Story

Haiti’s Forgotten Health Crisis: Women’s Cancers

July 18, 2017 | Pulitzer Center
By
Anna Russell
The public hospital in Gonaives, La Providence, was built in 2014 through a partnership with the Canadian government. La Providence serves over 300,000 people in the city of Gonaives—its focus has always been on maternal and child health. The hospital resides just outside Gonaives with few houses nearby. Many women will travel to the hospital either by donkey or moto, one of the most common forms of transportation in Haiti. The hospital is fenced and guarded, but once inside, it becomes a tranquil, clean atmosphere for the women and children visiting. In partnership with Innovating Health International, it provides monthly cervical cancer screenings to women. Image by Anna Russell. Haiti, 2017.

The public hospital in Gonaives, La Providence, was built in 2014 through a partnership with the Canadian government. La Providence serves over 300,000 people in the city of Gonaives—its focus has always been on maternal and child health. The hospital resides just outside Gonaives with few houses nearby. Many women will travel to the hospital either by donkey or moto, one of the most common forms of transportation in Haiti. The hospital is fenced and guarded, but once inside, it becomes a tranquil, clean atmosphere for the women and children visiting. In partnership with Innovating Health International, it provides monthly cervical cancer screenings to women. Image by Anna Russell. Haiti, 2017.

Lemour is one of the women visiting the hospital today. She is 37 years old and works as a secretary in Gonaives. Unlike many women at the screenings, she knows someone who has passed away from cervical cancer. A few years ago, Lemour’s neighbor was diagnosed with late-stage cervical cancer. In Haiti, no radiation therapy exists and Lemour watched her neighbor die a painful death due to her cancer. Seeing the effects of late-stage cervical cancer is what prompted Lemour to come today. When Lemour heard about the screenings, she knew she had to take the day off to come to the hospital. Image by Anna Russell. Haiti, 2017.

Lemour is one of the women visiting the hospital today. She is 37 years old and works as a secretary in Gonaives. Unlike many women at the screenings, she knows someone who has passed away from cervical cancer. A few years ago, Lemour’s neighbor was diagnosed with late-stage cervical cancer. In Haiti, no radiation therapy exists and Lemour watched her neighbor die a painful death due to her cancer. Seeing the effects of late-stage cervical cancer is what prompted Lemour to come today. When Lemour heard about the screenings, she knew she had to take the day off to come to the hospital. Image by Anna Russell. Haiti, 2017.

The screening program is held once a month at La Providence. In addition to the screenings, a health educator informs the women about the signs and symptoms of breast and cervical cancer. Some women hear about the program through community health workers, others from their doctors. Women who have been previously screened and tested positive also come to receive cryotherapy treatment. Like many women at the clinic, Lemour came today because the screening was free and she knew if she tested positive, she could get the treatment the same day. Image by Anna Russell. Haiti, 2017.

The screening program is held once a month at La Providence. In addition to the screenings, a health educator informs the women about the signs and symptoms of breast and cervical cancer. Some women hear about the program through community health workers, others from their doctors. Women who have been previously screened and tested positive also come to receive cryotherapy treatment. Like many women at the clinic, Lemour came today because the screening was free and she knew if she tested positive, she could get the treatment the same day. Image by Anna Russell. Haiti, 2017.

Lemour arrived late to the screenings and missed a bit of the presentation by the health educator. By the time Lemour got there, a large group of women had gathered. Women walking by would stop and listen in as the Innovating Health International cervical cancer program manager and health educator, Holdie Fleurilus, explained how to give oneself a breast exam and what symptoms could indicate cancer. While Lemour wasn’t aware beforehand that there would be an educational session before the screenings, she said she learned a lot about how to take care of her health and steps she could take to reduce her risk of cancer. Image by Anna Russell. Haiti, 2017.

Lemour arrived late to the screenings and missed a bit of the presentation by the health educator. By the time Lemour got there, a large group of women had gathered. Women walking by would stop and listen in as the Innovating Health International cervical cancer program manager and health educator, Holdie Fleurilus, explained how to give oneself a breast exam and what symptoms could indicate cancer. While Lemour wasn’t aware beforehand that there would be an educational session before the screenings, she said she learned a lot about how to take care of her health and steps she could take to reduce her risk of cancer. Image by Anna Russell. Haiti, 2017.

The health educator, Holdie, explains risk factors of cervical cancer to the group of women. For most women here, this is the first time they have been exposed to this information. Many people in Haiti believe that cervical cancer comes from being unclean or promiscuous. Cervical cancer is caused by the human papilloma virus (HPV). One study estimated that one in five Haitian women had the cancerous form of HPV. This can shock women because of strongly held beliefs about who gets cervical cancer and why. Image by Anna Russell. Haiti, 2017.

The health educator, Holdie, explains risk factors of cervical cancer to the group of women. For most women here, this is the first time they have been exposed to this information. Many people in Haiti believe that cervical cancer comes from being unclean or promiscuous. Cervical cancer is caused by the human papilloma virus (HPV). One study estimated that one in five Haitian women had the cancerous form of HPV. This can shock women because of strongly held beliefs about who gets cervical cancer and why. Image by Anna Russell. Haiti, 2017.

Each person who attends the education session gets a booklet in Haitian Creole explaining cervical and breast cancer and the actions they can take to prevent it. Holdie goes through the book, page by page, explaining how good diet and exercise, combined with no drinking or smoking, can reduce the risk of cancer. Lemour told me later that she did not know that drinking could affect the risk of cancer but she quickly added that she doesn’t plan to stop anytime soon. Image by Anna Russell. Haiti, 2017.

Each person who attends the education session gets a booklet in Haitian Creole explaining cervical and breast cancer and the actions they can take to prevent it. Holdie goes through the book, page by page, explaining how good diet and exercise, combined with no drinking or smoking, can reduce the risk of cancer. Lemour told me later that she did not know that drinking could affect the risk of cancer but she quickly added that she doesn’t plan to stop anytime soon. Image by Anna Russell. Haiti, 2017.

At the end of the education session, the group gathers for a picture. Most of these women will stay to get cervical cancer screenings and, if needed, cryotherapy. The other women will come back the next day to get screened. An individual screening takes about five minutes and women are moved through quickly. Both the nurses and Holdie perform the screenings on the women. Women who test positive line up against one wall and wait for the cryotherapy treatment. Cryotherapy is a painful, 11-minute long procedure. However, once women go through cryotherapy, they have an almost zero percent chance of developing cervical cancer. Image by Anna Russell. Haiti, 2017.

At the end of the education session, the group gathers for a picture. Most of these women will stay to get cervical cancer screenings and, if needed, cryotherapy. The other women will come back the next day to get screened. An individual screening takes about five minutes and women are moved through quickly. Both the nurses and Holdie perform the screenings on the women. Women who test positive line up against one wall and wait for the cryotherapy treatment. Cryotherapy is a painful, 11-minute long procedure. However, once women go through cryotherapy, they have an almost zero percent chance of developing cervical cancer. Image by Anna Russell. Haiti, 2017.

There are five beds in the ward where the cervical cancer screening takes place. One bed is occupied by a woman in labor and one is for women who need treatment but the other three are open for screening. Lemour ended up testing positive for pre-cancerous lesions. Thankfully, Lemour was able to get treatment that same day. While the cryotherapy treatment is painful, she said that she is glad it is finished and that she could live a life free from cervical cancer. Lemour plans on going back to her community to educate women about cervical and breast cancer. Image by Anna Russell. Haiti, 2017.

There are five beds in the ward where the cervical cancer screening takes place. One bed is occupied by a woman in labor and one is for women who need treatment but the other three are open for screening. Lemour ended up testing positive for pre-cancerous lesions. Thankfully, Lemour was able to get treatment that same day. While the cryotherapy treatment is painful, she said that she is glad it is finished and that she could live a life free from cervical cancer. Lemour plans on going back to her community to educate women about cervical and breast cancer. Image by Anna Russell. Haiti, 2017.

“Women in Haiti always put their health last,” Holdie Fleurilius, the cervical cancer program manager for Innovating Health International, tells me. We are sharing dinner together in a small café in northern Haiti after a long day at the nearby public hospital, screening women for cervical cancer.

 

She goes on to explain that women are expected to put their children’s health first, followed by their husband’s. Any leftover money or time can then go towards their healthcare. The consequences of this attitude are tremendous. Women are diagnosed with and die from cervical cancer in Haiti at much higher rates compared to the rest of the world.

 

Haiti, the poorest country in the Western Hemisphere, has faced many challenges over the past several years. While most people associate cholera and other infectious diseases with Haiti, these are not the largest causes of disease in the country.

 

As in many developing countries, non-communicable diseases like heart disease and cancer are high on the list of top ten causes of death. For women, the health challenges they face are enormous and many still die from preventable causes. While men’s life expectancy is currently above what was originally predicted, Haitian women’s life expectancy is below what statisticians and epidemiologists have predicted.

 

In discussing cervical cancer screenings, Fleurilius grows animated. “[Women’s] health is the last priority, even for the women,” she says. Women will often wait to visit a doctor until the pain is very severe, causing most breast and cervical cancer patients to only receive a diagnosis at the late stages of the disease. At that time, there is little that can be done for them.

 

Treatment options in Haiti are limited and expensive. Certain kinds of cancer treatment like radiation are not even available in Haiti. Women requiring radiation must travel to neighboring Dominican Republic for treatment, a journey that costs time and money. The Ministry of Health does not provide many resources for women’s cancer programs so care often falls to small NGOs in the larger cities of Haiti.

 

Women are also often hesitant to tell their husbands about their diagnosis, for fear that their husbands will leave them. This is not an undocumented fear. Fleurilius’ organization, Innovating Health International, has found that 80 percent of their breast cancer patients have had their partners leave them because of their diagnosis.

 

Several women say they feel trapped and scared by their illness. One woman had to keep her treatment a secret from her husband, another was in denial about having cervical cancer, and yet another could not find money to go to the Dominican Republic for treatment.

 

This last woman, Delia*, had, at the age of 29, been diagnosed with stage 4 cervical cancer. Her husband had left her and her three-year-old daughter as she tried to find money for treatment. With her daughter in tow, this woman traveled to several different NGOs in Haiti, trying to find someone to pay for her treatment. Unfortunately, none of the NGOs were able to afford the transportation and treatment in the Dominican Republic at a cost of $2000.

 

These constant logistical and social barriers are the reality for many Haitian women. The combination of a lack of access to healthcare and deep-rooted ideas about a woman’s place in society leave women destitute and dying, relying on other family members to take care of them and their children.

 

Fleurilius, and many others, are trying to change that.

 

The Ministry of Health and Innovating Health International are currently running a women’s cancer screening and education program in nine different sites around Haiti. This program provides cervical cancer screenings for any woman who attends. But first a short educational presentation is given. Women learn about the signs and symptoms of women’s cancers and how to perform breast self-examinations.

 

Several women attending these screenings speak about how important it is to them to learn how to do these self-examinations. These women had seen friends and family die of breast and cervical cancer and felt more empowered to take care of their own health after learning what they could do.

 

One of these women, Marie, is the mother of nine children. While her husband did not want her to take the day off of work to come to this, she said it was important to get screened so that she could be there for her children. She saw that her health was important enough to take a day off work. Marie still prioritized her kids and husband but she recognized that being in good health was the best thing she could do for them.

 

Marie may very well represent the change that is permeating the country. Programs like the one she attends are becoming catalysts to letting women make their health a priority.

 

*Not her real name