Nicole Daceus, who was recently tested for HPV through the University of Miami’s Sylvester Comprehensive Cancer Center, speaks with Valentine Cesar (right), a community health worker. Having culturally competent staff can be key to reducing health care avoidance and fear, Cesar says.
Veronica Zaragovia/ WLRN
hide caption
toggle caption
Veronica Zaragovia/ WLRN
Nicole Daceus, who was recently tested for HPV through the University of Miami’s Sylvester Comprehensive Cancer Center, speaks with Valentine Cesar (right), a community health worker. Having culturally competent staff can be key to reducing health care avoidance and fear, Cesar says.
Veronica Zaragovia/ WLRN
Over 300,000 women worldwide die of cervical cancer each year. In the United States, women of Haitian descent are diagnosed with it at higher rates than the general population.
The disease is preventable, however, thanks to vaccines and effective treatments for conditions that can precede cancer. That’s why healthcare workers and even the World Health Organization are focusing on Little Haiti in Miami in an attempt to save lives.
The rate of cervical cancer in Little Haiti is 38 per 100,000 residents, more than four times the overall rate of 8 per 100,000 in Florida, according to a study published in Cancer Causes and Control in July 2018.
One of the authors, Erin Kobetz, associate director of population science and cancer disparity at the University of Miami’s Sylvester Comprehensive Cancer Center, came up with the idea of bringing HPV testing to areas of the county. of Miami-Dade where women are less likely to get regular cervical cancer screenings from a gynecologist. The human papillomavirus is thought to be responsible for around 50% of cervical cancers.
Kobetz’s work and that of his colleagues, using a recreational vehicle dubbed the Game Changer, has caught the attention of the WHO. The International Health Organization announced an ambitious goal in August 2020: To eliminate cervical cancer by encouraging countries to fully vaccinate 90% of girls with the HPV vaccine by age 15 ; having 70% of women screened for HPV before age 35 and again before age 45; and treat 90% of women who have precancerous conditions. The WHO estimates that cervical cancer can be eliminated within the next century if countries meet these targets by 2030.
The “Centre for Haitian Studies” brings health care to the population
In Miami, the WHO relies heavily on the public health infrastructure already in place, including the effort initiated by Kobetz. In Little Haiti, this work takes place in a medical clinic called the Center for Haitian Studies, located on a commercial street in the rapidly gentrifying immigrant neighborhood.
Outside the building, “CHS-Santé” is written in large blue letters. A few small convenience stores and a tax service business are nearby, but most of the surrounding stores are clothing boutiques and trendy cafes or restaurants.
One weekday morning, the clinic’s street-facing windows filled the waiting room with sunlight, and community health worker Valentine Cesar struck up friendly conversations in Haitian Creole with patients as they waited.
The patients have an easy relationship with Cesar, who works for the Sylvester Center at the University of Miami. At the Center for Haitian Studies, she teaches people how to prevent cervical cancer by focusing on HPV. Specifically, Cesar shows women how to test themselves using a kit she distributes at the clinic. “We have a potty, and this is a cotton swab,” she said.
“Just because you are HPV positive does not mean you have cancer”
The process is not much different from using a tampon and is certainly easier than having a pelvic exam, which is the other way to test for HPV. Self-collected samples are sent to a laboratory. If the results are positive, Cesar displays her considerable people skills when breaking the news.
She recognized the panic that occurs when she tells people they have HPV. “We explain to them that just because you’re HPV-positive doesn’t mean you have cancer,” she said.
This means that a woman should be vigilant about her health and should be monitored for cancer, pre-cancerous conditions and other problems that can be caused by HPV. Cesar and his colleagues will encourage HPV-positive patients to seek treatment at the Center for Haitian Studies or other federally-approved health centers. The clinic is the main referral partner of the Sylvester Center in Little Haiti due to 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 scheduled days. On other days, the vehicle brings a similar message to different Miami communities.
“We are able to promote our services through our various community health workers who come out and talk about what we do, hand out flyers and have educational materials,” said Dinah Trevil, the former director of the outreach office. and engagement of the Sylvester Center. . “All of this helps us build awareness and awareness of our services and what we do.”
During a tour of the Game Changer vehicle, Trevil pointed to the HPV video that was playing and the pamphlets people can use to learn more about the virus. The vehicle has a main area with space to sit, as well as areas for private examinations or consultations.
Culturally Competent Employees Help Dispel Fear
Trevil understands why Haitian women sometimes avoid seeing a doctor. As she explains, “They believe, ‘If I go to the doctor, I’m going to hear bad news. I’d rather not go.’ “
As health educators, Trevil and Cesar try to talk people out of this fear-driven avoidance.
Research shows that self-testing for HPV can help more women accept other tests that benefit their reproductive health, Trevil said. “So we started using this test as a way to address some of the sensitivities and some of the reluctance of women to have a Pap test.”
Patient Nicole Daceus took a self-test for HPV this year after noticing the Game Changer vehicle and the name Sylvester Center on it. Health fears aren’t the only obstacle, Daceus said, noting that “people avoid the doctor if they don’t have health insurance or their immigration papers.”
However, no one at the clinic will ask patients about their immigration status – this is something Cesar and Trevil try to make sure patients know.
How to reach the next generation
Staff members at the Sylvester Center explain the issues to mothers, encouraging them to have their young teenage girls vaccinated against HPV. Vaccines for children are administered inside another motorhome, parked a few feet from the Game Changer – the University of Miami’s pediatric mobile clinic. It focuses on caring for uninsured children and locates near public schools, places of worship and community centers.
“We work in tandem with each other because the mobile clinic is able to provide vaccines, and that way we can make HPV prevention a family affair,” Kobetz said. “Boys and girls of eligible age can get vaccinated.”
Richard Freeman, who works in the office of the director general of the WHO, toured the vehicles behind the Center for Haitian Studies earlier this year. Freeman said the team’s work is vital to WHO’s global effort to end cervical cancer. No one, Freeman added, should die from a disease that tests and vaccines can prevent.
“Cervical cancer is the only cancer we can actually eliminate,” Freeman said. “We have the tools, and it’s all a choice of whether or not we’re going to use those tools. If we catch this cancer early and catch it in time, it’s curable. And so we want to see all of these interventions coming – not just here in Miami We want to see HPV vaccine supply also available and affordable in countries that have a higher burden of cervical cancer.
This article is from a reporting partnership that includes NPR, WLRN and KHN.
