Roseline had delivered her baby during the chaos of our first day at Mama Baby Haiti, a birthing center for women near CapHaitian, Haiti. Mondays are the busiest day at the center, located on a dirt road just off Highway 1, as it is the intake day for expectant mothers that are new to the program. Three of us had arrived the night before from the early spring of Minnesota weather to be greeted by unseasonable warm Haitian weather – 95 degrees and high humidity.
While we were teaching 10 Haitian nurses and physicians asked about cervical cancer screening in a low resource setting and Roseline was laboring with the aide of a Haitian trained nurse midwife to deliver her healthy baby girl. She graciously agreed to be interviewed only hours after the birth of her child and shortly before she was to depart for her home (patients stay at the center for only 4 hours after an uncomplicated birth).
As is true for many of the 30-40 women who deliver at Mama Baby Haiti each month, she had heard of the program through a friend. She lives 20 minutes away and had been seen for five prenatal visits. She was appreciative of the nurse midwives that seemed to listen to her concerns and the cleanliness of the birthing center. This was Roseline’s first child. The father of her baby was sick and unable to work and she supported herself with side jobs and help from her family. The cost of her care at the center was much reduced from what her care would have cost at the local hospital. Without the services of Mama Baby Haiti, she would have had to deliver at home, either by herself or with an unskilled birth attendant.
Mama Baby Haiti, along with other such organizations in the developing world, is partly responsible for reducing the maternal mortality by 50% since 1990. That is the good news for mothers like Roseline. The bad news is that because mothers are not dying in childbirth and are living longer lives, they are now more at risk of dying of cervical cancer in their 40’s and 50’s. Cervical cancer deaths have increased by 40% over the same time period that has seen a reduction in maternal deaths. Within the next 5 years, a woman in the developing world is more likely to die of cervical cancer than in childbirth. 90% of the deaths due to cervical cancer occur in the developing world. We have great opportunity and much work to be done.
Using the simple tools of dilute vinegar and a bright light, local providers are able to screen women for pre-cancerous cervical lesions and treat them by freezing the cervix at the same visit. Given the wonders of the digital age, we were able to load pictures of normal and abnormal appearing crevices onto an ipad and review them with the participants, in addition to screening 55 women who agreed to be teaching models. We also were able to educate Haitian women about what cervical cancer is and the risk factors. Just as knowledge about HIV has empowered women to reduce their risks of AIDS, knowledge about a similar virus that causes cervical cancer (Human Papilloma Virus or HPV) can help women reduce their risk by making better choices.
My wish for women in the developing world is that a new report will be issued in five years. Childbirth will be even safer and deaths from cervical cancer will be falling due to improved screening efforts and access to an inexpensive version of the HPV vaccine. Our work has only just begun.