Today we drove from the main La Liga clinic, to a mobile clinic site, to the referral clinic where patients would be sent if they tested positive at the mobile clinic. At each of these locations, I learned valuable information and collected important data, but perhaps nothing was more meaningful than what I learned in between these places. The commute between these clinics is worse than I imagined. Venturing all the way to the referral clinic is an extreme undertaking for a woman screened at a mobile clinic. The time and the money required for this journey are huge barriers for women in these areas. After the drives today and after having listened to many people, I am becoming increasingly convinced that the idea I discussed in my blog post yesterday is worth pursuing. Today I fleshed out that idea further through conversations with the team. We're discussing the idea of having Monday-Thursday at each mobile clinic site being 'screening days' and having Friday being the 'treatment day' in which a doctor would come out to the mobile clinic site to treat all the patients who received positive screening results earlier that week.

We're still figuring out how the logistics of that screening paradigm would work, but we're thinking about maybe pairing HPV testing with the Pocket in the mobile clinics. From what I've gathered this week, Pap Smears may not be an effective screening method in the mobile clinics due to the extremely long delay between the actual test and the notification of result (21 days). By the time these results are available to patients, it seems like women in mobile clinics have distanced themselves from the screening they underwent three long weeks ago, lowering the motivation of these women to pursue follow up care. (I want to ask more questions about Pap tomorrow). Today at the mobile clinic we heard multiple first hand accounts of how women who see pictures of their cervices taken on cell phones during VIA are more motivated to return for follow up care. I think the Pocket can enhance this same phenomenon. Implementing the Pocket and coupling it with HPV testing in addition to having doctors visit patients instead of having patients visit doctors, may be the most effective way to relieve the cervical cancer burden in rural areas. The amount of time we spent in the car today really spurred a lot of the conversation about how to eliminate the travel barrier as opposed to merely overcoming it, and this is where the conversation went. I'm looking forward to another day at the mobile clinics tomorrow.