If you had cancer would you want to know? If you were going to die, would you want a doctor to tell you? For most people, the answer to these two questions is “No.” So knowing this, how do you convince patients to get screened for cancer? This is currently one of the major struggles Barretos Cancer Hospital (HCB) is facing. HCB’s and our answer is to shift the thought process from “Prevention techniques like mammograms tell me when I have cancer” to “Prevention techniques like mammograms will help prevent me from developing (serious) cancer.” Currently there is a strong sense amongst the people the mobile units (or carretas) visit. Many believe that if they get a mammogram/pap smear/etc that they will find out they have cancer and will die. That these prevention techniques are actually detection. And while yes, they can be, they are meant to be used regularly to prevent serious, advanced stage cancer from developing.

HCB has done pretty much everything possible to make procedures like mammograms more enjoyable. HCB has a couple of sensory suites which plays music, shows calming pictures and even sprays a calming, good smelling spray into the air during mammograms. But now we have to make sure women use it regularly.

So one of the tasks Pablo and I have undertook is one of education. We want to be able to get the message out there that regular prevention screenings can save lives. We have two main projects we are working on to do so. The first is not for patients, but rather for the nurses (or enfermeras in Portuguese) who perform these prevention screenings. We want to organize the information that will allow for better access to training materials and communication between enfermeras. This will allow nurses to be better educated in prevention techniques as well as allow them to communicate about what methods they have found are the most effective in explaining to patients the importance of screenings.

Our second educational medium is video. We hope to create a video about the importance of frequent screenings. Currently, we are focusing on breast cancer. Most women who get a mammogram do not do so as regularly as they should. HCB wants women ages 40-49 to get a mammogram every year and women 50-69 to get one every two years. Yet, most women go 2+ years without one, regardless of what age group they fall in. These videos are primarily geared to be played in the waiting rooms of the carretas, but could be expanded to the internet, and waiting rooms in the main hospital. Eventually, we hope that more videos can be made (hopefully by fellow Rice students!) that can educate the patients and their families on the importance of screenings/prevention methods for all types of cancers.

We came to HCB with very specific goals. We believed most of our work would be extremely clinical and technical. Shadowing doctors/nurses, working on the clinical trials for Melacap, working with nurses to get device feedback, etc. However, our goals have changed. While as a future doctor, I really appreciate the opportunity to watch surgeries, I also really have enjoyed focusing on the education aspect. Over the last year and a half, I have become increasingly passionate about public health. Even as a doctor, I hope to focus more on the community/public health demographics and therefore I have always approached public health with a clinical mindset. However, this internship has really shown me how crucial and difficult the education portion is. With education on the importance of screening or checkups, no one is going to show up to see a doctor. But what if the demographic you’re trying to appeal to doesn’t have access to internet and has low literacy levels? What then? This internship has forced me to think about different aspects of health that we don’t usually see on a daily basis in the States. Here, there are full time HCB staff dedicated to fixing the cancer prevention education levels. It’s crucial. Yet another reason to fall in love with this amazing place.

Lastly, I leave you with this beautiful sunset over the wonderful Barretos!