Training with the Government of Cundinamarca.

TRAINING OF DOCTORS, NUERSES AND PROMOTERS IN THE CANCER CARE ROUTE

During 2022 with an extraordinary group of nurses (called Cancer referents) we develop a program that aims to train general doctors and specialists, as well as health nurses and promoters (called Gebis in the health system but prefer to continue calling promoters because this is how the community identifies them and they have similarity to the health promoters of many surrounding countries we know their activity)

Over time we have consolidated valuable information about the social reality of breast cancer in the municipalities of Cundinamarca, which is repeated in the municipalities that we have visited in all the distant areas that we have visited as a volunteer of the Colombian Air Force and other NGOs International

We know that of the women who have traditionally trained in previous years, only 21% are held self -examination, it is a constant that we find in all the places we have visited. 60-70% of women with breast cancer of rural areas when they consult for the first time already have advanced disease. Mortality for this cancer rose in 2021 to 13.9 (GLOBOCAN 2021). There are women who to take a mamography must travel 7-8 hours to get to the exam site, and must assume the costs of transport, the companion, the food and sometimes the lodging, reasons why this exam is often not performed. We have found women with waiting orders of more than 2 years. There are some EPS that come to take mammograms directly but are rare, in the last months we have found municipalities with more than 50 mammography orders waiting for more than 8 months to arrive the arrival of these mobile mammograms. When we asked women who wanted to know about their breasts, we found that the most frequent doubt was "doctor because my breasts hurt ..?" And we conclude that if we do not give an adequate answer to this question we could not teach how to find the breast cancer early. Moreover, if general doctors do not give an adequate response to this symptomatology, women are lost and often when they have a mass that does not hurt (more commonly associated with cancer) women do not consult on time.

All this led us to apply from the Government a novel training program based on the fact that women want health Transmitting really impacts epidemiology and motivates women to consult. We are left with few things, we discover, for example, among others, that teaching obesity as a cause of breast cancer is not important, has a relationship with many other cancers and does not generate credibility, that combating obesity is better through programs than the programs than Governance develops called lifestyles that seek the quality of life improving weight, the way of feeding, exercise and other factors.

Those few things we teach today are impacting.

Today, 3 years of follow -up, 80% of women trained with the Government remembers that signs should search to find a tumor of at least 2 cm (most scientific works conclude that women in general find a tumor with the Self -examination when they are 2.4 cm) and 52% of women are being carried out. The emergation is that we are decreasing the fear of self-exam skin, cause "sinking" and grant signs described in the informative brochures of many public and private institutions.

By the way we evaluate many of these brochures in low -income women and we found that the indication of "searching for a hardening in the breast ..." described in many brochures, only in 15% of women was identified as a sign of cancer. First many women describe normal hardening due to hormonal changes or confuse the ribs with these tightening. And many times hardening already correspond to advanced tumors. We believe that we must teach them to look for tumors as early as possible and in a simple way and we are achieving it ... there is a long way to go but we are showing results ...

Today our doctors, nurses and promoters trained with that program call us frequently and we have been able to advise them to avoid unnecessary exams and remissions. But above all they have motivated themselves to provide more compromised and human health care. We do not know that there is another department with these results ...

Today our team has trained doctors, nurses, health promoters, personnel of the health promoters, (EPS), supporting instants of Salus (IPS), communal leaders of most of the municipalities of Cundinmamarca teaching

1. Because a breast hurts

2. How to diagnose a breast cancer as early as possible

3. Know the Breast Cancer Attention Route with the indications to do according to the level of the health institutions of each municipality.

4. How to improve the clinical examination of the breast

5. How to teach patients with easy and simple methods.

6. How to improve quality indices on each site

We have also given all people trained the way to communicate with our specialist via telephone or by sopcial networks, which has served to reduce inception remissions. In the case of promoters, having the support of the surgery-mastology specialist has meant a motivation to promote the search for this cancer. In places like La Palma Cundinamarca, among others, it was very motivating for our team to find that the teachings we leave for 4 years was still remembered for our promoters. They are very valuable.

We only have to highlight the value of our team from the Government, there is an obvious leadership and a staff that has no qualms about moving to distant and difficult sites, sometimes with frustrating results because the number of people we expected did not attend, the difficulties for Update the information that health institutions must deliver, the difficulties of transport on many occasions and have to receive complaints for delays in the care of health promoting companies. But the results are seen and are very shocking if we compare them with many rtegions of our country or Latin America.

In the following photos we see a sample of our team in municipalities such as Sopo, Mesitas del Colegio, Caqueza, Arbelaez, Fomeque,Choachi, Villeta, Guatavita, Ubate, Nemocon,¡La Vega, Tocaima, Chia,Sesquile, Guasca, Anolaima, Gacheta,Fusagasuga,La Mesa, San Antonio de Tequendama, Soacha, Choconta, Girardot, Funza, Ricaurte, Madrid, Suesca, Mosquera, Zipaquira,Viota, Cajica , Facatativa y muchos mas .