Pacific health groups tackle breast screening barriers

Many barriers face Pacific Island women over breast screening in New Zealand, including problems accessing transport, different languages and a lack of information and understanding.

By Kara Segedin: Pacific Media Centre

Front line health organisations like the West Fono Health Trust in Waitakere city are making progress directly in their communities by addressing the unique barriers to health care facing Pacific people in New Zealand.

Earlier this year, the West Fono Health Trust was recognised for services to breast screening by Health West PHO. It won an award for most improved practice for breast screening after being contracted by BreastScreen Waitamata Northland to bring Pacific women into the national breast and cervical screening programmes.

Soana Havili is from the community team working with cervical and breast screening.

“We contact women and give them information,” she says.

Havili says there are many barriers for Pacific Island women attending screening, including problems accessing transport, different languages and a lack of information and understanding.

“They don’t know where to go,” she says.

The team helps by offering support and assisting with bookings, transport, and assessment.

“Sometimes their husbands don’t want them to go because there is a lack of understanding,” says Havili.

“The women also don’t want to go to male doctor.”

Wider community
The trust visits Pacific Island groups and churches to bring information to the wider Pacific community.

Havili has seen an increase in the number of women coming for screening in the last year.

“If we do well now it will be much better in the future,” she says.

Pacific Island women in New Zealand continue to be over represented in statistics for breast and cervical cancer. Breast cancer is the most common cancer for Pacific Island women and has a relatively high mortality rate.

Over the past 25 years, figures from the Ministry of Health show ethnic disparities in cancer survival have increased.

In a 2004 report, the Ministry of Health said barriers to breast screening for Pacific Island women included fear, procrastination and pain, whereas a GP’s recommendation was a major motivator to get a mammogram done

Figures from the National Screening Unit (NSU) show only 50 percent eligible of Pacific Island women had mammograms in the 24 months to May 2008. To address the low rates of screening, late last year the NSU ran an ad campaign specifically targeting Pacific Island women and their communities.

The aims were to raise awareness about breast screening, increase understanding of the benefits of early detection and the importance of two-yearly screening.

Graham Bethune of the NSU says for BreastScreen Aotearoa's programme to be effective they must screen 70 percent of the eligible population.

“We are currently at 61 percent for total New Zealanders, but only 50 percent for Māori and Pacific people,” he says.

Reducing deaths
BreastScreen Aotearoa aims to reduce the number of women developing and dying from breast cancer by early diagnosis, allowing treatment to begin sooner.

The goal of their ad campaign was to encourage Māori and Pacific Island women to make appointments to have breast screenings and to show them how to do this.

A campaign that simply targeted all New Zealand women would have been unlikely to significantly increase the percentage of Māori and Pacific Island women having breast screens.

Embarrassment, a lack of understanding of the benefits and where to go all make it difficult for Pacific Island women to attend screenings.

“Many Pacific women weren’t aware it was free,” he says.

The attitudes of husbands, families and the community can be a barrier.

“The ads help get the message into all families’ living rooms,” Bethune says. “It’s on national television, it’s not hidden or secret in anyway.”

The ads could be seen on TV3, Māori Television, iwi radio stations, Nui FM radio network, Mana magazine, Tu Mai, and Spasifik. They show breast screening as an “everyday part of family health”.

While not available in other languages, their advertising material is Pacific orientated, tested with Pacific women and addressing Pacific cultural issues.

It will take 12 months to get statistics to show whether the campaign been statistically significant.

“It’s too early to say, but anecdotally it’s been really positive,” he says.

Meremana Beconici, GSL Network, worked on the advertising with the NSU. The priority audience was Māori and Pacific Island women aged 45-69 who have never been screened or who do not have regular biennial screens.

“There is a secondary target,” says Beconici.

“The family, friends and community members who support and influence these women.”

Research showed women liked straightforward messages, which removed any mysteries associated with screening. They decided to use real people, stories, and experiences.

Suzanne McNicol, marketing and communications manager of the New Zealand Breast Cancer Foundation (NZBCF), says “we do know that Pacific women are 20 per cent more like to die than other New Zealanders (excluding Māori)”.

She does not know exactly why Pacific Island women along with Māori are more like to die from breast cancer, but “part of the problem is late diagnosis”.

The foundation’s goals are that all Pacific Island women and all eligible New Zealand women attend biennial breast screening.

“Screening doesn’t stop breast cancer, but does reduce the chances of dying from the disease by 33 percent,” she says.

“We recommend all women are breast aware, this is recommended for women of all ages. They need to know what’s normal for them,” says McNicol, and seek assistance from their doctor if they notice any changes.

“They need to attend screenings. That’s the key thing that’s not getting through. We want women to know that biennial screening is free for all New Zealand residents.”

McNicol says they had difficulties reaching the Pacific community in the past because “we’ve been using one message for all women”.

Previous health campaigns have not recognised that “different communities need different communications”.

Māori and Pacific people are more receptive to aural and verbal messages and not the pages of data and reports usually supporting health campaigns.

The NZBCF has partnered with community groups, churches, health groups and schools to get information to Pacific people. They are also changing their model of health education to better target the Pacific Island audience.

Kara Segedin is a Graduate Diploma in Journalism student on the Asia-Pacific Journalism course at AUT University.

NSU ad campaign [video]

Demand for Pasifika interpreters hard to match

By Sylvia Giles: Pacific Media Centre

Wanted: More interpreters – especially Pasifika - for the Manukau SuperClinic, which is catering for a district more culturally diverse than any other in New Zealand.

Interpreters used by the clinic - essential for the safety of patients and medical staff - include Afghan, Arabic, Cantonese and Vietnamese.

However, the free service is still having difficulty finding qualified interpreters for core Pacific languages, such as Tongan.

The Counties Maukau District Health Board (CMDHB) has more than double the Pacific population of any other district health board.

Pacific peoples make up 21 percent of the board’s population, compared to 6 percent nationally. The district also has a growth rate of 3.2 percent, double the national average of 1.6 per cent.

Carol Cameron, Interpreting Services team leader, is charged with the task of co-coordinating the extensive interpreting service, which also provides interpreters for Middlemore Hospital, courts and police in the area.

“For the safety of the doctors and the nurses, as well as patients, they should be using the recognised source, which is the Interpreting Services,” she says.

“We need to make sure the interpreters who are out there, doing the job, are trained and that we have regular updates with them, regular meetings and that everyone is aware of their responsibilities.

“The risk of using a family member or friend is that they may not understand the situation. They might interpret the wrong diagnosis, or may interpret wrongly,” she says.

“But also there is concern that if there is bad news, or something like that, they may not tell the patient the correct information. That emotion comes into it.”

Trained role
This explains the Counties Manukau policy that any interpreting must be done through their own interpreting services - by trained interpreters.

“We cannot hire anyone without having done the certificate in liaison interpreting,” says Cameron.

While there may be no shortage of Tongan speakers in the area, the lack of speakers with the necessary qualification hinder the ability to provide the service.

“Tongan people seem to be reluctant to do the course,” she says.

At present, they have one point five Tongan interpreter permanently on staff – between all the services they cover – as well as a small pool of casual interpreters.

Ineke Crezee, course coordinator for Translation and Interpreting Studies at AUT University, has found an increased demand for trained interpreters since the course’s inception in 1990.

However, the ability to produce interpreters still rests with the speakers that enter the course.

“We do not always get applicants representing particular languages applying to do the course and if we do, we sometimes find that their command of the English language is not such that they would be able to successfully train to be interpreters,” she says.

Crezee says the high demand for Pasifika language interpreters continues to hold strong, and she has noticed an increased number of Pasifika students coming to do the course.

Samoan legal terms
“This year we have a group of three Samoan students undertaking a legal interpreting paper, which is great because it enables them to discuss the correct Samoan translation of particular legal terms with their language peers.

“Two years ago we had three Tongan students in our liaison interpreting course. However, some of these were taking the paper as part of BA studies and went into alternative employment upon graduating,” she says.

“We get the whole range in terms of age, gender and ethnic and socio-cultural backgrounds, ranging from young second generation speakers of Chinese – whose English may be much better than their Chinese, since they did not complete secondary and tertiary education in a Chinese speaking country – to mothers wanting to train for casual work, to older community leaders with excellent skills in both English and their own languages.

Andrew Gordon, ear, nose and throat specialist at the Manukau clinic, estimates that for a clinic of around 10 to 12 patients he will have one or more that needs an interpreter.

“They are indispensable. Otherwise you just become a veterinary practice, to be blunt,” he says.

“And there are certain types of problems where the medical history is everything, like dizziness or tinnitus which is relatively subjective, unlike examining a lesion,” he says.

Nicky Hopping, surgical booker for the Ear, Nose and Throat Department at Manukau SuperClinic, will book interpreters at the same time as surgeries, and has encountered the lack of Tongan translators in particular.

Cancelled surgery
In her role, the worse case scenario is a cancelled surgery. But the cultural nuances involved with the job on the whole are subtler, making the job of a qualified interpreter all the more crucial.

“Sometimes the family doesn’t want an interpreter. Culturally, they just don’t like an interpreter being in the room” says Ms Hopping.

“Or sometimes, with some cultures, a man will feel protective of his wife and will not tell her the whole story.”

Carol Cameron agrees: “The entire service relies on identifying the need for an interpreter. Unless it is recognised either by the GP, or the person booking the appointment that an interpreter is required, someone may well come in, and struggling with English. They might get half way through the appointment and the doctor might think, ‘This is not going anywhere, I actually need an interpreter.’”

These last minute requests, Ms Cameron points out, are the hardest to fill.

“It is better for us to book an interpreter, and have the patient turn up and say ‘I am OK, I don’t need that,’ rather than us allowing a consultation to happen and maybe the patient walking out and not understanding a word that the doctor said.

“And they need to be qualified so that they understand issues of confidentiality. For the purposes of clinical safety, and medico-legal issues, they are absolutely needed,” she said.

In her experience, most patients felt confident to ask for an interpreter.
“I think the general public will say if they need an interpreter,” she says.

“It is better to do that than for the patient to walk away not really understanding. And if we can’t provide an interpreter, a follow-up appointment needs to be made.”

For any patient, who might already be feeling vulnerable or fearful, being put into the situation of not understanding the doctor would be frightening.

“It is not until you visit a country yourself that you know it’s really hard making yourself known,” she says.

“So, I also too think that we, working in Counties Manukau, need to be aware and if we feel that someone doesn’t understand it is better to check. And if not, ask the patient if they would like an interpreter.”

Sylvia Giles is a Graduate Diploma in Journalism student on the Asia-Pacific Journalism course at AUT University. Pictured: Manukau Superclinic.

Awesome work

Sounds like fantastic events at the PMC. Keep up the awesome work.

Ruth DeSouza
Centre Co-ordinator/Senior Research Fellow Centre for Asian and Migrant Health Research
National Institute for Public Health and Mental Health Research
AUT University
www.aut-camhr.ac.nz