Last August, Garry Pierre-Pierre spent three weeks in Haiti chronicling the services and impact health clinics had in the communities they served. The International Planned Parenthood Federation had approached Pierre-Pierre with the idea to do a series on their work in Haiti. He found this opportunity exciting and interesting given that few journalists have reported on this issue.
Part 4 in this five-part series explores cervical cancer treatment in Haiti.
PORT-AU-PRINCE, Haiti — Emmanuela Joseph looks every bit of her 45 years of hard scrabble life in Port-au-Prince. A few months ago, the mother of five children came for a regular check up (a Pap smear exam) at Profamil’s clinic in Port-au-Prince. The nurse explained to her that their clinic had a faster and more accurate test that would detect any cancer.
Though she was skeptical, Joseph reluctantly agreed to the test, called Visual Inspection with Acetic Acid. The result of the test was positive for early stage of cervical cancer. Doctors at the clinic treated Joseph treated using Cryotherapy technique, where an arctic cold liquid is sprayed on the cancerous tissue.
“The seriousness of it didn’t dawn on me until later,” Joseph said to a hotel maid. “I said God, please don’t let me die. My children need me.”
Joseph credits Profamil’s staff with saving her life and has become an unofficial ambassador and spokeswoman for the health program.
“This tells you what I think of Profamil. I’m back here because they helped save my life.”
Cancer of the cervix is the most common cancer in Haiti. This disease often attacks women in their 30′s and 40′s when their children are still young and in the formative stages of their lives. The fact that 90% of Haitian women have no access to treatment means that the mortality rate is very high.
Pap smears are generally not available and cervical cancer screenings are limited — as are pathologists that can read the Pap smear exams. Public health campaigns to raise awareness and educate women on cervical cancer are generally lacking.
“We do our job one person at a time,” Dr. Levelt Eugene said. He’s the director of Profamil’s clinic in Port-au-Prince. “In rare occasions we have a few people who come requesting our test. Ideally, we’d like to do a massive media campaign to get more women to do the test. But even in Haiti such campaign can be prohibitive for it to be effective. But this is important. We have to find a way to control this controllable disease.”
In a country whose healthcare system is devoid of the latest technologies and highly skilled medical personnel, Haitian women like Joseph are succumbing to a curable disease. Even for advanced cancers, half the women can be cured.
The Visual Inspection with Acetic Acid technique is relatively new in Haiti. Profamil is one of the few medical centers using this method to detect benign or malignant lesions in a population where most women see a doctor on an emergency basis. The benefits of this method is that it does not require a Pap smear, a biopsy, a pathology report or multiple visits to the doctor. Dr. Eugene says the procedure can be performed in one visit to a clinic. In addition, it affords an opportunity for women to be screened for HIV. Those found positive can then be referred to a HIV/AIDS clinic.
With 94 cases per 100,000, Haiti has the highest reported incidence of cervical cancer of any country in the world. Cervical cancer is the leading cause of cancer death among Haitian women — with an estimated 1,500 deaths annually. This is 50 times higher than the rate in the US, where Pap smears and cervical screenings have dramatically decreased cervical cancer mortality.
Women in Haiti have not benefited from these health screenings due to lack of public health infrastructure and trained pathologists; there are only four pathologists in this country of 10 million people. As a consequence, most women in Haiti have never been screened for cervical cancer.
Thus, cervical cancer is a little-known disease in this country, and there are few options for treatment. Caroline Joachin is one of many women with cervical cancer. Softly spoken, Joachin is very hopeful that cryotherapy can cure her. Her husband nods and reaches for her hand. The couple has a newborn daughter and a three-year-old son.
“If we can diagnose this often when can deal with it,” Dr. Eugene said, in the hot, airless health clinic on Martin Luther King Boulevard. “In the past we used to send patients home to die. They die in a very bad situation. You can say an inhuman condition.”
The reality for Haitians is that women are rarely screened, diagnosis comes too late, and adequate treatment is just not available.
Roseline Augustin, a 35 year-old mother of three, recently found out she has cervical cancer. She wanted to go to the Dominican Republic for radiotherapy treatment, but she couldn’t afford it. As fate would have it, Augustin was walking home and saw the indigo blue gate with a list of medical services for women. Intrigued, she walked in and asked to see a doctor. She was examined and told about her medical options.
“When they told me they will help me, I couldn’t believe it,” Augustin said. “All I can think of was dying and leaving my children alone. I thank God all of the time.”
Still, doctors and nurses working at Profamil’s clinics said that they are eager to learn more techniques to save lives. As effective as cryotherapy is in curing early stages of cervical cancer, Dr. Judner Jean Baptiste Michel says it has its limits. Dr. Michel is the director of the Croix des Bouquets clinic. According to Dr. Michel, a cancerous lesion covers more than 75 percent of a woman’s cervical area, cryotherapy is may not be appropriate.
“We need more training using the colposcopy method which would make a world of difference in these cases,” he said.
Garry Pierre-Pierre is the founder of Haitian Times. He is currently the executive director of the Center for Community and Ethnic Media at CUNY’s Graduate School of Journalism.