How a tragic death sparked a drive to save thousands of lives

In 1997, Fox Point native Dr. Miriam Cremer was in her fourth year of medical school at the University of Wisconsin-Madison. To complete her clinical rotation, she went to Arcatao, a small village in northern El Salvador. She was helping to provide basic healthcare needs to the community when she witnessed a tragic, unnecessary death.

“There was a young woman in our village who died of cervical cancer by bleeding to death in her home,” said Cremer, who later became a board certified obstetrician. “She had only aspirin for pain control.”

The death was particularly tragic because it was wholly preventable. For example, in developed countries, cervical cancer is typically prevented by routine Pap tests (or Pap smear) and tests to identify the human papilloma virus (HPV), which causes cervical cancer. If a pre-cancer is found, it can be treated, stopping cervical cancer before it really starts.

Cervical cancer used to be one of the most common causes of cancer death in women in the United States until the introduction of the Pap smear more than 50 years ago. But in developing countries, where poverty is rife and access to medical care is limited, cervical cancer is still a killer.

“It’s a disease of the poor,” said Cremer. “In El Salvador and many other poor countries, it is the leading cause of cancer death in women.”

The incident of the young woman’s death prompted Cremer to start a Pap smear campaign for women in the village. Little did Cremer know then, but her initiative was the first step toward becoming founder and president of Basic Health International (BHI), a Manhattan-based nonprofit dedicated to eradicating cervical cancer globally.

Rural poverty in a poor country

It can be hard for people who live in developed countries to understand the obstacles women in developing countries face to get something as routine as a Pap smear or HPV vaccination. That’s because many people in developed countries rarely encounter grinding poverty.

“I lived in a very rural community,” said Cremer. “In those days, 1997, there were no paved roads to get to the village. There was no electricity or running water.”

Cremer lived in the home of a healthcare promoter named Helida Rivera. Rivera, who had no formal education, took care of the health needs of the community using only a supply of basic medicines and first-aid equipment.

“Our home had a dirt floor and a wood-burning stove to cook,” she said. “There was only one phone in the village.”

To perform vaccinations in the area, Cremer and the people she worked with had to walk for hours in the tropical sun carrying coolers with the vaccines.

It takes a village

Despite the remoteness and poverty, Cremer’s first initiative — a cervical cancer screening program for 87 women in Arcatao — was a success thanks to the remarkable level of organization among the locals, particularly the “incredibly strong women in the community who worked to make things better.”

Said Cremer: “The health promoter I lived with helped me talk to all the women who needed screening and encourage them to come in for their test. I brought the slides back home to the University of Wisconsin, where they were read for free. When I sent the results back, I called the one phone in the village. I faxed the results of the 13 women I needed to see and gave them a date of when I would be coming. I had no idea if the results would get to the right people. When I came back a month later to see the women, it was the rainy season. The roads were really muddy and it was hard to get there, so I was hours late. All 13 women were waiting for me when I got there. That blew me away.”

A little help from her friends

Since then, Cremer has returned to El Salvador numerous times to continue her lifesaving cancer screening.

By 2003, Cremer started the groundwork to launch BHI. But she couldn’t have done it without help from friends. The first chairman of the BHI board helped Cremer build the website. A friend in law school helped draft the organization’s first bylaws.

But some of the biggest support has come from David Einhorn, a friend from Nicolet High School whom Cremer has known since 1983.

“I asked him for $5,000 for a medical mission in 2000,” she said. “He deposited $10,000 into our bank account. He has always been incredibly supportive of me and my work.”

Einhorn, who lives in Rye, N.Y., said he supports Cremer because “Miriam is one of the best human beings I have ever met and I am lucky to get to support her in her efforts.”

The role of Judaism

Cremer was raised in a Reform Jewish home. She’s raising her three young children in the Reconstructionist Jewish movement. Cremer said the part of Judaism that is most important to her is the focus on social justice.

“I believe that as a society, we have an obligation to our poorest citizens,” she said. “The reason I wanted to be a doctor was to help people. I was incredibly lucky to fall into a situation where I have been able to make a huge difference in peoples’ lives.”

BHI today

Basic Health International has seven full-time employees in the U.S. and more than 40 in El Salvador. It’s also extended its services to Haiti, Antigua, Peru and Colombia. In addition to cutting-edge research, BHI is implementing the third phase of a 30,000 woman project, The Cervical cancer Prevention Program in El Salvador, which is investigating the feasibility of using a low-cost HPV DNA test to screen women for cervical pre-cancer.

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Cervical Cancer Facts

  • Cervical cancer is the most common cancer among women in 45 countries
  • It kills more women than any form of cancer in 55 countries
  • 260,000 women die from cervical cancer each year
  • Of those 260,000, nine out of 10 were from low- to middle-income countries

How you can help

To learn more about BHI and to support the organization, visit BasicHealth.org