I spent Monday and Tuesday of this week at the Women’s Health Clinic’s satellite clinic for the Cervical Cancer Screening Program in Bontleng. It’s about the same distance from Pilane Court as is Princess Marina Hospital, but to get to the Bontleng clinic, you go the opposite direction after a turn in the road.
The clinic is busiest in the morning. From 7:30AM to 8:30AM, the nurses in the clinic walk over to the other side of the building, where there is a department that does HIV testing, measures CD4 counts, and distributes ARVs. The nurses talk to the patients about the importance of cervical cancer screening, and tell them where they can be screened (right across the building or at Princess Marina Hospital).
Later in the morning, after 9AM, the patients come in. HIV positive patients can participate in the See-And-Treat (SAT) Program, in which they are immediately examined on the same visit by VIA, and treated with cryotherapy if any lesions are seen. Patients with lesions that don’t qualify for treatment by cryotherapy are referred to the Women’s Health Clinic in PMH for other treatment. HIV negative patients, however, need to first obtain a Pap smear; if they have abnormal results, then they are referred to the SAT program. Usually, in the States, people always need to obtain Pap smears first; however, because the HIV rate in Botswana is so high and HIV+ patients are more prone to cervical cancer, the SAT program was established. Seeing and treating in one visit takes the burden off the patients who otherwise may be too busy to come back for follow ups.
Through observing at the Bontleng clinic, I was able to gain a deeper understanding of how the cervical cancer screening system is run, and see how patients were treated at a different location. All the nurses there were great; they were all so friendly and motherly! I told them that, and one of the nurses, Susan, replied, “Thank you! It is very important to establish rapport with patients. Otherwise, how would we get them to come back?” It’s a lesson that many healthcare providers often forget.
After talking to them, I learned that the Bontleng nurses also used to be midwives at some point in their careers. I was excited by this piece of information, and took the opportunity to present to them the SAPHE Pad and asked for their opinions:
1. Their initial reaction was one of doubt — they were doubtful about the accuracy of the absorbent squares. After I explained that estimation of blood spillage via the SAPHE Pad was tested and shown to be more accurate than simple visual estimation, they were a little less skeptical.
2. Another concern of the midwives was the ability of the pad to capture ALL of the blood that would come out; they said that in some instances, the blood gushes or even splashes out, and that the pad may need to have a wider shape to catch all the blood.
3. The midwives told me that the current method of estimating blood loss in the maternity wards was to use a calibrated cylinder, and then to visually estimate the blood on the soiled linen that was not captured by the cylinder. They believed that the cylinder was much more accurate, but that the estimation of the soiled linen could be aided by the SAPHE Pad.
4. Sterility isn’t an issue. It just needs to be clean. Sterilized packs of equipment are used, but the bed underneath the mother is just a regular bed.
Additionally, I learned some helpful information regarding the Invertabottle:
1. (the good news) Cancer patients are given morphine to take home (home-based palliative care), and the morphine is administered by family members.
2. (the bad news) Morphine is given to patients in the form of tablets.
…
Tablets. Tablets! Of course morphine would be available as tablets… Well, then there is no issue of over or under-dosing due to visibility issues or anything else. I wonder why Malawi, which the Invertabottle was designed for, doesn’t use tablets? Using morphine tablets instead of liquid would save distribution costs, since tablets are definitely smaller and easier to package and transport. Well. I consider this a business/marketing fail on my part — I definitely did not do my research on the current form of morphine administered in Botswana before I brought the Invertabottle here. I wonder if there are any liquid medications administered here that would require 1L bottles for patients to take home.
More on BTB technologies progress in my next update!
(A small note about this picture: I did a double take when I first saw a very bright blue and yellow sign by the road right outside the entrance to the Bontleng clinic advertising, in capital letters, “CIRCUMCISION OFFERED HERE!” I wanted to ask the nurses in Bontleng about it, but didn’t know how to phrase the question. It wasn’t until afterwards that I googled the benefits of circumcision, and learned that there have been proven studies about the reduced transmission of HIV and STIs if the male is circumcised.. there were other factors as well regarding the efficacy of circumcision, but I won’t go into them here.)