February 22, 2010, ST. LOUIS – Often an uninsured woman in St. Louis experiences a delay in receiving care after discovering a change in her breast or being told she needs follow-up for an abnormal breast exam or mammogram.
Barriers such as low health literacy, limited transportation and lack of health insurance may block access not only for women born and raised in St. Louis, but also for newly arrived refugee and immigrant women who face additional language and cultural gaps.
Barnes-Jewish Hospital’s “Daylight Program,” in partnership with the St. Louis Affiliate of Susan G. Komen for the Cure (R) and the Latinas Por La Cura Breast Cancer Survivor Group, will host the “Closing the Gap” Summit, March 8 at the Center for Advanced Medicine for community leaders and health care providers to propose strategies to shorten this delay to definitive care for both US born and newly arrived women in St. Louis.
“St. Louis has great health care,” says Barbara Bogomolov, RN, manager of refugee health and interpreter services at Barnes-Jewish. “But if a woman is at home feeling that lump in her chest and doing nothing, that great health care means nothing.”
While social and financial barriers can be formidable, language barriers are especially problematic in St. Louis. In a given year, Barnes-Jewish Hospital provides interpretation for over 12,000 limited-English speaking patients and their families in 81 different languages.
Through a grant from the St. Louis Affiliate of Susan G. Komen for the Cure (R), Barnes-Jewish screens refugee and immigrant women for breast cancer at no cost, primarily through outreach efforts on the Siteman Cancer Center mobile mammography van.
“The lessons we have learned in improving care for immigrant women has led us to wonder what might be transferable to women born in the United States who face similar barriers,” says Eva Enoch, MHA, outreach coordinator in refugee health and interpreter services. Enoch and fellow outreach assistants Irma Martinez and Belma Begic organized the summit.
The summit will explore the formal and informal referral process in St. Louis and eliminate system barriers that make it challenging for women to move from concern to actual care with qualified providers.
“The goal of the summit is to look at ways to change the present reality,” says Bogomolov. It takes an average of three months for a marginalized woman to be seen by a health care provider after she begins to seek care for a change in her breast. The barriers are such that some women put off seeking help until their problem is so serious they see no other choice but to present to an emergency department.
“You’re more likely to survive this disease at stage one or two rather than after a diagnosis at three or four,” she says. “Our goal is to ratchet down the disease stage at diagnosis by improving access to early detection services.”
Barriers for patients include questions such as: I don’t have a car so how do I get to the hospital? How do I pay for treatment? Who will watch my children? How do I call to make my appointment since I don’t speak English?
Ultimately, the summit should lead to a more savvy community of women who know how to get themselves or loved ones into care as soon as a problem is suspected or found. “There are women in St. Louis at any given moment wondering what they should do, and we want to create the same reality for them that we have for our best friends,” says Bogomolov. “That they know people who can help them get timely access to early detection and care.”