“If someone had told me, ‘This lump could be cancer’ I would have gone and had it tested without thinking twice, but I’d never heard anything about these problems.”
By MAAYAN HARUNIColor's breast and ovarian cancer DNA test(photo credit: Courtesy)
When Haldiya Abu Kamir, 52, a mother of two from Haifa, first felt a lump in one of her breasts over a decade ago, she didn’t think anything of it. Even as the lump increased in size over the next five years, she still wasn’t worried. “If someone had told me, ‘This lump could be cancer’ I would have gone and had it tested without thinking twice, but I’d never heard anything about these problems,” Abu Kamir recalls.“For five years, I had a lump in my breast, but never had it checked out. I finally had it checked not because someone educated me about the possibility of it being cancerous, but because it was growing larger and larger. So I finally went to the doctor.” Abu Kamir was diagnosed with a 2.5-c.m. tumor and subsequently underwent a mastectomy. “I was very lucky it wasn’t in the armpit,” she adds.Abu Kamir’s story is typical of what goes on in the Arab sector in Israel, where there is little to no awareness about breast cancer, since the subject is taboo.“In Arab society, no one dares to talk about it,” says Abu Kamir. She claims that this is the reason she didn’t reach out to a doctor earlier, and why she is trying to make inroads now that she has finished her radiation and chemotherapy treatments. She has begun volunteering for an organization called One in Nine, and goes around giving lectures and working to increase awareness about early screening and detection exams, such as mammography and breast self-exams.“If someone had told me their story before I got sick, I would have gotten checked straight away,” Abu Kamir says. “Luckily, I’m in remission. I want other women to know, though, what happened to me.”Abu Kamir says that the health funds in Arab towns offers residents information and calls women to tell them in an impersonal way that they should schedule a mammogram, but the Arab women just ignore these requests. “What’s necessary in these communities are personal conversations with local residents.”Another Arab woman who was diagnosed with cancer was Nibal Mana, 49, from Majd el-Kurum, who has five children and two grandchildren. She was diagnosed with breast cancer at the age of 40.“I noticed a tiny lump in my breast and so I went to my doctor and she referred me to a surgeon. I was only 40, so I wasn’t eligible for a free mammogram – I’d never even heard of the test. I made the mammography and ultrasound appointments myself and only afterwards did I go to my doctor with the test results.”According to Mana, who leads workshops with Abu Kamir, “A lot of Arab women don’t speak Hebrew well. One woman told me that she didn’t understand a word the doctor said to her. She hadn’t understood that the cancer had spread to other parts of her body, or what she was expected to do next. She wanted to start treatment, but hadn’t understood what it entailed or what the side effects might be.”Both of these women were intent on educating as many Arab women as possible by telling their own personal stories. Many women don’t tell others they’re sick because they’re afraid of the stigma and that it will negatively affect the chances that their daughters find suitable husbands.Hana Halaj from Sakhnin, who works as a nurse at the Clalit Health Fund and leads workshops for women in Arab communities, is the first Arab woman to help coordinate treatment for breast cancer.“This help is necessary for breast cancer treatment, since this affects patients’ feelings of self-worth. Anyone diagnosed with breast cancer can forget about finding a husband. In my work as a nurse, many times women come in to see me and even though I know very well that they’re sick, they pretend that they’re completely healthy. I respect their decisions, but it’s such a shame they’re not willing to talking about it openly. They’re not ashamed,” says Halaj, “just silent. It’s their right to keep this information private and not tell others what she’s going through.”The gap in the socioeconomic circumstances between the Jewish and Arab sectors is also a factor. “In general, the socioeconomic situation in Arab communities is lower than in Jewish communities,” continues Halaj. “The wealthier the community, the more likely it is that people will carry out research. In the Bedouin community, there is almost no awareness at all.”Another obstacle facing the Arab community is that they cling to superstitions. “Some women claim that breastfeeding causes cancer, or that a child got sick because he belched or had some other infection,” adds Halaj. “In our workshops, we talk a lot about risk factors and early detection. We also show them how to do breast self-exams to help them overcome their fear.”The number of women in Arab communities under the age of 50 who die from breast cancer is much higher than among Jews. Fifty is the age when the cost of mammograms begins being covered by the health funds.“Among Jewish Israelis, one in seven women gets breast cancer, whereas that statistic is half that among Arabs – one in fourteen,” says Sigal Ratzin, CEO of One in Nine. “And yet, on average they get sick 12 years earlier than their Jewish neighbors. Most people don’t imagine that a 30-year-old woman would get breast cancer.”“There are many similarities with the way our community and the Jewish haredi community deal with breast cancer awareness,” Ratzin continues. “Both are very traditional societies, and the worry about being able to marry off our daughters is strong in both communities. The discovery that someone in your family has cancer heavily affects your kids’ chances for marrying well. Also, it’s not so common for people to get psychological help. The women are the caregivers of the family, and they often end up neglecting their own health since they’re busy taking care of everyone else. There are serious ramifications to this.”Another problem is that patients in the Arab sector often fail to find out what expenses they could be reimbursed for.“Many women aren’t able to go to work while they’re sick,” says Shirin Jiris, the director of Rights Assignment at One in Nine, “but they aren’t aware that they’re eligible for compensation from the National Insurance Institute. Social workers in the hospital are supposed to help families fill out forms in Hebrew, but many Arabic speakers don’t understand what the social workers explain to them and so they don’t provide the authorities with the correct paperwork. Although the NII has all the information translated into Arabic and there are Arabic speakers available when they call in, many times people don’t even get to that stage.”“Sometimes women don’t do tests that they were told to do because they’re not covered by the health funds,” says Jiris. “They aren’t aware that they can submit a request for an exception and might receive approval. This has a seriously negative effect on women’s health.”Translated by Hannah Hochner.
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