Today, once again, perhaps the most valuable part of the day was a conversation I had in the car. While the traffic and the long drives are huge barriers for women trying to access quality cervical cancer care, they provide great opportunities for insightful conversations with Dr. Jeronimo and others at La Liga. Today in the car I followed up with Dr. Jeronimo on the idea of having both screening and treatment happen in the mobile clinics. I asked him if treatment would be allowed without Pap Smear results, and he enthusiastically replied with a 'yes'. He said that Pocket Colposcope alone would be enough of a screening measure to subsequently treat patients. He said that depending on how the political quarrel between midwives and physicians plays out, he could see the treatment paradigm shifting one of two ways.

The first way would be that midwives would NOT be allowed to perform treatment. In this case, midwives in the mobile clinics could potentially screen women with the Pocket Colposcope Monday-Thursday (or for some set period of time). Then a doctor could travel out to that mobile clinic for that Friday (or some shorter set period of time) to administer the treatment to the people who received positive screening results during that span. This would likely help overcome the follow up rate immensely, as the travel time/cost to the referral clinics is a huge barrier for women in many rural areas. The second way would be that midwives would be allowed to perform treatment. In this scenario, midwives would be able to screen and treat patients all in one visit. This would likely almost eliminate the follow up problem, as women would only have to make a return visit to the mobile clinic, as opposed to a far off referral clinic which would be expensive to get to and potentially take all day.

Both of these options seem like great possibilities for La Liga, and while they would require some institutional rearrangements, could result in significantly higher rates of patients in rural areas actually making it in for treatment, as opposed to just making it in for screenings. I'm excited to continue this conversation throughout the week and semester.

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