Friday is outdoor market day in Gros Morne. Orna, a nurse from our women’s health clinic, and I bargain with the women merchants for the best price for rice, beans, vegetables, cooking oil, and cans of fish. We insist on “diri jon”, the local Haitian yellow rice, which is more fragrant and tastier than the cheap rice from Arkansas that has flooded the Haitian markets. We encounter one of our nurses who has gathered a group of market women around her, encouraging them to come to our cervical cancer screening clinic. I put the food supplies on the back of our clinic motorcycle, and we head south out of Gros Morne on National Route 5.
Four miles out of town, just beyond the bridge crossing Trois Rivière, we turn onto an unpaved mountain road, and wind our way until we came upon Madame Beauchamp’s small thatch roofed hut. We stop, and I carry the food into her one-room house. Madame was sitting in the backyard, tired and emaciated, looking older than her thirty-five years. Cancer had taken a toll. Also, it is a hard life for women in Haiti, and many women age quickly. She is talking with her mother while her three small children scurry in and out of the hut.
“How are you today, Madame?”
“Kenbe la, Dokte Mike, wi, kenbe la” I am holding on, Doctor Mike, yes, I am.
“Kenbe la” is a response that many Haitian women use. The phrase means more than just holding on. It implies, “I am not defeated, not beaten back despite not having water or electricity, without a Haitian dollar in my pocket, and now battling this disease that is draining my strength.”
“How is the pain in your hip, Madame?”
“Not so bad, no.”
I don’t believe her. Haitians are stoic about tolerating pain, and her cervical cancer had spread to her bones. I convince her to take more analgesics.
After I return to Washington, Orna and another clinic nurse drive the motorcycle out to see Madame every few days, to make sure she has sufficient food and pain medicine. At 8 pm on a Friday night, Orna calls me by cell phone to tell me that Madame had died. Orna was by her side when she passed.
“She was too young to die, Mike,” she says in Creole.
Cancer of the cervix is a major cause of death of women in Haiti. Unfortunately, preventing cervical cancer is a complex social and medical challenge that cannot be solved by simply introducing critical technology, like the Pap test, or the HPV vaccine. To establish a successful cancer control program, we needed to initiate a community cancer education program, establish hospital-based and mobile clinics, train nurse/educators to perform a range of gynecological procedures, and establish an
infrastructure of competent pathologists, radiologists, and surgeons capable of performing definitive cancer operations. Medical care is not free in Haiti, and at each step we subsidize a high standard of patient care.
Despite establishing an effective cancer control program, there are many women, like Madame Beauchamp, who come to us with advanced cancer. We assume the responsibility for their care , which often involves providing food, and helping them to cope in their day-to-day lives.
We can measure our success by the number of women we have screen for cancer, the early cancers we have eradicate, the other conditions we diagnosed and treated, and the overall improvement in women’s health in the community (see table). However, we take the greatest pride in the cadre of highly skilled and compassionate nurses we have trained, who often travel dark country roads to ensure that our patients have sustenance, are free of pain, and are living with dignity.