ESTAMPA Study in Costa Rica: Pocket Colposcope Training | POCKET COLPOSCOPE FELLOWS

Libby Dotson

Today was an incredibly powerful and exhausting day. We visited two clinics, one in Puntarenas and the other 20 minutes away in Barranca. We trained two expert Colposcopists and three nurses that assist them with treatment and screening. In Costa Rica, only specialized colposcopists/gynecologists can perform the exam, nurses are allowed to assist. Both Doctors work on the ESTAMPA study. We had two very different experiences with each Doctor. Both very enlightening. *Things were very chaotic at first, this is because the entire healthcare workforce of Costa Rica was on strike the past two weeks. They almost cancelled this trip due to the strike.*

Clinic #1 with Dr. Carlos Sosa

This clinic was very large with sub clinics for different specialties. We taught reprocessing to the Doctor and Nurse, but the laptop did not have the software on it. We did not have wifi to download software at clinic, so Dr. Sosa drove us to his Dad’s house across the street to download software. His Dad is an electrical engineer! We dowloaded software with Carolyn’s help and went back to the clinic to finish training. They were impressed with quality of image, but concerned about biopsy. Additionally, the Pocket at this clinic, the light button did not work so the brightness did not change nor the green lights come on. This was a huge problem for Dr. Sosa, he was insistent that we send a functioning Pocket. We are letting him know this is not possible at this time, however this could impact the Pocket’s use in ESTAMPA. Dr. Sosa told us about how Costa Rica has one of the best public health systems in Latin America…most people have access to quality healthcare. He talked about how public hospitals are actually super well funded, more so than private hospitals, and have lots of resources. Recently, the government is decreasing the pay for public health workers in an effort to make all public hospitals private, hence the protest. We are returning to Dr. Sosa’s hospital today and watching a colposcopy with the Pocket live.

Clinic #2 with Dr. Monet

Dr. Monet was very excited about the Pocket. We started training when he let us know that he had no idea there was software and that he had already used the Pocket in nearly 50 patients. EVEN MORE, he stated he had performed around 7-8 biopsies with the pocket ALREADY! He said he loved it! He completed this all WITHOUT software. He just used the computers camera. He was very happy to know there was software. He also showed us a TV where he visually counsels all patients during their exams by connecting the laptop to a TV facing the patients and guiding the patient through the image of the vaginal canal and cervix. This was very exciting! We are returning to visit Dr. Monet today to interview him and understand his workflow in performing biopsy.

Quick update from the field

Dr. Calderón just explained the healthcare system in Costa Rica. The government pays for community health workers to go to EVERY single house and distribute pamphlets with information regarding HPV. Every single house! They then bring HPV positive women into clinic for consulting WITH their spouses and a nurse so as not to scare them. This is all free to every single woman in this country. Very powerful. It's important to point out that they do not do self HPV testing. It is community health workers who collect samples with the woman and then call them to set up consultation if positive. They were also telling us that they bring spouses in because it is commonly believed that HPV is caused by promiscuous behavior and this was one of the most significant barriers to bringing in HPV+ women.

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