Cancer: A Growing Public Health Problem in Haiti

Madame Louis and four other women sit in chemotherapy chairs at Bernard Mevs Hospital cancer center in Haiti as the nurse prepares their infusions. Madame Louis is a middle-aged woman with a malignant tumor. In the place where her right breast should be, a cauliflower-shaped tumor is growing through her skin. She pointed at it for me to see, but looked away, sad, angry, and shamefaced. Such enormous tumors, while rare in developed countries, are typical in Haiti.

The women at the cancer center are trapped by poverty, misinformation, and stigma, and often do not seek help. When finally diagnosed, many are given a poor prognosis for survival. Madame Louis confirms she has never performed a breast self-exam nor had a mammogram.

Breast cancer is a leading cause of death and disability among women, especially young women, in low- and middle-income countries. According to the World Health Organization, people from low-and middle-income countries like Haiti accounted for 57 percent of the 14 million people diagnosed with cancer worldwide in 2012 — but 65 percent of the deaths. Cancer kills more people in poor countries than AIDS, malaria, and tuberculosis combined. High fatality rates are likely due to a lack of awareness and early detection, and a scarcity of adequate treatment facilities.

Similarly to Madame Louis, Melissa is a 32-year-old woman battling advanced breast cancer. She discovered a lump in her breast while taking a shower. Assuming she was too young to have cancer, she sought the advice of family and friends who told her it was hardened milk from breastfeeding her youngest child. Melissa tried self-medicating with herbal concoctions, but eventually sought medical intervention after a first cousin was diagnosed with breast cancer. Her doctors are hopeful that treatment will provide a cure.

Most of the women were never screened for cancer. They all told stories of finding lumps in their breast, ignoring them, and hoping that they would go away. Marie admitted that, like Melissa, she went to traditional healers before seeing a doctor. Frustrated by the lack of results, she finally went to one.

At 78-years-old, Annette was the only patient who had had a mammogram, but only after a friend suggested that she go to Bernard Mevs Hospital.

Mammograms are not available to many women in Haiti and cost approximately $33.50 USD — a major expense in a country where the World Bank estimates that 59 percent of the population earns less than $2 USD per day.

During my conversation with Melissa, she revealed that she has two young children and relies on her “church family” for her moral, social, and financial support. Because she is unable to work during treatment, she is often unable to afford basic necessities, sometimes going without food to feed her children.

As a Fulbright-Clinton Public Policy Fellow, my work is challenging yet rewarding. The Haitian Ministry of Health and Bernard Mevs Hospital (run by Project Medishare in cooperation with Equal Health International) are improving cancer screening and treatment. A pathology lab is being built, and now cancer patients can access care throughout the country. In the past, care was centralized in Haiti’s capital, Port-au-Prince, and patients from remote parts of the country had to travel to Port-au-Prince for treatment. Fortunately, this is no longer the case. The Ministry continues to improve data collection and educate women on how take charge of their health.

Low and middle-income countries have made great strides in fighting communicable diseases. In my opinion, the same attention needs to be brought to chronic non-communicable diseases such as cancer. In Haiti, education efforts should acknowledge that many women, particularly those with less income and education, may not seek care when they feel a breast mass. On World Cancer Day, women like Melissa, Marie, Madame Louis, and Annette, are inspiring. Their wish is that people support those with the disease.