Cancer kills more people in low- and middle-income countries than HIV/AIDS, tuberculosis and malaria combined. And for people in the developing world – where the survival rate of breast cancer is less than half that of high-income countries – breast cancer can seem like a death sentence.
But it doesn’t need to be – not with adequate diagnosis and treatment facilities and critical early-detection programs, which many of these countries lack. In Haiti, the vast majority of women who walk into an oncology clinic are already in the advanced stages of the disease.
And the biggest barrier is not necessarily financial.
“[We] tend to say ‘Oh, it’s just funding’… as well as just access to health. But it’s more than that,” said Vincent DeGennaro Jr., assistant professor in the College of Medicine at the University of Florida, in an interview with Humanosphere.
DeGennaro leads a Haiti-based team that developed a Creole and English photo book to let breast cancer patients tell their stories. They are raising funds to distribute it to Haitian women to motivate them to seek early treatment. The team also supports a cancer screening and treatment program in Port-au-Prince through the nonprofit Innovating Health International.
DeGennaro’s clinic is one of several low-cost cancer centers in Haiti, but the women who come in seeking treatment usually already have stage 3 and 4 cancer. The reason is complicated.
“There’s fear of mastectomy, there’s a stigma against just being sick, there’s a belief that cancer kills 100 percent of the time,” DeGennaro said.
There are a whole host of other cancer-related issues, he added, like a lack of support from the patient’s partner before and during treatment, lack of support from the patient’s community, and the fact that 40 percent of DeGennaro’s patients are victims of domestic, sexual or economic violence (national data is lacking, but the overall rate in Haiti is estimated at 28 percent).
“It’s kind of circular, that the cancer is a reason that the women get abused by their husbands,” DeGennaro said, “But women that are the victims of violence are the ones who are coming in later; you know, in stage 4.”
Breast cancer is especially tricky to diagnose and treat, because the fear of losing one’s breast challenges the roots of a woman’s identity. When Haitian women hear that mastectomy may be a part of their treatment plan, they often refuse to have the surgery.
The fight against breast cancer in Haiti is unique, as the tiny country is widely viewed as a failure in the history of disaster relief. Haiti hosts hundreds of NGOs and has received billions in aid since the devastating 7.0 earthquake in 2010, yet it remains ill-governed and impoverished. This makes donation-run cancer care an especially unique challenge for fundraisers, who have the challenge of assuring donors that, this time, their money will make a difference.
This narrative of Haiti, according to DeGennaro, will be critical to change.
“It’s been six years. I think we need to move on from the earthquake,” he said. “I think we want to change the narrative about Haiti away from a damaged place. How do we reframe Haiti … [and]start talking about some of the positive things that are going on?”
There’s no doubt that cancer care in Haiti has a long road to navigate before matching the early detection programs and survival rates like those in North America, Sweden and Japan. But clinics like DeGennaro’s have made enormous strides in improving access to chemotherapy, mastectomies, breast reconstruction and other treatments in a country where, just a few decades ago, they were not yet an option.