Nan men gran m’et la: Pilot Palliative Care Intervention for Vulnerable Women with Advanced Cervical Cancer in Haiti

Haiti has long been a very challenging context in which to work. Given political instability which has grown steadily worse over the past 12 months, there have been very few opportunities for celebration. The challenges our team faced have been considerable. Continued gang violence resulted in the closure of Haiti’s international airport, resulting in tremendous difficulties in transporting staff and supplies. One of Haiti’s most important hospitals was firebombed and permanently closed. The road between the hospital and the port remains extremely dangerous and intermittently impassable, resulting in near constant shortages of all supplies. Further, the dangers of violence and kidnapping have resulted in the loss of many important staff, ranging from technicians to nurses and physicians. There has been little hope to offer patients with gynecological malignancies during this time.

However, in a context where victories are few and far between, even small victories are celebrated. Our intervention planned to assess the needs and perspectives of women with terminal cervical cancer in Haiti. Despite major barriers, our team completed 15 interviews with women seeking palliative care for cervical cancer in Haiti. These interviews focused on their experiences in seeking care in one of the poorest and most politically challenging places in the world, and the needs for women in these contexts. These perspectives will be added to the body of knowledge surrounding care for women with terminal cervical cancer in very low resource places through publication and dissemination. The addition of the perspectives of some of the world’s most vulnerable women will add important diversity to this body of knowledge, including these women in global discussions of health equity amidst unrest. Further, we are in the midst of using the interviews as proposed to design an education and training for healthcare providers, and a pilot package of critical goods and services aimed at these women.

Our team joined a national coalition, Haiti Sans Cervical Cancer (HSCC) to present these perspectives and our proposed solutions to representatives of the Haitian government and other leaders in this space. We have also formed a partnership with a team at Duke University who plans to implement our palliative care initiative at rural centers in Southern Haiti. Despite major challenges, including the loss of key team members and the disruption of core hospital functions, the award permitted a small package of patient-centered relief supplies to be sent to Haiti. These supplies, which included wigs for women undergoing chemotherapy and other supplies aimed at patient comfort, were some of the only such supplies available in the country. They also included supplies to boost the morale of front-line providers caring for some of the world’s most vulnerable patients.

Working amidst the challenges in Haiti teaches important lessons. Haiti teaches that sometimes it is impossible to progress as planned. When this happens, it is important to do what you can and to try to preserve the opportunity to make progress as soon as circumstances permit. When life is fraught with uncertainty, it is important to take opportunities for progress when they become available. This is the tactic taken by our project team. We still hope to implement the intervention that was planned, including a training on palliative care for patients with cervical cancer and a pilot intervention providing a frugal package of supplies for patients. However, we have had to accept that Haiti is not currently safe enough for such an intervention, in particular due to the disruption of our ability to send supplies. Instead, we continue to gather insights from patients to design our intervention, form valuable partnerships, and await a time when we can push forward with the project generously funded by the IGCS EDI grant.

View presentation from IGCS 2024 in Dublin