Integration of Breast Health and Palliative Care in the Nursing Curriculum in Haiti

Worldwide, the early detection of breast cancer is key to reducing its resultant morbidity and mortality. In low- and middle-income countries (LMICs), the lack of infrastructure and resources limits the establishment of population-based breast cancer screening programs of any kind, and, in particular, those that would rely on complex and resource-intense mammography as available in high income countries (HICs). As a result, women in LMICs present with advanced disease when even the most modernized treatment modalities, rarely accessible in low resource countries, can offer little in terms of cure. As a result the 5-year survival rate for breast cancer in LMIC ranges from only 40-60% versus that of up to 90% in HICs . Further, other authors note that, due to the confluence of rising breast cancer rates, inadequate resources for early detection and treatment, and “disproportionately high fatality rates, breast cancer has become an important cause of premature death and suffering in these less developed parts of the world”. These circumstances necessitate culturally and resource-relevant approaches to both breast health and palliative care in LMICs.

The World Health Organization’s (WHO) Global Action Plan for the Prevention and Control of Noncommunicable Diseases explicitly recognizes palliative care as part of the comprehensive services required for the management of Noncommunicable diseases. WHO further mandates palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological, and spiritual”. In an effort to address WHO recommendations and guidelines created by the Breast Health Global Initiative, health care advocates emphasize educating target populations on the value of early detection, breast health awareness and self-exam, clinical history taking for risk identification and Clinical Breast Exam .
Haiti is one such low income country where studies show that the majority of Haitian women diagnosed with breast cancer continue to initially present for care with advanced stage breast cancer.

In an effort to further understand and contextualize the continuum of breast health from primary prevention through secondary and tertiary care in Haiti, a delegation under the auspices of CUSON’s Office of Global Initiatives recently traveled to Port-au-Prince, Haiti. In collaboration with a five member Radiology International (RAD-AID) team, a nonprofit organization working to improve and optimize access to medical imaging and radiology in LMICs, we provided a three-day breast health and palliative care symposium. Attendees included the leading nurse leaders/educators from across Haiti, nurse representatives from the Ministry of Health, nursing and advanced practice nursing students, radiology residents from the Université d’état d'Haïti and University of Global Health Equity in Mirebalais. While there, the delegation engaged in several collaborative discussions as preliminary work with the nurse leaders/educators which resulted in their formulating requests for expert support in curriculum development and future in-person collaborative workshops in breast health and palliative care.