October is Breast Cancer Awareness Month both in the United States and in Haiti. The month and its ubiquitous pink ribbons are supposed to remind us of the importance of screening for breast cancer and what we can do to stop the leading cancer killer of women globally. It’s been an especially busy time for Project Medishare’s Women’s Cancer Program as we work toward our goals of raising awareness and increasing engagement with the medical system. Gabriel, our nurse coordinator, and I were guests on a talk show in Creole on Haitian radio. We talked about the signs of breast cancer and instructed women on how to perform a self-exam. We purchased radio airtime for advertisements that convey the necessity of screening and the availability of treatment. An American photographer whose mother has breast cancer visited our ward and took portraits of mothers and daughters we’ll use to raise awareness. We were "featured on the local news in Miami":http://bit.ly/1GnLqdR, speaking about the issues facing Haitian women with breast cancer. A professional film crew flew to San Francisco to interview us about a $60,000 grant we received for the awareness and engagement program. Our partners, the Haitian Support Group Against Cancer, organized a breast-cancer walk in which hundreds of people marched throughout Port-au-Prince in pink shirts and raised money for local treatment. The next day, we hosted a women’s cancer awareness day at the Women’s Health Center complete with a press conference, an appearance by Miss Haiti and our local treatment and advocacy partners. In order to capitalize on the momentum, we also screened 25 workers from a local business that employs primarily women for breast and cervical cancer. We’ll screen the remaining 200 employees over the course of the month. In the U.S., we’ve held two fundraisers and plastered Facebook with pleas for donations. The events in New York and San Francisco obviously help us fund the program for the rest of the year. However, they also remind people that breast cancer is still a major public health issue, and that women in Haiti have significantly fewer resources with which to combat the illness. Many Americans, especially in those wealthy cities, live such comfortable lives that it is easy to forget how difficult life can be for the majority of the planet. On the treatment side, we continue to expand access to chemotherapy in Haiti. In 2013, there were only two publicly available cancer treatment centers. Project Medishare opened its doors in Port-au-Prince that year and now we help equip the city’s public hospital as well. Today we are partnering with the Ministry of Health to offer chemotherapy in the cities of Jacmel, Gonaïves and Les Cayes. We help with the treatment, equipment and training, but the government provides the staff and space, meaning that the efforts require less and less from outside Haiti, putting them on the path to locally sustainable cancer care. Quite simply, it’s just not enough. Women in both countries continue to die of breast cancer. Not because it’s an incurable disease — most cases are curable — but because they don’t have the access and resources to get care. An unjust and unequal healthcare system in the U.S. alienates large percentages of poor and minority women. In Haiti, a country with a feeble public health system, women who cannot afford treatment will die. They die because they only make two dollars per day selling goods on the street, not because more research is needed to find a cure. Their children lose their mothers because the extended family can’t even afford the bus fare to the clinic, let alone the costs of treatment. Our program treats women regardless of their economic means and we’ll even cover bus fare and meals for those who need it. What can we do? The only answer is more. Pink cleats on football players alleviate our guilt, and may give us the impression that we’re doing more than we really are. Be conscious of those less fortunate. Observe the ways we perpetuate the systems that push these marginalized women further toward death, either in how we vote or what in the businesses we choose to patronize. Seek regular screenings for cancer as recommended by your doctor. Discuss women’s cancers at the dinner table and how they are neglected both home and abroad. Give more money to charities that support the fight against breast cancer or for equality of women. No matter how you get involved this October, choose to do more than simply put on a pink ribbon.
_Vincent DeGennaro is an internal medicine doctor and global public health specialist in the University of Florida’s Division of Infectious Diseases and Global Medicine and works half time in Haiti with the nonprofit "Project Medishare":http://projectmedishare.org. See his An American Doctor in Haiti blog._