|
Global Grant Proposal Form for Project G-1125 1. Host Partner Information
2. International Partner Information
1. Describe the benefiting community including its location, using any relevant geographic and demographic information (Please be as specific as possible). If the activity is a scholarship, enter "N/A". The greater Deschapelles area of the Artibonite Department which the Albert Schweitzer Hospital serves, comprises over 350,000 people of which 31.5% are women of child-bearing age (between the ages of 15 - 49 years) or 110,250. This area, about two hours northwest of Port au Prince, Haiti is a very rural, agricultural area serving a very impoverished population. This is the key demographic for cytology based cervical cancer screening. 2. What community needs have been identified? If the activity is a scholarship, enter "N/A". According to an article published in 2010 by Partners In Health, the largest nongovernmental healthcare provider in Haiti, 3,000 Haitian women will develop cervical cancer annually, and 50% will die from the disease, a mortality rate purported to be 30 - 50 times greater than in the United States where healthcare, in general, and cervical cancer screening, in particular, is readily available. There are many risk factors which contribute to invasive cervical cancer such as a women's age, socioeconomic status, living in certain geographic regions, access to health care and cytological screening, sexual behavior of the women and her partners, as well as the age of her first sexual intercourse, among many others. The catchment area of Artibonite Region of Haiti where Albert Schweitzer Hospital serves, is estimated to be 350,000 people with women of reproductive age (15 - 49 years) comprising 31.5% or 110,250. This is the specific population which needs to have access to cytology based cervical cancer screening. A 2012 Cancer Prevention Newsletter of the New York Presbyterian Hospital states that 'Haiti has the highest reported incidence of cervical cancer of any country in the world, with 94 cases per 100,000 population'. Cervical cancer is the second leading cause of cancer death in Haitian women. Based upon these numbers, 104 women within the area served will annually develop cervical cancer and, with a 50% mortality rate, 52 women will needlessly die every year. During a recent Rotary VTT trip to Haiti (October 2015) 708 women were screened for cervical cancer during a seven day screening campaign. Of the women screened, thirty-five (35) women were identified as having cancerous or precancerous lesions and received immediate treatment utilizing LEEP (Loop Electrosurgical Excision Procedures). LEEP is a minimally invasive procedure which allows the patient to return home about 30 minutes after the procedure is complete. In addition to the 35 women who were treated with LEEP, there were nine (9) patients whose cancer was too far advanced to receive any type of medical assistance. These results show a total of 6% of the patients screened were found to have cancerous and precancerous lesions. 5% of those screened were able to be treated at the time of screening; 1% were too far advanced to receive any beneficial treatment. Applying this discovery rate to our proposed initial screening population of 1,500 - 1,800 women during the two week VTT, 74 - 89 women would be saved from dying of cervical cancer. 3. How are these needs currently being addressed with local resources and/or government agencies, NGOs, etc.? If the activity is a scholarship, enter "N/A". Albert Schweitzer Hospital does not have any cervical cancer screening capability for this community which it serves. In addition, there is limited chemotherapy treatment available in the country, and radiation therapy does not exist. With an annual per capita income of $810 (per the World Bank), the average Haitian woman cannot afford a PAP smear that would provide early cervical cancer detection. In addition, it is reported that Haiti only has ten Pathologists in-country, which severely limits the ability for the slides of patients with abnormal results, to be read and processed in a timely manner, which also impacts the medical response rate and the mortality rate in the country. 1. Summarize the proposed activity(ies) in 250 words or less, including the need it will address, the intended beneficiary(ies), and the potential benefits to the community. This grant will fund the purchase of critical equipment and supplies needed to conduct a two week cervical cancer screening effort at the Albert Schweitzer Hospital in Deschapelles, Haiti, to screen between 1500 - 1800 women, using a Vocational Training Team. This team will be made up of Oncologists, Pathologists, OB/GYNs, Nurse Practitioners and Cytotechnologists. They will not only conduct the two week cervical cancer screening program, but also train an initial team of ten medical and healthcare professionals - two (2) OB/GYNs, two (2) General Practitioners, three (3) Nurse Midwives and three (3) Nurses - in Colposcopy, Cytology and LEEP procedures. Once trained and certified, this group would be able to conduct two screening days per month, treating an estimated 75 women each day, and utilizing the equipment purchased with this grant, continue screening an estimated 1,800 women each year. Again, if the same discovery rate experienced in the October 2015 VTT is applied, 112 women would annually be identified as having cancerous or precancerous lesions of which 89 could be treated immediately, saving their lives. This trained team will be the establishment of a permanent cervical cancer screening program at Albert Schweitzer Hospital. 2. Please list any cooperating organization(s) or university(ies) involved in the proposed activity(ies). Albert Schweitzer Hospital, Deschapelles, Haiti. Albert Schweitzer Hospital has been providing healthcare in the Artibonite Valley for over 60 years. 3. Describe how the benefiting community will be involved in the activity(ies) (Provide specific examples). If the activity is a scholarship, enter "N/A". Dr. Herriot Sannon, the Medical Director of Hopital Albert Schweitzer (HAS), Dr. Narcisse, HAS's Chief of Obstetrics & Gynecology, and Rachel Bedenbaugh, HAS's Senior Manager of Strategic Development and Program Evaluation have had numerous meetings with various groups to discuss their desire to establish a cervical cancer screening program at HAS. I met with this team and discussed their vision for a cervical screening program. Dr. Sannon, Dr. Narcisse and Ms. Bedenbaugh agreed with the goals and scope of this grant and have provided their vision as part of the structure of the grant. They will personally select the ten (10) medical and health professionals to be trained by our VTT, and will intimately be involved with all aspects of implementation and continuation of this program. 4. Has the benefiting community(ies) confirmed that it would like the activity(ies) to take place? Yes 5. Proposed Start Date: 15-OCT-2016 6. Proposed Completion Date: 15-OCT-2017 1. With which area(s) of focus is the proposed activity aligned?
2. Please describe how the activity(ies) will address the goal(s) of the area(s) or focus. Reducing the maternal mortality and morbidity rate - A projected 1500 - 1800 women will be screened during the initial cervical cancer screening effort, as well as an additional 1,800 women over the project implementation period. Based upon the infection rates seen in October 2015, it is estimated that approximately 6% of the women tested will be found to have cancerous or precancerous lesions, with 5% able to receive immediate treatment via LEEP procedures. This would amount to a reduction of almost 200 deaths related to cervical cancer. Improving access to essential medical services, trained community health leaders and health care providers for mothers and their children. - Dr. Cynthia Riviere, who opened a cervical cancer prevention clinic at the GHESKIO center in Port au Prince, states “In Kreyol, we say that the mother is the ‘poto mitan’ of the family; that means the center pole that holds the entire family up. Haitian families can’t afford to lose their center pole. That’s why we need to prevent cervical cancer'. This grant will provide for the training of ten (10) medical professionals who will conduct on-going cervical cancer screening services throughout the year. There are currently no healthcare professionals providing cervical cancer screening in Deschapelles at this time, so this project would substantially increase trained community health leaders, and will significantly increase access to healthcare for women, and ultimately reduce both morbidity and mortality in the community. Restavecs - The average Haitian woman who dies from cervical cancer leaves behind between five and eight orphaned children according to Dr. Jean Cantave, President of SHONC (the Societe Haitienne D'Oncologie) or the Haitian Cancer Society, Any number of these children could potentially become restavecs, child slaves. The Restavec Freedom Alliance estimates that 300,000 children in Haiti are restavecs, child or sexual slaves, and two thirds of these children are female. Not all restavecs are orphans; a significant portion are sold into what is purportedly indentured servitude by their parents who can no longer afford them, with promises for increased educational or employment opportunities., however those without a parent are at a higher risk to end up in this situation, or far worse - sexual slavery. Recent studies have shown that girls who become sexual active prior to the age of twenty, significantly increases her likelihood of developing cervical cancer from the Human Papillomavirus (HPV) infection. It is likely that many female children who are orphaned will willfully or forcefully become sexually active at a younger age for survival, and as a result, have a higher risk of developing cervical cancer later in life. By increasing access to quality cervical cancer screenings for women, HAS will reduce the number of women dying from cervical cancer, and this potentially reduce the negative health outcomes related to orphaned children. 1. What will be the immediate and long-term outcomes of the activity(ies). 2. Explain how all involved parties will act to ensure the sustainability of the activity(ies) and/or outcomes. Hopital Albert Schweitzer (HAS), as a representative of the local community, will play an active role in project implementation, including the following activities: (1) participation in theoretical and hands-on training related to cervical cancer screening and treatment; (2) ongoing provision of cervical cancer screening days, twice per month; and (3) ensuring all equipment remains in good working order, and sufficient levels of needed supplies are maintained. As a result of this grant, and the training and equipment provided, cervical cancer screening will become an integrated part of the package of services offered at HAS. The staff at HAS will be responsible for on-going monitoring of outcomes and ensuring the continuity of the cervical cancer screening program at HAS.
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||