Her daughter’s wedding was one of the highlights of Isemelie Bazard’s life; it was also something the 64-year-old Haitian street vendor had doubted she’d live to see.
In March 2013, Bazard was diagnosed with breast cancer. Treatment options were frighteningly few, so chances were slim she would see her daughter get married later that year. When she heard about a recently opened hospital in Mirebalais, she decided to try her chances.
On May 23, 2013, Bazard became the first patient to undergo surgery at University Hospital, which is run by Zanmi Lasante, as Partners In Health is known in Haiti. It was a success. She followed a six-month regimen of chemotherapy and has since been on medication to help prevent a relapse. More than three years on, she is still cancer-free. Thanks to PIH, she is now among a small, but growing, group of breast cancer survivors in Haiti.
“If it weren’t for this hospital,” says Bazard, a mother of four, “I would be dead.”
October is Breast Cancer Awareness Month in the United States, where the American Cancer Society estimates that 246,660 new cases of invasive breast cancer will be diagnosed in women this year alone. Yet early detection is common, and the chance that a woman will die from breast cancer is about 3 percent. Survivor stories here, and in many Western countries, are plentiful.
Compare that to poor countries such as Haiti, where a breast cancer diagnosis is rare and, usually, a death sentence. There are only three facilities that provide chemotherapy in the entire country. One is private, where the cost of care is too high for most Haitians, who live on less than $2 a day. The public Hôpital General in Port-au-Prince provides free care, but patients must pay for all medications.
University Hospital is the sole public facility where cancer care is completely free. In 2015 alone, 1,600 biopsies were performed on patients visiting the oncology department. Nearly 40 percent of these biopsies were breast-related. PIH clinicians who treat breast cancer in Haiti say it is aggressive, often strikes young women, and is well-advanced by the time of diagnosis.
Bazard was among the lucky few who detected a lump early. She asked her daughter, who was in nursing school at the time, to check the mass that had been slowly growing in her left breast. It didn’t seem normal. So she made an appointment at a public hospital in Port-au-Prince. She arrived in the pre-dawn hours and sat in a packed waiting room. It was early afternoon before she saw the doctor, who handed her a slip of paper with a list of recommended diagnostic exams. She knew she didn’t have the money to pay for each, nor transportation to get to the facilities scattered throughout Port-au-Prince.
The doctor, likely noting her look of desperation, said: “’Go to Dr. Damuse.’”
If it weren’t for this hospital, I would be dead.
Ruth Damuse, an internal medicine doctor by training, started providing oncology services on a shoestring budget at the PIH clinic in Cange in 2010. By the time Bazard landed in her exam room in late 2012, the doctor had already cared for dozens of breast cancer patients. She ordered an X-ray and sonogram of her patient’s breast, and then took a tissue sample to send to Boston for testing. (Brigham & Women’s Hospital, Dana Farber Cancer Institute, and Newton-Wellesley Hospital all provide pathology services to PIH). The sample came back malignant in March, and Damuse’s team decided that Bazard’s best chance at recovery was a mastectomy.
When Bazard heard the news, she started to cry. She was her family’s primary breadwinner, selling shoes to make ends meet, and worried about what was going to happen to her children. “I was thinking that I was going to die,” she says.
The stigma of losing a breast also wore her down. Oldine Deshommes, a PIH oncology social worker, shared a Haitian saying she often hears among patients facing a mastectomy. “Venn tete, se venn ke,” or "veins that feed the breasts are the same that feed the heart." Women express this concern because they feel that once some or all of their breast is removed, they will feel an irreplaceable void. Deshommes and fellow staff members speak with the women about these, and many other concerns, during breast cancer support groups.
Bazard took advantage of these groups and says that whenever she talked to Deshommes, it was “like death stopped to exist.” Eventually she came to terms with her diagnosis. She felt supported by PIH, loved by her family, and filled with faith that all would be OK. She was also honored to be the first patient to undergo surgery at the newly open University Hospital in Mirebalais.
Dr. Michelson Padovany, a general surgeon and Mirebalais native, performed the historic procedure on May 23, 2013, just two months after the hospital officially opened. All went according to plan. Within two months, Bazard was back to begin chemotherapy. She remembers experiencing nausea, vomiting, and bouts of diarrhea, but says—overall—“it wasn’t bad.” Her memory was likely colored by the strong bonds she built throughout the ordeal with Deshommes and Damuse, whom she calls her mother and daughter. They understood when Bazard asked for a break in her chemo so she could participate in her daughter’s wedding that December.
Bazard at University Hospital in 2013 after undergoing the hospital’s first surgery. Photo by Rebecca E. Rollins / Partners In Health
In September 2014, Bazard’s CT scan came back clear. Her tumor was gone, and there was no sign it had metastasized to other parts of her body. To make sure she remained cancer free, Damuse put her on Tamoxifen, an estrogen-blocking oral medication that has proven especially effective for Bazard’s strain of breast cancer. Her most recent scan in March was also clear.
Every two to three months, Bazard returns to University Hospital, where she has her prescription refilled and chats with Damuse, Deshommes, and the rest of the oncology team. Her second family. She says she’s been eating and sleeping well again. While she still has daily concerns, cancer is not one of them. Mostly, she worries about saving enough money to restart her small business.
For now, though, Bazard is busy as the local reference for neighbors who ask about University Hospital in Mirebalais. She sends them along, singing the praises of PIH staff.
“Here at the Mirebalais hospital,” she says, “you will always find kindness and a solution.”