Micheline came to Project Medishare’s women’s health center in Port-au-Prince as many of my patients do — with advanced cancer. At only 46 years old, she still had two young daughters and a family that needed her income selling clothing on the street. Micheline has cervical cancer, a disease that literally takes years to form and grow, is easily detected with simple tests, and is entirely preventable.
We initially launched the women’s health center primarily as a breast cancer treatment center, offering surgery and chemotherapy. While a huge step forward for Haiti, women continue to present in advanced stages of breast cancer, meaning that many of them are not curable. In order to catch cancers at earlier stages, we’re attempting to address women’s health care holistically and all in one location. Our program is modeled off of successful women’s health centers in the U.S. that offer breast and cervical cancer screenings, birth control, and HIV or STD testing in one location.
For breast cancer, we offer clinical breast exams performed by the doctors or nurses. The staff teaches women how to perform a self-breast exam, a key skill for low-resource areas that do not have access to mammograms, whether in Haiti or the U.S. Since 80 percent of our patients come to the clinic with advanced disease and half of the women are under 50 years old, interventions as simple as clinical breast exam and self-breast exam teaching can have a huge impact in population of poor women with low health literacy.
Haiti has the highest rate of cervical cancer deaths in the Western Hemisphere, all because of a lack of screening. The progression of the disease from the start to the advanced stages of cancer takes years, offering ample time to intervene on the slow-growing cancer if detected early. Unfortunately, as much as 80 percent of advanced cervical cancer occur in low and middle-income countries purely as a result of the lack of screening programs.
Our women’s health center offers family planning like birth control pills or injections and surgeries to remove the uterus in women who have decided that their childbearing is complete. We also offer HIV and syphilis testing as part of routine care. Diagnosing and treating HIV early improves overall health and reduces the risk of developing breast and cervical cancer.
Women’s health care services in the U.S., while some of the best in the world for those with access to care, are worse for those women on the fringes of society. Women living in poverty are significantly less likely to ever have had basic breast cancer screening, such as a clinical breast exam or a mammogram. Cervical cancer, the leading cause of cancer death in Haiti, is no longer an issue for women in the U.S. with access to basic screening such as Pap smears. However, studies in the U.S. demonstrate that minority women, women without a high school diploma, and those with lower socioeconomic status are more likely to never have had cervical cancer screening. Women in the U.S. also benefit more from reproductive health and STD services when they are offered in a bundled package at one women’s health center.
We’re launching a massive national cervical cancer screening program and building up the bundled services at the women’s health center to prevent these senseless deaths in Haiti. In the U.S., these services are already available to women of all socioeconomic and educational backgrounds through Planned Parenthood. Screenings for breast and cervical cancer, birth control services, and STD testing comprise 97 percent of the services offered at Planned Parenthood’s nationwide. In 2010, they performed 1.8 million breast and cervical cancer screenings, provided 4 million contraceptive services, and nearly 4 million STD services. Since 75 percent of the women served are below 150 percent the federal poverty level, these are exactly the women who are vulnerable to advanced cancers, poor birth spacing, and HIV infections as my patients in Haiti. As a doctor, I’ve cared for minority women in Miami and New York with advanced cervical cancer, a completely preventable disease caused only by lack of access to care.
There are a dozen reasons why Micheline and poor women like her present so late, regardless of what country they live in. Transportation can be difficult and expensive and with so few women’s health centers, the distances become larger and more expensive. If Planned Parenthood loses federal funding for women’s health, then the distances and expense for poor women in America will increase. Health care systems are complex and navigating referral networks from one clinic to another increases the chances of missing a follow-up appointment. A disadvantaged woman in the U.S. may also have to see several doctors at a few different clinics to receive all the services offered at Planned Parenthood. The bottom line for many women around the world is that the cost of care is an insurmountable barrier, and women often prioritize their families over their own health.
As a doctor in countries where patients have no access to reproductive health, I’ve witnessed firsthand the ravages of the lack of prevention. There is little I can do for Micheline at this point other than to keep her comfortable as she is slowly consumed by the cancer. In Haiti, the public health system lacks the resources to provide comprehensive women’s health services to poor women, but in the U.S., some would take an active decision to deny poor women access to basic health care by defunding Planned Parenthood. While we build up the services in Haiti, we must continue to offer women’s health care to the vulnerable women in our own country as well.
Vincent DeGennaro, Jr. is an internal medicine physician and director of internal medicine, Project Medishare For Haiti. He blogs at An American Doctor in Haiti and can be reached on Twitter @DoctorGlobal.