Introducing Cervical Cancer Screen & Treat to Haiti

By: Dr. Jill Ratner, President, Hands Up for Haiti

From Left: Rebecca Rowland, Heather Axelrod, Dr. Sue Malley, Dr. Jill Ratner

I opened my New York Times recently and my eye immediately went to a front page story entitled “Fighting a Cancer with Vinegar and Ingenuity”. I smiled, knowing what I was about to read.  I had just returned from a medical mission in Haiti doing just that. In the last 18 months I have become involved in an organization called Hands Up for Haiti that sends medical teams to northern Haiti.  During these week long trips, we provide medical care, introduce therapies, and conduct seminars for our Haitian colleagues. Being a pediatrician, with few tools and instruments- a stethoscope, an otoscope and a tape measure, I can accomplish quite a bit. But last July, I headed up an initiative with two Ob-Gyn physicians returning to the city of Cap Haitien and the clinics I had previously worked at seeing pediatric patients. Our mission: to set up a cervical cancer screening and treatment program for women. This would require nothing short of a miracle to acquire the necessary equipment and earn the trust of the Haitien community.

One of the Gynecologists, Dr. Susan Malley had become very interested in the plight of Haitian women and the astounding numbers who die from cervical cancer without access to simple PAP smears to screen for this devastating disease. It is the leading cause of cancer death for women in Haiti and it strikes them in their 30’s and 40’s. Dr. Malley instantly began to research work being done in resource limited countries to screen and treat women for cervical cancer. She contacted Dr. David Wormer who has been working in Haiti on this issue for the past ten years. Dr. Malley flew to North Carolina to meet with him and he was excited to share his research and experience with her.

Sue’s enthusiasm and belief that this screening was do-able on our upcoming mission, led us to acquire a cryo-machine donated by an office in the community. To educate our Haitien colleagues in this technique, Dr. Malley prepared a power point presentation on this diagnostic and treatment technique for cervical cancer, identifying abnormal cells with application of vinegar and then freezing those cells with cryo-precipitate.

When we arrived in Cap Haitien in July, our team of nurses and doctors were determined to make this happen. The next obstacle was obtaining a nitrous oxide tank.  After inquiring of many gynecologists and other health professionals in Cap Haitien, we discovered there were no nitrous oxide tanks in northern Haiti, The closest distributor was in Port au Prince, a city still recovering from the devastating earthquake. The broken pavement and dirt roads are treacherous and the drive is seven hours each way.  

Having established a network of support, I sent out e -mails to everyone I knew who worked in Haiti. My plea for help was answered by Richard Dubin, a man who operates the shipping and receiving dock in Cap Haitien. He found a truck coming weekly from Port au Prince, and fronted us the money to pay cash for the tank, nitrous oxide and the transportation.  The tank was ordered and brought to Cap Haitien, we picked it up in a borrowed car from other health care workers, who transported it in the back of a Kia where it was transferred to a pickup truck and brought to the clinic.

I then walked through the streets of Cap Haitien and purchased as much vinegar as I could find, and bleach for cleaning instruments. Even after all of our efforts, we had no idea if the connection between our cryo machine from the US and the nitrous tank from Port au Prince would fit. We held our breath, knowing we had made every effort. To all of our delight, it fit. It was a magical moment, bordering on miraculous after weeks of struggling to make this happen and overcome the obstacles which are inherent in practicing medicine in Haiti.  Dr. Malley and her colleague, Dr. Julie Dunne, were able to screen 100 women that week, and treated 20 for suspicious lesions. We worked brought this life saving treatment to a clinic in a devastated slum area in the city and a remote farming community outside of Cap Haitien. Not one woman refused the exam. And despite the pain involved in the procedure, not one woman complained about discomfort. These women who had never seen a gynecologist, or had an internal exam trusted us and realized what we were there to accomplish.

This was the first time such a treatment had been offered in the Cap Haitien area. Dr. Malley was then able to go to the teaching hospital, Justiniene and teach the physicians and residents about the procedure.  We were able to leave the tank, the nitrous oxide and the cryo machine in their capable hands, with plans for future trips to continue this work, along with our Haitian colleagues.

In this lifetime as a physician,  we each savor a moment when we can say we have made a difference. All the work it took to making this happen was well worth it for the twenty women who won’t die of cancer because of us, and for the innumerable women who won’t die in the future as the technique is perfected and utilized by our Haitian colleagues.

Hands Up for Haiti

Journal Excerpt: Through the eyes of a volunteer (part 2)

Author: Jayant “Jay” Kairam

While core medical skills, triaging and differential diagnosis are very translatable to my professional environment, where we must prioritize in service delivery and amongst finite resources. What needs to be addressed now? What can wait? What can subsist with basic service? Assess the problem and identify solutions. The right recommendations must weight costs and benefits, and balance the needs of all stakeholders. That is my form of differential diagnosis.

You have to trust. Trust yourself, your team and those that you’re serving.

Listen to the people, engage those you are serving. A lesson I learned a long time ago is development work is built on trust. It’s easy to get caught up in the stats, the best practices and innovation – how many kids did we see? How many cases of malaria did we diagnose?  But you need to recognize the human face and story behind it.

For me the reality was endemic, structural poverty. And that’s a hard lesson when you’re there for a week doing direct service. It’s hard to rationalize the value of your work. How can one make a change? One consult? You must recognize that the greater value is the change in you. Recognize how this motivates you? How did it teach you? Did it teach you? Be critical and compassionate.

There was no crisis. In my limited exposure to the people, they lived in the shadow of the cruise ship. Awareness of something better, but resigned to 50 years of political and economic ineptitude. Perhaps I’m projecting a bit. However, what I found most hopeful was the receptivity of people. That’s a credit to the work HVH has done in building relationships and committing to sustained development work.  I felt safe, I felt that the people, though enduring terrible hardship, were bound by kin and community. There didn’t feel to be an air of violence. These are critical aces on which lasting development work can be done. 

HUFH Journal Excerpt: Through the eyes of a volunteer

Author: Jayant “Jay” Kairam

“I found the daily visage of the cruise ship a too perfect analogy for the historic barriers the country continues to face. How can a place so close to so much wealth be so far away?”

Jay, taking a walk with the kids.

                 As the sole non-health professional on the team, I had to sort of explain my reasons for joining. They were primarily personal.  First and foremost among them was an opportunity to witness and work alongside my brother, who I’ve admired for as long as I remember. It is a rare chance to be afforded a chance like that. He has a passion for service and teaching, one that was instrumental in my decision to enter public service, and it was in full display during our days in the clinics. Call me sentimental. Second, though I work in the public sector, I rarely interact directly with constituents, or those to whom I’m supposedly most accountable. It’s an odd dynamic. In any case, I felt compelled to join this team, to regain a sense of perspective, humanity—and ultimately rejuvenate my desire to work in public service, which sometimes get lost in the minutiae of property taxes and civil service reform.  

What you quickly learn in situations like the clinic, is that boundaries and ostensible roles can easily blur and dissipate. A medical novice, I felt completely integrated into the cycle of treatment our roaming critic offered. It was a truly immersive experience and total crash course in a way of thinking where I’m obviously limited. This is a lesson for global health, or any development work where resources are scarce. You are pushed to become multi-dimensional, improvise and learn on the fly. If you can run with those things, if you are too tightly bound to conventions and structure, then frustration will hit fast.

To be continued…

Summary: A successful trip

This was our first educational mission for students and residents and I believe it was a success. The members of our team worked very well with the staff at HVH and our translators. Even Jay, who was non medical volunteer served an important role in helping with logistics and registration, as well as helping to run the pharmacy. We accomplished our mission of immunizing as many children as possible in four days in a very underserved area. We consulted on hundreds of children, treated many serious infections and gave reassurance to some parents who just had concerns about their children’s development.

In addition, I believe we fulfilled the Hands Up for Haiti Mission, of bringing health care to Haitians who are underserved and working collaboratively with the Haitian medical team. We had educational sessions that benefitted all and we brought needed medications and some equipment to the clinics we served.

We made connections with Haiti Village Health that will enable other groups to come in the future and have a well organized and supportive set up to work in. And we networked with Haiti Hospital Appeal as well as SOIL and Shada clinic.

I look forward to bringing other groups of students and residents to Cap Haitien and creating a Global Health curriculum that can be used by other groups as well.

From Left: McMahon, McAvoy, LoFrumento, Chauhan, our translator

Hands Up for Haiti partners with Haiti Hospital Appeal

After returning to Cap Haitian, Tiffany Keenan, Judy and I were able to visit Haiti Hospital Appeal and Nate Nickerson from Konbit Sante. Carwyn and Reninca, a  young couple from the UK have established a mini hospital that is amazing. Powered by solar panels, they have a spinal cord injury unit and are building a large physical therapy building to treat spinal cord and amputee patients.

They have a center for children with cerebral palsy that would rival any of our centers here. They are almost done with a maternity center which will include a neonatal unit. This is all staffed by Haitian medical professionals. They have also built a volunteer village that can house volunteers for about $30 a day. This would offer a convenient and affordable place for volunteers to stay who might want to work there and at other clinics in CAP such as Shada Clinic.

Cholera Center: While there, Judy and I also toured one of the remaining cholera centers staffed by MSSP.

Other Projects: We visited the school and delivered school supplies donated by a school in Orange NJ that has a large Haitian student population. These included paper, markers, pens, and pencils, as well as jump ropes and stickers. 

Clothing donation: We left several bags of donated clothing to be distributed to the children of Bod me Limbe and saved half of the clothing for the children of Shada.

Recreational: We met with the soccer league that arranges games between the villages and donated several soccer balls and a regulation net that Dr. Kairam and his brother brought from the soccer league in Summit NJ. We left three balls at HVH for the local kids under the supervision of Santos. They were also used by the staff and translators in the evenings as they played vigorous games on the beach.

HUFH Partners with Haiti Village Health

Dr. Tiffany Keenan (left), founder of Haiti Village Health

Tiffany Keenan: Dr. Keenan worked with us to ensure that everything went smoothly.  Problems were addressed as a group and solutions proposed. Tiffany very much wants to continue working with Hands Up for Haiti on collaborative efforts to improve medical care in Cap Haitien and the surrounding communities. They will welcome future teams who wish to come and work at Bod me Limbe or at Shada Clinic which will now be under her supervision.

Dr. Brinvert: The young doctor now works there five days a week. Each day one of the students worked with him in the BML clinic. He taught all of us so much about practicing medicine in Haiti. He came to Mombe with us and acted as a consultant, rounding on each station and asking if we had questions. It was a real example of the collaboration that is possible between the Haitian doctors and our medical teams.

 

Dennrik Abrahan: A third year medical student who is at the University of Southern Florida and the current coordinator for HVH this year. He has been working with the staff to make sure these programs go as well as they can.  Each night after dinner, we all met to discuss the day. Each person spoke about their role that day and what went right and what went wrong. Then everyone contributed with suggestions. The translators were included in these discussions. It was a really useful debriefing.

Staff: Santos is the manager who went out of his way to take care of our needs. Cholo is now the pharmacist and they are working on a detailed inventory for future missions and for their daily use in the clinic. and during our stay we also had Edward and Alysha who were helping to organize the program.

School’s Out! More Blitz.

Dr. Mary Ann Lofrumento, Team Leader Extraordinaire

Drive to Work

Because of the flooded condition of the roadways, we took a truck to the village of Monbin. The people of nearby Noman also came to this clinic.

 

Volume

The set up was the same but here we had a larger church that had better natural light.   The pastor was very helpful in getting the people there and taking care of all of our needs including providing lunch for us. Because Mombin has a road in good condition leading to the village and there is more market activity, the children and parents in this village were healthier and in better nutritional shape. Even so, they had had few government programs for vaccination. Our team saw 117 children. Most had similar respiratory illnesses, and abdominal pain or stomache ache, some had ear infections, but less major infections of the skin and less scabies. We still saw a few cases of clinical malaria.

BOD ME LIMBE

School’s Out! 

Taking advantage of a day when the school was closed, we set up an outside clinic to see the children of Bod me Limbe and the two smaller surrounding villages.

Patient Volume

We saw about 80 children. Again the children appeared healthy and well nourished for the most part. We saw less scabies than last year and even less tinea. Everyone received vaccinations who were scheduled to.  More education needs to be done in the communities prior to vaccination blitz’s regarding the purpose of the vaccines, what diseases we are preventing, and the usual side effects. If parents understand this ahead of time, it will increase the numbers of children who will get immunized and make these programs more effective. Hands up for Haiti helped by having our nurses also work with the Agent Sante’s to educate them on how to prepare parents and the community for vaccination programs.