Santiago, Dominican Republic

Ann Willis, MS, RDMS, RVT, a sonographer and SDMS member for nearly 30 years, joined a team of medical specialists traveling to the Dominican Republic in February to provide breast cancer screening, diagnosis, and surgical treatment to women in need. She was awarded a 2022 SDMS Foundation International Assistance grant to support her weeklong trip.

Ann volunteered through the International Breast Cancer Surgical Mission of Southampton (IBCSMS). Everything she had already accomplished during her sonography career made her an ideal choice for the team assembled by breast surgeon Edna Kapenhas, MD, leading her 10^th mission trip to Santiago, Dominican Republic. Dr. Kapenhas is a Fellow of the American College of Surgeons, the director of breast surgery and  medical director of the Ellen Hermanson Breast Center at Stony Brook Southampton Hospital in New York, and the founder of IBCSMS as part of Island Impact Ministries.

Three qualities Ann and Dr. Kapenhas share

Ann began in sonography in 1994. She has honed her skills in a variety of specialties – abdominal, breast, obstetrics/gynecology, pediatric, and vascular sonography, as well as neurosonology. She has also taught for 14 years at Baptist College of Health Sciences in Memphis, Tennessee.

Four years ago, breast sonography captured Ann’s enthusiasm and it hasn’t let go. She has made this specialty her sole focus since then. “It’s my new favorite! Abdominal and vascular were my earlier favorites. As for breast sonography, it’s the hardest thing I’ve ever done, with its ‘search and destroy’ protocol, and I love it!” Ann says. This passion infuses Dr. Kapenhas’ purpose-driven career, too. As early as the fourth year of her residency, she knew she wanted to dedicate herself to finding and destroying breast cancer.

Breast cancer is not just a physical burden. For women, the emotional cost is also high. This aspect may be responsible for the special bond that often develops between breast cancer patients and their healthcare team. Dr. Kapenhas was attracted to her specialty by this bonding. Even before setting foot in the Dominican Republic, Ann likewise recognized and supported a deeper connection she would have with her patients. Ann enlisted her employer, the Baptist Women’s Health Center, to donate special amenities for gift bags that were customized to the patients as much as possible. The proffered amenities included 35 prosthetic bras, 15 silicone prosthetic breasts, hats, wigs, and scarves.

The third quality Ann and Dr. Kapenhas share is a deep interest in technology advancements that improve the likelihood of a cure with early detection and treatment.¹ For both women, this was the high calling they served when they went to Santiago in February.

Dominican Republic’s breast cancer challenge

In the Dominican Republic in 2020, breast cancer represented 36​% of all new cancer cases in women and more than 17​% of all cancers overall, according to the World Health Organization (WHO) International Agency for Research on Cancer.²

The American Cancer Society says that from one-third to one-half of all types of cancer cases could be averted with prevention and early detection interventions, based on current knowledge of risk factors.³

In February, the volunteers’ week was filled with pre-identified patients at various stages in the diagnostic and treatment processes. “Some already knew they have breast cancer and may have received chemotherapy or additional imaging already,” Ann says. Only a few patients were walk-ins. Ann was the only sonographer on the team of two surgeons, an anesthesiologist, a pathologist, a nurse practitioner, a physician assistant, two nurses, and a medical assistant. In just a week, they completed a full complement of cases and performed 10 mastectomies. They worked from 7 a.m. to 9 p.m. Many hung around to catch a late dinner together.

The quick-developing conviviality and focused purpose of a medical mission team can present opportunities to interact more directly with other medical specialists in a way not traditionally available at home. Ann loved the atmosphere. “I very much enjoyed working closely with the pathologist, Dr. Robert Pu. Also, I was invited into the operating room to watch breast surgeries, and I did!” she says.

A surprise and a look to the future

This was Ann’s first international mission and trip to the Dominican Republic, so she wasn’t sure what to expect. She was surprised by one aspect. “I was anticipating we would be in a more rural area or near the water. But we were mid-country in a big city and working at a modern, mid-level oncology hospital. It was a lot more advanced than I expected,” Ann says.

Some rural dwellers would show up as walk-ins. One woman in particular is forever etched in Ann’s thoughts. “She had a mastectomy in 2017 and radiation therapy, but there apparently were no clean margins and maybe she didn’t follow up for some reason. She had horrible growths erupting from her skin and eating back into her lungs,” Ann recalls.

She tells about the poor woman’s plight only to emphasize the crucial necessity worldwide for early detection and rigorous treatment. Historically, breast cancer has been known as hard to detect until it has likely been growing in the body for two to five years.⁴ But now, Dr. Kapenhas has said it can be a different story with better technology. “Mammography has gotten so sensitive that you can pick up the slightest abnormality. Among all of those abnormalities that get called back, there are also those cancers, tiny little cancers, that maybe wouldn’t have been picked up years ago. Now they’re getting picked up because of better mammography techniques,” says Dr. Kapenhas.⁵

Ann is eager to investigate other medical mission opportunities, especially those that serve rural residents who have the most challenge getting needed healthcare. She has her eye on a medical mission trip serving children in Ecuador.

The sonography skills and knowledge that Ann has amassed over nearly 30 years have helped countless patients in the United States and in her home state of Tennessee. But seeing the needs that exist in other countries can enliven purpose and passion like nothing else. Ann is grateful to the SDMS Foundation for supporting her first medical mission experience. Chances are good that it won’t be her last.