Dr. Ruth Damuse, oncology program director for Partners In Health in Haiti, helped establish formal cancer care in Haiti in 2010, first at the PIH hospital in Cange, and then at University Hospital in Mirebalais. Between September 2012 and August 2013, the cancer program in Haiti screened more than 2,000 patients for breast and cervical cancer, diagnosing and treating more than 600 patients. To mark World Cancer Day, which is Feb. 4, the Haitian physician reflects on the moral imperative to treat cancer and recounts her experience providing care not previously available to poor Haitians.
Some think people in poor countries don’t get cancer.
But death from cancer is higher in poor countries than in rich countries. I know because the patients come in my door every day. I believe that if the patients are there, if they’re dying, we need to do something. And I think we’re doing something with this program in Haiti.
Partners In Health and Zanmi Lasante, our sister organization in Haiti, have always treated some cancer patients. We have seen patients with cancer since the beginning, and though we didn’t have comprehensive services available in Haiti, we did whatever we could to help them. We saw patients one by one, and sometimes we sent them to Boston for treatment.
If we weren’t doing it, there would be no way our patients would be treated. Now there’s hope for many patients.
I first got involved with Zanmi Lasante working in a hospital in the Central Plateau for my social service year, the year the government requires new doctors to spend working in a poor area. After this experience, I did specialty training at the general hospital in Port-au-Prince in internal medicine and then moved to Belgium to receive further training in immuno-hematology. But then the earthquake happened. I came back because I felt I had to do something to help rebuild after the earthquake.
In 2010, the Avon and LIVESTRONG foundations provided us a grant to develop comprehensive cancer care. We started from scratch, with nothing, but we had to just start. I opened the cancer clinic in Cange one day, and told the other clinicians to send me the cancer patients. From the beginning, we have relied on the Dana-Farber Cancer Institute and Brigham and Women’s Hospital to help us make diagnoses, develop treatment plans, and procure drugs. Soon we started to focus on breast cancer, because we see it often and it’s relatively easy to treat. We provide surgery and chemotherapy.
What’s really hard is that we don’t have a clear line between what we can treat and what we can’t treat, because of a lack of expertise or access to diagnostics and therapies. We don’t have all the resources of a cancer program in the United States, such as radiation or all chemotherapy drugs to treat different cancers. But everybody’s coming to us, because we give free care.
Sometimes we get a patient with very advanced disease, and even in the States they couldn’t be cured. We can’t treat them, but at least we can ease their pain, which is something. And we’re helping them understand what they have, so they don’t just go home and die without knowing. In those cases, we now have training to give palliative care, but it’s not something people want to talk about in Haiti. Doctors want to believe they can cure the patients, and the patients do as well. In the United States, you have hospice care, but that doesn’t exist in Haiti. We knew palliative care was a huge need we couldn’t avoid.
I saw a patient last month from Milot, in the very north of the country, who came all the way to Mirebalais on a Sunday. She had a CT scan, and the report showed she had advanced lung cancer with metastasis everywhere. Physicians feel like they fail the patient when they can’t fix it. Her doctor had heard there was a cancer program in Mirebalais and that maybe we would be able to treat her, but it was clear she needed good palliative care. Many times, I say to patients “I can’t treat, but I can help and ease the pain and suffering.” That’s very hard on me; it’s very hard on our small team. I try to forget about it when I go home, but it’s not easy.
We can’t just say that cancer doesn’t happen in poor countries, because we are seeing the patients and they are in need.
Still, there are a lot of patients we can treat, and if we weren’t doing it, there would be no way our patients would be treated. We provide care free of charge, so anyone who needs it can access it. I feel good about it because before there was no free treatment available, and now we have most treatment available. Now there’s hope for many patients. I’m happy when I see a patient early so we can start chemotherapy and do surgery.
We’re a small program, but we’re doing well. I tell my patients they’re only seeing me, but there are a lot of people behind me, including cancer specialists, so they know they’re receiving the best care possible. Now we’ve treated many patients, many who are now free of cancer. We have a social worker who talks to patients about their disease, the shame they feel, and about dying if we’re providing palliative care. We’re not only treating, but we’re doing a lot of community outreach about breast cancer and how to check for it. It’s a good start.
In the future, we want to be able to provide radiation therapy, see more patients with breast cancer, and treat more cancers—especially cancers of children and young people, which are so hard.
I think cancer care is a human right, and we need to provide it. We can’t just say that cancer doesn’t happen in poor countries, because we are seeing the patients and they are in need. We can’t leave them without anything. It’s not just about HIV, tuberculosis, malaria, and cholera, because cancer is there too. Before I started working in this program, I didn’t know about the extent of cancer in Haiti, but now that we’ve started, we’ve seen the patients. And we’re seeing the difference we’re making in their lives.