Henrietta Lacks in Haiti – Tackling the epidemic of cervical cancer


For those of you who may not have heard of Henrietta Lacks, allow me to provide a short tutorial of her immortal importance after her death. Ms Lacks died of an aggressive form of cervical cancer in 1951 at the age of 31. During this same time, researchers at Johns Hopkins Hospital in Baltimore were attempting to grow tissue cultures from human cells. Most of these cell lines died within a few days, but the tissue obtained from Ms Lacks tumor reproduced at a high rate and could be kept alive to allow for further study. The cell line became known as HeLa and was instrumental in developing the polio vaccine 3 years later as well as other breakthroughs in medical science. We now understand that the reason that her cells reproduced so rapidly, and also why she suffered from such an aggressive form of cervical cancer at a young age, is that her cells were infected with a high risk strand of HPV (human papilloma virus) which caused uncontrolled growth of infected cells. This understanding has led to the Gardasil vaccine as well as more sophisticated HPV testing, both of which have the ability to eradicate cervical cancer from the globe.

Cervical cancer is becoming strikingly more important from a global health perspective for two reasons:  Maternal mortality has been reduced by almost 50% and HIV infected woman are living longer on retroviral medication. Unlike Henrietta Lacks, most women don’t die of cervical cancer until their 40’s to 50’s. Keeping more women alive in childbirth means that there will be a larger contingent of women susceptible to the effects of HPV. Women living with HIV, although appearing healthy when taking daily retroviral medication, have a depressed immune system and are more likely to develop cervical cancer when exposed to HPV.  Currently, 85% of world-wide deaths due to cervical cancer occur in the low and middle income countries.

During my 25 years of practice in the US I have encountered 4 cases of cervical cancer. Each of those cases occurred in a woman who had not had a pap smear or pelvic exam in more than 10 years. More than 50% of cases of cervical cancer in the US are not due to the inadequacy of screening but rather to the lack of screening. With the recent addition of HPV testing to pap smears, the accuracy of this test has improved even further. My   work in Haiti has revealed a much different picture. In 15 trips over the past 10 years, I have diagnosed 12 cases of cervical cancer, all of which were well advanced. By some accounts, Haiti has the highest incidence of cervical cancer in the world with 94 cases per 100,000 women. Cervical cancer is the leading cause of cancer death in Haitian women, with 1500 Haitians succumbing every year. It kills nearly as many women as all other cancers combined. This is in comparison to the US, where cervical cancer accounts for only 3% of female cancer deaths. Keep in mind that cervical cancer is one of the few cancers that we currently have the ability to not only prevent but also to treat pre-cancerous lesions before they progress to cancer. Cervical cancer can become a forgotten disease in 25 years.


On the same evening that Henrietta Lacks premiered as an Oprah movie on HBO, I boarded a flight to Port au Prince, Haiti to participate in a conference addressing the need for a cervical cancer screening program in a country with low resources. Members of the Ministry of Health, Haitian ob/gyns and American aide groups came together to discuss and formulate a future plan. We discussed what works and what doesn’t work, the need for education in the community and how best to use limited resources to benefit the majority of women. Haiti sans Cervical Cancer has a tremendous amount of work to accomplish, but is stronger when everyone is pulling in the same direction.


Partners in Health, known as Zamni Lasante in Haiti, is part of our coalition of Haitian organizations that has approached seemingly insurmountable world-wide public health challenges in the past. They were pioneers in improving tuberculosis treatment when multi-drug resistance to the disease became problematic and were instrumental in bringing HIV medications to poor people suffering from the disease. In both of those cases, the “experts” said it couldn’t be done but PIH proved them wrong. Cervical cancer is an equally deadly disease, killing mothers in the prime of their lives. The solution, however, is much less expensive – receiving 2 doses of the Gardasil vaccine as a young teenager and then a $10 HPV test every 5 years starting in your mid 20s until mid 50’s. By reducing the rate of maternal mortality by 50%, we have been successful keeping many more women alive during childbirth – now we need to tackle the disease that can kill these women later in life.

Nepal – The land of Everest and Human Trafficking




March-June is the height of the trekking season in Nepal. Travelers come from all parts of the globe to climb the highest mountain in the world, Mount Everest. Unfortunately, there is a lesser known but more profitable trek between Nepal and India that is limited to women and children. Poor families in rural areas of the country are fooled into selling their children to traffickers so that they can pay for food for the remaining children. Women are lured into the sex industry and then kept prisoner with violence. The trafficking of women and girls from Nepal to India is considered one of the busiest sex trafficking routes in the world, involving 5000-10,000 females a year.

Bethany Richards, an artist in California, recently had the opportunity to travel to Nepal with the Wall of Hope Campaign. Never having traveled internationally prior to this experience and purchasing her ticket on a whim after meeting one of the mural artists, Bethany had no idea how this trip would change the trajectory of her life. She signed on with the idea that she would be the support team – cleaning paint brushes, mixing paint and hoping that she may get a few brushstrokes on the wall. When one of the artists needed to leave early, she was thrown into the intense day-long process of creating life-size art that was meant to bring awareness to sex trafficking as well as empower girls and women to break thru the cultural barriers that allow this practice to continue.

I know Bethany only peripherally; she is the daughter of my church’s pastor. I recently saw some of her Nepal mural paintings on social media, posted by her proud parents, and was intrigued to find out more. Two hours spent at a coffee shop with her was not near enough time to tell the entire story.  But what I did hear was fascinating and worth sharing here.

Wall of Hope had commissioned two murals to be painted on the European Union and Australian embassy walls in Kathmandu. The first day was spent cleaning and priming the wall, while explaining to passersby the intent of the paintings. 5 – 12 hour workdays later the first wall at the EU embassy was completed.


The story depicted in art moves from right to left, from darkness into light and from the street to the door of the EU embassy. The woman clothed in a red drape, measuring 6 ft tall and 12.5 feet wide,  is seen reaching out for help with her feet entangled in chains. As your eye moves to the left, a bird is seen breaking thru the chains of bondage, leading to the possibility of freedom. This is followed by the eyes of a Nepali girl, the first eye with a teardrop for sadness/empathy and the second eye bordered on the lower lid by a lotus flower, symbolizing strength and resilience.  The girl is able to see the violence against girls and women in her culture,  but unable to change her circumstances. Behind the eyes is an image of paradise drawn in the style of a traditional Thangka painting, a Tibetan style of art popular in Nepal. The wall appears to have “broken” in this area, allowing the girl to see a paradise that has previously been hid from view. The final painting of a girl and clouded leopard faded into each other is representative of the ability to become powerful even when threatened with extinction.

During the week numerous school groups visited and helped to paint while hearing explanations of the various elements of the painting, a form of art therapy designed to increase awareness about violence against women. Midweek a small group of women from a local women’s shelter visited the wall. Without explanation, they were able to interpret the individual elements of the mural because they had lived the experience of moving from bondage/abuse into a better life.  One of the girls stated that she felt that she didn’t yet have the power of the leopard but she hoped in the future to possess that quality.

The second mural was painted on the wall of the Australian embassy and broadened the them to include child labor. The artists were concerned that the Nepalese would be angry that a Western based organization was exposing a shameful part of their culture. Instead, they received only affirmative responses from the crowds that gathered to watch to week-long painting marathon. Most adults were aware of trafficking and child labor and appreciative that the paintings were not only sensitive to their culture but also that outsiders were helping to tell stories that increased awareness of the problem. One young man shared his story of engaging in sex trafficking and felt that society didn’t condemn his behavior enough. He stayed for 4 days to help with the painting as a way to absolve his behavior.


 On the left, smoke from a brick factory that exploits child labor is invading the room next to a picture of imprisoned children behind a barbed wire. The bed beneath the frame is representative of sex trafficking; the propped up doll reminding us that these are still children despite their circumstances. Serving tea is a universal welcoming gesture in Nepal with the words on the cup spelling out harmony below the peace flags. The steam emitting from the tea ceremony encircles the grandmother’s smile, signifying the ability of elders to look back in time and find degrees of happiness within hardship. The dancer is performing a Buddhist traditional dance with her expressive hand gestures representative of reflection and being grounded in the past while also looking into the future. The final symbol is the bookshelf in front of an open window, symbolizing that education brings knowledge and can be a window to the future and a better world.

The end of the trip culminated in a gathering of 800 students, ages 13-17 and mostly girls, for International Women’s Day. Bethany was asked to speak and share her personal story with the students. But this wasn’t a story about the paintings. Bethany had another story to share. Despite growing up in a stable family with loving parents who  were able to provide her with food and shelter, Bethany had been the victim of sexual abuse. Not once, but twice. Following is the transcript of her speech.


I had no choice. My innocence ripped away from me the first night I went to college. Infant, I don’t remember most of the event. I remember tripping and falling, the rough hand that grabbed me and the mean voice that yelled at me for crying and slowing him down. I remember the next morning waking up alone and realizing what had occurred because my pants were caked in dried blood and my insides hurt. I remember the shame and the pain I hid and carried for over a year before anyone else knew.

And then, three years later, it happened again. A different scenario. My boss and a coworker held me down one night after work while they took turns and choked me while demanding that I repeat words and phrases they dictated. This one, I couldn’t hide. This time, I not only lost my dignity, I lost my job, my boyfriend’s trust and I lost my ability to walk down the street and hold my head up high.
This time, I decided to press charges. This time I went to the hospital. This time, I gave my clothing to the police, gave blood and fluid samples to the nurse and this time, photographs were taken of my bruised body and I repeated my story multiple times to multiple people in order to get the true story. This time, shame piled ever higher.
It’s called the justice system. I thought it would bring me justice, I was told it would ease some of my suffering. A process to right a wrong that was made, to punish the men who scourged my body and who took years away from me through emotional and physical trauma. But the courts didn’t care about me, I was only a number, an unfortunate statistic for their book.
I will never forget the phone call that confirmed this, I was told I had no case because they claimed mine was a he said/ she said situation. There were two of them and only one of me and they said it was consensual, so there was nothing that could be done. The court decided this was not a crime, but if I wanted, I could pursue a civil case.
Just to reiterate, two men almost twice my age, held me down, choked and bruised a 21 year old girl in a restaurant while they took turns sticking their extremities into my orifices and the court system deemed this acceptable.
Think about what that does to a person. Think about the ripples that makes in the life of a girl, in the life of anyone.
In order to prove my innocence to my boyfriend and others who believed the court over me, I continued on with a civil case. I met with a lawyer in a fancy office in a tall building downtown. I was told this would not be pretty, that pursuing a case like this would force me to re-live my trauma and my life would be under a microscope. I would be drilled and have to defend any situation that could be perceived as a lie.
Ultimately, I decided to close the case. You see, I had made mistakes. I took a shower after the event, I didn’t report it until the next day. I had an extensive list of sexual partners, a residual coping mechanism from my first rape; an attempt at normalizing something I had not been able to control. I wasn’t living, I was reacting and I was scared. I did what I felt I needed to do in order to cope with this terrible shame that nobody seemed to care about.
This is why rape happens.
This is why violence toward women continues to happen.
This is why something needs to change.
I married that boyfriend who thought I was at fault in my rape. Abuse and shame were my companions. When the finger of blame is pointing at you from places of power, it becomes truth.
On my 28th birthday, I reached a breaking point, an incident involving a knife was my wakeup. I had had enough. I didn’t know it at the time, but something inside me said, you are worth more.
I am now 31 years old. I have spent the last three years in extensive therapy and I can now proudly say, my body is my own. I relearned basic movements. I relearned how to walk, how to hold my head high. I relearned how to talk to myself and give myself care when needed. I had to relearn how to think of myself as a person instead of an object. I had to relearn how to fear and how to love.
And now?
Now I want to hold all other women in my arms and in my heart. I want to hug you all tight and whisper in your ears that you are worthy, you are strong and you are not alone.
But whispers and hugs don’t stop rape or violence. Abuse, violence, rape won’t stop until we put our collective feet down and say enough. We must influence the perspective of our masses, our countries and our world so that we can heal as a society.
I have found my voice and I chose not to be silent any longer and I call on all of you to join me. Let us all become the role models we need for our children. Join me in saying enough to the perpetrators, the power seekers and the boundary breakers. Remove the stigma of being a victim and applaud them for coming forward. Lets use our voices as a tool to remove the fear and shame of talking about these crimes, because I did not choose for this to happen to me and I do not choose to let anyone think rape and abuse and violence are acceptable. Because I am a human. I am a woman and I have a mind, a soul and my body belongs to me. We don’t have to just survive, but we will all thrive because they might have bruised me, but together we can never be broken.
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Reflecting back on this life-changing experience and being cited as a “modern-day hero” by the audience that day, Bethany has chosen to believe that her past has a purpose – it allowed her to travel to Nepal and share her story, healing not only her heart but also the hearts of many other women and girls. Bethany’s heart has been torn and patched with tears, violence, love and laughter. She has found her leopard and is hoping that other women will hear her story and find the same strength to break free of their chains of bondage.
While the remainder of the team left for other projects, Bethany stayed on another 2 weeks and painted a third mural near a restaurant. Hand prints of girls from the school across the street were used to create the winds of change as a girl in a traditional sari stood in front of the Himalayan mountain range. The owners of the restaurant fed her two meals a day in payment for the painting. Not a bad way to end a life changing trip. Bethany is now working to develop a personal website and explore how she can use her art to empower women and girls throughout the world.


Breast Feeding, Jade Eggs and the Gspot

This post combines two of my favorite topics: international mission work and working to dispel rumors. You may wonder how the topics above have any relationship to each other. Stay with me for a few paragraphs and I think you will better understand.


When we are in Haiti for a medical mission week we try to listen as well as teach. This trip we became aware of the tendency for Haitian women to quit breast-feeding their children after 1-2 months so that their breasts can retain their “sexy” look. Powdered milk is now more available but still expensive. Thus, women use the powdered milk as a substitute for breast milk and dilute the milk to make it last longer. Water in Haiti is often contaminated with bacteria, leading to an increase in diarrhea diseases in children. Diarrhea in combination with poor nutrition from diluted milk causes chronic malnutrition. Parents aren’t able to purchase the medications or medical care and frequently abandon these malnourished children in orphanages. An entire cascade of problems that all started with a “sexy breast”.


Another story. Gwyneth Paltrow recently advocated the use of jade eggs for women to stick inside their vaginas to maximize their “feminine appeal” while increasing vaginal muscle tone and orgasms. Not coincidentally, she sold the jade eggs on her website for a mere $66!  The tragic part of this story is not that Gwyneth purports pseudoscience on her lifestyle website. The internet is full of more inaccurate medical theories than accurate. The crazy part is that the jade eggs sold out!! Women were willing to put their health at risk for a ridiculous theory that was backed by an attractive Hollywood star with no medical background. The benefit of this monetary and health risk was to improve their attractiveness to men. Are you starting to understand where I might be heading on this topic?


Third story. A patient in our clinic this past month had been paying to have Gspot amplification done in a clinic that advertises cosmetic gynecological procedures, such as labiaplasty and vaginal rejuvenation. Gspot amplification is a procedure that has no medical evidence to support it and is advertised as a procedure that needs to be continuously repeated. The benefit is that it improves vaginal tightness and restores appearance and function. Appearance and function for whom? Do you finally get it?

Women in Haiti and the US are not so very different. Each are willing to sacrifice their health, the health of their children and their money to appeal more sexual to men. Equally at fault are the men who help to perpetuate these myths for their own benefit. I don’t think you would see many men paying $66 for a jade egg to put in their rectum so that they would appear more masculine to women. Men wouldn’t allow an injection in their private parts to restore appearance and sexual function. Heck – they won’t even agree to a vasectomy after their partners have pushed out 2-3 basketball sized infants thru their vaginas. Vaginas that now need jade eggs and Gspot amplification to become restored. Sure hope that Gwyneth has a second shipment of those jade eggs arriving soon from Asia.

The American Welcome Mat Has Been Pulled


Our country is deeply divided on many issues, the most recent concerning immigrants from Muslim countries. I find it disturbing that the wealthiest country in the world is shutting the door on those that are the most marginalized and in need of our grace and acceptance. Arguing with those who don’t believe as I do doesn’t work. But sometimes personal stories cause others to stop and consider how we may appear to the rest of the world.

I have felt more acceptance and a welcoming spirit during my travels abroad than I have felt from my own neighbors here in Minnesota. During a recent trip to China, our guide became lost during a 6 hour trek thru terraced rice fields. When asking directions of a young man on the path, he offered to show us the shortcut to our final destination. He saw that we were wet and cold and had us stop by his house so that his elderly grandmother could fix us hot tea and serve us oranges. Three hours later we arrived safely at our destination and he waved at us as he turned and walked back home.


I have been welcomed into humble Haitian homes and served a Coke, knowing that the family may have skipped a meal in order to purchase the beverages.


When we traveled to Kenya as part of a medical mission trip, my group was hosted and feted almost every night for hours at a stretch.


Tapestry, a movement I co-founded to increase interfaith dialogue and acceptance, has been welcomed into Muslim, Jewish and Christian places of worship in the Mpls area. Unfortunately, it has been the Christian places of worship that have expressed more reservations when it comes to accepting the beliefs of another religion. In an attempt to spread the wonderful work that we are accomplishing, I have spoken to representatives of churches outside the metro area about hosting similar gatherings in their communities. I have not been successful in receiving a single invite. Those Christian communities who follow the same teachings of Jesus that I do – welcoming the poor, oppressed and marginalized – won’t let anyone cross their threshold who doesn’t “accept Jesus as their Lord and Savior”, to quote one person that I spoke with. And yet we Christians have been warmly welcomed and hosted by both a synagogue and a mosque.

Even Pope Francis has spoken out on the treatment of refugees by Christians. “It’s hypocrisy to call yourself a Christian and chase away a refugee or someone seeking help, someone who is hungry or thirsty, toss out someone who is in need of my help,” he said. “If I say I am Christian, but do these things, I’m a hypocrite.”

One final story about why America is already great. This picture depicts a Chinese American girl born in China, a girl whose father was born in Ecuador and a girl whose mother has survived breast cancer twice due to medical research in the US. These girls used their time last weekend to help pack reusable menstrual pad kits for less fortunate girls in Haiti. What are you doing to keep this country great? Are you reaching out to those who are less fortunate with a helping hand? Or are you supporting the America First Agenda where those who have much refuse to share with others. img_1551

The Power of Globalization

While many of my friends were participating in the Women’s March on Saturday, I was proud to be working with a group of seamstresses who were busy demonstrating the power of globalization and how it can be used to benefit others. 30 women and 1 man showed up to construct reusable menstrual pads for distribution to school girls in Haiti, as well as prepping fabric for our Haitian seamstresses to construct the same kits and earn a livable wage. We were our own march for the equality of women throughout the world, signifying that Women’s rights are Human rights. Helping others less fortunate causes all of us to rise; attempting to divide women by country, sexual orientation or race will only make us more resolute and determined.

The Paradoxes of Haiti


My first week back after a medical mission trip to Haiti presents many difficulties – some physical (I won’t expand on the topic of GI issues after eating rice, beans and potatoes every day for a week) but most psychological. At 10 am on Sunday I was enjoying the feel of sand between my toes and salt water on my ankles as I walked down the beach, knowing that 12 hours later I would be arriving to Minnesota and freezing temps. That is the uncomplicated part of the transition. The psychological transition is still a part that I struggle with and sometimes do better than other times. Following are just a few of the thoughts that have created a wrestling match in my head this week.

  1. We were able to prevent a woman from dying due to a bad infection in her foot by amputating her lower leg. She has very poorly controlled diabetes due to poverty, low IQ, and lack of resources for adequate administration of insulin. One of the last patients  I saw before I left for Haiti also has poorly controlled diabetes – due to lack of motivation to check her blood sugars and take medication, both of which are provided thru her insurance.
  2. Maternity was very busy the week we were in Haiti and our nursing volunteers spent many hours working with Haitian staff to improve breast-feeding and care of patients in labor. It is much easier to teach the mechanics of nursing care than it is to teach respectful care. Slapping and yelling at patients during labor is all too commonplace.
  3. Cervical cancer continues to be a preventable disease that kills all to many mothers, disrupting their families. We screened 67 patients for cervical cancer, treated 10 pre-cancerous lesions and diagnosed 1 locally advanced cancer that is untreatable and will be the cause of death in this woman within the next year. A combination of low-cost screening and vaccination with Gardasil has the potential to completely eliminate this cancer throughout the world. Due to unfounded fears of vaccines in this country, only 40% of young girls and boys are vaccinated with Gardasil.
  4. Motorcycles are the primary mode of transportation in Haiti. We treated 3 victims of moto accidents, one a  16-year-old girl who will have permanent scarring on her leg that impedes her ability to walk in the future. Once their wounds were cleaned, stitched and dressed, we sent them home on a motorcycle
  5. Most of the hysterectomies that we perform are due to fibroids (benign tumors of the uterus) and heavy menses. One of the patients that we saw was 41 years old and had not been able to conceive a pregnancy. She was severely anemic but her husband decided that they would pray to God for a miracle child rather than allowing her to have surgery. Another woman looked 8 months pregnant due to her enlarged uterus and her hemoglobin was 3 (normal is 12-15). She was in danger of bleeding to death with her next period. In the US, she would have received 4 units of blood before surgery. She received one unit of blood that was donated by a relative and infused during her surgery. She was also unhappy as she has only one child.
  6. A young man presented to clinic with a large abscess on his arm. His HIV test was positive, as was his syphilis test. He did not believe the results and declined government-funded HIV meds or antibiotics. We could not operate on him as he was at high risk of complications with active HIV.

When co-workers see me this week they often ask, “How was Haiti?”. Trying to find the words to describe the above and more can be difficult, if not impossible,  in a few minute passing conversation.  Do others really want to hear the confusion in my head or do they want to hear that we performed 49 surgeries, 67 cervical cancer screenings and 104 dental exams?  To say “Great job and thank you for what you do” and then move on. But what we do in one week is not enough. And that is the Paradox of Haiti.

When being a same-sex couple in Haiti can be easier than in the US


I was introduced to Jenn Schenk and Amy Syres a year ago when a friend led me on a tour of Haitian NGOs that are working to help Haitians help themselves. This can often be the more difficult way of helping and requires the ability to put self aside and allow the Haitians to support each other. I was given a tour of the building site of Second Mile Haiti and wrote a blog post shortly after I returned. Briefly, Jenn and Amy have turned their original mission of working in orphanages to now preventing children from becoming orphans when they are relinquished by their families due to malnutrition/illness.  The majority of Haitian orphans are not orphans in the sense that they have lost both parents but rather that their caregivers feel that they can no longer care for them due to severe malnutrition. These children and their caregivers are housed during the week while they are slowly re-nourished and the caregivers are empowered by learning about nutrition, agriculture and business opportunities that will support their families. Their program has been very successful with most children leaving after 2-4 weeks with their caregiver and few recurrences of malnutrition. As the program has expanded, they have continued to employ Haitians as nurses, farm workers and carpenters. I have never been more enthusiastic about any other Haitian program – and I have seen many over the past 10 years.

And that is why the recent turn of events has me both sad and angry. Because it is not a hurricane, an earthquake, a flood or any other event of Nature that has otherwise profoundly affected this island nation. This tsunami came from the US.  Amy and Jenn made the decision to marry this summer in a beautiful ceremony beneath the redwoods of California. This commitment to each other and their life’s work did not sit well with many of their donors – evangelical, conservative Christian congregations. They immediately withdrew their support, both financial and emotional. Haitians are more religious than most Americans but their opinion of Amy and Jenn and the work they are doing did not change. They were happy to welcome them back from their honeymoon as they continued to support Haitian children and families, growing vegetables to send home with the children on weekends and purchasing formula and medicines from local stores.

Throughout the fall, these women have worked to build back their base of donors. But due to attention shifting away during the election season and then the attention directed towards hurricane victims, their source of funds to keep the doors open is dwindling and they are in danger of shutting down by early 2017.  I am asking for a call to action for anyone who thinks that individuals can do great work no matter their sexual orientation. We need to provide the support these women need to keep their doors open, educate even more Haitian families about nutrition and keep children out of orphanages. This is a link to their webpage where donations can be made. Please share this with other like-minded individuals and prove to the Haitian community that we care more about the needs of Haiti than we do about the sexual orientation of the aid workers.