Reducing Barriers to Screening, Treatment and Support Services for Women in Eastern Suffolk County
When people think of Suffolk County, they see it as part of the sprawling NYC metropolitan area and home to the Hamptons. But the eastern end of Suffolk County is mostly rural, lacks transportation and is inhabited by many women without access to health care.
Peconic Bay Medical Center created its Cancer Services Program (CSP) of Eastern Suffolk County – funded by the NY State Department of Health – to ensure that un– or underinsured county residents can receive breast, cervical and colorectal cancer screenings.
“Mortality is tied to insurance,” explained Maureen O’Connor, LMSW, Director of the CSP. “The program provides clinic breast exams and mammograms to uninsured or underinsured women between the ages of 40 and 64. Early detection is key to survival.”
Komen Greater NYC provides the program with funding for a bi-lingual patient navigator (PN) – one of two who work with patients who have received an abnormal test results or have been diagnosed. Patients enter the program one of two ways – identified by CSP outreach staff or referred by other organizations. The program targets women who are:
The staff is entrenched in the community, spreading the word about the importance of cancer screening.
They visit health fairs, churches and community events, make presentations at libraries and reach out to local physicians. They go to community agencies on rainy days – when migrants are most likely seeking assistance. They have appeared at the local Shinecock Reservation, because although Native Americas receive health care from the Indian Health Service (IHS), mixed race reservation residents are not eligible for IHS services.
Many of the women are struggling with the question of whether they should take time off from work to get a mammogram or put food on the table for their kids. “When you’re living penny to penny, taking time out for a cancer screening may seem like the least important option,” said O’Connor. CSP outreach personnel schedule and follow up on screening appointments.
If there is an abnormal reading, additional diagnostic tests are ordered. And if there’s a diagnosis, the patient is referred to a PN, who sets up a treatment plan, enrolls her in the Medicaid Cancer Treatment Program (if eligible) and follows up to make sure she gets to all her appointments. The PN also works on barriers to care – language, transportation, financial and legal. “Each patient’s problems and issues are unique,” stated O’Connor. “ And our PNs don’t take ‘no’ for an answer.”
Maria, born in Spain and in her mid-40s, only speaks Spanish and lives in Montauk. Estranged from her family, she earned her living cleaning hotel rooms in Southampton. A referral to Peconic Bay Medical Center for screening resulted in a positive diagnosis. Undocumented, she was ineligible for Medicaid. SUNY Stony Brook was the only medical facility that would treat her.
The PN cobbled together a transportation team so Maria could get to her appointments– almost 78 miles each way – including a senior citizens program (making an age exception), local medical transport company (reducing its fee) and neighbors willing to drive her. Maria had surgery and chemotherapy. During treatment, she could not work and fell behind on the rent. The PN not only negotiated with her roommate, but also eventually brought Maria and her family together.
Today, Maria is back to her life and even owns a car. “I don’t know where she’d be if we hadn’t run into her,” said O’Connor.
Mary lived and worked on the East End her whole life. In her late 50s, she had a successful catering company and worked as a private cook for many of the Hamptons’ rich and famous. Lease issues caused her to leave Long Island but returned with nothing, moving in with her 95-year-old mother. Her only source of income is her mother’s Social Security. When she felt a lump in her breast, she decided to ignore it hoping it would go away. Mary had neither health insurance, a physician nor money to pay one. Mary was referred to the CSP program from a local mammography van. Referred to Peconic Bay, Mary had issues about it being a program for the underserved. The PN enrolled Mary for a mammogram and when diagnosed, provided access to MCTP for treatment. Mary now gives outreach talks on behalf of the Peconic Bay Medical Center Cancer Services Program and feels it is an essential program for those who are uninsured.
Tameka is a single, African-American woman, now 30. She felt a lump and went to a local health center, which referred her to Peconic Bay. Unemployed, she was uninsured. Too young to be in the program, staff had one of its partners perform her additional tests for free. Diagnosed with aggressive breast cancer, the PN enrolled Tamika in Medicaid and helped her get access to treatment. Tameka’s situation was unique. As a physically healthy, attractive, socially active young woman, she had to deal with disfigurement from surgery, fertility issues and changing her lifestyle – all of which were difficult for her. She received counseling so she could accept her treatment plan, which included a double mastectomy, intense chemotherapy and Tamoxifen.
Being unable to work and denied disability added to her trauma, causing her to fall behind on her mortgage. The PN got her legal assistance to deal with her disability and financial problems. Tameka was able to maintain ownership of her home by renting it out to help defray costs. Still on Tamoxifen and facing two more surgeries, Tameka now works as an outreach staffer for Peconic Bay Medical Center’s Cancer Services Program.
“Thanks to Komen Greater NYC funding, our patient navigators can guide women like these through the system – the difference between survival and death,” said O’Connor.