The Ball of Justice is Rolling into Cancer Health

For the past two years we have pushing the ball of justice up hill for cancer justice. Giving poor people, minorities, disabled, and aged persons access to cancer care has been our major goal since we learned that this Cincinnati population has the highest cancer mortality in Ohio. We have built a cancer prevention organization of agencies that serve the poor and, gaining their permission, have formed a Cancer Justice Network. Included in were agencies and individuals that wanted to partner with us in providing primary care physicians, sites for free screening for cancer, assistance in obtaining insurance, cooperation in developing low cost transportation options to health meetings, and, last and most important, patient navigators to accompany people on every step of gaining access. We have volunteer navigators from the first year medical student class at UC; nursing students from Xavier University, communications students from UC, community navigators drawn from the aged population of social action agencies, and one graduate of the Harold Freeman Patient Navigation Training Program who is also a new social work faculty member at UC. (Go to the website to find out more information: cancerjusticenetwork.org) October 4, 2016 the ball moved: six navigators, two representatives of Crossroad Health Center, a physician, and the staff of the Cancer Justice Network were welcomed to the weekly dinner for the poor offered by Christ Church Cathedral. Here is how it happened: We arrived at 4:30pm to meet Christ Church Cathedral's coordinator, Pat Coyle. He led us into the church's library so that we could review which of the six navigators would go to tables where 8 people waited to be called for dinner. We learned that each navigator would have 4 tables to talk with about cancer prevention. We distributed binders and cancer education,papers, and stickers saying, "I Care About Cancer."

At 5pm people were coming into the large room of the church, the Undercroft, and signing in and sitting at one of 24 tables. After a few minutes, most of the 216 people were seated or getting a drink of water, coffee, lemonade and meeting new and old friends. Nemat Moussavian, MD, medical director of the CJN, was introduced and a hush greeted him as he began to discuss the definition of cancer and why it was important to get an early screening. The room was quiet and attentive. Steve Sunderland, PhD, director of the Cancer Justice Network, followed with a short definition of navigation as an act of friendship, introduced the navigators (Pat Murray, Pat Youngblood, Sue Wilke, Anjanette Wells, PhD, MSW, Allison Valentine-Love, Barbette Thompson) and supported the point that we were present to encourage everyone to get an exam. Jordan Oberdorfer and Lee Ann Russ, from Crossroad Health Center, were sitting off to the side at a table. They were prepared to sign people up for exams, primary care providers, and cancer discussions.

The six navigators were seated at different tables throughout the room, some joining their group as they went up to get a dinner, others meeting with people as they waited to be called. As people were going to the dinner line, Dr. Moussavian moved throughout the room, stopping at each table and discussing cancer, answering questions, and providing support. People, accompanied by navigators, began coming to Jordan and Lee Ann and registering for exams. This was the flow for about an hour.
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The dinner ended a little after 6pm with some latecomers being seated and getting a dinner. The navigators continued to bring people to Jordan and Lee Ann and this connecting continued for the next half hour.

The navigators, the CJN team of Nemat Moussavian, MD, Robert Harris,DD and Steve Sunderland, PhD, along with church staff, Pat Coyle, MSW, and Frank McWilliams, MD, adjourned to a room to discuss their experience. We were joined at a little after 6:30 by Jordan and Lee Ann. We heard that 19 people had signed up and we were thrilled to hear this news. Overall, the navigators and the Crossroad staff had a very positive experience: building rapport, a trusting relationship didn't seem difficult as the people were open to meeting the navigators and seemed, in some cases, eager to engage in discussions about their health. People seemed to be in 3 groups, Anjanette Wells suggested: 1) people who didn't want to talk; 2) people who wanted to think more about whether they wanted to have an exam; and, 3) people who were interested and wanted an exam. We heard from the navigators that people shared their family histories about cancer and other health issues. Some people had physicians and some had insurance. The navigators reported that they liked having four tables of people to discuss cancer. Everyone could be talked with about whether they understood cancer and general health issues.

The key issue that emerged was follow-up. Dr. Moussavian expressed his belief that a momentum was created, a trust established, and an expectation for continued connection. For some people continuing to connect would be difficult since they didn't have phones, although some lived near Crossroad and could stop in. The navigators did get phone numbers of everyone they met with who wanted an exam. Following up, keeping the appointments at Crossroad, and assisting people with any barriers to taking action, were all seen as vital next steps. Pat Coyle asked: "Should we wait before coming back next week?" The overwhelming response was to return next week and build on the successful relationships established. We agreed to reflect a day on these points and then make a decision.

Overall, it was a deeply moving experience for both the people, the church, and the navigation effort. Our goal of linking low income people to cancer prevention and screening access was begun with gusto. The community worked with us and we responded in kind. The dinner was a perfect environment to share not only good food, but the spirit of friendship in facing cancer. The journey has begun! We will return to Christ Church Cathedral on October 11 for another sharing with the expected 200 people. We do expect to see some of the same people and we will want to find out if people made their appointments for screening and/or whether they will need further support. Most importantly, the good will of Christ Church Cathedral has now permitted a foundation for cancer education and prevention to both exist and be a key part of what we mean by justice. We will find out, in time, just how many people, going to an exam, found their cancer soon enough for effective treatment. And, also important, how many people learned that they are cancer free. Access to high quality treatment, good food, spiritual support, and good discussions are now a critical part of the health of the city.

by Steve Sunderland