Testimonial written by Dr. Jean-Claude Ulysse and edited by IGCS Communications Specialist, Debbie Leopold.

I’m Jean-Claude Ulysse and I am one of the local faculty at the University Hospital in Mirebalais, Haiti. I am the former Director of the OB-GYN Residency Program and former Chief of OB-GYN Service. I am proud to be a part of the IGCS because this means I am part of a bigger group fighting one enemy—cancer. I started my oncology work 20 years ago in Haiti and it has been my personal mission to advance the standards of care here, even though we have a large gap in care and knowledge.

IGCS bringing the Gynecologic Oncology Global Fellowship Program and Project ECHO tele-mentoring program to Haiti has brought us out of the darkness and into the light. I am so grateful for IGCS bringing the manpower to open the door to bigger ideas and a supportive community. I am now happy to say I am living “the IGCS way” to reach my objective to positively impact people living with cancer.

In Haiti—and in many low-resource countries—a cancer diagnosis is often a confirmation of death. The lack of proper knowledge and training among clinicians here meant there was no access to quality care. I’ve been here working with patients with cancer diagnoses since my last year of residency, 20 years ago. We didn’t have oncology training and we are still working to get this training here that is available in other parts of the world. I am proud that my program is producing physicians who practice the art of medicine with a strong foundation in ethics and a priority for the poor.

Dr. Jean-Claude Ulysse (center), director of the OB-GYN residency program at University Hospital in Mirebalais, Haiti, chats with a patient at the beginning of morning rounds.
Photo by Cecille Joan Avila / Partners In Health

From 2000-2003—in the three years after my OB/GYN Residency—I saw women passing away with advanced cancer, unable to access the care they needed. In 2003, I started to provide care to cancer patients. To help the people who came to me, my only choice was to review my textbook, review the anatomy, and attempt to operate and remove the cancer from patients with cervical and vulvar cancer. Even though I didn’t have specific training in gynecologic oncology surgery, I had to do something to help. Too many women were dying because we didn’t have the knowledge or facilities.

Surgeons in training at the Chittaranjan National Cancer Institute in India perform surgery to remove a large, rare tumor. Tumors of this size are not uncommon in low-resource countries as many patients are diagnosed late when the cancer is more difficult to treat.
Photo submitted by Dr. Manisha Vernekar.

Two years later, Residents from the General Hospital asked me to allow them to come and see what I was doing. I opened the door, even though I was not sure if I was qualified to be teaching others what I had learned myself. I didn’t really have a choice. At that time there were no chemotherapeutic drugs available in my work community and the patients were living in poverty. Sometimes I see some of my former patients in the community and they remind me that I operated on them and likely saved their life. Now with the IGCS Project ECHO clinic, we have access to cancer experts all over the world who are helping us and mentoring us to improve the care of our patients with the resources we do have.

After my experiences, successes with patients, and teaching other physicians, I felt somewhat empowered and decided to keep on this pathway. We must keep going for our patients. Every year in December, I work to see as many patients as possible so they can enter the New Year with peace of mind. Learning of a cancer diagnosis is one of the most difficult situations for any person to face anywhere in the world, but especially a country like Haiti where the care gap is so massive.

I attended the 2022 IGCS Annual Meeting in New York and observed the care gap as I watched the high level of presenters and researchers, learning about what they can do compared to what is available in some countries. The idea to fight inequity—as mentioned by the IGCS President, Prof. Keiichi Fujiwara—is the cornerstone of the IGCS.

Drugs, radiotherapy, and imaging associated with skilled providers and all the other multidisciplinary cancer care team members are components of the fight. Here at my hospital, I could perform miracles if only I had access to radiotherapy. But we do not have the facilities. I would give up half of my salary if only to gain access to these live-saving treatments. I offered—but it is still not enough.

I remember vividly years ago, one of my patients leaving the outpatient clinic laughing at the end of our difficult conversation. She had advanced cervical cancer, and I could do nothing to help. I explained the disease to her and the situation we were in. I saw the humanity in us both. She was happy and at peace when we shared hands at the end. She considered herself healed as our conversation about the relative value of life so affected her mindset in the presence of a loving family member.

It was a very deep moment to meet someone who will soon die and explain to her how to manage the rest of her life, to continue with strength in her daily activities. To consider the power of communication in treatment and her social environment serving as a non-chemical treatment. We both knew the gap was too wide—the gap caused by deficiencies in our environment leaving us unable to complete the care. She had made peace with her fate, and I was amazed by her strength.

A moment of laughter at the DaNang Oncology Ward in Vietnam. (Note, this is not the patient described in this article).
Photo submitted by Dr. Linda van Le.

Sitting with someone after her examination and knowing the diagnosis and clinical stage associated with the prognosis is a difficult moment. So many women do not know about cancer screening. Cervical cancer grows slowly, but without screening, diagnoses, and early treatment, it will take hold. It is deep work with these patients.

When I took part in the IGCS Meeting, seeing all the doctors and nurses come from different cultures, different environments, speaking different languages, I knew we all have one thing in common. The goal to advance cancer care, improve the lives of our patients, and to save lives. The common language among us is English and I was glad for someone to help me write this piece in our common language so I could communicate more clearly my experiences. 

Trainees and mentors posing for a group photo at the IGCS 2022 Annual Global Meeting in New York.
Photo by Debbie Leopold.

My hope is that we can use this approach, working together worldwide to BRIDGE THE GAP among patients around the world as described by the IGCS President. I would like to see a world where we can erase the borders among patients. It could be difficult for several reasons, but not impossible. I have a dream to see one day that patients can travel from one nation to another in search of advanced care that is not available at home. They would come back to report their experiences, educate our communities, and encourage others to be screened.

Whenever I can, I work to increase cancer screening here in Haiti. When women are accompanying their mothers, sisters, and friends for cancer treatment, I always encourage and invite those women to have a screening test for themselves. This is a way to educate our communities on cancer prevention. Most of the time, they accept my referral to the screening office. I see this as progress.

Dr. Jean-Claude Ulysse standing under the Haitian flag where his name was displayed on the participant wall at the IGCS 2022 Annual Global Meeting.

The field of onco-gynecology surgery has greatly advanced here in Haiti since the new hospital opened in 2013. This is where I’m currently working. Other types of surgery such as cytoreductive surgery have now become part of the field here. More progress. I am now being mentored by expert gynecologic oncologists, Dr. Thomas Randall and his colleagues to learn more about surgical care and techniques. I was invited to visit them at Massachusetts General Hospital when I traveled to attend the IGCS Meeting. It was a such a positive experience and I'm very grateful to Dr. Randall and his colleagues for this.

In my final words, I’d like to say that I'm available and ready to be used as a “weapon” in the IGCS global fight against gynecologic cancers. I am ready to keep learning and working to bridge the gap. Thank you IGCS for opening the door.