Fighting cervical cancer in Haiti

Roselene (left) after finishing treatment for cervical cancer in March of 2002

In March 2010, Zanmi Lasante’s (ZL) Loune Viaud received a phone call she has received too many times in the past. A friend was calling from Cap-Haïtien—a large city on Haiti’s northern coast—to ask if Loune could help refer his patient, Marcelle, to one of ZL’s hospitals. He told Loune that his patient had cancer and needed access to resources not available at his hospital.

ZL staff brought Marcelle to a cancer research hospital in Santiago, Dominican Republic, to obtain an evaluation. Tests confirmed that not only did she have cervical cancer, but that the cancer had already progressed to an advanced stage. “When we were informed that all the hospital could do was palliative care, after several weeks in Santiago, she returned to Cap-Haïtien to spend her remaining days with family and friends,” says PIH representative Kamila Przytula. “We made sure that she would receive pain medication [morphine] to help her with the pain. Sadly, she passed away on May 22.”

Each year, an unknown number of women across Haiti die from cervical cancer, a condition most often caused by human papillomavirus (HPV). Too often these women afflicted with HPV go undiagnosed because of lack of access to cervical cancer screening. Although Pap smear is available in Haiti it remains inaccessible to most women because of cost and challenges of pathology—the process where in tests are sent to a laboratory for forensic evaluation. Most facilities lack the resources needed to treat moderate to advanced cancer and there is no radiation therapy available in Haiti. These circumstances too often turn an otherwise highly curable form of cancer into a death sentence.

In response to this public health problem, ZL is working to increase women’s access to cervical cancer prevention at its clinics by incorporating screenings into routine checkups. Staff are also working to ensure that women who develop cervical cancer have access to treatment as soon as possible, before it becomes untreatable. “The other scenario is when a woman seeks medical attention once the signs of cervical cancer are obvious to her,” says Kamila, “once she thinks something is wrong—which in some cases means it is too late for treatment.” Like Marcelle, these women’s conditions are only detected during the disease’s final stages, when symptoms such as profuse hemorrhaging suddenly propel these women into life-threatening situations.

Despite having both skilled staff and access to medications at Hospital Bon Sauveur in Cange. ZL physicians can only treat abnormal cervical lesions and stage 1 cervical cancer. Most often, ZL uses one of two procedures to deal with cancerous cells: cryotherapy—a treatment where an extremely cold liquid is used to destroy pre-cancerous, but abnormal, cells; or, LEEP (Loop Electrosurgical Excision Procedure)—a treatment where a thin, low-voltage electrified wire loop is used to remove cancerous cells if the cancer is still in its early stages.

However, Marcelle’s tragic death drove home the fact that ZL needed access to more advanced equipment and medicines to respond to cervical cancer. Her death sparked a new ZL project aimed at referring cervical cancer patients to the Instituto Oncológico Regional del Cibao (IORC), a charity cancer hospital in Santiago de los Caballeros, Dominican Republic.

Between July 2010 and June 2011, 15 Haitian women will receive treatment for cervical cancer at this cancer hospital through a combination of radiotherapy, chemotherapy, and brachytherapy—a type of therapy where a radiation source is placed inside or next to the area requiring treatment. This ZL project is part of an institutional relationship with the Patronato Cibaeño Contra el Cancer, a Dominican charity that raises funds to support the cancer hospital and treat cancer patients who cannot afford care at other facilities.

Madam Blanc is the first of the 15 women ZL will be bringing to the IORC for treatment. “She was diagnosed at the ZL hospital in Cange with cervical cancer stage 2B—where the cancer has spread to tissue near the cervix. Once in Santiago, however, the doctors diagnosed her as being at stage 3B—where cancer has spread to the pelvic wall. She is currently receiving treatment,” says Kamila. Despite the cancer being at a relatively advanced stage, ZL and IORC staff are hopeful that Madam Blanc will make a full recovery.

Zanmi Lasante staff standing in front of the IORC

She, like with other women who will come after her, will go to IORC with all of her preliminary lab work already completed by ZL staff in Cange. This means that after arriving in Santiago, each woman will be ready to begin treatment almost immediately—as opposed to the typical 4 to 5-month waiting time. “The actual length of each woman’s stay depends on how well she responds to treatment and whether or not new lab tests need to be performed throughout the duration of her treatment,” says Kamila.

While in the DR, each woman will live in a ZL-operated house with a family member. The apartment is small; it has one bedroom with two beds, one bathroom, and a kitchen. But ZL staff have carefully and thoughtfully outfitted the house with amenities that will allow all the women to feel comfortable during this difficult time. “We [ZL] will pay for their transportation and food costs, while, of course, covering all treatment-associated expenses,” says Kamila.

Dr. Gary Jean, a Haitian doctor working at the IORC, will help the women navigate through the treatment process. He will also serve as a link between the hospital and ZL staff during each patient’s treatment.

ZL has been in contact with the IORC since May 2001, when ZL brought an advanced cervical cancer patient there for the first time—after Dr. Maxi Raymonville, in charge of Women’s Health at ZL, learnt about the facility. Roselene, a young woman from Cange and mother of two children, spent several weeks in Santiago and returned to Cange after successfully completing therapy.

In addition to diagnosis and treatment, ZL is also working to prevent cervical cancer through an HPV vaccine pilot. Gardasil is a vaccine that prevents around 70 percent of the most dangerous types of HPV, specifically those that cause cervical cancer. The pilot targeted girls 10-13 in 3 communes of the Central Department. In addition, ZL is also piloting HPV DNA testing by self-sampling. This sensitive test that women can do in their own home allows for the identification of women with a high risk HPV infection—one known to cause cervical cancer—so that they can receive further medical attention, preventing invasive cancer.