This piece was written by Basic Health International

Nanotte, a 43 year old mother of one, sold assorted goods in a market in Port-au-Prince, Haiti, to try to add to her family’s income.  She heard through word of mouth that there was a free cervical cancer screening clinic.  Basic Health International (BHI) and Direct Relief had initiated a program to give more Haitian women access to screening and early treatment. Despite potentially losing income if she didn’t go to the market, she decided to visit the clinic.  She waited with many other women, and when it was finally her turn, she took a deep breath and went inside one of the rooms. She took off her underwear as instructed, lay down on the table, put her feet in the stirrups and pulled up her skirt.  A white sheet was placed over her legs so she wouldn’t feel exposed. She was nervous, but knew she was doing a good thing. 

When the midwife asked for the doctor, Nanotte had a sense something was wrong.  And then the doctor took a look and told her they were going to remove a small piece of her cervix (take a biopsy).  The biopsy didn’t hurt, but she wasn’t quite prepared to hear what they said next: there was a growth on her cervix that did not look healthy, and they were sending a small sample of it to the local pathologist for analysis.  The biopsy confirmed the diagnosis of squamous cervical cancer. 

Nanotte was the first patient screened through the program to be diagnosed with cervical cancer.  Treatment with cryotherapy, freezing the abnormal tissue on the cervix, was not an option due to the advanced stage of her disease.

With any cancer screening program, there will be people who are not eligible for easier, more accessible early interventions because the disease has progressed beyond the beginning stages and much more complex treatments are needed.  Many times, these people can be referred to a local hospital or to the national cancer institute, where they can receive the necessary care.  But these were not options for Nanotte since radiation therapy was not available anywhere in the country.

She was petrified. She returned to the clinic with her husband.  She was told she would need surgery and then probably both chemotherapy and radiation. She found out that her treatments would be free, but she told the doctors that she needed to delay surgery so she could work to pay off the debts she owed to other health care providers who had previously tried to figure out what was wrong with her.  She was advised that time was of the essence and not to wait.  Nanotte was a religious woman, and she went to church and prayed. She told her doctors that she was putting herself in Jesus’ hands.

Two gynecologists and a gynecologic oncologist (cancer doctor) returned to Haiti to perform a radical hysterectomy.  The surgery went well and Nanotte recovered quickly.  Results from the surgery revealed a 2.8 centimeter tumor, which meant that radiation therapy and chemotherapy were both necessary, but radiation therapy was not available in Haiti.

Finding a place to send Nanotte for treatment was incredibly complicated. She had never left Haiti and this treatment would require her to stay for a prolonged period in a foreign country where she did not know the language.  Translation services would be needed for her medical visits.  Lodging, food, and all the basic necessities of life would need to be arranged.  Also, Nanotte’s daughter would need to be taken care of in her absence, and someone would need to accompany her to help navigate travel and care.

After a great deal of effort and tenacity from the team in Haiti, Nanotte and her husband were issued passports and visas to the Dominican Republic, where it was determined she would go for her treatments.  She was understandably anxious as she left her home and boarded the bus to the Dominican Republic. But her husband was by her side and she was greeted by the health care team in the Dominican Republic upon her arrival.  She was also introduced to the Haitian community in the town where she was staying.  Imaging scans and lab tests were repeated since several months had passed since her surgery.  A seven-week course of chemotherapy and radiation began.  Her husband stayed with her for two weeks, but then had to return to work and to their daughter. The seven weeks turned into sixteen weeks as Nanotte experienced adverse affects from her treatment.  Her husband returned for a few weeks to help take care of her.  It was a difficult time, but by November 2014, Nanotte successfully completed her treatments and safely returned to Haiti.  A follow-up exam in the Dominican Republic in January 2015 revealed no evidence of cancer. 

Nanotte’s story highlights how imperative it is to screen and treat women for cervical cancer early, when they are still in the pre-cancerous stage.  Many women do not have the opportunity or the resources to access life-saving care. Many women die of cervical cancer in terrible pain, because they also don’t have the ability to obtain medications to help relieve the pain.  This disease is entirely preventable.   We have a vaccine to prevent it; low-cost, low-tech screening tests to identify those who are at risk; and low-cost, low-tech treatments that can ensure that the pre-cancer does not advance to invasive cancer.  We just need to provide women access to these life-saving opportunities. 

The eradication of cervical cancer is truly an attainable goal, and one that can be achieved with coordinated efforts from nations around the world.  Seeing Nanotte’s smile reminds you that it is a goal that is worth the fight.

To learn more about how you can help, visit: www.basichealth.org.

Together, we can eradicate cervical cancer.

Because no women should die of an entirely preventable disease.