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Haitian women receive breast cancer support, care

By Joanne Silberner
On January 7, 2013

  • In Haiti, as in many other developing countries, women rarely seek medical help for cancer until it’s too late.

Haiti is the poorest country in the Western Hemisphere. Having breast cancer here often means no care at all, or care that's too costly for any common person to afford, or a lot of initial missteps.

 "I felt something in my breast that hurt," recalled a woman who asked to be identified only by her first name - Merlyn.
 She's a big woman in tight braids, with a tough look on her face and a forceful way of speaking. But, she admitted, she was scared.
 The lump grew so large that it broke through her skin. Her clothes couldn't cover it. Local doctors were no help.
 Merlyn eventually got referred a clinic run by Haitians and Americans from Partners in Health, a medical charity that has launched a new push to fight cancer.
Preparing for the fight
In the little Haitian town of Cange, Partners in Health's sister organization - known in the local language (Kreyol) as Zanmi Lasante - runs a clinic.
 The clinic, led by Dr. Sara Stulac, has been setting up cancer treatment rooms, lining up supplies, and training workers on cancer issues. They are focusing on breast and cervical cancers - the most common cancers among Haitian women.
 Dealing with breast cancer in a place like Haiti takes effort and compromise.
 The effort starts with the patients. When Merlyn showed up at the clinic with advanced breast cancer, she got a mastectomy. Now every two weeks she takes a 12-hour trip on one of Haiti's creaky and overcrowded buses to get to the clinic for chemotherapy.
 Merlyn said she is bucking what her neighbors tell each other.
 "If you get cancer, people say you're going to die because there's no treatment for it," she explained. "They say even if you see a doctor, you won't find a solution."
 The breast cancer statistics for women like Merlyn are grim particularly because women come in late, or not at all.
 "I don't have a definite number, but I can say that it's very bad," said Dr. Ruth Damuse, who is heading the oncology efforts at Zanmi Lasante. "Like half of the women, they will die."
Reaching out
Dr. Stulac said for a medical charity like hers, focusing on cancer means getting organized. "You do have to make sure that you have access to advice, to diagnoses, to medications."
 And patients need some sort of social support system to help them get to the hospital. That is no small order in countries with bad roads - or no roads.
 With patients coming in so late, diagnosis and treatment often fail, so last year the Haiti medical workers received training in how to use painkillers and provide other comfort care for people dying of cancer.
Help from Abroad
For medical advice, the clinic in Haiti relies on experts at the renowned Dana Farber Cancer Institute in Boston, headed by Dr. Lawrence Shulman.
 One woman had had a mastectomy last fall, but the cancer returned. Shulman suggested a different kind of chemotherapy.
 Another young woman had a breast lump removed. In the U.S., lumpectomies generally require weeks of daily radiation treatments after the surgery, but Zanmi Lasante doesn't have any way to administer radiation. So Shulman suggested a full breast removal.
 "She needs to go back and have a mastectomy," Shulman said over the phone. "Then she needs five years of tamoxifen."
 The tamoxifen costs just pennies a day, affordable even in Haiti. And there are other opportunities to keep costs down. In Haiti - for unknown reasons - breast cancer mostly hits women in their 20s and 30s, and mammography does not work well in women this age, so Zanmi Lasante doesn't offer it.
 Cancer surgery, chemotherapy, and aftercare can be costly, however. Partners in Health provides all of this for free and relies on donors to finance it.
Making cancer a priority
"I think some people would say we shouldn't [tackle cancer], but the fact is people are suffering and dying," said Dr. Stulac. "We can't save all of them, and we can't save the same group of patients with the same group of diagnoses that we can in the U.S., but there is so much suffering that we can avoid, and there are so many cancers that we can treat."
 People used to say that AIDS drugs were too costly and too difficult to deliver in developing countries, yet millions of people with HIV in places like Africa and Haiti are now being saved. Stulac said there's no reason that can't happen with cancer.
This story was reported with assistance from Ansel Herz. The series was produced with support from the Pulitzer Center on Crisis Reporting.
This story is part of a special series, Cancer's New Battleground - the Developing World. 

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