Problem Addressed: Cancer

Healthy People 2010 Objective: 3

Web Address: http://www.health.state.nd.us/localhd/CDHU

SNAPSHOT

Custer Health, a local public health unit serving five counties in North Dakota, is affiliated with Women’s Way¾the North Dakota Breast and Cervical Cancer Early Detection Program. Women’s Way has a statewide network system where the state health department, local public health units, and health care providers work together to provide breast and cervical cancer screening for eligible women. The program provides counsel on screening guidelines for breast and cervical cancer, education, and case management for women enrolled in the program to ensure that the women are screened. Custer Health’s service area is considered rural and has one of the state’s reservations within its boundaries. Minority women, primarily the Standing Rock Indian Reservation women, are a focus for the program. Thirty percent of all women enrolled with the Women’s Way program from the Custer Health service area are American Indian.

THE MODEL

Blueprint: Women’s Way is a statewide federally funded program that pays for breast and cervical cancer screening. Women’s Way is the North Dakota component of the National Breast and Cervical Cancer Early Detection program. They work with all area clinics and have a volunteer network system that is referred to as outreach or recruitment. On the state level, there are many partners such as American Cancer Society, the Governor’s wife, Blue Cross Blue Shield, and the Avon Corporation. Custer Health, the umbrella organization, serves five counties in North Dakota and provides services via the Women’s Way program. Women’s Way has had great success with this program throughout the service area, but in particular in the Standing Rock Indian Reservation in Sioux County. Women’s Way works with the Indian Health Services and Tribal Health throughout the reservation.

At Custer Health, there are approximately 60 hours per week of paid time divided among three staff people. An Avon grant pays for an additional part-time nurse (16 hours per week) on the Standing Rock Indian Reservation. All Custer Health public health nurses work with the program enrolling women into the program at the community level. Their time is all donated to the program. Custer Health has approximately 75 volunteers in the Women’s Way program serving the five county areas. Some volunteers may work four to six hours per month, and others may donate one to two hours per year.

The Women’s Way program serves all women ages 18 through 64 who are either uninsured or underinsured and meet the financial guidelines for the program. The primary minority group in the state is American-Indian women, and this is the focus of the program. Women’s Way pays for breast and cervical cancer screening for eligible women. Women’s Way provides case management of women enrolled in the program to ensure that they receive appropriate and timely screening, which includes a diagnostic work up and treatment if needed. Women’s Way also counsels women on screening guidelines for breast and cervical cancer. They educate women on breast and cervical health, including teaching women how to do a breast self-exam, assisting women with scheduling appointments for breast and cervical cancer screening, and serving as a community resource regarding breast and cervical cancer screenings. The program works directly with clients by enrolling them into the Women’s Way program and teaching them about screening guidelines and women’s health issues. Women’s Way then refers clients to their provider to schedule appointments for breast and cervical cancer screening. The clients undergo follow-up and continue through the screening process, including assistance with scheduling diagnostic work if needed. The program promotes annual screening, contacting women annually to re-enroll if eligible and re-schedule appointments and screenings.

Making a Difference: Women’s Way sets goals every year, based on the population of potentially eligible women. Their goal is to serve 10 percent of potentially eligible women within the service area and then measure the number of women served on a monthly basis. The data manager with the state health department for the Women’s Way program provides each local public health unit with this information. Women’s Way also tracks the number of women served locally. Currently, about 19 percent of eligible women are being reached by the program.

Beginnings: The Women’s Way program started in North Dakota in 1993 at four pilot sites, with screening of women beginning in September 1997. Custer Health was not a pilot site and came into the program April 1997. Women’s Way began enrolling women into the program November 1997. The program was fully implemented by spring of 1998, with enrollments occurring in all five counties in the service area. Currently, Women’s Way serves 420 women in the service area. A total of 575 women have been in the program since its initiation in 1997.

Challenges and Solutions: Women’s Way has encountered several challenges with the program. State and local Women’s Way staff continuously work to sustain the program by networking with CDC at the national level, and health care providers and the community at the local level.

Due to the ruralness of the area, availability of mammogram screening is a significant barrier. There is no mobile mammography throughout southwest North Dakota, thus some women may not get a mammogram at all during the course of the year. Many women have no transportation to go 50 to 150 miles for a mammogram. Time off work may also prohibit them from going that distance for a mammogram.

This is especially true for the women of Standing Rock. With support from an Avon grant, transportation is arranged for women to travel from Fort Yates to Bismarck for mammography. This enables 170 women to have access to mammography who otherwise would not have had access to the service. This is certainly not enough for everyone, but it is a start. Women’s Way is encouraging local providers to bring a mobile mammography unit into the area, which would increase access.

Trust in the program and staff working with the program is another challenge, especially for the women of Standing Rock. Women’s Way has been working in the Standing Rock community for four years, and it is slowly seeing more women willing to come in to the local clinic for screening and inquire about the program. With the addition of the Sioux County nurse, the county in which the Standing Rock Indian Reservation is located, the Women’s Way program continues to build trust among the community members.

PROGRAM CONTACT INFORMATION

Joyce Sayler RN

Women’s Way

Custer Health

210 2^nd Ave. NW

Mandan ND 58554

Phone: (701) 667-3370

Fax: (701) 667-3371

E-mail: jsayler@state.nd.us