We started last week by traveling to see the cancer prevention mobile vans I had mentioned in a previous post.  It was about a 45 minute drive to each of the two we visited, fairly close to the central hospital. These were the local vans, used by the cancer hospital to push forward cancer prevention in Barretos and the 18 small towns surrounding it. I tried to find a map, and the best I could find is the one below. Bear with me, the language and knowledge barrier prevents me from quality checking the map, but I think it shows the gist.

So the system works by sending mobile vans with nurses and radiography technicians to each city to do cancer prevention. They team up with local clinics (known as “UBS”, which stands for “Unidades Básica de Saude” or “Basic Health Units”) to publicize that they’ll be coming to the area and train workers. Then, they show up and spend the whole day getting patients screened and sending their health records back to the main hospital.

We visited two mobile units, one in Monte Azul and the other in Viradouru, both small towns near Barretos (you can see them on the map, they’re below Barretos). The mobile units were doing pap smears and mammograms (incredibly, the mobile units have digital mammogram machines in them and are built to reduce vibrations of the trucks and protect the equipment), and were set up in busy areas to encourage traffic. One was on the road next to a women’s health clinic and the other was in the middle of what looked like a public park. The mobile units have a goal of screening 80% of the target population (women between 40 and 69 years of age).

Apart from the incredible experience of seeing this cancer prevention effort in action and getting to see the mobile units for ourselves, a big part of our internship is needs finding. We’re looking for hiccups in the design of the healthcare systems here where our engineering design students might be able to step in and positively impact the movement. This was our very first experience with the mobile units, so we didn’t stay long enough to really steep ourselves in the work they were doing and find any major needs, but we did go ahead and ask the nurses up front – “What is the most difficult part of working these mobile units?” just to see what they thought the problem was.

Unexpectedly, her answer was simple: scheduling patients. Amanda, the head nurse, told us that the toughest part of coordinating the cancer prevention effort was just getting patients to come by at all. The local clinics don’t do a great job of publicizing the mobile van schedule, so a lot of patients don’t know to come when the mobile van arrives. But it’s worse than that. The nurses would often try to encourage traffic by going door to door and asking people to come get screened, and a lot of people just don’t want to get screened. There’s a stigma against cancer screening. People are scared, and a lot of people don’t want to know if they have cancer.  A lot of patients think that if you look for it, you’ll find cancer and worry about how to react. The nurses have their work cut out for them convincing patients that by detecting cancer early they can prevent or treat cancer before it becomes threatening.

I can see why patients are squeamish. Cancer is typically seen as a kind of death sentence, and many patients are of the view that if you had cancer, you’d rather just not know about it. However, it feels like this intuition comes from lack of education on the possibilities of cancer prevention and treatment. Hopefully, with education and awareness will come more screening, and certainly the mobile unit program is doing everything it can do move that along. Even so, the healthcare staff here really has their work cut out for them every step of the way.