Taking It to the Streets

Roshani Patel, MD, breast surgeon at Dartmouth-Hitchcock Manchester, noticed something was different—wrong even—when she first came to New Hampshire in 2010.

Focus article photo

Roshani Patel, MD, breast surgeon at Dartmouth-Hitchcock Manchester is working to educate refugees on breast cancer detection and treatment.

She was hearing of women being treated for locally advanced breast cancer, women who had come to Manchester, New Hampshire, seeking health, safety, and prosperity as refugees from war torn countries.

To women who don't even have words in their first language for the disease that is ravishing their bodies, Dr. Patel offers information on breast cancer signs and symptoms, screening methods and treatment options.

Obstacles to breast cancer detection

As a designated refugee resettlement city, Manchester's refugee population has increased dramatically since 2004.  This is a vulnerable population with limitations in income, transportation, and communication. Language barriers and lack of certain terminologies in native languages prohibit women from being able to communicate their health care concerns.

Elevated risks in certain populations?

Dr. Patel says "Many of Manchester's refugees come from countries where the incidence is lower than the United States, but they develop breast cancer at younger ages and these cancers can be more aggressive than what we typically see. It is apparent that many women in Africa and Asia do not get care for cancer or other diseases until it is too late and they have to undergo procedures with high morbidity." Unfortunately, she has seen a few cases of advanced, very aggressive breast cancer.

Cultural barriers to breast cancer treatment

"Often times, because of cultural barriers, these women don't seek care until their disease has significantly progressed and many have no words for the issues they are dealing with." Once diagnosed, Dr. Patel shares that many are resistant to receiving chemotherapy as they are the only care-givers in their families.

In addition to delaying care, cultural barriers often impede proper education. At one group Dr. Patel visited, a male translator prevented her from showing the breast models that she typically uses to demonstrate how to do a self-exam and what breast lumps feel like.

Connecting with Manchester's diverse population

Of Dr. Patel's work, Dana Jean Blanc, former Deputy Director of the Somali Development Center, says "Dr. Patel is very committed to the refugees in this area. She is very patient and her style of teaching makes it easy to understand. She is focused on understanding what our refugees' health care needs are and looking forward, wants to address those needs."

Dr. Patel visited the Somali Development Center twice to teach about breast cancer. Unfortunately, the center has closed.  Now she is working with Monica Zulauf at the YWCA on Manchester to develop a similar program.

"We need to work together to educate and empower refugees so that they can better help their families. By sharing resources, we may be able to streamline care for the community and increase access to available resources," said Dr. Patel.

Living healthy after breast cancer

Since 2010, Dartmouth-Hitchcock Manchester has worked with other organizations in the community to develop a comprehensive rehabilitation and exercise program to assist patients with survivorship in a positive, nonjudgmental, care and safe environment.

Dr. Patel pioneered a partnership with the YMCA of Greater Manchester, and Catholic Medical Center's Outpatient Rehab Specialists and Wellness Center, to create an exercise program for a group of her patients. This pilot group of women experienced benefits including weight loss, decreased medical problems (i.e. better control of diabetes, less joint problems, decreased lymphedema, etc.), less side effects from chemotherapy, radiation, and surgery, and a more positive outlook towards life.

The program is being expanded to help all cancer survivors in the area. A comprehensive nutrition program in conjunction with Elliot Regional Cancer Center and Dr. Polina Sayess (Concord, NH) is underway to complement the exercise program at the YMCA for all cancer survivors.

Not letting income get in the way of getting better

Recognizing that for refugee populations, income level is often prohibitive of engaging in such exercise and nutrition programs, Dr. Patel has been working with the above organizations to be able to fund services and find more support for low income women. "I want to make sure that all women have access to resources that support their health. We need to care for the whole patient, not just the cancer."

October 22, 2012