Driving to Our Women's Health Vision: Dr. Diane Snyder and Nadine Flaharty's Mission Trip to Costa Rica

Dr. Snyder and Nadine recently returned from their women's health-focused mission trip to Guanacaste, Costa Rica.  Let’s find out what they learned and discovered from their trip.

Article by Dr. Diane Snyder

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I've wanted to do medical volunteer work for many years but never found a trip that fit into my family or work schedule. After seeing pictures of the gynecologic mission trip last spring to Costa Rica it sounded like the perfect place to begin. I already knew most of the people involved locally which made it much easier to get excited about the work. There were others in my practice who were also interested in joining along (both who were bilingual in Spanish!)

We started with an organizational meeting to get oriented to what we needed to do and equipment and supplies that we would need to bring with us. Since a group had already been to the clinic, there was a better sense of how things would run and what would be needed. We asked our medical supply vendor, Mckesson, if they would be able to donate supplies and we were pleasantly surprised when 10 boxes of supplies were delivered (gloves, drapes, pregnancy tests, cleaning materials,cotton swabs, etc). We borrowed equipment from our offices (speculums, scissors). 

The first day started very early with a 4 am pick up to make an early morning flight. All the equipment and supplies made it through security! After a few hour lay-over in New York, we headed to Liberia, Costa Rica after a delay taking off. All the luggage made it and then we were very creative in fitting 6 of us and all the luggage into a minivan. We intended to get to the clinic to set up that night but we couldn't seem to find it and after the long travel day and being exhausted and hungry we headed to sleep (after dealing with a few logistical issues of not enough beds for all of us!) and finished putting enough Ibuprofen into small containers to add to bags we were giving to patients after their procedures (with instructions, sanitary pads and some chocolates).

We made it to the clinic by 7am the next morning and got organized quickly setting up two exam rooms, an equipment cleaning area and an intake area. Patients started arriving by 8am and we got to work! Since I don't speak Spanish, I was assigned volunteers to translate for me. The first volunteer was a young student who was a bit nervous being in the room but soon got very comfortable. The second volunteer was a social worker/therapist who had grown children of her own and was an extremely calming presence for the patients and helped them with guided visual relaxation techniques as well as flagged a number of patients who she felt needed additional support in the coming weeks. I quickly got used to the headlamp (like miners wear) as the rooms didn't have lights for us to use. We needed to be creative with the space and the limited equipment that we had (it did make us appreciate the comforts of our exam rooms back home).

After a quick break for lunch at the CEPIA center (they were the organization that organized the program) we headed back to finish the afternoon. The next day ran a bit smoother as we were all comfortable with the process.

The patients were extremely appreciative of our help. They asked many good questions about their reproductive health and things that they needed to do after the procedures. My youngest patient was 15 years old ...she came with her mother and her 19 year old sister. Her sister had an 18 month old infant and also had an IUD inserted that day. The insertion for the young patient was challenging and required the IUD to be inserted with ultrasound assistance and after a few attempts was able to be safely inserted. I was amazed at how she was able to handle the procedure. I knew that this young patient now had a chance to finish school without worrying about having a baby and how that would give her a chance to improve her education and her future. 

The CEPIA staff and volunteers were wonderful to work with and were truly making a difference in the lives of the women and families that came those few days. Personally, it was gratifying to use the skills that I had to help so many women in a short time. 

Article by Nadine Flaharty, CNM

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Costa Rica??? The name of this country immediately evokes visions of beautiful beaches, undulating mountains and lush vegetation. Gynecologic care? Not so much but I was receptive to anything after Diane Snyder and Cara Simmonds described the mission that would bring four GYN practitioners and 2 capable staff people to this small Central American Country under the auspices of Paul Chesters Children's Hope Foundation. Women from Latina countries have always held a special place in my heart; I speak (serviceable) Spanish and have always loved giving OB and GYN care to these women throughout my professional career. So armed with everything we would need for our very short 4 day trip to the Guancaste region of Costa Rica , we arrived and settled in to our temporary "office away from our office". The Beachside Clinic generously offered us their facilities with a PLETHORA of volunteers organized by CEPIA (a Costa Rican based organization non profit offering services to underserved Costa Rican families... more about them later) .

We arrived at the clinic very early, met by Laetitia Deweers and other staff from CEPIA already setting up. Organized so that each women would be registered, educated, interviewed and given medical care, we were impressed with the smoothness of the organization. Because many of the volunteers were new to the concept of the IUD as an efficacious and safe method of contraception, we took the opportunity to proselytize and educate them. As providers, we had the opportunity to "interview" the women prior to the IUD insertions to confirm their suitability for a copper IUD. Ranging in age from 15 years old to mid 40s, they came with their husbands and boyfriends, sisters and cousins many of whom decided that they too wanted to avail themselves of our services. They came with their children and their nursing babies; all had received an orientation to the "Cobre T" (Copper T) but still had questions.  "Will it hurt" ? (yes but briefly) "Does it work well"? (yes... 99.4 % effective) and suprisingly they had questions about us.I was asked frequently "why are you here"?  Ostensibly to put IUDs in but they wanted to know why I really came. I tried to avoid political overtones (and anyone who knows me knows how difficult that is for me to do) but my answer was that we wanted to let the women and people of Costa Rica know that the people of the United States cared about them. This seemed to satisfy all. 

When appropriate we medicated some of the women who were at risk for STDs (the expense of testing them prior to our arrival was prohibitive so we screened the women and had a "low threshold " for treatment and all women were tested for pregnancy (everyone tested negative.) All of the women had stories and woven in to the tapestries of their lives were some special stories that still bring affect me. And everyone waited.... patiently and cheerfully with nary a complaint. by the end of Saturday we had placed 79 IUDs ; Leticia reported that all of the women were happy with the services and planned to,let family members and friends know about the Cobre T. And as we were just about ready to leave, one last woman drove up. She had been stuck in traffic and wanted to see if we could accommodate her even as we thought we were done for the day. So we placed our last IUD ... # 80 in this dear lady who had tried to be here on time but was thwarted but circumstances beyond her control. And thats what it was all about.... reaching out and serving each woman and her family individually... meeting their needs, individualizing our care and serving the community. And as each woman thanked us and called us "their angel" and blessed us for coming, I realized that all of us got just as much from out interactions as we gave...if not more!!

My thanks to CEPIA (acronym for Culture, Education and Psychology for Infants and Adolescents) and everyone who is involved with this deserving organization, the volunteers who came from the community to assist in the smooth operation, the staff of the Beachside Clinic who graciously shared their facilities during those 2 days. Thanks to Cara Simmonds who organized us and “ sweated the small stuff” and to Leslie our fabulous medical assistant and Glennie who helped everyone. Thanks to Diane Snyder ( my boss and fellow provider) who, along with Women’s Health Specialists afforded us the time to make this trip. Also thanks mostly to the women that we served who shared their lives with us and trusted us and invited us back.