Cancer patients in Haiti face death sentence due to distance, gangs, lack of resources

Miami Herald

a day ago

For four years Jean Fritz Dieu fought to stay alive, traveling by motorbike over rugged mountains and through gang-controlled streets to get treatment for an aggressive tumor. When the armed gangs took over the final open road, he used a barge on the bay to reach Haiti's capital.
On Saturday, Dieu, known as 'Presnel' to family and friends, lost his years-long battle with cancer. He died in the neighboring Dominican Republic, where he had been receiving radiation treatment with the help of a South Florida-based charity, Flying High 4 Haiti.
'Presnel risked his life just to stay alive,' said Ines Lozano, a Miami resident and founder of Flying High 4 Haiti. 'He clung to hope, attending Mass every Sunday to pray for healing and give thanks to those who supported him. I hope we continue to dream of a future where all cancer patients in Haiti have access to essential treatments like radiotherapy. His legacy lives on through the compassion of all those who donated for his treatment.'
While Dieu, 42, didn't survive his fight, his journey is serving as a stark reminder of the roadblocks and immense challenges Haitians with cancer and other chronic illnesses face amid the country's widespread gang violence and crumbling healthcare infrastructure.
It's also underscoring the need for access to better care. While radiation therapy remans an important part of cancer treatment, there is not a single machine in Haiti, where the last clinic with a gamma radiation device closed more than 20 years ago.
'You should have one radiation machine for every 2 million inhabitants and you have 12 million people in Haiti and we don't even have one machine,' said Dr. Oriol Jn Baptiste, director of the SESHAD Services de Santé Haitiano-Dominicaine, in Santiago de los Caballeros in the northern Dominican Republic, where Dieu was being treated. 'A public health system in charge of a country cannot afford to not be thinking about the treatments for cancer.'
Dieu was 38 and working at a school Flying High 4 Haiti supports in Ille-a-Vache, an island off Haiti's southwestern coast, when he first discovered he had a tumor.
In the last few months, Haitians have not only seen the further collapse of their already fragile healthcare system, but for those with cancer, life-saving treatment has become even harder to obtain.
In March, gangs attacked the city of Mirebalais, forcing the evacuation of the 35-bed University Hospital of Mirebalais. Haiti's most modern health facility, the hospital offered free cancer care and was featured in the Miami Herald's 2019 series 'Cancer in Haiti.' The series explored how deaths from preventable diseases like cervical cancer were growing due to limited early detection programs and a lack of radiation treatment. The series also explored the lack of public health priority to pediatric cancer cases.
The attack on Mirebalais was among several on hospitals that has stopped 40% of health facilities in the capital from operating. Among them is the St. Francis de Sales Hospital, which treated hundreds of cancer patients annually.
'It has been very rough,' said Dr. Joseph Bernard, an oncologist who worked at the Catholic hospital and has since opened his own private cancer clinic, Clinique de Cancer St Francois de Sales, in the capital. Dr. Bernard was Dieu's doctor before he was forced to seek care in the Dominican Republic because the chemotherapy had run its course.
Dr. Bernard said since the closure of Mirebalais and St. Francis, demand for care has gone up and many patients are at advanced stages. of the disease.
In addition to having to pay for previously free care, patients from Mirebalais face another complication: The cancer specialist hasn't been able to get access to their charts. Then, there is the lack of treatment equipment.
'We still have limitations regarding radiation therapy,' Dr. Bernard said.
In the past, patients had the possibility of traveling to the Dominican Republic or Cuba if they had the financial means. However both have become nearly impossible to get to because of medication shortages and a lack of direct flights in the case of Cuba, and border closures with the Dominican Republic.
As a result, patients, including children in need of radiation therapy, have had difficulties getting humanitarian visas to seek treatment.
'I've been fighting for two years for a humanitarian visas for Haitians who need treatment; I've written to the Dominican consulate and they never answered me,' said Dr. Baptiste, who added he was working with Nos Petits Frères et Sœurs in Port-au-Prince, which offers the only juvenile cancer program in Haiti, to transfer cases to the Dominican Republic for radiation treatment before the border closed.
In 2021, Dieu spent six months undergoing radiotherapy in the Dominican Republic for his cancer. He was doing well until a small tumor was detected behind the right ear, Dr. Bernard said. 'We tried to shrink it with chemo. It did not work. The tumor started to bleed a lot and it became very infected.'
'When cancer reoccurs, it's very aggressive,' said Dr. Bernard, noting that radiotherapy is one of the three main components of cancer care, which also includes surgery as well as chemo. 'In the end, he needed radiation therapy.'
During a visit to the Dominican Republic, Lozano, who had arranged for Dieu's prior treatment with the help of Nuestros Pequeños Hermanos, a Catholic children's charity with programs in Latin America and the Caribbean, approached officials about getting a humanitarian visa for Dieu and his wife. It came a few weeks later. With Dieu too weak to make the journey by road, Lozanao arranged for him to fly from Les Cayes to Cap-Haïtien, the country's second largest city in the north. He then traveled to the border, where an ambulance transported him to the clinic in Santiago, three hours away.
Radiation treatment is expensive and most of the patients never finish the course, said Baptiste, who noted that the stay in the Dominican Republic also adds up the costs. He determined that Dieu would need at least 33 rounds of radiotherapy over 10 weeks. The cost was $19,000, which Lozano had hoped to absorb with the help of a GoFundme effort that remains open.
On Saturday, Dieu collapsed. It's unclear what went wrong, though he arrived for treatment needing six rounds of blood transfusions with his head severely infected.
Dr. Bernard said most people don't realize the psychological toll Haiti's present gang crisis poses for cancer patients.
'There are a lot of things we really cannot evaluate, like the impact of stress, for example, on treatment outcomes' he said. 'These are things that are tough to evaluate but we need to consider them seriously.'
In the case of Dieu, he faced a perilous journey trying to get to treatment in Haiti before he went to the Dominican Republic. What previously consisted of a boat ride from Ille-a-Vache and then a bus ride into the capital along a main highway suddenly became an arduous journey through gang tolls, shootouts and police blockades.
After temporarily moving to Port-au-Prince to get to his treatments he sent a voice message one day, over the sound of gunfire, explaining that he could not get there because the capital had become a war zone.
Lozano began to fear that if the cancer didn't kill Dieu the gangs would. She hired a driver to transport him overnight on the back of a motorbike. He made the seven-hour journey every 21 days to get to his chemo treatments.
When traveling 5,000 feet high along a mountain range, no longer became an option this year after gangs seized control of the last open road in the hills above the capital in Kenscoff, Dieu, with his head wrapped in bandages, texted to say that he had found another way: via barge through the bay of Port-au-Prince.
Dr. Bernard will be expanding his services next month to Les Cayes at the private Caramel Hospital. It will be the first oncology unit in the coastal southwestern city where many cancer patients from the south are diagnosed too late or not at all.
'Too many Haitian women are dying from cancers that are treatable, simply because there is no access to care in the south,' said Skyler Badenoch, who runs Hope for Haiti, a Naples-based nonprofit that provides health care access in southwest Haiti. 'Dr. Bernard's plan to open a cancer treatment facility in this region could be transformational. Together, we can bring early detection, treatment and dignity within reach, and ensure that where someone lives no longer determines whether they live.'
Lozano says the expansion of cancer care to the south is good news.
'There are a large number of patients in the south who haven't been able to go chemo or anything, and they're dying,' she said, adding that Bernard's clinic opening will bring a lot of hope. 'In spite of all the problems that exist in Haiti, there's a lot of acts of hope that people don't know.'
On Sunday, an ambulance, paid for by Lozano, transported Dieu's body in a casket back across the Haitian-Dominican border so. his four children could say goodbye.
'We had high hopes for a better outcome, but at least he died with dignity and receiving the kind of care every Haitian deserves,' said Lozano. 'That is his legacy. I hope that Presnel's battle serves as an example of the urgent need for radiotherapy in Haiti to save other lives.'