Driving to Our Women's Health Vision: Dr. Cara Simmonds' second mission trip to Costa Rica

Dr. Cara Simmonds recently returned from her women's health-focused mission trip to Guanacaste, Costa Rica. This is Dr. Simmonds’ second mission trip to Costa Rica in 2018. Let’s find out what she learned and discovered from her trip this time.


Q: How did you get involved with this women's health-focused mission trip?

A: “I became involved with The Paul Chester Children’s Hope Foundation in May when I participated in a trip to Costa Rica to provide intrauterine devices to underprivileged women.  We partnered with CEPIA (Culture, Education and Psychology for Infants and Adolescents) which is a Costarican non-profit nationally accredited organization that seeks to promote culture, health, sports and education for children and teenagers from low-income families in the coastal communities of Guanacaste, Costa Rica.  CEPIA provides services for families in poverty including education, medical, psychological services, and meals.  Our foundation donated Copper IUDs - which we inserted in women who had been educated, screened, and counseled by CEPIA and our team.  The women we serve do not have health insurance and therefore do not have access to screening for sexually transmitted infections or for affordable birth control.  We provide treatment for presumed sexually transmitted infections if indicated during our screening interviews as well as intrauterine devices for birth control.  During our first trip in May we were able to serve 60 women. This November we saw 80 new patients as well as some of the women from May who were having problems.

After our first trip in May, Bill Chester, the head of The Paul Chester Children’s Hope Foundation, asked me to be the coordinator for future IUD Mission trips to Costa Rica.  Therefore, after only participating in one medical mission, I was now responsible for gathering supplies, recruiting providers and medical assistants to join me, as well as coordinate with our partners CEPIA and The Beachside Clinic in Costa Rica.  I was very humbled by the opportunity to serve as leader of these missions, but was nervous about having all the moving parts in place in order to successfully serve the women of Guanacaste.”

Q: Tell us a typical day of being a volunteer physician in Guanacaste.

A: “Our past 2 missions have included travel Thursday and Sunday with clinic days Friday and Saturday.  Our days begin around 7 am setting up our 2 exam rooms and sterilization room with supplies for the day.  At 8am the women begin arriving to register. They register with CEPIA volunteers and fill out a questionnaire regarding their current birth control and possibility of pregnancy, exposure to sexually transmitted diseases, and medical history.  Many of the women have participated in an education class given by CEPIA to inform them about the Copper IUDs prior to arrival. Those who have not been educated about the IUDs,  receive the class at the clinic prior to seeing the doctors.  Once the women have been educated and their urine pregnancy tests are negative (thankfully this time we did not find any positives!), they are interviewed by one of our providers. If we are concerned about sexually transmitted diseases, the women receive antibiotics. Testing for STIs is costly and not easily obtained, so we made the decision to have a low threshold for treatment instead of risking pelvic inflammatory disease post insertion. After the interview, the patients are escorted to the exam room for IUD placement. Once insertion is completed the patients participate in an exit interview by CEPIA volunteers to assess their experience as well as gather information regarding their social situations and need for additional CEPIA services.  We usually take a short break for lunch with our volunteers.  The last patient is registered around 3:30pm and after cleaning up and taking a supply inventory, we leave the clinic around 5pm.”

Q: What’s the best part of this second trip?

A: “One of the things I loved about this second trip is hearing the positive stories our November patients had heard from the women we saw in May. We seem to be developing a reputation as “the kind doctors from America”!  One patient I saw had received an IUD in May.  She had presented to a local emergency room with fever and abdominal pain within the past month and was treated with 3 days of oral antibiotics but continued to have fevers each night and pain.  One of our doctors had contacted GE and had a portable ultrasound for our use during the mission. We were able to see that although the IUD was in good position, she had a small complex cyst on her right ovary that was possibly a tubo-ovarian abscess caused by a pelvic infection.  We removed her IUD and treated her with a longer course of multiple antibiotics. We instructed her to return to the emergency room for possible admission for IV antibiotics if she did not feel better in 3 days.  She was also clearly suffering from hyperthyroidism  as well, but could not afford the iodide treatment needed. CEPIA was able to follow up with her and get her care for her thyroid condition.”

Q: What did you learn from these mission trips?

A: “I feel that we do so much good for so many women in a very short time, but each visit leaves me with ideas of how we can serve this community further. The first time I visited Guanacaste I realized that the women had little funds for feminine hygiene products and that condoms were not culturally acceptable therefore many women were hesitant to purchase them.  So this trip we provided condoms and feminine hygiene products.  We also met many women with very heavy periods who would have been better served with a progesterone releasing IUD instead of the Copper IUD which can cause heavier periods. In November, we were able to provide 8 women with progesterone IUDs.  I learned during this November trip that although Guanacaste is a site for multiple NIH/NCI funded research projects involving Gardasil (HPV vaccine) and cervical dysplasia, the women we serve do not know about the studies and/or do not have access to Gardasil or cervical cancer screening.  I am now contacting multiple resources to obtain Gardasil for our next trip.”

 
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Dr. Cara Simmonds

Dr. Simmonds’ warm personality and expertise are recognized by both patients and colleagues. Dr. Simmonds received her Doctor of Medicine from The University of Miami. Her Obstetrics and Gynecology residency was completed at Georgetown University.

She is a board-certified practitioner and has been in private practice in Montgomery County, Maryland since 1995. Since 2010 she has focused on Office Gynecology and especially the areas of adolescent gynecology, perimenopause and menopause.

She is a member of The North American Menopause Society and will become a Certified Menopause Practitioner in 2018. Dr. Simmonds recently published an article titled “Genitourinary Syndrome of Menopause” on The Lady Docs Corner Café blog and was recognized as a 2017 Washingtonian Top Doctor.