The First of Many Gross Updates

WARNING: this post contains pretty frank descriptions of pap smears, how they are done, what the results of them look like, and sexual health in general. Don´t read it if you are squeamish, do not already know what a pap smear is, or are 7 years old or so and somehow found my blog.

If you don´t want to keep reading, here´s a hilarious video that also deals with women. but isn´t quite as gross.

Today at the clinic it was really slow. Normally, there is a huge line of patients waiting to be seen as I walk in at 830, but today there were maybe three or four. Dra. Espinoza is on vacation like everyone else is or wants to be, so its basically impossible to get any procedures done with out her. Apparently, though, she had committed to doing all these pap smears, so she showed up around 930 to get them done and leave.

It was odd to be in the empty clinic. I´m used to having to step over kids, people in constant states of undress and injury in the waiting room, loudness and lines. But today the lawn chairs in the stone room were empty, no one was watching the TV blaring a documentary about Princess Diana. Even the neighborhood dog that we have to shoo out a couple times an hour was missing. It was just me, grumpy older nurse, and cheerful younger nurse.

We called each woman in before the doctor got there to fill out the form required to do a pap smear. This was to be efficient, and also to avoid having to fill out the form while the pap smear is done, which can lead to awkward back and forth questioning from the doctor and nurse, like, ¨what´s your cell phone number?¨followed close by ¨how long have you had this discharge?¨

Most of this time, I sat around watching cheerful younger nurse (CYN) fill out this form with the patients. I really wanted to help, but I felt shy infringing on her job, and also I was really worried I would make a mistake. Making a mistake is a huge to-do when it happens. All the forms are in duplicate or triplicate, so you either have to start the whole form over or go fine a white out pen and go over each sheet. I´m still pretty bad with numbers over two digits, so the 11 digit cedula is tricky and so is the phone number unless they say just like ¨eight seven two four¨ instead of ¨eighty seven twenty four¨ which I almost always mess up.

Dra. Calle came in, grumpy but still her usual enthusiastic. She´s so young and idealistic, she could be on ER. We started with the pap smears, asking each woman to come in, go into the attached bathroom to put on the cloth robe, then lay down on the OB GYN table. Dra Calle and CYN crouch between her scared legs and adjust a large floor lamp with some Winnie The Pooh stickers on the base. I´ll spare you the details of the actual procedure. Mostly, I make eye contact with the woman while she grimaces. After we get the two samples on the slide to send to the library, the woman gets up and gets dressed, and CYN and Dra. Calle exchange looks about how bad the sample was.

And the samples are bad. For the majority of the first world, except for those horrible visits when your stomach drops and every thing changes, going to the doctor means not much is wrong. Just checking on it, catching it early, just making sure its nothing. Women should get pap smears about once a year, and the vast majority of those are going to come back normal. But for these women in Puembo, this is their first or second pap smear, after two or three children and years of sexual activity. And these women don´t take the morning off work to get checked out if nothing is wrong. They come in for a pap smear with discharge or stomach pain or bleeding that won´t stop. And its not like I have a microscope or anything, its not like I look at the samples that closely, but blood is pretty easy to spot. And of the 20 or so pap smears I´ve seen, only one or two haven´t been bloody.

I know this is really gross and graphic, but its my job and it’s the lives and health of these women. At least they are getting screened, even if we have to use the Winnie the Pooh lamp, even if the results take three weeks to come back, even if it might be too late. There are free pap smears every Thursday, and the doctor will come back from vacation to make sure they get done. And another happy point: we ask on the form about births and abortions (that’s the Spanish terms for miscarriages). And of these twenty women, only one has reported a miscarriage. And we know its true, because for many of the patients, their prenatal care was done at the center in Puembo. Low infant mortality? Clinical relationship with a single health care location? Those are huge steps in public health.


Unfortunately, tuberculosis is making a come back in Puembo. Whoops!