Sites: Haiti - Leogane

2 Sites: Blanchard, Port-au-Prince | Leogane, Haiti

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Location1:
Leogane, Haiti

Academic Affiliation:
Hopital Sainte Croix & Family Health Ministries, Inc. 1
(www.familyhm.org )

Site Director(s) : Delson Merisier, M.D.
Director of Cervical Cancer Prevention Department of Obstetrics and Gynecology Hopital Sainte Croix Leogane, Haiti

Jack Lafontant, M.D.
Medical Director Hopital Sainte Croix Leogane, Haiti

Background: In 1993, Dr. Jean-Claude Fertillien (Hopital Sainte Croix) and Dr. David Walmer (Duke University) began a collaborative effort to prevent cervical cancer in the Leogane Commune of Haiti. As part of this effort, Drs. Fertillien, Noel and Merisier from Hopital Sainte Croix have received colposcopy training at Duke. For the first 9 years in Haiti, this program was a part-time effort within the women's health care clinic. In 2002, support from Family Health Ministries (FHM) allowed the program to acquire a dedicated clinic room, medical director, administrative assistant and resources to begin screening and treating women at Hopital Sainte Croix full time. As of 4/12/2005, the medical director Dr. Delson Merisier screened 1,642 women & identified 64 advanced cervical carcinomas (3.9%).

Since there are no options for palliative treatment of women with advanced cervical cancer, Dr. Gustavo Montana traveled to Haiti to evaluate the potential for providing palliative care in Haiti. The infrastructure was not felt to be adequate to support radiation therapy and it was decided that resources should be directed exclusively to cancer prevention at this time. Precancerous lesions are being treated with either CO 2 cryotherapy or hysterectomy.

Clinical Opportunities: Opportunities exist for faculty, residents and medical students to participate in the cervical cancer prevention program at Hopital Sainte Croix in Leogane, Haiti.

Research: After evaluating the limitations to care in Haiti, this collaboration inspired the development and testing of a portable battery-powered colposcope through collaborations with Dr. David Katz in the Department of Medical Engineering. This data was published in the Journal of Acquired Immune Deficiency Syndromes 37(3):S167-170, 2004.

Dr. Walmer and Dr. Merisier continue to investigate the effectiveness of single day screen and treat strategies for premalignant lesions of the cervix in Haiti.

In 2005, Dr. Walmer became a co-investigator with Dr. John Bartlet on a 4 year NIH ISAAC grant to study the relationship between HIV and HPV in Moshi, Tanzania at the Kilimanjaro Christian Medical Centre (KCMC). This collaboration has allowed the integration of resources from Duke, KCMC and HSC. Dr. Delson Merisier is providing colposcopy training to Tanzanian gynecologists in Haiti and in Tanzania. Dr. Walmer is setting up a research database, digital colposcopy and training the Tanzanian personnel in the clinical research protocol.