Vendors sell goods in the city of Cape Haitien, Haiti, which is the poorest nation in the Western Hemisphere.
Loralee McMahon was shocked as she asked a Haitian ob-gyn doctor and nurse how surgical specimens were used after an operation.
McMahon, 41, is the supervisor of Immunohistochemistry (IHC) in the Surgical Pathology division at the University of Rochester Medical Center.
In February, she took a solo trip to Haiti where she spent two weeks volunteering in the nation's two largest cities. Her task was to set up a full working histology lab at a hospital and train local lab technicians in IHC.
As she spoke with two women whom she was staying with in the city of Cape Haitien, McMahon was about to get a reality check.
"I said, I'm trying to train people in histology and it would be great if you guys could take the specimens to the lab. What are you doing with the specimens now?"
"We just throw them away," they responded.
Haiti is the poorest country in the Western Hemisphere and, with over 10 million people, the second most densely populated. Like most low income countries, the state of healthcare is bleak and options for cancer diagnosis and treatment are few.
Enter McMahon, who was first inspired to help after hearing Dr. Jennifer J. Griggs speak at URMC. Griggs is a medical oncologist based at the University of Michigan who previously completed a postdoctoral fellowship at UR.
Griggs took a one-year sabbatical to work with two schools with nursing programs in Haiti, which, like many low income nations, lacks the heath care infrastructure to diagnose and treat cancer.
In addition to poverty and overcrowding, Haitians face many barriers to treatment, especially when it comes to breast cancer. Many women live with symptoms of breast cancer before seeking medical attention, Griggs explained. As in other countries, they often fear what a diagnosis might mean for their lives.
"(Women fear) what treatment will involve, losing a breast and no longer being desirable if they lose a breast,” Griggs wrote in an email. “They fear that, even if they get treated, they will still ultimately die of their disease. Major public health efforts are needed to inform women that medical care, when delivered early, can improve their chance of cure.”
After her presentation, Griggs asked how to set up a pathology lab for breast cancer specimens. McMahon and other staff put together a list of equipment to summarize the supplies needed to build a histology lab from scratch. McMahon's interest in joining the effort started to snowball from there.
She contacted Dr. Vincent DeGennaro Jr., an internal medicine doctor and public health specialist at the University of Florida who works for the nonprofit Project Medishare, an organization that built a hospital in the capitol city of Port-au-Prince after the devastating 2010 earthquake rocked Haiti.
After postponing the trip due to political unrest in the country, she arrived in February 2016. McMahon spent the first week of her trip in Port-au-Prince where she trained two young lab technicians at the National Public Health Laboratory (NPHL) and began to set up immunochemistry (IHC) testing on site.
Right: Members of a Project Medishare breast cancer support group (photo courtesy of Vincent DeGennaro).
IHC – the detection of proteins indicative of certain diseases in tissue cells – is almost nonexistent in Haiti. Pathologists are extremely rare, and work in private pathology labs that lack resources to perform IHC. As a result, many send their specimen slides to the U.S. for IHC testing. The resulting turnaround time for lab results is outrageous and the need for independent testing greater than ever.
The mindset of healthcare providers in Haiti is different from that of Western institutions. Hospitals are overcrowded, so treatment must be quick. If a patient has surgery to remove a tumor, the problem is considered "fixed" unless the lump comes back. The tissue is thrown away and the patient is sent home. Needless to say, these conditions put medical research at a great disadvantage.
During the second week of the trip, McMahon saw just how severe things were on the ground. Gone was the air-conditioning and running water at the NPHL in Port-au-Prince as she and her trainees went to Justinian Hospital in the city of Cape Haitien.
The hospital was a collection of fenced-in buildings guarded by armed security while sick and injured patients and their families crowded into an outdoor waiting area. On the first day, McMahon turned on a faucet to wash her hands and nothing came out, so she started bringing jugs of water to work each morning.
The outdoor waiting area at Justinian Hospital. Below: The early beginnings of a histology lab.
Despite the difficult working conditions, the two trainees showed great enthusiasm as McMahon instructed them via the translator who was hired off the street. They were laying the groundwork for a working histology lab at the hospital. They were making small advances every day as McMahon learned to work through interruptions, like frequent power outages that brought her lessons to a halt.
"There were a couple times during the week where I was like, this is way too much," she said.
"I'd come home at night and be like, this is just pointless - Why am I here? Then the next morning the techs would be there before I arrived and be excited and ready to learn."
It's the start of real progress, and McMahon hopes momentum will continue to build as more volunteers provide help. At the time of this interview, a breast pathologist from Canada planned to go in March and bring lab supplies to Justinian Hospital.
Four additional volunteers were slated to go as well, but the project was stalled because the Haitian government would not renew expired paperwork authorizing the crew's large equipment to be taken into the country.
When the lab equipment is finally installed, McMahon hopes the lab at Justinian Hospital will start to see specimens trickle in. As Haitian doctors and nurses start to realize the benefits of pathology in patient treatment, she believes the nation has a fighting chance to combat the cancer epidemic.
"I started telling the surgeons to save their (tissue) specimens. Even if you got a lab tech to take the specimen at least get is started so it doesn't go to waste," she said. "At least practice."
McMahon says she eventually wants to go back to help move the mission forward, but understands that real progress will not happen overnight.
"By the end of the two weeks I saw that this is way bigger than making a histology lab," she said. "But you have to start somewhere."
For information Project Medishare, or to make a donation, click here.
This year, the Department of Pathology and Lab Medicine is benefiting from donations provided by Friends of Strong, a volunteer organization that supports Strong Memorial Hospital through fundraising.
In 2015, FOS allocated a total of $110,004 to Pathology. These funds were used to purchase lab equipment including a triple headed microscope, four centrifuges, a spectrophotometer, a tissue cassette printer and gel photography system.
"The Department of Pathology and Laboratory Medicine is both thankful and gratified at the generous contributions from the Friends of Strong," said Dr. Bruce Smoller, department chair. "So often, a supporting department such as ours, and its needs fall beneath the radar screens of well-meaning organizations and individuals and we are genuinely delighted that the Friends of Strong recognize the manifold important functions of our department."
Friends of Strong is supported by proceeds from Friends of Gift Shop, Finger Lakes Coffee Roasters, the Specialty Shop, and Baby Prints Photography at Strong Memorial Hospital.
In photo: Friends of Strong Council President and volunteer, Rose Faucette (left), Pathology Department Chair Dr. Bruce Smoller, Friends of Strong Director Sandy Arbasak, and Pathology Vice Chair for Administration David Strong.