Danta Bien-Aimé, BSN, RN, MMSc-GHD
In 2016, The ASCO Post published an article titled “An Oncologist Battles a Preventable Epidemic: Cancer of the Cervix,” highlighting the work of Robert D. Hilgers, MD—now deceased—and the Women’s Global Cancer Alliance (WGCA) in building a cervical cancer screening and prevention program in Haiti. At the time, Dr. Hilgers emphasized that sustainability would depend on building long-term relationships with government officials and the communities being served.
Nearly a decade later, that question of sustainability became the central test of the program itself.
Haiti continues to face many of the same barriers described in the article: political instability, limited pathology and oncology services, shortages of trained providers, financial constraints, and interruptions in access to care. Cervical cancer remains one of the leading causes of cancer-related death among Haitian women, despite being largely preventable through screening and treatment of precancerous lesions.
I was involved in the WGCA program for several years, first as clinic director, then as a member of the organization’s board, and later as interim board director responsible for overseeing the program’s transition to the public sector. Looking back now, what stands out most is not only what it took to start a cervical cancer screening program in a resource-limited setting, but what it took to keep it going over time.
A Program Built Around Prevention
In 2015, WGCA established a free cervical cancer screening clinic in Gonaïves, Haiti. The clinic operated as a local screen-and-treat program using visual inspection with acetic acid, colposcopy, and cryotherapy to treat precancerous cervical lesions. The model was intentionally simple. The clinic operated with two nurses, periodic external supervision and training, donated equipment and supplies, and referral relationships with providers in the capital city of Port-au-Prince and beyond. Cryotherapy gas was obtained from Port-au-Prince, approximately 67 miles away, and suspicious cases were referred there for biopsy and pathology review. In fact, Haiti has only a handful of pathologists serving a population of more than 10 million people, all located in the capital city. Treatment options for invasive cervical cancer were extremely limited, and the program relied on referral efforts and external networks for women needing higher-level care, which often proved impossible due to resource constraints.
For those of us working in the clinic, the most difficult moments were not only the abnormal clinical findings but the conversations that followed: explaining to a woman that she had cervical cancer, that she had presented too late, and that the treatment she needed was not readily available in Haiti.
In some cases, we attempted to connect women with care in the Dominican Republic (DR) through personal networks and outside support. But even when treatment options technically existed, the financial barriers to travel and stay in the DR were often impossible to overcome. Patients frequently needed to cover at least part of the cost themselves, which many families could not do.
Over time, maintaining treatment services became increasingly difficult. Around 2019, worsening political instability made regular travel to Port-au-Prince for cryotherapy gas refills increasingly dangerous and unreliable. Eventually, maintaining access to gas became impossible, and the treatment component of the clinic was progressively disrupted.
Screening services continued, and thousands of women were evaluated over the years, many receiving cervical cancer screening for the first time in their lives. But the gap between screening and treatment gradually widened. At the same time, Dr. Hilgers became ill, funding became less stable, and operational challenges accumulated. The program continued largely through adaptation, personal commitment, and informal problem-solving rather than stable infrastructure.
When Screening Is Not Enough
One of the lessons that became increasingly clear over time was that screening alone is not sufficient. A screening program depends on everything around it: treatment availability, referral systems, supply chains, transportation, staffing, and follow-up capacity.
Cryotherapy gas had to be transported from Port-au-Prince to Gonaïves. When political unrest or insecurity disrupted travel, treatment services were directly affected. During periods when cryotherapy was unavailable, women with precancerous lesions sometimes had to be referred to private facilities, which introduced additional financial barriers.
The clinic itself also experienced disruptions. During periods of unrest in Haiti, the facility was vandalized, and operations became increasingly difficult to maintain consistently. Funding became less stable over time, and the broader political situation in the country continued to deteriorate.
Yet the program adapted continuously. Staff modified workflows, communicated with outside specialists, relied on informal referral networks, and attempted to preserve continuity of care under increasingly difficult conditions. The small, nurse-led structure of the clinic allowed for flexibility and local problem-solving in ways that larger systems often cannot.
At the same time, many of these adaptations depended heavily on personal relationships and external goodwill. They were not substitutes for a stable referral system or a fully developed oncology infrastructure.
After the Founder
Following the death of Dr. Hilgers and amid ongoing funding and operational challenges, the remaining equipment and resources from the program were transferred to Hôpital La Providence, the largest public hospital in Haiti’s Artibonite department.
The Dr. Bob Hilgers Clinic was inaugurated there in September 2025.
The transition represented an important effort to preserve cervical cancer screening services within the public sector setting and create a more durable institutional anchor for the program. However, it also revealed how difficult sustainability can be in practice, particularly in fragile health systems already facing severe resource constraints.
From September to December 2025, the newly transitioned clinic saw 150 patients, including 116 first consultations. Nine women were diagnosed with precancerous lesions, and five were diagnosed with invasive cervical cancer. Two of the women later died, while the remaining three received palliative support through volunteer physician networks.
These numbers reflected both continuity and persistent unmet need. Women continued to seek screening from Gonaïves and surrounding areas where similar services were unavailable. But the transition also exposed ongoing gaps in treatment access, referral systems, financing, and infrastructure.
For example, women diagnosed with precancerous lesions required referral for thermal ablation because treatment technology was not yet available locally. Referral pathways for cancer treatment continued to rely heavily on external relationships and informal support systems.
The transition created a public-sector anchor for the clinic, but it did not automatically resolve the structural barriers to cervical cancer care.
What Sustainability Actually Requires
One of the major lessons from this experience is that sustainability involves far more than maintaining a clinic site or transferring equipment.
Programs supported by nongovernmental organizations often survive because they are flexible. They rely on donated materials, informal networks, external expertise, and rapid problem-solving. Those strengths can help programs function in unstable environments, but they are not always easy to transfer into public institutions operating under different financial, administrative, and staffing realities.
The public hospital in Gonaïves, like many health facilities in Haiti, continues to face serious challenges related to infrastructure, staffing shortages, equipment maintenance, and operational funding. Leadership transitions within institutions can also complicate continuity efforts.
None of this means that transition to the public sector is the wrong goal. In fact, long-term sustainability likely depends on stronger integration into local health systems. But this experience reinforced that transition itself requires planning, financing, workforce development, referral coordination, and long-term institutional support.
Perhaps most importantly, it reinforced that cervical cancer prevention cannot stop at screening targets alone. Women must also be able to access treatment, pathology services, follow-up care, and palliative support when needed.
Looking Forward
Cervical cancer remains one of the most preventable forms of cancer worldwide, yet women in low-resource settings continue to die from the disease because prevention and treatment services remain fragmented or inaccessible.
The experience of this program reflects both the possibilities and fragility of cancer prevention efforts in resource-constrained settings. It also raises broader questions for global oncology efforts moving forward—not only how to expand access to screening, but also how to sustain the systems required to support care over time.
Nearly a decade after the original TheASCO Post article was published, the question is no longer simply whether cervical cancer screening programs can be implemented in places like Haiti. It is what it takes for them to endure.
DISCLOSURE: Ms. Bien-Aimé reported no conflicts of interest.
Ms. Bien-Aimé is the former Interim Board Director of the Women’s Global Cancer Alliance.
