Global Doc: One year

Author: Dr. Vincent DeGennaro Jr. ’02

A year has passed since the doors opened to the chemotherapy program at Project Medishare in Haiti. The team treated 11 patients in the first week last year; now we see that many patients nearly every day. What has been gained and who have we lost?

Some patients have touched us because of their endurance and ability to prove the naysayers wrong. Jean Marie came to the hospital too weak to walk and unable to breathe comfortably. She had cancer in her lungs, liver and bones, and one might have thought she didn’t have long to live. One year later, she’s still caring for her child, walks without a limp and still works selling goods on the street.

Some patients have brought us tremendous sadness. Jean Claude, the 24-year-old who died of colon cancer, displayed strength in the face of adversity, but, perhaps more profoundly, he also knew when to let go and admit vulnerability. The small details are those I remember most: the way his bony knuckles protruded through the skin when he held my hand, or how, when he finally broke down and cried, his body was too dehydrated to produce more than a single tear.

Overall, the good news far outweighs the bad. We’ve seen nearly 250 patients with all types of cancer. We’ve given chemotherapy to more than 110 women with breast cancer. We’ve treated three teenagers who were too old for the pediatric cancer program at the partner hospital up the road. Four women still in their 20s presented with breast cancer, and five women came for treatment while in their 90s. In addition to breast cancer, we’ve treated cancers of the cervix, colon, ovary, eye, brain, throat, muscles, blood (leukemia), bones and connective tissue, such as the deeper layers under the skin.

We’ve sent a dozen patients to the Dominican Republic for radiation treatment at a cost of $2,000 per patient. While cheap compared to the U.S., the cost would have been untenable for our fledgling program. Since joining with Watsi, a crowd-source fundraising website, we’ve been able to obtain funds for all patients who require radiation and have not yet had to say no to a treatable patient because of a lack of funds.

Two women with breast cancer that had spread all over their bodies are still living full lives a year after starting treatment. They’re not beating the odds — those are the odds. When treated properly, women live an average of two years with metastatic breast cancer, and we refuse to lower our standards because we are treating cancer in a poor country. In another year’s time, the team fully expects to have at least a dozen women living similarly full lives with metastatic breast cancer.

Many of the patients presented with diseases incurable even in the United States. In those cases we’re left to provide palliative care, which shifts the focus of medical treatment from cure to patient comfort. We address all the possible symptoms of cancer: pain, nausea, derangement in bowel habits, cough, abdominal distention, dry mouth and lack of appetite. In the U.S. we can offer patients a more complete armamentarium to combat the numerous symptoms. In developing countries, however, palliative care is a novel concept, the cutting edge of medicine. However, something as simple as offering a patient morphine instead of ibuprofen hugely impacts the comfort of the patient and the end of life process for the family caring for their loved one.

Exactly 25 patients have died in the first year, the majority of whom presented to the program with advanced, metastatic disease. Those who died once entering the program knew that the doctors and nurses cared for them and felt the compassion and connection of the medical team. Every patient and their family knew we would do everything medically possible to help them before they passed. Cancer care can be depressing, but only if we dwell on the negatives. For every patient who has died, there are four more who are living, working, playing and enjoying their lives.

Daniel, the 15-year-old boy with throat cancer, returned from four months of radiation therapy in the Dominican Republic yesterday. When he and I stood outside the gates of the Dominican embassy pleading to be allowed inside, he looked weak and pathetic, barely able to stand on his own in the mass of people. This week, the massive neck tumor that distorted the contours of his face has disappeared and he’s slowly gaining the weight that he had lost when he couldn’t swallow food. I first met Daniel in February 2013 and he received chemotherapy in our ward for the first time in July of last year, one of our initial patients. Daniel has been through so much, a living symbol of what can be accomplished in Haiti, despite all the setbacks. When school commences after the summer ends, he’ll rejoin his classmates, going back to playing soccer and shooting marbles, like any other young man from rural Haiti.

Vincent DeGennaro is an internal medicine doctor and a global public health specialist at the University of Florida’s Division of Infectious Diseases and Global Medicine and works half time in Haiti with the nonprofit Project Medishare. See his An American Doctor in Haiti blogs.