To be honest, telling people that the HCB “sends mobile units around Brazil for cancer prevention” is a really vague description that probably elicits a lot of different images. What exactly is a “mobile unit”? Where exactly around Brazil? What is “sending” them and how do they go about? These are all questions with which we started our experience in Barretos, and now Mato Grosso, especially since there are different kinds of mobile units.
As I mentioned in my previous post, the mobile unit system is quite complicated, but I’m going to divide it into two levels, or “circles” to continue with the Dante theme — the localized care in the mobile unit, and the greater organization surrounding the mobile unit’s activities.
The unit itself
Mobile unit 3 is a massive truck which hauls a long container, which is the health unit itself, housing all the rooms where the care happens. This container unit is painted green outside, with a huge red “PREVENÇÃO DE CÂNCER” (CANCER PREVENTION) title on it, and features four rooms inside, with a long and narrow hallway connecting all of them. At the end closer to the actual truck part, there is the surgery room, which has a patient bed and necessary supplies. Continuing to towards the other end, there is the room for the prostate screening exams, a little waiting area for two people, an office room with a desktop computer, the room for the Pap smear tests, and a waiting room for that. In order to separate the patients for the exams, there is a sliding curtain right after the little office that is extended during working hours. And the amazing thing is that all of these rooms are fully air conditioned.
The team
The mobile unit teams consist of one unit driver, one doctor, one head nurse, and three technical nurses. The unit driver is kind of an understatement, since he is not only responsible for driving the massive truck itself, but also taking care of any unforeseen malfunctions, as well as helping out with the flow of patients during the preventive tests. The doctor is mainly in charge of carrying out the skin inspections and any necessary skin lesion surgeries. The head nurse is also an understatement, as the nurse in our mobile unit was really more of the coordinator of the whole team, whose main function was resolving all of the issues that came up at each location, in addition to serving as the communicator with the local agents at each city (more on this on my next blog post). Last but not least, the three technical nurses each rotate between handling blood test paperwork, drawing the blood itself, and performing the Pap smear tests, in addition to processing all of the paperwork at the end of the day.
The daily schedule
In rough terms, work days follow the same schedule:
0 Arrival (8:00AM)
1 Set up
2 First phase of tests — Pap smears and skin inspections
3 Second phase of tests — prostate rectal exams
4 Third phase — skin lesion removal surgeries
5 Lunch
6 Clean up
7 Departure (2–3:00PM)
Arrival and set up
Work days on mobile unit 3 start early, with breakfast around 7–7:30AM to be ready to start by 8:00AM. Before any patients can be seen, the mobile unit has to station itself at the pre-determined spot, usually near a local clinic or school (for reasons I’ll explain later), to set up the mobile unit. Set up begins by parking the unit and connecting it to the closest power source (usually a power line nearby). Part of the pre-determination of the mobile unit’s location is to ensure that it has an accessible power source, without which the unit would not be able to properly function.
Once connected to power, the team heads inside to organize the materials necessary. This means, taking them out of all the storage places and containers, as well as cleaning the necessary surfaces from all of the dust that makes it way in. Two particular set up activities involve the transport and installation of the centrifuge from its storage spot to the little office, as well as procuring ice to maintain the blood samples cold. The centrifuge is rather heavy and unwieldy, which causes discomfort, and the ice usually comes in large blocks which must be broken into smaller pieces to place in the coolers. These were two particular activities that I noticed the team seem less than excited to complete.
The three phases of preventive tests
Once set up has been completed, the prevention team begins their work. Each day follows the same schedule and number of tests in mobile unit 3, and it has three phases.
The level of efficacy in their execution is lost when their work is described as “performing tests” on patients. As I mentioned, mobile unit 3 is always on the move, and their goal is to be as much of a factory assembly line as possible. My first thought when I heard about the mobile units involved the mobile unit arriving at a city, setting up, and attending anyone who came and requested screening tests.
Turns out, that idea could not be further from the reality.
In the first phase, the team carries out 50 Pap smear tests, 40 skin inspections, and 40 blood collections for PSA analysis. The blood tests take about an hour, while the Pap smears and skin inspections take closer to two hours. The three nurses each rotate between handling blood paperwork, drawing the blood itself, and performing the Pap smear tests. The doctor handles all of the skin inspections.
The Pap smears and skin inspections take place inside of the mobile unit itself, each in separate rooms, and the waiting areas for each are separated by the curtain I described before. The patients are normally waiting outside in chairs provided by the local partners, and are called into the waiting room, and then to the testing room. In the skin inspections, the doctor may find a suspect lesion that can be removed in the mobile unit, and will schedule the patient for the later surgery phase. Depending on the lesion however, the doctor may also opt for cryogenic treatment, or schedule an appointment in the HCB itself. If an HCB surgery is scheduled, the patient receives the appointment that day, though the surgeries may be weeks or months later.
The second phase involves the 40 prostate rectal exams for the men who also had their blood drawn, and these tests are done in the same room as the skin inspections. This can also take around an hour. During this time, the nurses begin organizing all of the other materials to be ready for departure, and one of them begins to prepare the paperwork for any in-house surgeries that will be carried out in the surgery phase.
The third and last phase involves any skin lesion removal surgeries, which can be from one to fifteen, and are performed by the doctor and head nurse in the surgery room. This phase is the most variable in terms of time, since the number can vary a lot. At the end of the surgery, the patient receives further information regarding the care for the surgery wound, and the date when they can remove any stitches they may have.
Lunch, clean up, and departure
The team always aims to finish before lunch, but if work is taking longer due to unexpected issues or a higher number of surgeries, they will usually break around 1PM to eat. Most of the time, the local team will help the mobile unit either by providing food or by driving them to a nearby restaurant, making it easier for the team to continue their job.
After lunch, the team dismantles the mobile unit — the connection to power, the stairs leading into the mobile unit, and the surgery room inside — stores all of the materials and tools, and usually starts heading out to the next destination, which may be anywhere from two to seven hours away. And due to the size of the mobile unit and the condition of the roads, the mobile unit travels much more slowly than a regular car.
I know this was a rather long read, but I’ve tried capturing just the essential of a day’s work of the mobile unit 3 — there are still so many other things I could describe! But the most important thing is that these people in these traveling units are there to work, and they carry out all of these tests in a very organized and professional matter, with high efficiency.