The end of 2015 marked the third year of Direct Relief’s partnership with Basic Health International (BHI) and the St. Luke Foundation to implement a cervical cancer screening and treatment program at St. Luke’s Manitane Clinic in Port-au-Prince, Haiti. It also marked the successful treatment of our second patient diagnosed with advanced cervical cancer.
Successful completion of cervical cancer treatment is always a milestone worth celebrating for patients, their families, and the providers that implement their care. However, it holds special significance in Haiti, where most women diagnosed with cervical cancer will, unfortunately, die.
Cervical cancer is preventable and easily treated if caught in a pre-cancerous state, but due to lack of access to cervical cancer screening services, the incidence of cervical cancer in Haiti is the highest in the Western Hemisphere (65.73 per 100,000 women in Haiti as compared to 8.1 per 100,000 women in the US).
In light of these statistics, we knew, when the cervical cancer screening clinic was set up in 2013, that we would likely find cases beyond the pre-cancers that the staff at Manitane were prepared to treat; such was the case when we met Micheline. A 48-year-old single mother of 7 boys, she had been bothered by vaginal bleeding since July of 2014. At the time of her diagnosis, Micheline was selling goods at the local market in Cite de Soleil, one of the most densely populated and impoverished areas of Port-au-Prince. Before that, Micheline worked for the state maintenance service, cleaning the streets in the metropolitan areas of Port-au-Prince. With very limited resources with which to support her family, visiting a doctor to address the bleeding must have seemed insurmountable. However, in the spring of 2015, Micheline heard about the free screening services offered at Manitane’s maternal health clinic and came in for a visit. Her physical exam revealed the possibility of cancer, and at the end of April, we received the biopsy results confirming invasive cervical cancer.
A diagnosis of cervical cancer is never what anyone wants to hear, but it poses especially difficult challenges in Haiti because there is no access to radiation therapy anywhere in the country. Radiation therapy is essential for successful treatment of advanced cervical cancer, and so for women of limited resources who cannot afford to travel out-of-country, sometimes the only option is palliative care.
After experiencing the many challenges of facilitating cervical cancer treatment for our first patient diagnosed through the program in 2014, Direct Relief established a cervical cancer fund to be used exclusively for the travel and medical costs of women needing care outside of Haiti. Although we knew that we would have the funds to provide Michelin’s care, there were still some logistics that would need to be sorted out. We were lucky that, during the timeframe of Micheline’s diagnosis, we connected with Dr. Vincent DeGennaro, Director of Internal Medicine at Project Medishare and his colleagues at the Bernard Mevs Hospital in Port-au-Prince. They too had been working to expand screening services for cervical cancer in Haiti. Best of all, they had the expertise and the scanning equipment at Bernard Mevs Hospital to stage cancer patients and were already sending patients to the Dominican Republic for treatment. With Dr. DeGennaro assistance, Bernard Mevs agreed to take Micheline on as an oncology patient, and Micheline underwent the necessary visits to assess the extent of her cancer and determine what course of treatment would be needed. This was great news. It saved Micheline from having to travel outside of Port-au-Prince for her initial assessment visits.
With Micheline in the care of Bernard Mevs, Dr. Marc Edson Augustin, Associate Medical Director of the St. Luke Foundation, went to work on the lengthy and arduous process of procuring a passport and visa for Micheline to travel to the Dominican Republic. By July, and after much effort, Dr. Augustin had succeeded in obtaining the proper documentation for Micheline, and Project Medishare and Bernard Mevs made the necessary lodging arrangements and referral appointments for her to receive treatment at the Instituto Oncologico Regional del Cibao in Santiago. After an initial attempt to get to the Dominican Republic failed, due to a border closure, Micheline finally arrived in the Dominican Republic on Tuesday, August 4th. Micheline’s stay was projected to be for six weeks of chemotherapy and radiation. Her children, who ranged in age from 24 to 10-years-old, stayed behind to care for each other in her absence. St. Luke provided some funds to assist in the care of the boys, and Micheline arranged for the father of the boys to check in on them from time to time to make sure they were well.
Due to complications from her chemotherapy, Michele did not return to Haiti until mid-November. She spent a total of three months in the Dominican Republic. Dr. Augustin checked in with Micheline weekly and sent periodic updates allowing Dr. Rachel Masch, Executive Director of BHI, to provide guidance on Micheline’s medical care as needed. When asked about her experience, Micheline said it was all worth it. She said she felt alone in the beginning, but Project Medishare arranged for her to stay in a guest house with other Haitians, and she quickly integrated into the Haitian community in Santiago – attending church in Creole, cooking her preferred Haitian foods, and receiving support from other women with cancer. Part of the funds provided to Micheline went to the purchase of a cell phone, and she said that talking on the phone with her boys also made the time go by quickly.
While Micheline was in the Dominican Republic, her boys decided that it was too dangerous to remain in Cite de Soleil, due to gun violence, and relocated the family to the La Plaine neighborhood. Micheline now resides there with her family and is picking up her fourth-year school classes previously interrupted by her cancer treatment. Micheline will continue to receive follow-up care at Bernard Mevs to ensure that she remains cancer-free and in good health.
Providing successful treatment for Micheline’s cervical cancer and enabling her to have a good health outcome is entirely due to our partners. It is thanks to organizations like St. Luke Foundation, Basic Health International, and Project Medishare and Bernard Mevs, organizations that are dedicated to providing quality charitable care, that any of this is possible. Providers such as Dr. Augustin, Dr. Masch, and Dr. DeGennaro, who are tireless in their pursuit of providing care with dignity for all patients, inspire us every day. It is only fitting that in January, which is cervical cancer awareness month, that Micheline allows us to tell her story and express our gratitude to our partners for her successful treatment.
To date, the cervical cancer screening and treatment program at Manitane Clinic has screened more than 4,600 women and treated 886 women for pre-cancerous lesions.