Clinical nurse Mary Macdougall now struggles to fit immigrant women into her busy schedule.

Joint outreach program helps aging immigrant women take charge of their health

As the clinical nurse for a St. Joseph's Healthcare program for mature women, Mary Macdougall knows how critical regular breast screening and pap smears are for her patients.

So she was concerned when she noticed something missing among the women making appointments to see her at the Women's Health Centre. While the number of patients had grown steadily ever since the centre opened its doors in 2001, all were non-immigrants. The same was true for the centre's breast-screening program.

"We were getting all kinds of women in the community who were coming in," Ms. Macdougall recalls. "But neither of us was seeing any immigrant women at all."

The patient shortfall was all the more troubling because nearly a quarter of all Hamiltonians are immigrants and statistics show immigrant women are twice as likely to forego pap and breast screening.

To find out why, Ms. McDougalland the centre's medical director, gynecologist Amie Cullimore, interviewed -- with the help of interpreters -- women from the city's immigrant communities The results of the 2004 survey weren't surprising and were consistent with similar studies elsewhere.

Key barriers included language, cultural sensitivities, being unaware of the service and difficulties in arranging transportation to the centre, located in St. Joseph's ambulatory care centre in the city's east end.

"As a screening, this is a population that we definitely want to target," she says.

Luckily, the study coincided with a decision by the city's health department to hire and train educators to hold health information sessions for women from the Chinese and Vietnamese communities to stress the importance of screening.

As a former health department nurse, Ms. Macdougall seized the opportunity to establish a partnership -- to the delight of the educators, who were unaware of the centre's services.

"They said to me, 'We're going out and talking to our women about screening, but we don't know where to take them,'" she recalls. "They don't want to go to their family doctors for a lot of cultural reasons. They wanted females."

Ms. Macdougall joined the educators at sessions, allowing her to put women at ease about visiting the centre.

"They knew then that if they came into the clinic, this is who they would see," she says. "And I think because I was female and I was there talking to them, they certainly felt comfortable, so a lot of women, after these sessions, decided they wanted to come in."

Four years later, appointments have grown to the point that she finds it hard to fit them in her two-days-per-week schedule. Initially, the women came in groups, but many now book their own appointments. The public health department has also increased the number of educators to include the South Asian and Arabic communities.

Ms. Macdougall says a key benefit of her "well-woman care" program, which is open to women aged 40 to 69, is that she can take the time for a comprehensive health assessment. Besides providing pap smears and pelvic examinations, she also discusses a wide range of health issues like medical history, menopause changes, diet, exercise, mood, employment and social relationships -- something many family doctors don't have the time to do.

"I'm able to sit down with these women for 45 minutes to an hour and answer all sorts of questions about aging," she says. "Many of these women have never had a pap smear, and yet they'll come in and say they've had five children."

The outreach initiative, which won a leading-practices award from the Ontario Hospital Association last year, is helping close the cultural gap on pap smears.

According to 2001 statistics, 20.5 per cent of immigrant women in Hamilton aged 18 and older had never had a pap smear, compared to 10 per cent of non-immigrant women.

Ms. Macdougall says that's a big concern because pap smears are the only way to screen for cervical cancer.

Screening should begin within three years of first sexual activity and continue every one to three years, she says, while mammogram beast screening should start at 50 and continue every two years unless prescribed earlier by a doctor.

For more information on the mature women's health program, call 905-573-4849.