Haiti Albinism Clinic Grows in Reach and Effectiveness

People with albinism in Haiti stand out because of their lighter skin, but also for their heightened risk of skin cancer in a country where many physicians remain unaccustomed to diagnosing and treating malignancy in their type of skin.

Top row, from left, Francius Adler, M.D. (Haitian general surgeon), Sammy (Haitian translator), Brian Morrison, M.D., Robert Griffith, M.D. (UM dermatology resident). Bottom row, from left, Mona Jeanty, M.D. (Haitian dermatologist), Danie Dure M.D. (Haitian dermatologist), Shesly Jean Louis, M.D. (Haitian dermatologist), Wilhelmina Edouard, M.D. (Haitian dermatology resident), Claudemene Charles, M.D. (Haitian dermatology resident), Ariel Eber (UM medical student).

“They are getting a lot of sun damage and very early skin cancers. The degree of skin cancer that we are finding among  people, even kids who are 10 or 12 years old, is surprising,” said Brian W. Morrison, M.D., a voluntary assistant professor in the Department of Dermatology & Cutaneous Surgery at the University of Miami Miller School of Medicine.

The basal cell carcinoma and squamous cell carcinoma lesions are typically those seen in much older people here in the United States, Morrison said.

Morrison travels to Haiti for the Oculocutaneous Albinism (OCA) clinic every three months, often accompanied by a UM resident or medical student. Their goal is to help people with albinism, to train the local doctors and clinicians, and to support a broader message that educates the public about albinism and its associated health risks. Morrison has recognized the great need for dermatology services since visiting Haiti as a medical trainee. The most recent OCA clinic was result of a partnership between the Miller School of Medicine, the Wound Clinic at Hospital Bernard Mevs/Project Medishare and the Albha (Albinism Haiti) Foundation.

Morrison lends his expertise and is clear champion of the outreach initiative, but the clinic is really driven and staffed by the local clinicians, he emphasized, including Haitian dermatologists, ophthalmologists and other specialists. His fellow dermatologists, Drs. Shesly Jean-Louis, Danie Dure and Myriam Fethiere are co-founders of the Albha Foundation. They worked for months prior to the clinic coordinating patient transportation, doing radio and television interviews to promote the clinic, and creating educational videos for public health education about OCA. They also recruited local Haitian celebrities — specifically James Germain — to increase awareness about OCA.

Helping Local Doctors Make a Difference

There are a lot of dedicated doctors in Haiti who are motivated to help their community, Morrison said. “We basically are training the local doctors how to identify and treat skin cancer in white skin. Our main mission is to teach the local doctors how to take care of these patients themselves. That way they can do it on their own, and they won’t need us.”

Part of the strategy is to teaching the Haitian physicians how to perform minor excisions so they no longer have to refer patients to general surgery. “Our unique training as dermatologists emphasizes many treatments that are less aggressive than wide local excision of the malignancy, and often result in more desirable cosmetic outcomes,” Morrison said. Alternatives to surgery include topical therapies and curettage of a lesion, he added.

Protecting Patients

“A lot of these patients don’t have the means to receive medical care. Some can afford to see a doctor; most of them cannot,” Morrison said. However, the unmet need for these services stems from more than their socioeconomic position. “Some of the people don’t even know they have albinism – they think they’re just light. And they don’t realize they’re at extremely high risk for skin cancer.”

The clinic staff focuses on educating people about albinism, including its genetic inheritance. People also learn strategies to reduce their risk of skin cancer, including the wearing of protective clothing, hats, sunglasses, sunscreen and more.

A Growing Popularity

The efforts are paying off and attracting patients beyond the Port-au-Prince city limits. “Every time we hold an albinism clinic, we double the number of patients we see, because more and more people are coming from more distant sites as word spreads.” The team of local Haitian physicians reaching out to their communities also contributes to the clinic’s success.

On June 14 – 15, 2017, clinicians saw 65 albinism patients, including two-thirds at OCA clinic for the first time. “All of our patients received education regarding their condition, a full body skin exam and a care package that included sunscreen, protective clothing/hat, sunglasses, SPF lip balm and Heliocare (for adults). Kids also got a small toy,” Morrison said. The patients presenting that day included 13 who underwent surgery and 27 examined by a volunteer ophthalmologist.

“The clinic far exceeded my expectations,” Morrison said. The next OCA outreach is scheduled for September. For more information, contact Morrison at [email protected]

Tags: Dermatology and Cutaneous Surgery, Haiti, Hospital Bernard Mev’s Medishare, Miller School of Medicine, Oculocutaneous Albinism, Port-au-Prince, skin cancer, University of Miami