Since arriving to live and work with the midwives of ACAM in June of 2017, I have watched them with awe as they become more and more capable women’s healthcare providers. Last Monday was no exception. I felt I might burst with pride as they performed their first ever cervical cancer screening clinic.
I just got “home” to ACAM a week and a half ago after spending several weeks back home in Seattle visiting my family and friends. I scheduled my return date carefully so that I would be back just in time for the screening clinic on Monday, February 5th. Back in October of 2017, seven of the ACAM midwives, along with myself, my midwifery colleague Mary Ellen, and our project physician Valeria, completed a rigorous cervical cancer screening course using visual inspection with acetic acid (VIA). VIA screening is more accessible than pap smears in low-resource settings as it doesn’t require being sent off to a lab and results are immediate. The midwives put their hearts and souls into the course (see post “Softening” for more detailed info on the VIA course). Last Monday, armed with their new knowledge, they put all they had learned into practice.
I arrived back to ACAM on the evening of Sunday the 4th and to my amazement the midwives had transformed our prenatal consult rooms into perfectly equipped cervical cancer screening stations. They had thought of every last detail from screening supplies, an area to disinfect equipment, a microscope room to do testing for vaginal infections, and a sterilization area using our new autoclave. We had even obtained the equipment needed to perform cryotherapy for immediate treatments for patients who tested positive for pre-cancerous lesions.
“What if nobody comes??” the midwives asked nervously on multiple occasions during the months leading up to the clinic.
“They’ll come!” I would reassure them, silently hoping I was right.
They had passed out flyers, placed radio ads, and promoted the event to their friends, neighbors, family members, and church congregations.
The clinic was scheduled to begin Monday morning at 8am. To the midwives’ relief and delight, women started trickling in at 7:30am. By 8:30am, the waiting room was packed. Excitement flickered in the midwives’ eyes as they got to work.
As the screenings began, the midwives worked together seamlessly, rotating through their different stations and supporting each other throughout the day. While they did pelvic exams and screenings, Mary Ellen and I were in charge of the microscope, where we worked with the midwives to improve their microscopy skills and diagnose infections. At one point, Mary Ellen found live sperm on one of the slides and all of the midwives came to see the little swimmers. They were dying of laughter!!!
Around 10am, reporters from Nuestro Diario, one of Guatemala’s national newspapers, arrived to interview the midwives and Doctor Valeria. They had learned about ACAM a few weeks earlier and when they found out about the midwives’ upcoming screening clinic they decided to return to publish a piece on them. The article came out the following morning!
By 4pm, forty-three women had received cervical cancer screening. Of those patients, four tested positive for pre-cancerous lesions. Imelda, our lead midwife who became certified in cryotherapy during our course, performed the treatment on each patient. Two of the women were her neighbors. They had never received cervical cancer screenings in their lives. She counseled them thoroughly, in their native language, before performing the treatment. Many of these women would likely never have pursued testing if it weren’t for the trust they have in the ACAM midwives. Without treatment, the four women would have likely gone on to develop cervical cancer, which is often found too late in Guatemala.
The midwives of ACAM are pioneers in so many ways. With minimal formal education, they got through a highly technical medical course in order to provide a service to women in their community. Many of those women would forego cervical cancer screening throughout their whole lives due to fear and mistrust of the Guatemalan medical institution. The ACAM midwives have created a space where these women can receive competent care where they are treated with respect and cultural sensitivity. Their efforts are saving lives.
ACAM will hold it’s next cervical cancer screening clinic on March 5, 2018.