New partnership reaches out to underserved women

Donna Sanderson, left, and the Susan G. Komen Foundation are bringing promotoras like Ivy Felix into underserved communities to increase breast cancer awareness among women in high-risk groups.

When UC Davis physicians and medical students discovered low rates of routine mammographic screening among members of some cultures, they devised a plan that led to a productive partnership between the Susan G. Komen Foundation and three student-run medical clinics. A cluster of three grants from Komen funds a "promotora" program that is encouraging more African American, Asian-American and Islamic women in the Sacramento area to get mammograms.

A "promotora de salud" (Spanish for "health promoter") is a lay health-care adviser who performs educational services, traditionally within Hispanic communities. UC Davis physician Amerish Bera thought the concept would work well among other cultures, too, and consulted with Komen to expand the concept.

Photo of Pearl Ma"With relationships that only promotoras can develop, we now are able to confidently reach women in areas and among populations that otherwise might not be comfortable at all with discussing breast cancer."
— Pearl Ma, second-year medical student and co-director of UC Davis' Imani Clinic

"At the core of the model is a community health worker who has engendered credibility and trust within the community," said Bera, an associate clinical professor of internal medicine and a mentor for medical students. "Our intention is to reach out to ethnic communities, involving medical students in that process."

The Komen Foundation awarded its grants in 2005 to actively reach out to women in the black, Muslim and Vietnamese communities in Sacramento, who might not be aware of breast cancer screening options. The clinics, in which medical students under the supervision of physicians provide free primary care to patients, are an ideal location in which to coordinate the promotora program and identify patients in high breast cancer risk groups.

Since the initial grant began, the Komen partnership has supported everything from the hiring and outreach work of seven promotoras, to mammograms, educational materials and simple office supplies like envelopes and stamps, which are used to send vital reminders to woman about the need to have periodic cancer screenings.

Second-year medical student Pearl Ma, a co-director of UC Davis' Imani Clinic in Sacramento's Oak Park neighborhood, was in charge of submitting the initial foundation grant. When the Komen funding arrived, Ma hired two women who were already actively involved in the community and its local health fairs. Ma trained them how to do a proper breast self-exam and how to demonstrate the technique to a group using a mannequin model.

"Studies have shown that community-based interventions and outreach are much more successful in reaching women targeted by this initiative than conventional methods," said Ma, who is studying to become a physician in an underserved community.

"Promotoras go door-to-door to visit women who have been referred to them by other women. They conduct small presentations in varied settings such as a woman's living room, an apartment building patio, community room or church."

The relationships promotoras establish with women in their local communities are a crucial aspect of the program's success and among the reasons why the UC Davis program stands out for a cancer awareness organization like Komen. Not only do the promotoras personally distribute educational materials and provide health information in a culturally sensitive manner, they also conduct surveys and collect accurate information so that screening referrals and the all important follow-up reminders for mammograms can be more effective.

"With relationships that only promotoras can develop," says Ma, "we now are able to confidently reach women in areas and among populations that otherwise might not be comfortable at all with discussing breast cancer."

Since the promotoras program began, nearly 200 women have received clinical breast examinations, many for the first time, and nearly a thousand women have received counseling and educational materials to increase awareness about treatment options. For Ivy Felix, one of the promotoras at the Imani Clinic, it's about learning and making a difference in the lives of women in her community.

"I love my job," said Felix. "I have the opportunity to help women get the mammograms they need and to help UC Davis conduct surveys so we all can better understand why the mortality rates among African-American women are so high. Our job is to find the causes. Is it that women don't go to the doctor, don't know where to get regular check ups, or what? Women don't have to say they don't know anymore. We can know and it gives me great joy to be a part of the process."