cervical cancer, have I really done anything when they will then probably die of tuberculosis, malaria, HIV/AIDS, post partum hemorrhage, water-borne illness, tribal uprisings, or political unrest?

Then I realized yes, you are doing something. You are making a start to changing healthcare there, even it is only one of the hundreds of issues that need attention. And you are making people more aware - both in Africa and in the States. In Uganda alone, where the prevalence of HIV/AIDS was once 25% of the population, the same percentage throughout most of Africa, they have managed to bring it down to 6% in the past 10 years. It is an example of how education, knowledge, treatment, and determination can actually help to make a difference. And the doctors that we worked with in Uganda told us that if this program was successful, the governmental agencies would consider initiating this screening program on a national level. If that were the case, then we can truly say we are working towards change, towards making a difference. You can’t overcome huge obstacles without using stepping stones to get there.

So this is where I am at now. I have more than 2 1/2 years of my residency left filled with long hours and difficult days. I try not to get caught up in my life here but sometimes it is hard not to. I know I want to dedicate my life to bettering the future, both here in the states and abroad. Working in these poor communities with these amazing people is the whole reason I went to medical school to begin with. I just have to keep remembering through the grueling times that I love medicine, I love this field, and I love trying to make a difference.

I thank everyone for their support, emotionally and financially. I thank my parents for being so open and not letting their fear of the unknown get in the way of allowing me to have these unforgettable and inspiring experiences. I thank PINCC and the awesome people that were with me on this trip. I thank the trainees in Africa for volunteering their time to come and learn something completely new in order to improve their communities. And I thank all the women in Africa for being so strong, courageous, and determined; for trying to understand the importance of being screened for something that they do not actually have symptoms of, and for making Africa the warm and welcoming place that it is.

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