Cancer patients in Haiti face numerous barriers and lack access to routine oncology services. Breast cancer is the leading cause of cancer mortality among Haitian women. In Haiti’s current health care system, patients must assume all the responsibility to not only seek initial cancer care when diagnosed, but also coordinate their follow-up care across the cancer continuum. This stress on the patient, coupled with a lack of general education or cancer screening and a fragmented health system adds to the heartbreak of a cancer diagnosis. For vulnerable patients that are ill, this burden is far too great. For many women with metastatic breast cancer (MBC), returning for a follow-up appointment often requires missing work and a day’s pay. In rural settings, the likelihood of patients returning to the clinic after the initial visit to confirm diagnosis, establish staging, or initiate appropriate treatment is low due to system-related, societal, cultural, financial or psychological barriers.
Zanmi Lasante (ZL), a Partners In Health’s (PIH) sister organisation in Haiti, supports 12 public health facilities, and is the largest health care provider in Central Haiti, serving 1.3 million people. In 2013, PIH/ZL opened University Hospital of Mirebalais (HUM), a 300-bed public teaching hospital serving a population with generally limited or no access to quality health care.
HUM offers advanced clinical services; an open-source electronic medical records system; telemedicine capacity; expanded laboratory services; and medical education for doctors, nurses and other healthcare professionals free of cost to the Haitian population outside of a registration fee of less than one US dollar. Based on reviews by Haiti’s Ministry of Health, the cancer programme at HUM is the most comprehensive in Haiti.
HUM receives thousands of patients daily through its outpatient clinics and emergency rooms. Due to the high volume of late-stage cancer patients, the burden of cancer is felt through many departments in the hospital. HUM not only sees a large volume of patients but also a wide spectrum of cancers which are not treatable due to lack of infrastructure, technology, medicines, or trained staff.
Despite this unmet need, an average, over 300 patients are treated every year and impactful curative and palliative treatment options are offered. Over 75% of patients receiving treatment at HUM are breast cancer patients.
Thanks to the SPARC grant won in October 2019, ZL is launching a new project for MBC patients. Patient navigators will provide support care coordination with an initial cohort of 50 MBC patients on treatment, chemotherapy, hormone therapy, and medications for symptom management, to ensure that 90% or more of follow-up appointments are attended by patients. The most vulnerable patients will be selected based on criteria that will include financial, social and emotional factors. Gradually throughout the project, enrolment will increase with additional MBC patients added to the programme, and it is envisaged that by the end of the project, 100 MBC patients will benefit from improved care coordination. The goal is to reduce loss to follow up and increase the retention rate of MBC patients from approximately 50% to 70%.
100 MBC patients will benefit from 21 education sessions throughout the year. The HUM team will also hold support groups for patients’ families each quarter.
"As a grantee of SPARC we will strive daily to build delivery systems that increase healthcare access, utilisation and quality for all. We hope that as a grantee, we will ensure that no woman in Haiti will die due to a lack of access to obstetric or cancer care as part of Universal Health Coverage (UHC), and that the realisation of the right to health, particularly women’s health, not be ignored."
The mental health and wellness of MBC patients will also be addressed by holding individual and group psychosocial discussions, and by providing 50-100 families of MBC patients with transportation fees. Screening for depression will take place for 100% of the selected MBC patients at least once during treatment after confirmation of diagnosis and disease staging.
As a result of this project, 100 of the most vulnerable MBC patients and their families will increase their health literacy on metastatic breast cancer. These individuals will in addition receive extra accompaniment to reduce the risk of becoming “lost to follow up”. Patients’ knowledge acquisition throughout the duration of the project will be assessed and the team will focus on topics that may need further education. MBC patient retention rates as a result of better psychosocial and financial support will be measured.
The HUM team anticipates that as a result of better accompaniment, MBC patients are less likely to drop out of cancer care, with subsequent improvements in the retention rate, aiming for an increase from 50% to 70%. The oncology team hopes that patients will be encouraged to become advocates within their communities to share their knowledge obtained from patient navigators and care received at HUM. The patient navigator training will also have an impact on the quality of care the oncology team provides to patients more broadly.
In conclusion, the improved coordination of care for MBC patients at HUM should ease the burden on them, ultimately improving their psychological and physical well-being.
(Information from the project description and context is compiled from the grant application)