The Power of One: Bringing Together the Many “Moroccos” to fight against Breast Cancer

By Suzanne Baazet, Vital Voices Local Advocacy Coordinator for Morocco, Coordinator for the October 2009 Forum for Leadership-Building Against Breast Cancer in Casablanca, Morocco

Participants from 2009 Forum for Leadership-Building Against Breast Cancer, Casablanca, Morocco

When my Moroccan mother-in-law was diagnosed with breast cancer two and a half years ago, I saw first-hand the challenges that patients in Morocco face to obtain accurate information, to create networks of support, and to access quality medical care. After seeing her experience, I vowed that someday I would find a way to personally contribute to the important cause of improving the situation, both medically and socially, of women with breast cancer in Morocco. I was honored to have the opportunity to organize last month the first Forum for Leadership-Building Against Breast Cancer in Casablanca. Associations and advocates play such an important role in Morocco. They raise awareness about the disease and ensure that women have access to screening. In the very sad cases, where women are rejected by their husbands as a result of their illness, the associations serve as shelters and support mechanisms. The opportunity to bring together a group of associations and advocates to provide them with important training about the disease and about how to more effectively manage their associations was a dream come true, but I knew that if we really wanted to help women from all of Morocco, it would not be an easy task.

Having lived in Morocco for many years, one of the things that always amazes me is just how many different “Moroccos” there are. I live in an urban area, which could easily be mistaken for a European city. It is a stark contrast to the mountainous and rural areas where running water and electricity are much-coveted luxuries. If the geographical and socio-economic divides aren’t enough, Morocco has another layer of complexity, which are its languages. People from Casablanca and Rabat tend to prefer French, other urbanites Arabic, those from small villages in the High Atlas or the Rif are most comfortable in their native Amazigh, and in the Northern parts of the country it is much easier to get around in Spanish than any other language. So how do you bring together all of these diverse contingencies to tackle such an important issue as breast cancer?

This was the challenge we faced in organizing the Forum. Many organizations who work in Morocco are never able to overcome the geographical, linguistic, and socioeconomic barriers that prevent people from coming together. At other NGO trainings I have attended, Casablanca and Rabat, which represent only 15% of the country’s population, represent over 90% of the participants. I made it my personal mission to ensure that our training was different. I know that breast cancer touches everyone in Morocco, and I knew that there was an important need to create a network between those who have more access to resources for screening and treatment with those who don’t. We set out to bring all of Morocco together in one room to get all of Morocco thinking about breast cancer.

It wasn’t an easy endeavor, but in the end we were successful. We had every major urban center and many rural areas represented at our Forum. There were men who came to discuss the important role that men need to play in supporting women who have the disease. There were young women interested in running awareness campaigns in high schools. There were psychiatrists interested in starting the first formal patient support groups in Morocco. There were survivors who want to reach out in the most remote areas to ensure early detection and prevention. No matter how diverse the group was, and even though many struggled to find a common language to communicate, the amount of synergy and collaboration that the group identified was impressive. They came up with creative ways that different associations can support each other and continue to collaborate together after the forum. After seeing so many leaders of associations from around Morocco so excited about playing a role in fighting against this disease, I now feel that in my own small way I have been able to contribute to ensuring that Moroccan women win in the fight against breast cancer.

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Stronger Than Breast Cancer

By Enas Abdo M. Mohsen, Sana’a, Yemen


Sometimes in life we work hard, prepare for everything to have satisfying results, and expect everything to go perfectly because we tried to do our best. We are shocked when the opposite happens. Unfortunately, that is exactly what has happened with me. (Don’t worry it isn’t so bad.)

After the success we had in the first stage of our breast cancer awareness campaign sessions for women and the great participation by our target group, I expected girls in secondary schools to be interested and excited with our sessions, too. So what happened?

Actually, many of the girls in our target group are very good girls. They want to learn and improve themselves; however, some of them don’t respect anyone. Maybe they are teenagers and don’t think about this disease or feel sympathy for the patients who are suffering. Life for them is just fun, laughs, and good times with friends.

On October 15, we conducted an awareness session in Al-Salam Secondary School for Girls, one of the most famous secondary schools in Sana’a. We planned everything to make the session successful. When the health educator began her presentation some girls started laughing and making noise. The school’s manager stood up and told them to stop. They listened to her but after she left the classroom they started laughing and making noise again. This time they didn’t listen to anyone, not even their teachers. They told them, "If you don’t want to listen please go out and allow others to listen to the session.” Nothing worked. We were very angry and decided to leave. The teachers apologized and promised they would punish the students. Because of the students’ reaction, the health educator said, “How can we do sessions in other schools, Enas? That’s very embarrassing and unacceptable. It’s a waste of time.”

Throughout this sad conversation between the health educator and me, one girl named Shadia stood up and shouted at the other girls. “Please shut up! I had breast cancer two years ago. I had a mastectomy and my doctor told me, ‘If you had detected the disease earlier, you would not have needed to remove your breast. You know why I didn’t detect the disease early? Because I didn’t know that I had breast cancer. When I felt pain in my breast I was too shy to tell anyone, even my mother. Now I know about early detection and everything about breast cancer but after I had removed my breast. It isn’t easy at all. I have had so much pain. You don’t feel what sick people suffer from. You are selfish."

All the girls were surprised. They didn’t know that Shadia had breast cancer and removed her breast. All they knew was that she was sick. No one knew about the breast cancer, not even her teachers and close friends. Shadia couldn’t stop her tears so she left the class with her teacher.
All the girls were shocked. Those who were laughing and annoying didn’t know what to do. After a while, one of them stood up and said, “I am sorry. We apologize to you. We didn’t know it is so serious. It is the first time we have ever talked about breast cancer. Can you repeat the session from the beginning please?"

The health educator started the session over and all the girls participated. All of them wanted to try early detection on the model and on their selves. In addition, the health group in the school plans to host sessions for other classes that couldn’t come.

After we finished, we went to see Shadia and give her our support. We said, “Sweet Shadia, you are stronger than breast cancer. You overcame the disease. You are alive. Why didn’t you make this experience a message of yours in your life? You can make other girls aware of it. Don’t be ashamed. Women and girls will listen to our sessions but, after that, we aren’t sure. They may have forgotten what we said and not use it. But when they listen to you, they will never forget it because nobody can explain the pain except someone who had it and no one can feel what it means to be healthy except someone who has lost it. Shadia, be strong, optimistic, and try to forget the pain. I want to thank you so much for your courage and help.” Read more!

The Power of the Ribbon

By Dr. Samia Al-Amoudi, Associate Professor and Head of Sheikh Mohammed Hussein Alamoudi Scientific Chair for Breast Cancer at King Abdulaziz University, Jeddah, Saudi Arabia

You cannot imagine how effective the pink ribbon can be as the beginning of a dialogue about breast cancer. On October 28th, we installed two large pink ribbons at King Abdulaziz University (KAU) Hospital—one at the entrance of the building and one in the atrium. In addition, staff members wore pink ribbons to increase awareness about this devastating disease. The staff’s reaction was wonderful. Even the hospital security guards wore pink ribbons. And for our medical students, there was an educational program that included distributing educational books and brochures, plus a special edition of the school's newsletter, "Words to Inspire: Med School's Deeper Lessons."

The event, attended by Dr. Adnan Almazroa, KAU Vice President, and guests from Jagiellonian University, in Krakow, Poland, is part of KAU's plan to increase breast cancer awareness among health care providers, especially medical students. Since that day, many medical students have become excited about breast cancer and even offered to volunteer their time to increase awareness.

The newsletter features an article that captures my direct experience with breast cancer—as a woman and a doctor, and as someone who deeply loves her God and her country. Reflecting on my own diagnosis more than three years ago, I continue to share my story as a message of love I extend to every woman: Do not forget to make regular checks for possible tumors in your breasts. There are people who can help you win this fight—from your family to nurses and doctors.
Read more!

"Pink Glove Dance" Breast Cancer Awareness Video

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Pink Pyramids of Giza Send Global Message of Breast Cancer Awareness

"A dream has come true. Another triumph in the fight against breast cancer," said Mohamed Shaalan, Breast Cancer Foundation of Egypt, following the lighting of the pyramids in Giza, Egypt on October 24th.

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Breast Cancer Awareness Event in Palestine Features Animated Film Fatenah

By Carol El-Jabari, U.S.-Middle East Partnership representative in the West Bank.

Patient’s Friends Society-Jerusalem and survivors from the Sunrise breast cancer support group held the first Palestinian Breast Cancer Awareness Event on Sunday, October 11th, at the Ramallah Cultural Palace. The goals were to raise awareness about the importance of early detection, celebrate life, and show how women are currently facing their diagnosis and treatment.

HE Majeda Al Masri, the Minister of Social Affairs, opened the day with an address on the importance of early detection. She then joined approximately 400 people in the March to Celebrate Life. Next, a lecture on early breast cancer detection was delivered by Dr. Sahar Araj Marzouka, an obstetrician/gynecologist. Several breast cancer survivors also shared their experiences with the audience.

Thanks to Dar Films and the World Health Organization they screened the film ‘Fatenah’ during the event. It’s the first Palestinian animated film and conveys the story of one young woman’s tragic breast cancer outcome. The film was well received and made quite an impact on the audience.

The day closed with classical music performances and a raffle.

The event participants came from all over the country--men, women, youth, and children. Thanks to the generosity of many supporters, many of the local businesses, but also TIPH (the temporary international presence in Hebron), the American Colony Hotel, and the Housing Bank ( Jordan), they were able to bus them to Ramallah—a first for many!

Preparing for Patient Friends Society's 11 October 2009 event- Photo Carol Jabari

Sunrise ladies signing the ‘celebrate life’ poster at Ramallah Cultural Palace on 11 October 2009-Photo Carol Jabari Read more!

Yemeni Women Embrace Breast Cancer Education Sessions

by Enas Abdo M. Mohsen, SOUL for the Development of Women and Children, Partnership Advocacy Grant Recipient


Before I started the Breast Cancer Awareness Campaign in Yemen, I thought women, girls, and all Yemeni society wouldn’t listen to my breast cancer awareness information. I thought they wouldn’t care and would be afraid to talk about this disease because they think if you have breast cancer or cancer in general, you will not be cured and die. Cancer is a sudden disease and there aren't enough early diagnoses of it. So I was thinking, “How can I convince Yemeni women that breast cancer isn't like what they have been thinking?”

Before I started the Breast Cancer Awareness Campaign in Yemen, I thought women, girls, and all Yemeni society wouldn’t listen to my breast cancer awareness information. I thought they wouldn’t care and would be afraid to talk about this disease because they think if you have breast cancer or cancer in general, you will not be cured and die. Cancer is a sudden disease and there aren't enough early diagnoses of it. So I was thinking, “How can I convince Yemeni women that breast cancer isn't like what they have been thinking?”

I was so afraid to start the session. “Nobody will come,” I said to my direct manager—but I didn't have a choice. I had to host the session.
At the first session, I looked at the whole health center and counted the number of ladies that arrived to listen. Over time the numbers of ladies increased. They didn't leave. They were listening attentively and asking very important questions. They wanted to have earlier clinical diagnoses for breast cancer by our health workers. Many of them told us they will host awareness sessions for their families, neighbors, and friends. I couldn't believe all of the interest in breast cancer. It was very exciting and amazing. "I must be dreaming," I said to myself. All of the women thanked us for the awareness sessions and asked, "Why didn't you come and host the sessions before?”

I learned many lessons from this campaign. I learned how I can be positive, strong, and do something good that will be a benefit to my society. No words can explain what I feel and how happy I am. I hope this small article will help. I would be grateful to receive your comments and share experiences with you. Thank you very much.


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Pink for a Day: Free Mammograms Save Lives in Egypt

By Sean Lena


There are a number of obstacles to getting women to schedule annual screening mammograms. Dr. Hanan Gewefel, a radiologist and the Director of Breast Imaging at the Woman and Fetal Imaging Clinic (WAFI) in Cairo, says the primary obstacle is fear—of both the procedure and of possibly learning you may have cancer. The next obstacle is the stigma associated with a breast cancer diagnosis. And, the cost of a mammogram discourages many Egyptian women from getting screened more than once.

To address these obstacles, Dr. Gewefel founded Pink for a Day, a program that provides free mammograms once a week to disadvantaged women aged 40 and older. In addition, she makes these events more than just a medical appointment by offering “coffee mornings” to encourage groups of women to come together in support of one another.

During 2008, WAFI provided 839 free mammograms, with 33 women receiving a “suspicious” diagnosis, and 9 women diagnosed with cancer. By de-mystifying the screening process through weekly events and separate educational seminars, Dr. Gewefel hopes to increase the number of women who make mammograms a regular part of their health care.

Pink for a Day is funded by a number of local sponsors including health organizations, banks, pharmaceutical companies, and cosmetics companies. Dr. Gewefel promotes the program through advertisements in women’s magazines, but finds that word of mouth works best. To help ensure that women keep their appointments, she sends out appointment reminders via text messages and email.

Dr. Gewefel believes that free mammograms represent a first step towards a brighter future without breast cancer. Although sponsor support has recently decreased due to the worldwide economic situation, she hopes to continue serving these women for a long time to come.

For more information about the Pink for a Day program, visit the WAFI’s website (www.wafi-clinic.com) or contact Dr. Hanan Gewefel at drhanan@drhananclinic.com. Read more!

Breast Cancer Awareness Event in Alexandria Reaches Nearly 1,500 Women

By Hanaa Ismail

The following post was submitted by Hanaa Ismail, program coordinator at the Suzanne Mubarak Regional Center for Women’s Health and Development in Alexandria, Egypt.


To increase awareness about breast cancer and provide women with information about breast self-exams, we set up a stand at the Carrefour City Centre Shopping Mall in Alexandria, Egypt. For three days, from 10 a.m. to midnight, members of our team handed out brochures to women and, when the women asked, they were taught how to do a breast self examination.

Our stand was decorated with pink balloons and we gave out pink ribbons and pink sweets to women and their families. In addition, free mammograms were offered at our clinic. We had a large flow of requests for further consultations with physicians. Our team was pleased that we reached nearly 1,500 women through this event and we also received excellent media coverage from local news stations. Read more!

Partnership Expansion Activities in the West Bank and Gaza

By: Chris McKallagat, Country Lead, West Bank and Gaza

Chris McKallagat with Mariam Awad from Bethlehem University’s Faculty of Nursing and a member of the Partnership’s Advisory Planning Committee working to develop a breast cancer nursing training of trainers workshop in conjunction with the Oncology Nursing Society (ONS).

Recently, I traveled to the Palestinian territories to meet with key stakeholders, including the Palestinian Authority Ministry of Health (MOH), to initiate Partnership expansion activities. Recognizing the leading role of the MOH, the Partnership’s activities will strengthen and complement the Palestinian institutional response to breast cancer and help raise awareness among women and families. Breast cancer is the most commonly diagnosed cancer among women in the Palestinian territories and too many lives are lost unnecessarily. In fact, breast cancer kills more women in the Palestinian territories annually than the next three most frequently diagnosed cancers combined.

In response, the Partnership supports an approach to addressing breast cancer that works to improve institutional capacities, such as training for health care professionals and capacity-building of local organizations, while at the same time raising awareness at the community level through grassroots advocacy support and community mobilization and education.

American Near East Refugee Aid (ANERA), will spearhead an initial set of activities on behalf of the Partnership to strengthen the ability of Palestinian public and private institutions to work collaboratively in the areas of breast cancer prevention and management. In order to truly make an impact on breast cancer in the Palestinian territories, it is clear that greater coordination and collaboration among various stakeholders is needed. With leadership from the MOH and support from the Partnership, Palestinian women and families will be equipped with greater resources to fight breast cancer. The U.S. has gained amazing ground over the past 25 years in decreasing breast cancer mortality by increasing awareness and improving early detection and screening. The Partnership is pleased to actively support Palestinian women in their fight back against breast cancer.

Check out the Partnership’s Baseline Assessment of Breast Cancer Awareness and Care: West Bank, Gaza, and East Jerusalem
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Le Partenariat Indroduit un Programme Régional au Maroc lors d’une Table Ronde

Dans le cadre de l’extension de ses activités au Maroc, le Partenariat Etats-Unis – Moyen Orient pour la Sensibilisation et la Recherche sur le Cancer du Sein a tenu une table ronde Mardi le 23 Juin au Royal Mansour Le Meridien à Casablanca. Cette table ronde a été organisée en vue de lancer le Programme au Maroc et surtout d’établir le dialogue avec les professionnels du Cancer du sein et les associations actives dans le domaine. Ce fut la première fois au Maroc que les oncologues, les chercheurs, les psychiatres, les associations de lutte contre le cancer, les survivantes du cancer du sein se réunissent ensemble pour échanger sur une maladie qui concerne les femmes de toute classe et de tout niveau social.

La table ronde a été inaugurée par Rob Jackson, chargé d’affaires à l’Ambassade des Etats-Unis d’Amérique, qui a exprimé le soutien de l’Ambassade au Partenariat Etats-Unis – Moyen Orient pour la Sensibilisation et la Recherche sur le Cancer du Sein et son soutien personnel et celui de son épouse étant elle même une survivante du cancer du sein. Monsieur Jackson a félicité l’ensemble des associations et personnes qui oeuvrent pour la lutte contre le cancer du sein au Maroc et particulièrement l’association Lalla Salma pour ce qu’elle a accompli en si peu de temps.

Après des présentations sur l’état et l’analyse situationnelle du cancer du sein au Maroc, sur les objectifs Partenariat pour la Sensibilisation et la Recherche sur le Cancer du Sein au Maroc et une présentation Vital Voices (une ONG américaine en charge de la mise en œuvre d’une partie du programme relative au renforcement des capacités des ONGs au Maroc dans le domaine du cancer du sein), les participants se sont livrés à un débat front et fructueux sur les actions et activités à mener dans le moyen et court terme, à savoir :
1. Etablir un réseau réunissant des professionnels de la santé et associations actives dans la lutte contre le cancer du sein, qui pourrait être baptisé « Alliance Nationale du Cancer du Sein » ;
2. Etablir des groupes de travail par région ainsi que des groupes de soutien ;
3. Elaborer un flyer pour l’autopalpation ;
4. Etablir un guide des étapes à poursuivre en cas de cancer de sein depuis le dépistage;
5. Former des infirmières sur le cancer du sein et sur les soins palliatifs ;
6. Mettre en place une ligne téléphonique spéciale sur le cancer du sein « Hot line »
7. Mettre en place des unités mobiles de soins à domicile ;
8. Assurer des campagnes de sensibilisation et de dépistage dans des régions lointaines.

Les témoignages de plusieurs survivantes a éclairé davantage les participants ainsi que l’équipe du Partenariat sur la difficulté de certaines patientes des régions lointaines et défavorisées à détecter le cancer du sein à temps, de trouver des laboratoires spécialisés, de bénéficier des soins à domicile en plus du cout élevé des soins et l’absence du soutien psychologique et sociale.

Le Partenariat Etats-Unis – Moyen Orient pour la Sensibilisation et la Recherche sur le Cancer du Sein se félicite du lien étroit qu’elle a créée entre professionnels et activistes dans le domaine
du cancer du sein et a promis de mener des actions à grand impact dans la limite du temps et du budget alloué par MEPI.
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To Combat Breast Cancer, End the Stigma

The Partnership would like to share the following editorial, which ran in the July 14th issue of The National, an English newspaper launched by the Abu Dhabi Media Company.

‘Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.” These are the words of Marie Curie, the Nobel-prize winning scientist who was the first to treat cancer with radiation. Her words are more relevant than ever today in the Emirates, where breast cancer has taken such a deadly toll on women, and the stigma attached to the disease continues to prevent women from getting diagnosed early enough to survive it. The mortality rate for women with breast cancer in the UAE is unacceptably high. As The National reports today, four out of five women diagnosed with breast cancer in Dubai have an advanced form of the disease by the time they finally seek treatment. And largely as a result of such late detection, 44 per cent of breast cancer cases are fatal...
For a country in which women have made remarkable strides in other facets of life, these are distressing statistics. Women make up over 60 per cent of students in state universities and consistently outperform their male peers in school. Female literacy in the Arab world is near 80 per cent; in the UAE it is 92 per cent. Women hold prominent positions in the Government and are also leading initiatives in the fields of arts, business and fashion. Why then has this society not realised its collective obligation to take the steps necessary to reduce the number of deaths from breast cancer?

The stigma associated with the cancer is doubly concerning considering that the UAE has some of the most state-of-the-art facilities to treat cancer. But despite the presence of world-class medical personnel and equipment, many women remain reluctant to have routine examinations and only do so when it is too late. Rashid Hospital in Dubai has even introduced two new methods of early detection that are found nowhere else in the Gulf. With all these options, there should be no reason for so many cases of breast cancer to be diagnosed at such a late and lethal stage. Yes, effective health care depends on individual responsibility. But women need to be better informed of what is at stake.

Over one million cases of breast cancer will be diagnosed this year worldwide, according to the World Health Organisation, and more than a third of women with breast cancer will eventually die from the disease. Even though medical breakthroughs may continue to decrease the number of deaths associated with the disease, early detection is still the single greatest factor in helping women beat the disease.

In these circumstances, a public dialogue about the importance of breast cancer screening is even more important than any set of technological advances. Dubai Hospital is to be commended for launching an awareness campaign that will generate a public conversation aimed at changing attitudes towards the detection and treatment of breast cancer. We have the material means; all we need is to change the way people think.

Now is the time we must understand this disease more and fear it less.

http://www.thenational.ae/article/20090714/OPINION/707139910/1033
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Jordan Workshop on Starting a Support Group Energizes Local Advocates

By Susan Brown, Director, Health Education, Susan G. Komen for the Cure®

Susan and colleague, Sandy Finestone, conducted a workshop with members of the Jordan Breast Cancer Program in Amman, June 3-4, 2009. Together, they are developing a curriculum and materials for institution-based support groups.

Sandy Finestone and I spent two days with more than 20 women in Amman, Jordan. The topic of our workshop was “How to Start a Support Group,” but the information and passion shared by participants really extended beyond that topic. We watched women support each other—with a hug, a smile, a pat on the shoulder—when a group member was tearful as she recalled a friend who had lost her life to breast cancer and when another got a call on the second morning that her friend had died...

The women were there because they want to do something to help women in their communities who are diagnosed with breast cancer. No, they really want to do MORE, because they are already at work in their communities helping women with breast cancer.

We observed women think about new concepts, listen hard (as we did) to simultaneous translators to not miss anything that was said, work in groups, exchange ideas, and enthusiastically participate and compete in an ice breaker about old Arabic songs that caused a lot of laughter.

We saw that women who are involved with the breast cancer cause are more alike than not. Wherever they are, they are energetic, passionate, committed, creative, deliberate, and determined. We are eager to learn all of the great things they accomplish in the coming months and years. Read more!

Women are the World's Peacemakers

By Dr. Samia Al-AMoudi
I was proud to be part of the 21-member international delegation supporting the first Susan G. Komen Global Race for the Cure®. Our delegation included women from 18 countries--women from different cultures and races, and with different religious backgrounds. But we all spoke the same language when it came to fighting breast cancer. This was not a political or social fight, but a message of pure love for each other and for every other person on this planet...

We came to tell the whole world that breast cancer knows no boundaries and women's issues are the same everywhere. We might not have been able to prevent our own breast cancer diagnoses, but we are determined to do all that we can so that our daughters can live in a world free of breast cancer.

Dr. Jill Biden, a long-time advocate for breast health education and wife of U.S. Vice President Joseph Biden, said to the Race participants, “You are paving the way for a breast cancer-free world through your efforts."

For the Race, Komen Founder Ambassador Nancy Brinker brought together women from across the globe to write a new page in a new era of peace to make breast cancer history. This is the way I felt as a Saudi woman, and as a breast cancer survivor attending the Global Race. I am a happy that the U.S.-Middle East Partnership for Breast Cancer Awareness and Research is helping to bring us together. I wanted to share my feelings with women of all nations.


Dr. Samia Al-Amoudi isAssociate Professor and Consultant Obstetrician Gynecologist
Head of Sheikh Mohammed Hussein Al-Amoudi scientific chair for breast cancer
King Abdul-Aziz University, Jeddah, Saudi Arabia

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Daughters’ Marriage Prospects Top Concern for Woman with Cancer

By Hana Abu Shareb
As a nurse, Hana Abu Shareb, Health authority Abu Dhabi has worked with many people with cancer for the past eight years. She shared with the Partnership how one patient’s reaction to a breast cancer diagnosis has really stayed with her.

“I worked with a 45-year-old woman who was shocked to receive a breast cancer diagnosis. Her shock quickly changed to concern for her daughters who she felt would lose many marriage opportunities based on her diagnosis. While this is not unusual in our culture—not just for breast cancer but for any life-threatening disease--I was still surprised to hear her voice this as her primary concern.

Women, especially mothers, regularly put their needs behind the needs of their families. But, because this woman shared her concerns with me I am prepared to discuss this with other women and better guide them in the next steps for referral and treatment. I do not know how things ended up with this courageous woman because she returned to her homeland. However, her impact on me continues to benefit others who receive the same diagnosis.” Read more!

Stories from the Field

Alice Rezien, of the Suzanne Mubarak Regional Center for Women’s Health and Development, in Alexandria, Egypt, submitted the following post.

In conjunction with International Women's Day (February 10-12, 2009), the Suzanne Mubarak Center organized and conducted a three-day training program for 30 nurses working in outpatient clinics and family health care centers in different sectors of Alexandria. The training, titled Breast Cancer: Awareness, Early Detection, Breast Self Examination, Treatment Modalities, Peri operative Care and Quality of Life, focused on the development of knowledge, skills, and attitudes necessary to enhance awareness about breast cancer in nurses, and women, in general. Presenters also strove to motivate participants to practice breast self examination. Further, the Center promotes quality care for women with breast cancer throughout the stages of treatment and rehabilitation, with the ultimate goal of ensuring an acceptable quality of life.

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أسبوع الشراكة للعمل الأجتماعي

لتظهر مساندتك لنشر الوعي والتأييد لمكافحة سرطان الثدي: قم بتنظيم فعالية خلال انعقاد أسبوع الشراكة للعمل الأجتماعي الأول للفترة من 24- 30 آيار، 2009

تتشرف شراكة الولايات المتحدة الأميركية والشرق الأوسط لمكافحة سرطان الثدي ونشر الوعي والبحوث أن تعلن عن أنعقاد أسبوع الشراكة للعمل الأجتماعي الأول. حيث سيجتمع في شهر آيار الحالي نساء ورجال مهتمين بموضوع سرطان الثدي قدِموا من الشرق الأوسط وشمال أفريقيا ليعبروا عن آرائهم بصوت مسموع. إذ يمكن لفئة قليلة أن تؤثر تأثيراً فعالاً. ويمكن ان نظهر مدى عزمنا وقوتنا جماعياً لدى قيامنا بتنظيم سلسلة من الفعاليات المحلية حول أهمية نشر الوعي لمكافحة سرطان الثدي والقيام بالكشف والفحص المبكرين عنه. وأليك بعض الأفكار عن كيفية مشاركتك معنا


أعمل على تنظيم أو الأشتراك بفعالية في منطقتك: يمكن أن تشمل هذه الفعالية أي شئ ---- كالقيام بجمع مجموعة من الأصدقاء في بيتك، مكان عملك، أو في أي مكان عام. وكلما كان عدد الأشخاص المجتمعين أكبر كان هذا أفضل.

قم بتشجيع الحضور لهذه المناسبة: يمكنك أن تعلن عن هذه المناسبة في الموقع الألكتروني الخاص بالمنظمة، على صفحتك الشخصية للفيسبوك، لوحة أعلانات المنطقة- وفي اي مكان يمكن أن يشاهده الناس. الرجاء إرفاق الموقع الألكتروني للشراكة (www.bcpartnership.org) وشريط وردي اللون للدلالة على سرطان الثدي.

أعمل على القيام بواجب الضيافة لهذه المناسبة والتقاط بعض الصور: إذ يمكننا حينها أن نتقاسم ما تحصل عليه من نتائج مع شبكة الشراكة كلها (bcpartnership.ning.com).
قم بالتعريف عن نفسك: سنقوم بإدراج الفعاليات الأكثر إبداعاً من التي تصل لآسماعنا على موقعنا الآلكتروني (كما يساعد التقاط الصور وتصوير افلام الفديو على أبراز القصة بشكل أوضح). كما نعمل على أيجاد طرق أخرى تساعد في التعريف بجهودك، لذا إبق مصغياً لنا!

للمزيد من المعلومات، الرجاء زيارة الموقع الخاص بأسبوع الشراكة للعمل الأجتماعي أو أرسال إيميل على العنوان الألكتروني التالي partnership@bcpartnership.org.

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Partnership Community Action Week

Show your support for breast cancer awareness and advocacy: organize an activity during our first Partnership Community Action Week, May 24-30, 2009

The U.S.-Middle East Partnership for Breast Cancer Awareness and Research is proud to announce the first Partnership Community Action Week. This May, women and men from across the Middle East and North Africa who care about breast cancer will come together to make their voices heard. A few people can make a major impact. By holding a series of local activities on the importance of breast cancer awareness, early detection, and screening, we can collectively show our strength. Here’s how you can get involved:

1.) Organize or join an activity in your community: Your action can be anything-- gather a group of your friends together at your home, office, or in a public place. The more people that get involved the better!

2.) Promote your event: You can post your event announcement on the Partnership network, on your organization’s website, your personal Facebook page, on community bulletin boards—anywhere people will see it.

3.) Host your activity and take photos: We can then share your results with the entire Partnership Network (bcpartnership.ning.com).

4.) Be recognized: The most creative actions we hear about (photos and video really help tell your story) will be featured on our website. We also are exploring other ways to recognize your efforts, so stay tuned!

For more information see our Partnership Community Action Week pager
http://tinyurl.com/communityactionweek

Questions? Email us: partnership@bcpartnership.org.

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“Breast Cancer Detection Under Budget Constraints”; Mammography Screening in Low- and Middle-Income Countries

By Marilys Corbex

The editorial in the last issue of the UICC Global News Alert (the International Union Against Cancer newsletter) is about the use (and abuse) of mammography screening in low- and middle-income countries, which presents an important lesson for advocates working with breast cancer in the Middle East.

The article reflects the growing conviction in the scientific and expert community that low- and middle-income countries should avoid engaging mammography screening too quickly as this consumes a lot of resources without benefiting many women. It also explains that advocates should be careful about pressuring their ministries of health for mammography screening as it can be counter productive to their cause. Instead, advocates should advocate for better treatment and effective early diagnosis that is readily accessible to all women of the country.

The editorial (below), plus other interesting related topics, is available at: http://www.uicc-community.org/templates/ccc/images/GNA_March%202009.pdf

Breast Cancer Detection Under Budget Constraints

By Paola Pisani, Senior Epidemiologist, Oxford University, and Joe Harford, PhD, Director, Office of International Affairs, NCI, Bethesda.

In developed countries, the debate regarding the benefits and harms due to possible overtreatment of indolent tumours discovered by mass screening via mammography continues. The health care infrastructure required for the management of suspicious or abnormal mammograms and for the treatment of breast cancer is generally present in these countries and is taken for granted in discussions.

However, the situation is different in low- and middle-income countries where breast cancer incidence is lower and where the requisite infrastructure for breast health is often suboptimal. In these settings, governments, health providers and advocacy groups struggle to develop sustainable strategic plans to control the disease, which is often the most common cancer in women, although it occurs at a lower rate than in Western countries.

These plans often focus on the introduction of mammography in emulation of early detection and screening programs that exist in more developed countries. There is no question that early detection can have a profound and positive impact on breast cancer outcomes as shown by falling mortality rates—the chief measure of efficacy. However, by focusing exclusively on introducing the detection test, health systems in low- and middle-income countries often fail to ask whether they are really ready to deal adequately with what is found through the new screening program.

Improvements in breast cancer outcomes in the United States and Western Europe began before the introduction of mass screening of asymptomatic women. In these venues, breast cancer awareness grew together with the development of comprehensive health systems that made quality care accessible to the population at large, raising expectations and trust and, eventually, demand. Breast cancer mortality began to fall in the 1960s and 1970s, in generations of young women who used health services for contraception, safer pregnancies and provision of healthcare for their children. At this time, breast cancer incidence was already increasing and state-of-the-art treatment relied largely on surgery and radiotherapy (chemotherapy and tamoxifen were to come later).

In the 1990s, mortality rates began to fall in women of all ages before all those eligible were able to receive a mammogram. The improvement in outcomes caused by the early (prescreening) movement can be attributed to the systems set up, as part of the screening policy, to manage the disease—systems that provided quality diagnosis and treatment to all breast cancer patients, most of whom still presented with overt symptoms of the disease (e.g., a palpable mass). Programs for screening asymptomatic women were implemented in an environment that already had an enhanced capacity to diagnose and treat breast cancer effectively.

In many low- and middle-income countries, breast cancer diagnosis and treatment are usually of low quality, or access to quality care is restricted to those who can afford to pay for it. In many poorer countries, only a small subpopulation of women gets state-of the-art breast health care. The introduction of mass mammography in the absence of a health care system capable of dealing with the suspicious and abnormal mammograms that are inevitable is a classic case of “cart before the horse”. Without generalised access to diagnostic and treatment services, low- and middle-income countries will see neither the early benefits of screening observed in the West nor the late ones that follow 10 years of regular screening.

In those societies where breast cancer awareness is raised, stigma is reduced and barriers to adequate diagnosis and treatment are removed, near-term improvements in breast cancer outcomes are likely to mimic those seen in the West. Health administrators in low- and middle-income countries have every reason to invest in delivering effective care to the population at large rather than investing in mammography screening, which will have a lower yield than in the West. Good management of early—yet symptomatic— tumours produces short-term, measurable reductions in mortality. Success of these programs aimed at reducing mortality and suffering will encourage funding and participation of the population. The consideration of more sophisticated and expensive programs to screen asymptomatic women is not today’s highest priority.
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Sharing Strategies on Starting Support Groups in Kuwait

Breast Care Kuwait Patient Support Workshop. Picture Credit: Carol Jabari 2009

In February, Breast Care Kuwait held a regional conference on breast cancer support groups. The two-day workshop demonstrated the importance of psychological support during cancer treatment and provided guidance on starting a group. Debby Stewart, a coordinator for the Johns Hopkins Breast Center Survivor Volunteer Program in Baltimore, Maryland, attended the conference and was kind enough to share her experience at the conference below.

"I have been a coordinator for the Johns Hopkins Breast Center Survivor Volunteer Program for nearly five years. The program started 11 years ago when Lillie Shockney, a fellow Hopkins nurse, saw a need to support women with breast cancer....

She started with five survivors who volunteered to provide support for breast cancer patients. The volunteer program grew to over 30 passionate, well trained women whose mission is three-fold: to make a difference for women newly diagnosed, to educate the community on breast cancer awareness, and to advocate and support research and breast health initiatives. I came to the Hopkins Survivor Program because I am a 30-year breast cancer survivor. I was first diagnosed in 1979 at age 25 when breast cancer was still a taboo subject and people were just beginning to talk about the disease publicly. A few brave women shared their stories in magazines and television interviews, but there were no Komen or pink awareness ribbons to spread awareness. When I first learned I had cancer, I was shocked and devastated to lose my breast, but my husband, family, faith, and friends saw me through. It was my experience with a volunteer, a survivor, who helped show me that that there is life beyond cancer. That made me want to support other women.

Dr. Nouralhuda Karmani, the Founder of Breast Care Kuwait, asked me to speak at her workshop on breast cancer survivors, which was held in conjunction with the first annual Kuwait Breast Diseases and Oncoplastic Reconstructive Surgery Conference. I accepted her invitation because I am excited to tell others about the success of the Hopkins model and share stories about the amazing volunteers with whom I work.

The first day of the workshop began with a quick breakfast and a review of plans with Carol Jabari. Carol is an American-born nurse, who lives and works in East Jerusalem, her home of 20 years. She has been involved in breast cancer issues, including establishing a support group of volunteers seven years ago—no easy task. At the conference, the two of us took turns presenting information on our respective programs. It was an honor to work with Carol who is recognized as a leader in nursing and in the U.S.-Middle East Partnership for Breast Cancer Awareness and Research.

On the second day, we presented our respective support programs to doctors and survivors. Carol began by describing the program she leads. I followed, explaining Lillie's vision and the steps she took to "prove" that the program works to people who were originally skeptical of the idea, including our radiologist.

In the afternoon, Carol and I met with the survivors again. I was pleased to see so many potential volunteers, both breast cancer survivors and family members. We formed a circle of chairs that quickly filled with women in both traditional and western clothing. Before we knew it, those in traditional dress unveiled to reveal their lovely smiles. Using microphones and earphones, our English and Arabic was translated to enable smooth communication.

We asked the group to share their personal breast cancer stories. One woman described her experience and how she was supported throughout the process by her family. Another described the importance of a survivor volunteer from the U.S. who changed her treatment perspective and gave her a more hopeful outlook. Two women had started speaking out about their breast cancer experience in their country (Saudi Arabia)—one was “breaking the silence” and the other had started a support group. Another woman shared that she cried even after treatment ended. These women wanted to share their stories, emotions, and what they had learned. What an amazing experience for me. I thought this is no different than when we gather for our retreats and support groups in the U.S. Here, a world away from mine, I once again felt the courage and witnessed strong women weaving their lives together through their shared experiences. We are women on a mission, women living life with its struggles and uncertainties, making sense of it all.

With some patience and obstacles to overcome, I suspect that this group will form into a volunteer team. They have support and direction from Nour as everyone figures this out together. It is open to possibilities. I am very excited for them. Maybe this is how Lillie and her first volunteer, Judy, felt 11 years ago. First a vision, then a movement filled with stories and passion to make a difference.
Like Lillie Shockney, Dr. Karmanhi has a vision and an unstoppable drive. The volunteers will continue to find their voices to share beyond their group to serve others. Diagnosed with breast cancer 30 years ago, I see Kuwait at a similar point. But I believe they will move rapidly into an era of awareness. As a former volunteer, I hope they find that giving of themselves is rewarding and meaningful, and that this work becomes accepted among cancer survivors and their families."

-Deborah Stewart is a coordinator for the Johns Hopkins Breast Center Survivor Volunteer Program in Baltimore, Maryland

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International Women's Day and Mother's Day

Athar Foundation teaching university students about breast cancer. Picture Credit: Athar Foundation, Yemen

This spring, advocacy groups from throughout the Middle East organized outreach events for International Women’s Day on March 8th and Mother's Day on March 21st.
The following is a sampling of events that have taken place in the past few months:

In February, the group Breast Care Kuwait held a regional conference on breast cancer support groups. Partnership advisor Carol Jabari of the Patient Friends Society and Debby Stewart, Volunteer Coordinator for Johns Hopkins Medicine’s Breast Health division shared with the participants their experiences with support groups.... The two day workshop was designed to teach women about the importance of psychological support during cancer treatment and to walk them through the steps of starting a group.

Neel Stallings was recently profiled in an advertisement for Pandora Jewelry in Glamour Magazine’s March 2009 issue, for her breast cancer advocacy work. Stallings is a founding member of the Charlotte, NC, affiliate of Susan G. Komen for the Cure®. She has been a passionate breast cancer advocate since she and her sister were diagnosed and treated for breast cancer. Neel was a speaker at the U.S.- Middle East Partnership’s “Building Bridges for Advocacy” MENA Regional Advocacy Conference in Amman Jordan, and spoke about how to organize and recruit volunteers. See the advertisement here.

To celebrate International Women’s day this year The Egyptian Society for the Promotion of Women and Children’s Health held lectures about cancer pain relief and palliative care on March 5th for oncology nurses at Mansoura University Hospital in Cairo. A second workshop on March 7th taught oncology nurses how to protect themselves when working with chemotherapy agents. The society also convened a meeting for local women to discuss diseases, cancer risk factors, methods for early detection and how to improve life style.The society is preparing for a symposium on Mother’s Day on cancer prevention, methods for early detection as well as how to perform breast self exams and the psychosocial impact of body image and sexuality for women with breast cancer.

Athar Foundation in Yemen held an awareness workshop with female university students on the symptoms and health effects of breast cancer and physical and psychological impact of the disease. The sessions sought to educate women about breast self-exams and stressed the importance of screening. This Mother’s Day, Athar is planning a Safe Motherhood Awareness session which will teach women about breast cancer.In Syria, the Syrian Society of Senology is working with local hospitals to offer women a free mammography on Mother's Day. In addition the society is organizing a ten-day public awareness campaign on breast cancer from March 18-30 at Beirouni University Hospital, a comprehensive cancer center in Damascus.

The Women and Fetal Imaging group in Egypt offered free mammograms every Tuesday in February and March in honor of International Women’s Day and Mother’s Day.

In the United Arab Emirates, the Health Authority of Abu Dhabi is planning to celebrate Mother’s Day by distributing care cards from sons and daughters to their mothers to remind them to perform regular breast exams. The cards will be distributed through local newspapers and magazines on March21st. This will be followed by a breast cancer awareness campaign in April.

Finally, the Yemen Family Care Association will be conducting two general awareness sessions and distribute brochures and posters regarding breast cancer early detection. Also they will place feature articles in two newspapers on the importance of early detection.

Does your organization have anything planned for Mother’s day this year? Post your event here, or discuss it in our Network forum!

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Bone Drugs May Help Fight Breast Cancer

Photo by Erik Charlton

A recent study has found that a class of drugs that are most commonly used to combat bone loss may reduce by a third the chance that some breast cancers will spread or recur--NY Times.

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US-Middle East Partnership in the News: CNN Vital Signs

This past October, CNN’s Barbara Starr attended the Partnership’s Regional Breast Cancer Advocacy Conference in Amman, Jordan, and produced the above piece for the show Vital Signs. The report highlights the advocacy efforts of Dr. Samia al-Amoudi, a Saudi obstetrician and long-time Partnership supporter. Starr also interviews Dr. Mahmoud Sarhan, director general of Jordanian partner institution King Hussein Cancer Center. The report underscores many key issues discussed at the conference such as how to dispel cultural taboos, how to convince women to do self breast examinations, and increasing the number of women screened. Read more!

الرضاعة الطبيعية تحمي الأم من سرطان الثدي

(Breast Feeding Protects Mothers from Risk of Breast Cancer)

فوائد الرضاعة الطبيعية عديدة ومفيدة سواءً للأم او الطفل ، بالنسبة للطفل فإنها تساعد جهاز مناعته وتقويها ضد بعض الأمراض المعدية هذا وتعتبر الرضاعة الطبيعية جسر التواصل بين الام ووليدها فهي تقوي الروابط بينهما وتوصل له بهذه الطريقة الحب والحنان والدفء فيشعر وليدها بنفس المشاعرتجاهها .
اما فوائد الرضاعة الطبيعية بالنسبة للأم فهي كثيرة ومن ضمن هذه الفوائد ماأظهرته دراسة حديثة ان الام إذا قامت بإرضاع طفلها لمدة سنة خلال حياتها كلها فإن ذلك يقلل من مخاطر إصابتها بمرض سرطان الثدي .
وقامت مؤسسة أبحاث السرطان العالمية بتحليل 7 آلاف دراسة سابقة وتوصلت الى أن الرضاعة الطبيعية تقلل الإصابة بسرطان الثدي بنسبة 4.8 في المائة .
ولذلك من المهم للنساء معرفة فوائد الرضاعة الطبيعية فقد أظهرت الأبحاث الحديثة ان 3 من كل 4 نساء في بريطانيا لايعرفن أن الرضاعة الطبيعية تقلل من مخاطر الإصابة بسرطان الثدي وتقول الدراسة ان 3 أرباع النساء يمارسن الرضاعة الطبيعية إلا أن 22 في المائة منهن فقط هن اللاتي يواصلن الرضاعة الطبيعية بعد 6 أشهر . فلذلك من المهم تكثيف الوعي عن فوائد الرضاعة الطبيعية في المجتمع .

(A new study shows that breastfeeding reduces the risk of Breast cancer. If a woman breastfed her baby for a year once in her lifetime, it would reduce her risk in getting breast cancer by 4.8%)

Modia Batterjee

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Partnership Spotlight Series: Creating the Baseline Assessment of Breast Cancer Awareness and Care in the Palestinian Territories

Carol Jabari laughed out loud the first time I asked her to describe her experience putting together the US Middle East Partnership’s Baseline Assessment of Breast Cancer awareness and Care: West Bank, Gaza, and East Jerusalem. This past summer, in the sweltering heat of the Palestinian July, she and a team of local researchers investigated the current status of breast cancer services in the West Bank and Gaza. “We worked 18 hours a day for a month to get that thing done,” she recalled, a touch of incredulity in her voice. Despite the long hours and grueling schedule, Carol believes that the final report represents an unprecedented and invaluable resource for everyone working with breast cancer in the Palestinian territories.... The assessment, which Carol presented at the Partnership’s Regional Breast Cancer Advocacy Conference held in Amman, Jordan, was a decisive first step towards improving breast health in the Territories and a valuable tool that will help direct Ministry of Health strategic breast health plans for 2009 and beyond.

The US-Middle East Partnership approached Carol to take on an assessment of this size and scope in the Palestinian Territories because breast cancer has long been a significant problem with few resources available to address it. Carol, who has been working on breast cancer issues for over twenty years in the Territories, was a natural choice for the job. She has spearheaded several innovative breast cancer initiatives in the region and has worked with local government officials and international organizations. Carol’s accomplishments include: helping establish the first mammography unit in East Jerusalem; drafting the National Breast Cancer Screening Guidelines for the Palestinian Territories; establishing the Reach to Recovery program—a training program that instructs people on how to do outreach to breast cancer patients; and founding the Patient Friends Society, the only organization in the territories that offers psychosocial support for breast cancer patients.

Regardless of Carol’s familiarity with the Palestinian Territories, gathering the requisite information to distill a clear picture of breast cancer conditions on the ground was still a difficult undertaking. To start, the healthcare infrastructure of West Bank, Gaza and East Jerusalem is still in disarray from years of conflict with Israel and there is a lack of services for the more than 1.5 million women who live there. In addition, the Palestinian Authority grapples with the challenge of providing services with limited resources across a fractured geographical area. As a result, access is a huge problem and it is very difficult to reach people with the myriad checkpoints, military zones, and security walls that crisscross the landscape. Finally, cancer statistics, the responsibility of the Palestinian Central Bureau of Statistics and the Ministry of Health, are questionable and the health information system is not integrated, comprehensive or fully functional.

Despite the difficulty of the task and the obstacles that lay in their path, Carol Jabari and her team were undaunted. The team did in–depth personal interviews with hospital directors, administrator, and other key personnel across the three main health sectors. The team conducted focus groups of well women in four different communities in Nablus, Hebron, Bethlehem, and Jerusalem districts and interviewed women living with cancer from Gaza, the West Bank and Jerusalem. These women shared their experiences living with cancer, detailed the difficulties they had accessing care and shared their hopes for the future. They got the information they needed first-hand from in-depth interviews and focus groups. When checkpoints prevented them from doing interviews, she did them over the phone. Overall, she found that despite all the obstacles, people were very receptive to what she was doing. Ministry of health officials lent their full support to the project. “People were quite forthcoming,” she said. The women trusted her and were eager to share what they knew.

After Carol and her team had gathered all the information they needed, the next step was to analyze their findings. Although she was not surprised by many of her findings, such as the and physical barriers to care and lack of infrastructure and capacity to handle breast cancer cases, what amazed her was the lack of awareness among Palestinian women about breast cancer. For example focus group of well women from Hebron and Nablus revealed a consistent lack of understanding among the women who participated. At the end of the session, “I was shocked at how uninformed they were. They didn’t know anything!” In fact, they found that because NGOs in the past had focused their breast awareness campaigns at rural women, “we found that women from rural villages actually knew more about breast health than city women did.” It was proof that the Palestinian Territories still have a long way to go and a lot of work to do to improve breast health awareness.

Based on the results, Carol believes that there are several aspects of care that need to be addressed immediately, including:

• Upgrading the knowledge and skills of the professionals in West Bank and Gaza, through web or video conferencing and disseminating treatment guidelines through educational sessions.
• Training and recruiting more qualified x-ray technologists, including more female technicians
• Tackling the dearth of knowledge about breast cancer by funding programs that inform the public about screening protocols, referral mechanisms and the importance of early detection

Despite all the challenges, Carol remains hopeful about the task ahead. What gives her hope is number of people she met who are committed to improving breast care in the Palestinian Territories. The Baseline Assessment is a first step in the right direction. Now government officials, NGOs, and implementers in the development world have a better idea of where the need exists and can strategically plan and implement concrete programs that work towards improving awareness and breast health care in the Territories. With the assessment in hand and a little bit of elbow grease, advocates in the Palestinian Territories are helping pave the ways towards meaningful long-term change.

Read the Baseline Assessment of Breast Cancer awareness and Care: West Bank, Gaza, and East Jerusalem

Carol Al-Jabari is the US Middle East Partnership for Breast Cancer Awareness and Research’s local representative in the West Bank. She is a trainer to promote breast cancer screening among professionals and student nurses. Currently she works as the executive director of the Patient Friends Society in Jerusalem.

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