RFS Voices: Adventures in Peru

This year’s Goldberg-Reeder grant recipient travels to Cusco, Peru.FullSizeRender

As I prepared to pick up my bags from the conveyor belt at the Cusco, Peru airport, I was a little nervous. But that was nothing compared to the excitement I felt at beginning my journey. I had been waiting for what felt like a lifetime for this moment.

My passion for global health didn’t start with Peru. A brief visit to the Red Cross museum in Geneva during my undergraduate study abroad program forever changed the direction of my life. One of the exhibits demonstrated how physicians were involved not only in the physical rehabilitation, but also the emotional healing of others. Standing there, I realized that I wanted to dedicate the rest of my life to the healing of others.

FullSizeRender 1Filling out all the required paperwork for the ACR Travelers Grant felt like a breeze. Ever travelled abroad? Yes. Ever travelled to a third world country? Yes. After months practicing ultrasound scanning and completing a series of ultrasound modules I’d use to help teach basic ultrasound scanning to local Peruvian physicians, I felt extremely prepared to take on this challenge.

My trip took me to the Cervicusco clinic in Cusco, Peru, a not-for-profit organization committed to delivering cervical cancer prevention, screening, diagnosis and treatment mainly to impoverished women, as cervical cancer is one of the most common causes of cancer death among Peruvian women. I had originally planned to teach local clinicians the basics of ultrasound; however, once I got there I was told that because of economic constraints, setting up the classes had not been possible.IMG 7146

Instead, my new task was to perform ultrasound scans on patients and to participate in their cervical cancer campaigns. With a radiology resident on board, we also provided free breast ultrasounds, abdominal and transabdominal pelvic ultrasounds in addition to cervical cancer care.

I journeyed to a small town with no running water or electricity in their health center. When you have only lived in countries where running water and electricity are always accessible, you don’t plan for there being a lack electric plugs to connect an ultrasound machine to.

But luckily, I was resourceful. After 45 minutes, multiple sets of wires connected by multiple pieces of tape from an electric source in a neighboring town and multiple reassurances that connecting these wires wouldn’t cause an electrical malfunction that would lead an small explosion, I was ready to scan.

To detail a month’s long experiences of learning through trial and error would result in an extremely lengthy article. But here are a couple lessons learned:

IMG 7335I thought this trip would solely be about me providing services to a group of people who did not have access to the types of resources that we sometimes take for granted, and in part it was. I traveled to towns where women had multiple children, but had never seen an ultrasound of their unborn child. I traveled to clinics where there were so patients waiting anxiously for a sonogram that the line was wrapped around the building. Despite hours of scanning without a break, I still couldn’t get to every patient that wanted to be seen, and that was heartbreaking for me.

I spent countless hours explaining to young women that cyclical breast pain was not an indicator of breast cancer, but most likely related to physiologic hormonal changes associated with menses. I received endless amounts of hugs for being the first physician to come to their town, perform an ultrasound and explain the findings without there being a language barrier.

But this trip was also about personal and professional growth for me. My focus changed. I’m happy to report that after just a couple of days of being in Cusco, I no longer saw poverty everywhere I looked, but a majestic city with breathtaking architecture and a humble, warm and inviting community.

I learned that when there is a lack of resources, you may have to settle for a performing a test that by American standards is not standard of care. For instances, many women over the age of 50 wanted me to perform breast ultrasounds for the purpose of breast cancer screening. At first, it felt misleading to perform an exam that’s not the standard of care you’re used to. I didn’t want them to feel that because theyFullSizeRender 2 had received a negative breast ultrasound that it meant that they were free of malignancy. However, I realized it was nearly impossible for some of these women, who had sometimes walked 8-12 hours to receive care to actually get a mammogram. So, I offered the best care I could. I still performed “screening” breast ultrasounds, but each time, I made sure that my patients understood that mammography was still the best modality for breast cancer screening and that a negative breast ultrasound did not necessarily mean that they were cancer free.

In sum, I learned that in global health, residents must adjust expectations they set for themselves and their equipment. Despite the fact that I had spent months practicing scanning, sub-standard equipment and lack of trained sonographers limited the quality of the images that I was accustomed to interpreting.

By Frances Perez, 3rd year radiology resident at Medical College of Georgia and a 2015 recipient of the ACR Goldberg-Reeder Resident Travel Grant.

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