I won't lie, i am a little scared of what to expect when we get to Haiti. I am not afraid of typhoid, rabies, cholera, malaria, dengue fever, etc... despite the shots i have just received. I am, however, really apprehensive about witnessing the extreme poverty and difficulties of the Haitian citizens. I am afraid of the pain and hunger i will see. I have always been too empathetic. To combat my fear i am arming myself with a plan to help. Once I signed on for the trip a few months ago, I started to research where i could be of most use. Our group, handsupforhaiti.org,is not quite a year old, and the physician-led teams to date have been focused on pediatric concerns. As the first gynecologist of the group, i have been deeply affected by what i have learned about the lives of Haitian women. From a gynecologist's standpoint, they have the highest rate of cervical cancer in the world. (This is a preventable disease with even reasonable access to medical care.) With sparse infrastructure, few caregivers, rare pathologists, lack of transportation, unreliable refrigeration and electricity, (things that we take for granted)... like the dreaded Pap smear, are not possible in low-resource settings. Many wonderful physicians and researchers have struggled with this, such as Paul Farmer (pih.org) from Harvard and David Walmer from Duke (familyhm.org), establishing networks where before there were none, introducing prevention of disease and recognition of precursor lesions, overcoming many barriers as they struggled to work toward reduction of risks for this dramatically underserved third world country. We can never thank them enough for their forward-thinking, brilliance and generosity, so instead, my hope is to carry their torch with them, in some small way. Monday, my pre-med student, Heather and I fly to Raleigh-Durham, to meet the unbelievably down-to-earth David Walmer, MD, PhD, chief of gynecology at Duke Medical Center. While he has a fellowship in reproductive endocrinology and infertility he recognized the need for cervical cancer prevention when visiting Haiti 18 years ago. For the past decade he has been a pioneer in this goal in southern Haiti, even inventing a battery-operated colposcope, "cerviscope", for areas lacking electricity. With a team he organized, Dr. Walmer has been organizing groups from Duke to collect data and care for Haitian women, build health care facilities, while identifying needs, prioritizing and fundraising on their behalf. When I meet him Monday, after the effusive gratitude, I hope to ask him how to get the most done with each trip. Knowing I cannot afford to leave my Westchester practice and move to Haiti, I hope to learn from him how to engage the local caregivers, to partner with the community leaders to bring the women to me, and to earn their trust. Ultimately, I hope to train local providers in the "screen and treat" protocols currently recommended by the alliance for cervical cancer prevention (http://www.alliance-cxca.org/) The future for screening is likely with rapid DNA testing, as soon as it is available. Until then, we will utilize the proven "VIA": visualization with acetic acid. (It is faulted for excess false positives, requiring potentially unnecessary treatment. I can live with overtreatment, knowing that with no treatment and with absolutely no raditation facilities in Haiti, i will be protecting some women from an inevitably painful death from cervical cancer.) For now, I am listening to Creole CDs in the new car (totalled the Volvo last week after a long day at work, hit a Hummer who stopped short - airbag felt like a cannon to my chest - question why tanks like Hummers are on regular roads...), and starting to focus on the ways i can learn to help the women of Haiti. I believe that by caring for Haitian women, i will be caring for the children and fathers, too, because, as we know, women are the heart of the community. As the liberation theologian Juan Segundo put it: "The world that is so comfortable for us is the same one that is so unbearable for billions of others." On a more positive note, Dr. Walmer, when meeting with the Haitian Ob/Gyn society last month, said: "Haiti can be a leader in the development of protocols for cervical cancer screening in low resource countries.” I hope to be a very small part of this very important goal. |
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