USE CALLS HO
House Calls
Innovative program increases breast cancer screening rates among South Asian women
Q: How can spiritual or religious beliefs help some patients cope with serious illness? A: I am reminded everyday when I enter the hospital that to lose one’s physical health and former capacity is a profound loss. For those who are in good health, it is hard to grasp the enormity of loss for some. Yet I bear witness to it everyday. When I make my rounds at the hospital and visit with patients who are seriously ill, I am often brought to a quiet place. A place which suggests that although it may appear otherwise, patients are some of the hardest working people within the hospital. Spirituality grounds people. For some, spirituality is nurtured and expressed within the context of faith and religion. For others, spirituality is reflected through the love of family, gardening, music, art or the wonder of nature. Spirituality has to do with how we make sense of the world. It includes how we connect with ourselves, each other and the world around us. Spirituality supports the inherent value of a person and of life itself. When a patient becomes aware of and then begins to grieve the losses associated with serious illness, their sense of personal value is often diminished. Although this is a normal part of grief, it can cause a period of deep personal suffering. Connecting with one’s spiritual beliefs and practices becomes very important. Grief cannot be shortchanged yet spiritual beliefs ground a patient to their deeper truth and, in time, bring restoration to their sense of personal value. A patient whom I visited recently put it this way: “It’s important to connect to your deeper values so you don’t get caught up on physical changes. I look at my legs now – just bone and skin – while just last fall I played golf and tennis. I have a new physical reality; but it doesn’t change the essence of who I am.” Connecting with others becomes very important for those facing disease or illness. Creating or maintaining interactions and relationships with cherished people in one’s life can be uplifting. This love and support from others may not take away deep personal suffering, but it can ease the pain even if only for short periods. While in hospital, this support person or group could be a family member, a friend, a faith or spiritual community, a nurse, a social worker, a doctor, or a chaplain. At Hamilton Health Sciences, chaplains are available to help guide and support patients of all spiritual and religious traditions through their journey. The chaplain provides emotional support, grief counseling, and coordination of rituals and services. If you or a loved one is in hospital, speak with a member of your healthcare team to arrange a visit with the chaplain on site. House Calls is written by experts at Hamilton Health Sciences. Ann Vander Berg is a chaplain and specialist in the spiritual care program at the Juravinski Hospital and Cancer Centre.
Connecting directly with immigrant South Asian women in person was essential to the program’s success. In the first six months of the project, Roodaba met with more than 400 South Asian women through educational sessions and displays hosted at community centres, festivals, schools, English as a second language groups, and faith centres. She arranged group screening appointments and complimentary transportation via the OBSP’s shuttle van and, when necessary, accompanied women to the OBSP to provide translation services and cultural support during appointments. Reaching out – Pictured above (centre), Roodaba Alvi, Ontario Breast Screening Program (OBSP) women’s health educator, escorts women to the OBSP to provide cultural support and translation services during their breast screening appointment.
For many immigrant South Asian (SA) women, proactively screening for breast cancer is something that isn’t often considered. There are many cultural beliefs around participating in a test that requires a woman to expose an area of her body that is normally covered, and so the topic is considered taboo. This, in addition to educational barriers and transportation challenges that may prevent SA women from seeking and accessing mammography services. Thanks to an innovative partnership between the Juravinski Cancer Centre, Ontario Breast Screening Program (OBSP), and the City of Hamilton’s Women’s Health Educator program, more SA women are participating in proactive breast cancer screening. The initiative began in April 2011 and set out to increase screening rates among immigrant SA women by targeting three main audiences: SA immigrant women, family physicians who serve the increasing SA population, and staff of the OBSP sites in Hamilton who actually provide the mammograms. The key to the program is Roodaba Alvi, who was seconded to the initiative on a part-time basis. She’s also part of the City of Hamilton’s Women’s Health Educator program, a free service designed to help women who speak little English to access health services and learn how to stay healthy. Roodaba speaks four languages - Urdu, Hindi, Punjabi and Arabic – and her ability to relate with this population in their native language is essential to the program. As a member of the South Asian community herself, Roodaba is also in tune with the culture and challenges faced by immigrant women. “Many South Asian immigrant women lead isolated lives, “ says Roodaba. “They may be focused on getting a job, housing, schooling for their children or caring for elders. Thinking about their own health or knowing what is available to them isn’t something that they are likely to be concerned about.”
This unique approach to support and outreach is only part of the solution. The program also aims to help healthcare providers understand the unique cultural and educational needs of immigrant South Asian women, so that women have a positive experience and return again in the future for a routine screening appointment. Roodaba and Cindy Mutch Thomson, former regional health promotion coordinator for the OBSP, have been meeting with family physicians, primarily of South Asian descent, to find solutions to help physicians better communicate with and educate their South Asian patients on the importance of proactive screening. It’s widely accepted that the single, best recruitment strategy for cancer screening is for a patient’s family physician to recommend their patient to be screened. Through their efforts, Roodaba and Cindy have helped seven doctor’s practices to send a personalized letter inviting all of their eligible patients to participate in breast screening every two years or as required. Translated materials are also included in the mailing. “The physicians are all very happy we’re doing this work. They have seen significant improvements and increases in breast cancer screening rates among their South Asian women,” says Roodaba. A third significant part of this initiative is to ensure that when the South Asian women attend their screening appointment, they’re cared for by people who understand their cultural sensitivities. Roodaba and Cindy conducted cultural sensitivity training sessions to over 200 healthcare staff at the OBSP and to diagnostic imaging staff in Hamilton, to help them understand the perspective of the SA woman so they can deliver the best care possible. “This initiative is very rewarding because it’s helping to build trust and understanding among the SA women and the healthcare providers, and we’re already seeing an increase in the number of women coming to the OBSP for screening.” says Roodaba. The Juravinski Cancer Centre Foundation provided a $25,000 educational grant to fund this important work that will help improve the health of many immigrant South Asian women.
The Ontario Breast Screening Program The Ontario Breast Screening Program (OBSP) is a program of Cancer Care Ontario. The Juravinski Cancer Centre oversees the OBSP-affiliated clinics in our region. The OBSP provides high-quality mammography services for women 50 years of age and older. Mammograms are free-of-charge for women in Ontario. Breast cancer screening is the regular examination of a woman’s breasts to find breast cancer early. A breast X-ray (mammogram) is the best screening tool. Breast cancer screening saves lives. Between 1989 and 2005, breast cancer mortality rates in Ontario women aged 50–69 decreased by 35 per cent due to improved cancer treatments and increased participation in breast cancer screening. Regular breast cancer screening can find cancer when it is small, which means: • There is a better chance of treating the cancer successfully. • It is less likely to spread. • There may be more treatment options. Women interested in attending the OBSP can call directly to make an appointment. A physician’s referral is not required. Call (905) 389-4411 x 42497 or visit www.cancercare.on.ca for more information.
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