MIAMI – Although many low-income women from developing nations wrongly believe screening in search of precancerous lesions in the cervix is a waste of time and money, Haitian women have the highest incidence of cervical cancer within the Western Hemisphere.
The largely preventable disease is linked to poverty and a lack of access to primary health care, but now researchers are interested in understanding how Haitian women's secret practices could have made them more susceptible to cervical cancer.
For generations, some Haitians have chosen to rely on sacred oils and rites with medicinal plants, animals and candles to deal with health issues. Some have done so in secret to avoid criticism from some practicing Catholics and other Christians who believe the traditions to be witchcraft.
"They use the plants for medicinal purposes in terms of boiling for teas, potentially doing cleaning with the leaves, taking baths, things of that nature ... The use of some of these plants could, in fact, be causing some changes in their bodies," said Dinah Trevil, a senior research associate at the University of Miami.
Trevil speaks fluent Creole, and she hits the streets of Miami's Little Haiti regularly to try to earn the trust of as many migrant Haitian women as she can. Building these relationships is part of her effort to help Erin Kobetz, a researcher with the University of Miami's Sylvester Cancer Center, who is trying to understand why Haitian women are at a higher risk and how this can change.
Researchers know Haitian women's life expectancy is below what statisticians and epidemiologists have predicted. Cervical cancer is the most frequent cancer among Haitian females between 15 and 44 years of age.
Health officials estimate that 1,048 Haitian women are diagnosed with cervical cancer and 575 die from the disease every year. Some 60 percent of cervical cancer cases are attributed to HPV. Researchers have already found a link between the human pappillomavirus, or HPV, and Haitian women's intravaginal use of pigeon pea and lime juice.
"Anything that we ingest or use has the potential to influence, let's say, the microbial diversity of our gut or cervix in such a way that it may lead to increased susceptibility to viruses," said Kobetz, who is also a senior associate dean for health disparities at the UM Miller School of Medicine.
Kobetz is a thyroid cancer survivor and this, she says, has changed her. Dealing with an autoimmune condition known as Hashimoto's thyroiditis after the birth of her son and facing her own mortality in 2004 changed her as a scientist.
"I no longer wanted to pursue science that was only statistics-based, because I had been the statistic myself," Kobetz said during an interview with Reader's Digest.
Collecting and interpreting the anecdotal evidence to document behavior is a challenging mission, but she is not alone. She has the support of the Cigna Foundation and Fairchild Tropical Gardens.
Kobetz believes in the power of community engagement. To understand what happens to low-income women in rural Haiti, she is connecting with low-income Haitian women in Miami who are loyal to tradition.
In the U.S., immigrants who have health insurance and access to primary care are a minority. Haitian women don't always understand the importance of the annual PAP smear, or Papanicolaou test, or have access to expensive visualization techniques, electronic detection methods or an HPV DNA test.
Some nongovernmental organizations have given Afro-Caribbean women access to the most inexpensive testing: The visual inspection with acetic acid, or VIA, testing. It started in the '90s, but many with access to VIA don't know that about 80 percent of the women who get tested get false negatives.
In an effort to understand the challenges, Kobetz established a UM-community partnership in Miami's Little Haiti called Patné en Aksyon, or Partners in Action. It has become Sylvester Comprehensive Cancer Center's model for community engagement. She also has community health workers who collect plant specimens.
The Cigna Foundation awarded Kobetz its World of Difference grant, which is now allowing her to also work with researchers at Fairchild Tropical Garden who are helping UM researchers to understand the botany behind the commonly-used plants.
"The work of Dr. Kobetz exemplifies the importance of helping people overcome barriers to health and well-being and to live up to their potential," David Figliuzzi, the executive director of the Cigna Foundation, said in a statement.
The information from the community and the botanists will help UM researchers gain knowledge about the potential biological links between the use of these plants and the high incidence of cancer. Kobetz said she will be using this knowledge to come up with ways to save lives.