Saving Lives Through Early Detection

Story and photos by Ben Gray / LWF

After two years working as an oncology and chemotherapy nurse at The Lutheran World Federation’s Augusta Victoria Hospital (AVH) and seeing many patients with late-stage breast cancer, Murjan Abed decided she wanted to fight cancer a different way. She had read that early detection was the key to saving lives and she wanted to see that for herself, so she began working in the mobile mammography clinic as a senior nurse.

Now, seven years later, she knows that she has helped dispelled myths and taboos about breast exams, brought services to remote, poor villages and saved countless lives.

“When the woman has a good outcome and we help her to have a better life… I can’t describe that feeling,” she says with passion filling her voice. “All of the struggle we go through to work in these remote villages, the hard circumstances, they are worth it because of what we give to the women. It brings me great satisfaction and pride.”

The locations the clinic visits are identified in conjunction with the Palestinian Ministry of Health and are chosen because of the need and because there aren’t nearby health services the women can access. This remoteness means that Abed and her technicians spend much of their day traveling. On this day, the clinic was set up in a schoolyard in the West Bank village of Kofer Sour, 130 kilometers from the AVH campus on the Mount of Olives. Due to checkpoints and having to pick up personnel who can’t easily access Jerusalem, the trip took more than two hours each way.

“At AVH, we are so proud of the hard work of our mobile mammography clinic staff,” said Walid Namour, CEO of AVH. “The impact of their work is widely recognized and even led to the clinic being a finalist for the prestigious Haj Ahmad Abu Ghazaleh Award of Excellence in Health for the year 2018.”

"We strive to bridge the gap and provide adequate access to screening mammograms for the medically underserved communities of the West Bank. Screening mammograms clearly save lives: they are considered the international gold standard for detecting breast cancer early,” said Nammour.

When the crew arrived at the school, they took a few minutes to recover from the road trip with a quick cup of Arabic coffee, then straight to work. Leading up to the visit, the Palestinian Medical Relief Society did outreach and education in the village, and identified a mix of teachers and local women in need of screening. They gathered in a small library and Abed started with a group session to dispel myths about breast cancer and mammography and to build trust with the women.

Often the first question asked is whether any male nurses or technicians will be part of the exam. In a culture that prizes modesty, this would certainly be a deal-breaker for many of the women. Knowing this, the technicians who work in the clinic are all female, which puts the women at ease.

After the group session, Abed interviews each woman individually to hear any concerns they have, teach them how to perform a self-exam and explain what to do if they ever find a lump, then they are off to have the actual mammogram. She also gathers mobile phone numbers so that she can follow up with patients personally.

The mobile mammography clinic sits at the end of a hopscotch court at the edge of a playground. As schoolchildren play games, participate in P.E. class and practice prayers in Arabic, the 10-year-old van hums as women take their turn in the quiet interior for their exam, often their first ever mammogram.

This process repeats as many as 2,000 times every year, providing 30% of all mammograms in Palestine. In 2018, that number dropped to 1,316 due to malfunctions with the aging clinic and inconsistent electrical supplies at some locations.

When the program started in 2009, 80% of breast cancer diagnosis were for late-stage cancer. Over 10 years, that number has dropped to 52%, setting an example of how effective outreach and education can be. Still, fewer than 5% of women who need a mammogram in Palestine get one.

“We have saved the lives of many, many women.” –Murjan Abed

An upgrade to the mobile clinic is needed so more patients can be seen and diagnoses can be made more quickly. “If we can replace our current analog mammography machine with a fully digital one, we can perform twice as many mammograms each day and those files can be instantly sent to AVH and read online,” said Ahmad Abu Al-Halaweh, director of the Department of Community Programs and Diabetes Center, which oversees the clinic. AVH is a center of excellence for cancer care and having their doctors read mammograms in real time will speed diagnosis and treatment.

“We are not simply replacing an old machine," Nammour said, "we are shifting technology from analog to digital. By deploying this digital technology, we will be building on our strengths at AVH. In addition to the superior technical advantages including imaging display, storage and retrieval, there are clinical and ergonomic benefits. Digital images will be transferred electronically to our central location at the hospital, where our radiologists, oncologists and other medical professionals can provide an immediate diagnosis.”

“If we have a new machine it will facilitate many, many things,” Abed said. “The new machine can be more modern and more effective. Maybe the unit will be bigger than this, and have many rooms… maybe a room for ultrasound and a room for other services. If we can change this unit to a new one with a generator, we can go more places where there isn’t electricity and serve more women.”