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Language barriers don''t stop breast cancer

  • June 30, 2004
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From nightmarish refugee holding sites, from wars, poverty and hopelessness, the women come to St. Louis. They are from Somalia, Bosnia and Iraq. Mexico, Colombia and Togo. They speak French, Dari, Russian and Af-Maymay.

With tubes taped into her chest and her bald head covered with a knit cap, a 43-year-old woman - who asked me to refer to her as A.A. - fled western Africa without her four daughters. Other women fortunate enough to bring their children are like a lot of mothers. The children come first. The women may have lumps in their breasts the size of plums, but what they''re concerned about is immunizing their children.

For some of the women, it has been taboo even to discuss breast cancer aloud. The translation may be the "rotting disease," caused by an ill wind or some mistake the woman made in child-rearing. A woman may feel it is sinful to look at herself naked in a mirror.

Or the women are behind a veil. They stay in their St. Louis homes, where decisions are made for them by a protective husband or brother-in-law. So it was that Toybat Ibrihimi, a Kurdish immigrant and Barnes-Jewish Hospital interpreter, went into a home where women were baking bread for a wedding. Between the mixing and kneading, Ibrihimi taught them how to examine their breasts.

There are very few gatherings in St. Louis, or any American city, that bring together people of literally every age, race, creed, culture, political belief and socio-economic and educational level. In a way, it''s sad that a killer of 40,000 innocent Americans every year - a 9-11 a month - is the force that brings us shoulder to shoulder this weekend. That killer is breast cancer.

Every year I hate it more, even as my own survival numbers stretch into the safety zone of 16 years (Lefty) and seven years (the jealous twin who apparently would go to any extreme for equal attention). But Saturday''s Komen Race for the Cure was about more than the memorials, hope and spontaneous love shared by some 50,000 people crowding downtown streets, and others "virtually" racing from wheelchairs and beds by entering online. The event has become a consequential money-making machine.

From a humble take of $309,000 in 1999, last year''s event rang up almost $1.4 million. Three-fourths of that money remains right here in the St. Louis area.

One of Komen''s relative drop-in-the-bucket grants goes to the Daylight Project, run out of Barnes-Jewish Hospital''s Refugee Health and Interpreter Services. The office tends to the staggering needs of all foreign men, women and children who come through the BJC system. There was only so much money and manpower that could be diverted to the daunting task of talking to women of myriad cultures about breast health, especially the importance and methods of early detection of cancer - a concept often entirely new to them.

Two years ago, the St. Louis Komen foundation stepped in with a grant to expand and fund most of the Daylight Project, devoted exclusively to this effort, reaching nearly 4,000 women a year. Mammograms alone number close to 500 a year.

Now Eva Enoch, a native Romanian and refugee health outreach coordinator, can devote 90 percent of her time articulating difficult messages to women in Romanian, Hungarian, Russian and French, helping them navigate detection and treatment. A team of women has been trained to go into immigrant communities, teach breast self-exams and help them get mammograms.

Last year, a woman from Somalia landed in the office of Barbara Bogomolov, a nurse who runs the refugee health service. Having heard about the Daylight Project program from a fellow immigrant, the woman had the biggest breast tumor Bogomolov has ever seen. Bogomolov was relieved when she ran into the woman recently in the lobby, although she wasn''t able to speak to her without someone who could interpret Af-Maymay.

"All we could do is smile," Bogomolov said. "Then she placed her hand first over her heart, then over mine. I knew what she meant."

Thank you, to all the strangers who cared.


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