With her rosy cheeks, fit physique and easy smile, Mirna Bardales looks like the picture of health. Perhaps watching up to five children in her home day care keeps the 65-year-old Towson resident looking so young. Receiving routine cancer screenings also helps ensure Bardales’ continued good health. But until four years ago, when the Peru native learned of an outreach program at the University of Maryland’s St. Joseph Medical Center’s (UM SJMC) Cancer Institute that provides uninsured women in the Baltimore area with breast health education and free breast cancer screenings, Bardales had never even heard of a mammogram.
One Voice began in August 2011, when the hospital received an 18-month American Cancer Society grant that allowed participation in the 100 Free Screening Mammogram and Education Program: breast cancer screenings for 100 underserved, uninsured women in Baltimore City and County. To date, the program—no longer grant-funded—has provided more than 500 mammograms at no charge. Thanks to the generosity and partnership of individuals and programs within and outside of the hospital, One Voice continues to evolve and grow, offering diagnostic and referral services in a safe and comforting setting.
“Initially, we only did breast cancer screenings. Then we realized we needed to do diagnostics. Then we realized these women also weren’t getting screened for cervical and colon cancer,” said Donna Costa, community outreach program manager at the UM St. Joseph Medical Center Cancer Institute, who coordinates One Voice.
Despite the onerous task of continually identifying, forging and maintaining partnerships with several key players and components of One Voice, Costa appears calm, composed—and wholly invested in keeping the program moving forward. “It’s truly a collaborative effort,” she said, deflecting attention or credit for the program’s success. Instead, she points to the partners of One Voice, including Advanced Radiology, which continued to provide free mammography services after the original American Cancer Society grant ended.
“We’re just glad to partner with the hospital, to support the patients, and to be a part of the community that helps these patients,” said Julia Flukinger, MD, a radiologist with Advanced Radiology, housed at UM SJMC. “Mammography is the one thing that’s proven to reduce deaths from breast cancer.”
The population served by One Voice is less likely to get regular mammograms than other women. Women ages 40 to 64 who are not insured are less than half as likely as women with health insurance to have received a mammogram in the past two years. Further, all Hispanic women in this age range—insurance status notwithstanding—are less likely than both black and white women to receive regular mammograms, according to the Susan G. Komen organization. And although Hispanic women statistically are less likely to get breast cancer, they are 20 percent more likely to die from it. Experts theorize that this is partly because the disease is often detected at advanced stages among this demographic. These statistics are particularly relevant to UM SJMC’s One Voice population, about 95 percent of which is Hispanic.
Several barriers prevent women served by One Voice from receiving regular, potentially life-saving screening services like mammograms. “They don’t have insurance. They don’t have primary care,” said Sandra Villa de Leon, Baltimore program manager for Nueva VIDA, a partner organization of One Voice that supports medically underserved Latina women in the Mid-Atlantic region with cancer screenings and treatment. Lack of proper residency status, transportation and health information also present obstacles. Nueva VIDA understands the barriers and reaches out to women in the community to help overcome them.
Villa de Leon first came in contact with One Voice patient Bardales through St. Clare Medical Outreach, started by SJMC in 1998 as a mobile van providing free primary care and health education to uninsured community members. Bardales, who receives care from the bilingual staff at St. Clare’s (now at a permanent site in Lutherville), learned about One Voice there.
Initially, Bardales says she was nervous about getting a mammogram, a procedure that she’d never had done. But Villa de Leon made her feel comfortable, educating her on the process and helping her navigate additional steps when results from the test indicated that she would need diagnostic services. After receiving close follow-up every six months at UM SJMC for some time, Bardales has been cleared to return to once-a-year mammograms.
“The patients trust Sandra. And because they trust her, they bring their sisters, their mothers, their friends,” said Costa about Villa de Leon, whose native Spanish language facilitates communication with many One Voice patients. So does Villa de Leon’s approachable manner, which she applies at local health clinics, churches, community centers, and even at supermarkets when she encounters women she thinks may benefit from One Voice.
Getting women to agree to come to UM SJMC for a mammogram is often the most challenging part of the process. “I feel comfortable when I come,” Bardales acknowledged.
Staff members recognize the barriers these patients face, and do their best to provide a welcoming atmosphere. “I have never encountered issues with trust once these patients step through the door,” said Dr. Ethan Rogers, a surgeon with UM SJMC’s Breast Center. “I never felt they were suspicious or distrustful.” He has honed his Spanish-speaking and -listening skills as a result of working with patients from the One Voice program, and demonstrates compassion for the circumstances of patients who end up requiring breast cancer treatment.
“My job is not only to make sure their cancer gets treated, but to make sure they have adequate support systems to get through that process. It’s hard enough to get through [the process] when English is your first language,” said Rogers, who has gone to great lengths to ensure his patients’ comfort, even writing a letter to the embassy of one of his patient’s homelands so that her mother would be granted permission to be with her daughter as she received cancer treatment at UM SJMC. “Surprisingly, it worked,” he said of the letter.
Evolving to meet patients’ needs
Previously, One Voice patients whose mammograms indicated a need for further diagnostics would have to apply through the county or state for medical coverage of those processes. To date, about one-third of patients who’ve receive mammograms through the One Voice program have required diagnostics — either additional diagnostic mammograms or breast ultrasound. Many patients found the process, which required paperwork and additional logistics, too burdensome to complete.
“We were losing people to follow-up,” Costa said.
That’s when One Voice stepped up its involvement. Now, the program works directly with patients to register them for Maryland’s Breast and Cervical Cancer Diagnosis and Treatment Program, which covers the cost of surgeries and follow-up care for uninsured patients. So far, all but one of the patients who have needed treatment for breast cancer chose to receive care at UM SJMC.
One Voice continues to expand its scope by connecting its patients to additional ealth resources. Recently, it joined forces with the Baltimore County Department of Health to take part in a pilot program in which a bilingual staff member from the county comes to UM SJMC on the appointed day of the month when One Voice offers its mammogram screening program. Here, they register eligible women for free cervical and colon cancer screening programs provided by the county.
Thanks to One Voice, Bardales is currently up to date on her breast, cervical and colon cancer screenings. She now volunteers to help translate for eligible One Voice patients as they register for cervical cancer screening. “When I come here, I feel good. Safe,” said Bardales, who has also told some of her neighbors about One Voice.