During our second day in Yangcheng, the study was gradually becoming closer to fully operational, with 20 women coming to screening appointments in both the morning and afternoon. Eventually, 80+ women will be screened daily, which is quite a throughput, and after seeing how the exams are conducted, I'm not sure it would be possible in the US without much more infrastructure in the way of exam rooms, exam equipment, and clinicians.
Since I am female, it is no big deal if I am in the room during vaginal speculum exams; sadly for Adam (especially since he wants to be an ob/gyn!) he did not have as easy access and was forced to wait in the hallway. I still thought that my presence could possibly make the woman feel uncomfortable as it would add an extra person to the room and I was hesitant to enter at first, but once I was installed in the back of the exam room behind the 2 examiners and the data recorder, I realized that women definitely have less sensitive privacy barriers in China than in the US. There were no less than 10 study personnel in the room at once at any one time, with anywhere from 1-4 patients in various stages of undress. At home, there would never be any more than 3 medical personnel and definitely only 1 patient at a time, and the doctors/students leave the room for her to unclothe. There is all sorts of elaborate draping to maintain modesty as much as possible, which is nonexistent in China. One patient would be on the table getting examined, another one next to it with her pants down waiting her turn, another by the chairs with her pants completely off doing the HPV self-collection (inserting a sample collection device into her vagina and swabbing around) and another waiting by the door. After the vaginal exam, they would get off the table and redress as the next woman got on the table to begin her exam.
If anyone had trouble with any of the steps, multiple nurses/doctors would approach and cajole and coach them into the appropriate position, which could involve shoving legs lower on the table or using your hands to pull the woman into the best position for the self-test. There was also no warning before speculum insertion; once on the table the vagina was fair game. In medical school at home, we spent an inordinate amount of time learning the appropriate technique and language to do a vaginal exam in order to make the woman as comfortable as possible, and it involves and slow and steady approach to speculum insertion, first stating that you will touch her leg, then that it might feel like pressure, etc etc. The state of things in China certainly made the whole thing seem like less of a big deal and enabled rapid throughput of patients, which is great in a resource-poor setting where there would not be enough clinicians or equipment to enable screening of so many woman in a short time. It would take some getting used to if I were to ever serve in China as a clinician!
Picture slideshow; more to be added soon:
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