Haiti: Cervical Cancer Education, Screening, and Training
In 2013/2014, Basic Health International Executive Director, Dr. Rachel Masch, collaborating with Direct Relief (directrelief.org), and the St. Luc Foundation, led three training teams of obstetrician/gynecologists, nurses, and public health professionals to Port Au Prince, Haiti. Their mission was to provide educational and clinical training in cervical cancer prevention to women’s health care providers from the St. Luc Fondation. In three sessions at Klinik Manitane, two health promoters, and sixteen providers (doctors, nurses and midwives) were trained. During the three delegations, approximately 1500 women were screened for cervical cancer, and the nearly 300 women who were found to have evidence of cervical pre-cancer were treated or given appointments to be treated.
In October 2014, Dr. Masch hosted a follow-up quality assurance visit to Klinik Manitane. Eight midwives were observed performing Visual Inspection with Acetic Acid (VIA) and cryotherapy, and all were approved to perform these procedures independently. They also successfully completed a written exam and an image exam. Since the program’s inception in June 2013, the Klinik Manitane has screened more than 2,600 women for cervical cancer, performed approximately 400 cryotherapy treatments and executed one successful operation on a patient named Nanotte who was diagnosed with invasive cervical cancer. The screening program continues, and the midwives screen 20-40 women every week. They are investigating ways to disseminate these techniques nationwide.
In August 2013, a 43 year-old mother named Nanotte came to Klinik Manitane for a free cervical cancer screening that took place during one of the cervical cancer training delegations led by Dr. Masch. Her pelvic exam revealed that she had a lesion that was suspicious for advanced cervical cancer. The biopsy subsequently confirmed the diagnosis of squamous cervical cancer. Nanotte was the first patient to be screened through Dr. Masch’s training delegation to be diagnosed with an advanced case of cervical cancer. Cryotherapy, which Dr. Masch’s group was trained to perform, was not an option due to the advanced stage of Nanotte’s cancer.
To provide Nanotte with the level of care she needed, Dr. Masch returned to Haiti in February of 2014 to perform a pro bono radical hysterectomy assisted by her friend and colleague, Dr. Jill Whyte, a gynecologist oncologist at North Shore LLIJ Cancer Institute in New York.
The surgery was performed at St. Luc’s sister facility, St. Damien’s Hospital, which generously donated its surgical suite and hospital services. Pathology from the surgery revealed a 2.8 centimeter tumor, and radiation therapy and chemotherapy were indicated for treatment.
Neither chemotherapy nor radiation therapy were available to Nanotte in Haiti, so she had to leave the country to receive her treatment. After much assistance from multiple non-profits and the absolute persistence and tenacity of Dr. Marc Augustin, the medical director of St. Luc Fondation, Nanotte obtained a passport and visas, secured lodging, transportation and food, and had her treatment at Instituto Oncológico Del Cibao in Santiago de los Cabelleros, in the Dominican Republic (DR). While there, Nanotte was supported by The Fundacion Solidaria del Divino Nino Jesus (FSDNJ), headed by Father Eduardo. Direct Relief paid for the cost of the treatments, transportation, food and lodging.
Nanotte arrived in the Dominican Republic in August 2014, and after a series of scans and the completion of lab work, a seven-week course of chemotherapy and radiation began. The seven weeks turned into sixteen as Nanotte experienced adverse affects from her treatment. But, by November 2014, Nanotte had successfully completed her treatment and was safely returned to Haiti. A follow-up visit to the DR in January 2015, revealed no evidence of cancer.
Dr. Masch returned to Haiti in the spring of 2015 with CryoPen founder Dr. Michael Haas and BHI Founder and President Dr. Miriam Cremer to see the cervical cancer screening program in action at Manitane Clinic in Port au Prince, Haiti. See the blog post here.