Olá pessoal!

Tonight I’m blogging to you from Cláudia, a very small city in the state of Mato Grosso. We’ve been having such a great time out here with the Mobile Unit, so I thought I’d tell you all the exciting things we’ve been able to do and see. For those playing at home, you can follow our route on this map.

This post got a little long, so I’ve broken it up into two parts to make it easier to read. I’ll post the second half when we get back to Barretos!

 

Day 0

We’re going to call Wednesday “Day 0” because, for the most part, all we did was travel on Wednesday.

So, we got up at 4 a.m. to drive to Ribeirao Preto, where we took a flight to Brasilia, from whence we flew to Sinop. From there, Marcelândia is about a 2 hour drive over the bumpiest, craziest dirt road I’ve ever had the pleasure of driving on (Ecuador, I’m looking at you).

But finally we arrived! The team was already here, checking out the Mobile Unit and hanging at the hotel. All that was left was to head to dinner – and dinner was super delicious churrasco at the home of a local farmer. We got to meet a lot of people that night who invest a lot of time and money into securing donations for HCB, and they were so welcoming. We headed to bed that night with full tummies and happy hearts.

 

Day 1

Thursday started bright and early, and we headed over to a local church where the Mobile Unit had been set up.

This Mobile Unit is set up a little differently than the ones I’ve described before. This unit is able to screen for cervical, prostate, and skin cancer. Inside the truck, there are 4 rooms: one for Pap smear collection, one for digital rectal examinations, one surgical room where they excise cancerous skin lesions, and a sample room with a refrigerator and freezer for storing blood and tissue samples. The nurses collect blood samples from male patients in order to determine PSA levels, but this is usually done outside of the truck.  The team consists of one doctor, one nurse, three nurse assistants, and one driver.

Two months before the Mobile Unit arrives in the city, the chief nurse of the city travels to Barretos for 3 days of training. Training covers a huge amount of information, including the paperwork and administrative necessities of hosting a Mobile Unit, and details on cervical, prostate, and skin cancer (remember this! It’ll be important later J). The nurse then returns to the city and it becomes her responsibility to sort of “pre-screen” her patients, deciding who gets to be seen on the one day that the Mobile Unit is in the city.

So these were the patients that we saw in the morning! We spent most of our time in the surgical room with Dr. Julio, watching him screen patients for skin cancer. Ideally, a doctor would do a full-body exam with a dermatoscope, but there are too many patients for this to be feasible on the Mobile Unit, so instead Dr. Julio would examine the lesion that the patient was concerned about and then also examine the patient’s arms, face, and neck since 85% of skin cancer cases appear in these areas.

It was really cool to watch him work. Most of the patients didn’t have skin cancer – only 6 of the 40 patients he saw actually had a cancerous lesion. These 6 patients were asked to come back in the afternoon so that Dr. Julio could excise the lesion.

We were able to sit in on those surgeries as well, but I had to leave half way through because I could not handle the smell of burning flesh. Yay for electric scalpels. All I’m saying is, those patients are so much braver than me.

We were also able to spend some time with the chief nurse in Marcelândia, and we demonstrated a project we’ve been working on while we’ve been here. So, you remember how I told you that the nurses are expected to absorb an insane amount of information in a super short period of time, and then retain all that information for the next two months? Yeah, it sounded crazy to us too. But it would be really expensive to print off all of the training PowerPoints that they are shown during their time at HCB, and they’d all print off in black and white anyway, which isn’t conducive to looking at pictures of skin lesions.

Yian and I brainstormed a bit with the help of Dr. Carlos, and then decided that the best plan of action would be to take all of the information that is given to the nurses during their training and make it into a single PDF, or “e-book” as we’ve been calling it, which can be burned onto a CD and given to the nurses after they’ve completed their training. The nurses can take this information with them and share it with other nurses in their regions, in order to pre-screen her patients better.

We showed our rough draft of the e-book to the chief nurse in Marcelândia to get some feedback. We asked her if she thought it would be helpful, what she thought it was missing, and any other suggestions she had. It was awesome to get this kind of feedback while we were out in the field, especially since she was our target audience exactly.

The day wrapped up pretty quickly after we spoke with the nurse, and after a delicious dinner, we went to bed early in anticipation of an early morning.

 

Day 2

Friday started even earlier than Thursday, because we had to drive to Analândia in the morning. Analândia is about an hour’s drive from Marcelândia (yay for more dirt road bumpiness!), and it’s a really small city, so there were no hotels for us there. Instead we loaded up the van and headed out at 6 a.m.

Unfortunately, the truck had been having some technical difficulties. Three of the four shock absorbers had broken on the way into Analândia, and it caused a lot of damage to the interior of the truck. Before it could be driven to any other city, those shock absorbers needed to be fixed. So, the truck spent the day in Marcelândia getting repaired, and we packed up all the necessary equipment to do the screening in the back of the van.

In Analândia, we were stationed in the local health clinic. The chief nurse for Analândia is the same nurse for Marcelândia, so we didn’t have an opportunity to continue getting feedback on our e-book. Instead, we spent the morning with the nurses collecting blood from the male patients for PSA testing.

In addition to PSA testing, there is also some research being done using the Mobile Unit about the prevalence of hepatitis infections. Each of the men who come for prostate cancer screening are also asked to fill out a questionnaire for this research, and the collected blood is also tested for hepatitis.

A poster on the wall of the clinic sparked an interesting discussion about domestic violence in Brazil. The rates are, unfortunately, quite high, especially in rural regions, like where we’ve visited. Domestic violence also has a big impact on HCB’s breast and cervical cancer screening programs, which I was surprised to hear. A number of men will refuse to let their wives get Pap smears or mammograms because they believe that male doctors perform these procedures. In the past, it has even lead to some serious altercations. One time, a husband found out that his wife was getting a Pap smear at the Mobile Unit, and he came to the truck with his machete, ready to cut the doctor’s hand off for touching his wife. Sometimes, even after explaining that only female nurses perform Pap smears and mammograms, men will still refuse to let their wives be seen by the Mobile Unit.

It’s horrible that women are unable to get the care they need, and it makes me wish that there were more that we could do about it. Unfortunately, it’s a little outside of our current capabilities, so for now the best we can do is hope to reduce the spread of misinformation so that more people can be screened properly.

After wrapping up at the clinic in Analândia, we headed to União do Sul for the night. We arrived at the hotel early enough to watch the opening ceremonies for the Olympics that evening. We cheered for both the Brazilian and American athletes, which was an exciting way to end our second full day in Mato Grosso.

Tchau!

Jessica