Madeline, 38 and a mother of four, lives in the town of Léogâne, Haiti. Every month, she endures severe pelvic pain. Her periods are so heavy she has become anemic, and medication isn’t giving her any relief. When she visits the local clinic, they tell her there’s nothing more they can do to help except refer her to a medical facility two hours south in the city of Jacmel. Hoping for answers, Madeline boards a lavishly painted bus called a tap-tap, a modern-day staple in Haitian public transportation. And it’s not until she reaches the Jim Wilmot Surgery Center that she is diagnosed with a uterine fibroid the size of a grapefruit.
This is a common scenario in Haiti. With nearly 11 million people living on the island, over half live below the poverty line, leaving the majority without access to medical care.1,2 This means women like Madeline will rely on non-profit medical organizations to help diagnose and treat conditions like fibroids. This year, Community Coalition for Haiti (CCH), a 501(c)3 non-profit, teamed up with Ask4UFE to bring Haitian women uterine fibroid embolization (UFE), a minimally invasive treatment for fibroids that would otherwise be unavailable.
“Haiti is the poorest country in the Western Hemisphere. On average, a family makes around $750 per year. Many can’t afford medical care,” says Dr. Wayne Reichman, medical director and medical co-chair of CCH. “Even if Madeline sought out care in a public hospital, the waiting period for an open hysterectomy to treat her fibroids would be a one to two year waiting list.”
Uterine fibroids are noncancerous growths that develop in the wall of the uterus and are a common tumor of the female reproductive system. They become more frequent as women age and are especially found among women in their 30s and 40s through menopause.3 Although women of any race can develop fibroids, black women are at a higher risk for multiple fibroids as well as larger fibroids and tend to develop this condition at a younger age with more severe symptoms.3,4 Although noncancerous, fibroids become even more serious in countries like Haiti.
According to Dr. Reichman, the majority of women seen through CCH at the Jim Wilmot Surgery Center have fibroids that grow to resemble the size of a 20-week pregnancy. “For the most part, the majority of the fibroids we see in Haiti are not the size of the fibroids seen in the United States. Women in the U.S. have access to medical care. They’ll be followed by a gynecologist and treated, whereas in Haiti women don’t have access to medical care and fibroids just continue to grow.”
In cases where fibroids grow to be this large, hysterectomy is likely to be the only treatment available in least developed countries like Haiti—but comes with serious risks. Even in developed countries, complications associated with hysterectomy include infection, bleeding, and injury to surrounding tissue.5 These risks are heightened even more so in impoverished areas. Damage to Haiti’s infrastructure from the 2010 earthquake left half of the rural population without clean water and 90% without access to improved sanitation.6
“Because the uterus grows so large in these situations, hysterectomy puts surrounding organs like the bladder and ureters at risk of injury. But the biggest complication is blood loss during surgery and in Haiti there’s limited access to blood to transfuse patients,” Dr. Reichman tells Ask4UFE. “Post-operative care is also a challenge. Because of the environment, there’s a higher risk of infection compared to the U.S. Patients are discharged the day after surgery because there’s limited room at our facility to keep patients long-term. Even in public hospitals there’s only 24 hours of observation and then women are discharged with Tylenol or Advil.”
Recovery after a hysterectomy requires at least two to three weeks rest, but for many women in Haiti, taking time to recover is an unattainable luxury. Most people residing in rural areas are small-scale farmers called “planteurs” who live off their land and sell any crops they can at markets.7 Dr. Reichman explains that along with tending to crops and traveling to make sales via dirt roads that are difficult to traverse, women in Haiti have family responsibilities that make recovery after hysterectomy difficult.
Given the complications related to surgery and the many obstacles Haitian women face, minimally invasive UFE is a practical option. Unlike hysterectomy, UFE is an outpatient procedure that generally requires only a matter of days to recover. A small pinhole is made in the wrist or groin area and then a thin tube called a catheter is inserted and threaded through the arteries that lead to the uterine arteries. Once these vessels are reached, tiny particles called embolic are injected, blocking blood flow to the fibroids. This process called embolization causes fibroids to shrink and die and symptoms to improve. UFE has been shown to significantly alleviate fibroid-related symptoms in 85-90% of patients and has proven effective in women with large fibroids.8
To make UFE available to women in Haiti, Ask4UFE donated Embosphere® Microspheres to CCH. An established embolic of over twenty years, Embosphere is used around the globe for embolization procedures and made it possible for six Haitian women to be treated with UFE this year—the first UFE procedures performed on the island. “We’ve been using Embosphere for about a year now,” Dr. Reichman continues. “One of the most important benefits Embosphere offers, especially treating patients in this type of environment, is its ease of use. Embosphere provides predictable and reliable results as opposed to some of the other embolics on the market.”
After women undergo UFE, they’re sent back to their referring clinics to ensure fibroids are shrinking and that they’re no longer experiencing fibroid-related symptoms. What’s more, post-procedure quality of life patient questionnaires provide Dr. Reichman and his team with valuable follow-up information. “In 2017, five out of the six patients reported being completely satisfied with UFE,” Dr. Reichman notes. “The other patient was lost to follow-up.”
Thanks to the generosity of many hands and hearts collectively working together, the lives of Haitian women are changing for the better because of UFE. “I appreciate the support of Ask4UFE in helping us deliver health care to the poor in Haiti,” Dr. Reichman says. “In the next two years, we’re hoping to enroll more patients and follow their progress after UFE with the goal of showing that fibroid embolization is an effective alternative to hysterectomy in under-developed countries.”
ABOUT THE AUTHOR Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English education and nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and well-being. She is a paid consultant of Merit Medical.
ABOUT THE DOCTOR Wayne Reichman, MD, is medical director and medical co-chair of Community Coalition for Haiti. A board certified vascular surgeon from Baltimore, Dr. Reichman joined CCH in 2012 to expand medical care to the people of Haiti. The Jim Wilmot Surgery Center provides free medical care to a region of 250,000 people and is a surgical training site for Haitian health-care providers. In addition to gynecologic procedures, care includes vascular surgery, plastic surgery, orthopedics, general surgery, urology, ophthalmology, and dentistry. For volunteer opportunities, Dr. Reichman can be reached at [email protected].
- Central Intelligence Agency. (n.d.). The World Fact Book. Central America and Caribbean: Haiti. Retrieved https://www.cia.gov/library/publications/the-world-factbook/geos/ha.html
- Central Intelligence Agency. (n.d.). The World Fact Book: Population Below Poverty Line. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/fields/2046.html
- Office on Women’s Health, U.S. Department of Health and Human Services. (2017). Uterine Fibroids. Retrieved from https://www.womenshealth.gov/a-z-topics/uterine-fibroids
- Eunice Kennedy Shriver National Institute of Child Health and Human Development. (n.d.). How many people are affected by or at risk of uterine fibroids? Retrieved from https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/Pages/people-affected.aspx#f5
- Clarke-Pearson, D. L., & Geller, E. J. (2013). Complications of hysterectomy. Obstet Gynecol, Mar;121(3):654-673.
- Gelting, R., Bliss, K., Patrick, M., et al. (2013). Water, sanitation and hygiene in Haiti: past, present, and future. Am J Trop Med Hyg, Oct 9; 89(4):665-670.
- Oxfam International. (2017). An economic lifeline for women in rural Haiti. Retrieved from https://www.oxfam.org/en/countries/haiti-haiti-earthquake-4-years-later/economic-lifeline-women-rural-haiti
- Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: a focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675-692.
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