This article first appeared in the St. Louis Beacon, Sept. 30, 2011 - When Barnes-Jewish Hospital began offering special breast screenings for refugees nearly a decade ago, the program was shunned by some of the women it sought to help. The hospital learned that mammograms were a low priority among women uprooted by political strife and violence in their homelands and struggling to rebuild their lives in the United States.
Over time, Barnes says it has developed and refined a culturally sensitive program that has helped it reach more refugees for cancer screening and treatment. At the heart of the system, says the hospital's Eva Enoch, who manages the program, are "wise women" -- trusted and influential females from local refugee and immigrant communities. Fluent in languages spoken by the refugees, these women are helping Barnes bridge the cultural gaps and remove barriers to screening and treatment for breast cancer, Enoch says.
The work of wise women will be among the topics discussed in during Washington University Institute of Public Health's conference "Beyond Borders: Transforming Health at Home & Abroad," which runs from 12:30-5 p.m., Wednesday, Oct. 5, at the Eric P. Newman Education Center. Keynote speaker is Dr. Roger I. Glass, director of the Fogarty International Center and associate director for global health research at the National Institutes of Health.
Topics include lessons learned from local and global health initiatives, especially those aimed at meeting health needs in a St. Louis that's becoming more diverse. Click here for more information.
Enoch is as excited about the conference as she is about the wise women's program. Since it began in 2002, the Wise Women program's name has changed to the Daylight Project. The new name reflects an effort to bring breast cancer out into the daylight, program leaders say.
Some Consider Breast Cancer Shameful
Enoch says it didn't take Barnes long to discover that it had to do more than pass out pamphlets and assume immigrants would flock to the hospital to get mammograms.
"In many cultures, breast cancer is considered a shameful disease," she says. "Even if you have it in your family, you don't talk about it. You keep it secret. And you don't go to have screening because in case you find out that you have it, that would bring shame on your family."
In addition, Enoch says, mammograms didn't necessarily fit into the schedules of female refugees who must learn a new language and find housing, employment and child care.
"But when we go into the communities, we emphasize that the mother is very important to the survival of the family," she says. "That is why it is important for the mother, the woman, to take care of herself and be healthy."
The key to getting across this message has involved establishing trust with refugees.
"If a refugee woman goes to a food market and sees one of our fliers, even if the flier is written in her language, the trust is not there. Would she call us to schedule an appointment? Maybe not."
That's why wise women have made a difference. An estimated 25,000 female refugees live in St. Louis. Enoch's program has screened more than 7,000. They have learned how to do breast exams and have been taught the importance of early detection.
Wise women "are the ambassadors of the program. They are residents of the community, speak the language, know the culture. They are the ones who go in, teach and empower women. "
Delay In Diagnosis Can Be Harmful
One report on the program says the differences in language, culture and beliefs can all complicate or delay a refugee's access to health care.
On average, according to a nurse in the Daylight program, it takes about 90 days from the time a refugee woman notices symptoms until she seeks diagnosis and care. That's a crucial issue since later detection usually results in poorer outcomes, according to the American Cancer Society's guide to cancer survival by stages. The survival rate drops sharply as the disease is detected in later stages.
The BJH program has 17 wise women. More have been trained, but some have dropped out because they are in school or have full-time jobs.
"We are still looking and seeking to train more women," Enoch says. "They still have work to do in reducing morbidity and mortality related to breast cancer in St. Louis."
She has no hard data on the incidence of breast cancer among refugees or their survival rates. But others point to anecdotal evidence showing that Barnes' program is leading to earlier detection and better outcomes.
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.
