[Written on July 12, 2016]
I’m writing this in my room in Rio Verde, Goiais, Brazil. We just got back from a wonderful first day with the mobile van, visiting the town of Monte Vidiu, roughly 1 hour away from Rio Verde. The mobile van team consists of only a small team – 1 doctor, 4 nurses, and a driver. For context, the mobile van is absolutely gigantic, with space for multiple examination rooms, including a room for pap smears, a room for small skin cancer surgeries and biopsies, and more space to store and maintain samples and supplies for the trip. The mobile van goes on the road for more than 1 month, with the medical teams that work the van swapping out throughout the trip.
Today we saw 130 patients for pap smears, skin cancer examinations, and prostate exams. On a large scale, the numbers make it obvious why Barretos is so mobile-van focused. A team of 6 people serviced 130 patients in one day. Over the course of the week, they’re on pace to see more than 600 patients in their mobile van alone. It’s an extremely efficient way to do cancer prevention screening from a human resources perspective. Upon further reflection though, it seems likely to increase attendance as well. First of all, patients are more likely to get screened because you’re bring the screening to them. This eliminates barriers to access (remember that universal healthcare means that this service is free in Brazil). But it’s more than that. The mobile van’s annual arrival makes an event of cancer screening. Rather than including it in an ever-growing list of activities that people *should* do to live longer lives, activities which are often viewed with suspicion by members of these rural communities who are only acquainted with them by anecdotal reputation, it brings cancer screening to the communities in a more palatable way. It’s made a large event, accepted by trusted authorities and by the acceptance of peers who you see next to you in line to be screened. This has to increase willingness to get screened. It’s also well publicized – if all of your friends’ calendars are booked to get screened that day, it’s likely you won’t forget that it’s happening either.
On a smaller scale, though, I thought it was amazing how closely the mobile van is able to mimic the hospital environment. Shadowing doctor’s interactions with patients in the mobile van, I felt like I was shadowing any other doctor consult back at Barretos. The mobile van makes easy to forget how far from the high resource central institution we are, hopefully giving patients the same comfort they’d get by attending the major institution itself.