The Women’s Health Clinic (also known as IDCC) has “clinic days” every Tuesday and Thursday. On these days, women who have abnormal PAP smears and are referred to Princess Marina Hospital’s IDCC for colposcopy. All the patients arrive around 7:30AM, and go through three stations: in-take, see and treat, and leaving. At the in-take station, the OB/GYN history is taken in Setswana, so Mma Monare suggested that I observe in the “see and treat” room. In “see and treat,” Dr. Hove performs colposcopy by visual inspection with acetic acid (VIA) and visual inspection with Lugol’s iodine (VILI.) Abnormal areas, or lesions, are indicated in VIA by a defined white patch, and in VILI by a defined yellow patch. If no lesions are seen, then usually Dr. Hove obtains a biopsy using a method called endocervical curettage (ECC), in which a small brush is inserted into the endocervical canal to scrape off tissue. If a questionable lesion is seen, then a punch biopsy is performed by snipping off a small bit of the lesion, and the tissue may or may not be cauterized (burnt; the smell of burnt flesh is a little nauseating at times). If a clear lesion is seen, Dr. Hove performs LEEP — loop electrosurgical excision procedure, in which an electrified metal loop is used to scoop out a chunk of the cervix containing the lesion. The whole philosophy behind the IDCC’s one-visit “see and treat” is that the patients don’t need to make difficult sacrifices for numerous follow-up visits; rather, lesions are treated immediately.

I helped out with the nurse’s duties of handing Dr. Hove his equipment and helping prepare the room and sterilized pack for each patient. During the colposcopies, Dr. Hove would pause and let me look at the cervix, explaining what abnormalities to look for and what distractions to ignore. If you search for “cervix” in Google Images, you’ll get an idea of what I was looking at for 5 straight hours. I definitely gained a clearer view of the daily routines of an OB/GYN physician and a greater understanding of the methods used. The body’s ability to heal itself still amazes me; the cervix heals fully within 2 months after a chunk of it has been scooped out!

The patients are all very compliant and respectful. They completely trust us — not just with their bodies, but their lives as well. For example, one patient had a string coming out of her cervix; Dr. Hove explained that it was a method of contraception called “the loop.” It’s a method of contraception that a woman discreetly uses if her husband stubbornly refuses to use condoms and doesn’t want her to take the pill, either (some of these women have had 4 kids within a few years!). In a society in which women are often completely dependent on the men for food and shelter, the confidentiality of such a tiny thread of information is what prevents lives from unraveling.