[Re: https://www.hifa.org/dgroups-rss/cervical-cancer-9-q1-how-do-people-your... ]
Dear Neil, and colleagues,
Thank you for opening this discussion. I write from Somos Amigos Medical Missions, a free primary-care and dental clinic serving 32 rural mountain communities in the Dominican Republic, with patients who are Spanish-speaking and, many of them, Haitian. Screening for cervical cancer is part of our routine care. It is the second most common cancer among Dominican women, with over 1,000 new cases and more than 700 deaths each year (ICO/IARC Information Centre on HPV and Cancer), and I offer what we see from the ground, taking your questions together.
Much of the Ethiopian picture you shared definitely resonates: the partial understanding, the fear of the exam itself, the stigma. Some younger women are reluctant to have a Pap for fear it will somehow leave them “marked,” no longer a virgin; some fear that an abnormal result will be read as proof of a partner’s infidelity. Among our Haitian patients these barriers run deeper still — misconceptions are more entrenched and access to reliable information scarcer — and, as I will come to, their obstacles are not only ones of belief.
Where our experience diverges from that study is in what happens next. We do not wait for symptoms, nor for worried women to come to us. We offer Pap testing with HPV co-testing at every clinic day, keep track of who is due, and actively encourage women in. A physician performs the test; specimens go to a laboratory in Santiago; a physician reviews and communicates every result. When a woman needs follow-up — a biopsy, treatment, further examination — we provide it or refer her, most often to an NGO clinic in the city, and we cover all costs. We monitor every step. For most of our patients that proactive, trusted, end-to-end care is what overcomes the fear: a woman reluctant to be “marked” is reassured not by a poster but by a clinician she trusts, in her own language, over the years. In our experience, it is this proactive care, and the trust built over years, that keeps misinformation from deciding whether a woman is screened.
But I must be candid about the women for whom it is not enough. Most of our Haitian patients are undocumented. When one needs that follow-up care in the city, we would fund it as readily as for anyone — but reaching the city is itself a danger, because transporting an undocumented person is unlawful here, and the risk of the journey can outweigh the care waiting at the end of it. For these women the barrier is not cost, which we can remove, nor information, which we can provide, but a legal and structural one that a clinic cannot. It is the hardest gap we face with these patients, and the one I most wish a discussion like this could help address: the women most exposed to cervical cancer are sometimes the ones a referral can least reach.
One honest note on prevention. We tried to establish health education for school-aged girls — as we do successfully for oral health through our local school — but found few takers on the women’s-health side. Reaching adolescents before fear and rumour take hold remains, for us, an unsolved problem. It matters all the more now that the Dominican Republic has added the nonavalent HPV vaccine to its national schedule (since March 2026, free for girls and boys aged 9 to 14) — a strong foundation for the next generation, if uptake can be achieved.
If I could offer one recommendation, it is that reliable cervical-cancer information travels best through a trusted local messenger attached to the care women already reach — and that, for the most marginalised, undocumented migrant women among them, it be matched by attention to the structural barriers that information and funding alone cannot overcome.
With best wishes,
Frank Brightwell
Founder and Executive Director
Somos Amigos Medical Missions
El Naranjito, San José de las Matas, Dominican Republic
HIFA profile: Frank Brightwell is Executive Director at Somos Amigos Medical Missions, in the United States. Email: frank AT somosamigos.org