Miami’s Little Haiti has joined the global effort to end cervical cancer

More than 300,000 women worldwide die from cervical cancer every year. In the United States, women of Haitian descent are diagnosed at higher rates than the general population.

The disease is preventable, though, thanks to vaccines and effective treatments for conditions that may precede cancer. That’s why healthcare workers and even the World Health Organization are focusing on Miami’s Little Haiti to try to save lives.

The cervical cancer rate in Little Haiti is 38 per 100,000 – more than four times the overall rate in Florida, 8 per 100,000. Research published in Cancer Causes and Control in July 2018.

One of the authors, Erin Kobetz, associate director of population science and cancer disparities at the University of Miami’s Sylvester Comprehensive Cancer Center, came up with the idea of ​​bringing HPV testing to areas of Miami-Dade County where women are less likely to have it. Routine screening for cervical cancer at a gynecologist’s office. Human papillomavirus is thought to be responsible for about 50% of cervical cancers.

The work of Kobetz and his colleagues, using a recreational vehicle dubbed the Game Changer, drew the attention of the WHO. The World Health Organization announced a lofty goal in August 2020: to eliminate cervical cancer by encouraging countries to fully vaccinate 90% of girls with the HPV vaccine by age 15; 70% of women are tested for HPV by age 35 and again by age 45; and treating 90% of women with precancerous conditions. WHO believes that if countries meet this target by 2030, it is possible to eliminate cervical cancer within the next century.

In Miami, the WHO is relying heavily on the public health infrastructure already in place, including the efforts initiated by Kobetz. In Little Haiti, this work is taking place in a medical clinic called the Haitian Studies Center, located on a commercial street in a fast-moving immigrant neighborhood.

“CHS-Health” is written in large blue letters outside the building. A few small convenience stores and a tax service business are nearby, but most shops in the neighborhood are clothing boutiques and hip cafes or restaurants.

On a weekday morning, sunlight fills the waiting area from the clinic’s street-facing windows, and community health worker Valentine César strikes up friendly conversations with patients in Haitian Creole as they wait.

Patients have an easy relationship with Cesar, who works at the Sylvester Center at the University of Miami. At the Center for Haitian Studies, she teaches people about cervical cancer prevention with a focus on HPV. Specifically, Cesar shows women how to test themselves using a kit she provides at the clinic. “We have a little jar, and it’s a cotton swab,” she said.

The process is not much different from using a tampon and is definitely easier than a pelvic exam, which is another way to test for HPV. The self-collected sample is sent to a lab. If the results are positive, Cesar deploys his remarkable people skills as he delivers the news.

She admits to panic when she tells people they have HPV. “We explained to them that just because you’re HPV-positive, it doesn’t mean you have cancer,” she said.

This does mean that a woman needs to be careful about her health, though, and needs to be monitored for cancer, pre-cancerous conditions and other problems caused by HPV. Caesar and his colleagues will encourage HPV-positive patients to seek care at the Center for Haitian Studies or other federally qualified health centers. The clinic is the Sylvester Center’s primary referral partner in Little Haiti because of the cultural and linguistic competence of the staff.

The Sylvester Center’s Game Changer vehicle supports the Little Haiti Clinic’s education efforts and parks behind it on designated days. On other days, the car brings the same message to different communities in Miami.

“We’ve been able to promote our services through our various community health workers who go out and talk about what we do, hand out flyers and educational materials,” said Deanna Trevill, former director of the Sylvester Center’s Office of Outreach. preoccupation “They help us bring knowledge and awareness to our services and what we do.”

On the Game Changer car tour, Trevill showed the video on HPV that was playing and pamphlets that people could use to learn about the virus. There is a main area with car seating, as well as space for private examinations or consultations.

Trevill understands why Haitian women sometimes avoid seeing doctors. “They have the belief, ‘If I go to the doctor, I’m going to find some bad news,'” Treville said. “‘I’d rather not go'”

As health educators, Treville and Caesar try to talk people out of this fear-motivated avoidance.

Trevill says research shows that self-exams for HPV can help more women accept other tests that benefit their reproductive health. “So we started using this test as a way to address some of the sensitivity and some of the reluctance among women to actually get a Pap test,” Trevill said.

Patient Nicole Decius did a self-test for HPV this year after noticing the Game Changer car and the Sylvester Center name on it. Health scares aren’t the only barrier, Decius said. “People avoid doctors if they don’t have health insurance or their immigration papers,” Decius said.

One photo shows Nicole Decius talking to Valentine Caesar from a desk
Nicole Decius, who was recently tested for HPV through the University of Miami’s Sylvester Comprehensive Cancer Center, talks with Valentine Caesar (right), a community health worker.(Veronica Zaragoza/WLRN)

While no one at the clinic will ask patients about their immigration status, Cesar and Trevill try to make sure patients know.

Sylvester Center staff educate mothers to encourage their young adolescents to be vaccinated against HPV. Vaccines for children are administered inside another RV, parked a few feet away from the game changer — the University of Miami’s pediatric mobile clinic. It focuses on care for uninsured children and places near public schools, places of worship and community centers.

“We work together with each other because the mobile clinic is able to provide vaccinations, and that way we can make HPV prevention a family affair,” Kobetz said. “Age-eligible boys and girls can get the vaccine.”

Richard Freeman, who works in the WHO director-general’s office, visited the vehicle behind the Haitian Studies Center earlier this year. Freeman said the work is critical to the World Health Organization’s efforts to end cervical cancer. No one will die from a disease that tests and vaccines can prevent, Freeman added.

“Cervical cancer is a cancer that we can actually eradicate,” Freeman said. “We have the tools and it’s just a choice whether we’re going to use those tools. If we catch this cancer early and detect it on time, it is curable. And so we want to see all of these interventions, not just here in Miami. We would like to see that the supply of HPV vaccine is also available and affordable in countries with a high burden of cervical cancer.”

This story is part of a partnership that includes WLRN, NPR and KHN.

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