Case 1
Submitted by Maribel Serrano, M.D.

E.S. is a 32 year old Latina from Sonora, Mexico, who has never routinely been seen by a physician for regular care (partially because she has never had health insurance).  She immigrated to the U.S. when she was 21 years old with her husband. She recently arrived to visit her sister who lives in Texas.  Shortly after her arrival, E.S. began to have severe lower abdominal pain and heavy menstrual bleeding (which was very unusual for her).  Her sister rushed E.S. to the Centro de Salud (medical center) near her home to be seen by a local physician. E.S. was grateful that the clinic had health care providers that spoke Spanish since she knew very little English (and Spanish is only spoken in their household). 

E.S. underwent an examination which included a pelvic exam and pap smear. She informed the physician that she had never had a pap smear. Her only sexual contact has been her husband. Other labs were also ordered to determine the source of her problems.  She was prescribed medication to help with her pain, and was advised to rest until her lab results came in. 

Soon after, E.S. received a call by one of the nurses from the clinic and asked her to come in to see Dr. Munoz in order to discuss the results of her tests.  E.S. was informed she had cervical cancer. 

Please go on to Case #2.