Breast Cancer Village Outreach

As my time in Albania comes to a close, my counterpart and I have officially wrapped up our Breast Cancer outreach grant project! I am happy to report that we have exceed our goal of reaching out to 300 women in village areas by more than 200! Below is a summary of our activities and some of the issues we faced in administering the campaign. (With photos, of course!)

BREAST CANCER VILLAGE OUTREACH - A PEACE CORPS PCPP GRANT PROJECT

 Participants practicing detection with breast model

Breast Cancer continues to be an issue in Albania, particularly in regions where information is limited. Geographic barriers and isolation of rural village areas in the Librazhd Region of Eastern Albania have caused a dangerous lack of education leading to deaths due to breast cancer. My counterpart and I decided to take on this issue in our community for both professional and personal reasons. As the de facto supervisors for all the local health centers, we decided to utilize them as leverage for this project, both to actively help with gathering women and to create a network to better do outreach to the entire community. There are 77 villages in Librazhd Region across 11 Komuna. Over 85% of the population under DShP Librazhd jurisdiction live outside of Librazhd City. That is why we chose these remote areas as our areas of focus. These villages, some hours away in the mountains represent some of the most impoverished communities in Albania, and Europe by extension.

Me presenting with a nurse from our partnering health center. Speaking in Shqip (Albanian) was quite a challenge at first!

Goals Achieved - We successfully held seminars in all 11 komuna, an achievement never before seen in the region. We reached out to more than 500 women across these areas and even held two additional sessions as well as a Training-of-Trainers with all the nurses in the area. By the end of the grant period, my counterpart had contacts both at the health centers but also through the schools in every area of the county. We have essentially built a better network of outreach that can be used for future health campaigns. Also, my counterpart has learned valuable skills in project design and management that will allow him to access future project funds. 

By collaborating with local nurses, we were able to more-effectively reach out to women and build a greater health network.

We initially planned to hold formal seminars in each region, by working closely with local community members across the 11 komuna. We had to change gears a bit as it was extremely challenging to schedule these sessions, and, due to the spread out nature of the village areas, the isolation of certain communities, reluctance from local health staff and the changing weather all made formal sessions a practical impossibility in some areas. We therefore changed our strategy and instead did a few smaller presentations, one at the health center and another at the local school with teachers. To further our reach we sometimes went with a local trusted community member and walked the streets to greet women and visit their homes to share this information. This strategy made it easier for our local partners to schedule our visits as it put less pressure on them to organize women. 

This truly was a collaborative effort. We couldn't have done this project without our local partners - even the cafe owners!

The overall community feeling has been positive and we have found that most people are very receptive to gaining information for themselves and the women in their lives. We even encountered many men who were so worried about the health of their family and friends that they demanded we give them information for the women in their lives! 

Many have heard about breast cancer but were too afraid to learn more or even perform a proper self-examination for fear of detection. For these people, detection meant death. We acknowledged their worries and catered our outreach appropriately, addressing such concerns in our presentations. We reassured them that this disease is treatable, especially when detected early. That is why it is so important to learn as much as you can about risk factors, symptoms and proper exams (self-exams and mammography, based on age) 

A community partner demonstrating detection methods with local women in her community.

Capacity and Skills Built

My counterpart had developed many skills throughout this project, as well as in the project planning period. We met and together did a community assessment, looking at all aspects of life in Librazhd, particularly relating to health needs, services offered and places for intervention. After such discussions we did a brainstorming session to come up with ideas for a viable community project. We then attended a Project Design & Management workshop together and my counterpart had the opportunity to learn a lot regarding project planning, design, evaluation as well as the grants process. We co-wrote the grant application, worked together on each outreach session, and compiled all the information and prepared the grant report together. 

Women came from nearby villages to attend the seminar and bring back info to their families and communities.

My counterpart has gained valuable skills that increase his capacity in his current position, as well as develop himself professionally. Through our collaboration with local health professionals across the region, many had the opportunity to practice their presentation of information regarding Breast Cancer - some doing so for the first time. This will allow them to feel more comfortable doing similar work in the future, and have more impact through such engagements.

Sometimes humor is the best way to start addressing a serious and uncomfortable topic.

 

Sustainability

Through the successful collaboration across the 11 districts, we have achieved our goal of building a sustainable network of professionals (both local health center nurses as well as school directors). My counterpart can now utilize this network for future health campaigns.

Through the training of trainers for all komuna nurses as well as their re-engagement during the local health outreach sessions, we have prepared them with information they need to continue to reach out on our behalf. Many nurses agreed to continue to speak to all their community members about Breast cancer to make sure everyone in their regions has access to this information. We gave each nurse as many additional brochures as they thought they might use in the future. Thus the impact of these efforts will continue past the initial grant period, and possibly for much longer.

Unexpected Events

My counterpart and local partner walking the muddy mountain roads to outreach to extremely isolated communities.

As stated previously, we did not expect the seminars to be so hard to plan. We faced many issues in trying to plan large-scale sessions in remote areas where we are unknown, and where we know very little about the community layout and habits. We had to do mini-community assessments, including a daily calendar to identify the appropriate times to visit these areas. Many nurses were not able to gather many community members, thus we had to be creative and reach out ourselves once we got to these sites. 

Our community partner demonstrating a self-exam for our participants.

 

We recommend that the portable Mammography machine come back to Librazhd several more times, allowing more people to get a mammography, particularly poorer women. There is a great need across the region, and attention should be made to focus on rural areas, isolated mountain communities and poor women.

Lessons Learned

We learned that although women are aware of breast cancer, they are often believe it to be a death sentence, and thus do not seek out services nor perform self-exams. This is putting many women at risk of not detecting a malignant mass in time. Risk is further exacerbated by a harsher living conditions - including extreme isolation, lack of power, lack of cell phone reception, lack of internet access and very poorly-funded health centers. Since we can’t go to every woman in the community individually, we should work with those who have access to them. This proved extremely effective for this project, as these small communities are very tight-knit and they are very willing to share this information. It is about helping each other, and the community by extension, survive.

When geographic barriers existed, we did what we could to meet women where it was more convenient. Sometimes at work!

 

We found that, in full Albanian tradition, many agreement and work is done over coffee. We had many informal discussions with our potential partners before each session to build trust and to understand and assuage any concerns they may have. This was also our way of doing a community assessment. They know their community best, and we were able to leverage that simply though chatting before our engagement. Now that my counterpart has all these contacts at his disposal, he can increase his capacity for additional engagements. 

Breaking the Ice

Winter is Persimmon season!

With temperatures hovering near freezing, life out here in Librazhd seems to be slowing down. It's like we are all preparing to hibernate. No one is scheduling any new activities for the rest of the year. It is a sort-of domino effect. If one person is out, then others hold off their planning and meetings until they return. This causes everyone else to put things on lockdown for the time being. Integration in Peace Corps is all about adjusting to your environment. When people say 'wait,' you wait. That being said, there is still much that can be done until the complete holiday shutdown. In fact, this has actually been a productive week. With two active grants, I am quite pleased to see things moving along. One grant for LGBT outreach and another for Breast Cancer.

University students posed for a group photo with presenters from Peace Corps and ProLGBT

The LGBT Outreach project has been progressing splendidly. Our outreach team (the "pink posse") held its third outreach session in the Southern sea-side town of Saranda. Response from the University level audience was primarily positive. A couple participants had an issue with acceptance of LGBT people, but it made for some good discussion. Despite some differing opinions, all participants were respectful and gave us their full attention throughout the session. I feel like if we allow people to ask the questions they need to ask in order to understand what being LGBT is like, then they might be more willing to change their pre-existing beliefs. If we can leave the audience with a good impression of us, it may help improve their overall opinion of LGBT in general. I believe that face-to-face interaction in very important. If you can like just one LGBT person, you will be so much more likely to be open to others. So far, we are seeing some mostly-positive reactions.

Students presenting on HIV

My counterpart and I held a session on HIV/AIDS with 8th and 9th graders at town about 30 minutes down the road. They actually knew many facts about this subject, which was a great surprise. This was through our work with the Directorate of Public Health in Librazhd (which essentially oversees Public Health outreach throughout the region - roughly 87,000 individuals.) We are trying to get out of the city of Librazhd and bring our lessons to more areas of need. Of course this is quite a challenge, as funding for such efforts is not always available. It is a mystery, but a reality - how can a community promotions department operate with a budget of 0? Usually my counterpart and I will end up paying for our work travel ourselves (which is rather silly, as neither of us is earning very much at all.)  We got a grant to fund our expense for the Breast Cancer project, but we are still left to our own devices for all other health lessons and outreach. If dipping into our wages can help us do our jobs more effectively, then it's just something that needs to be done. I do wonder what will happen when I eventually leave my position here. I hope my counterpart will find a sustainable way to keep on doing this good work.

Middle School students wore red ribbons to raise awareness about HIV/AIDS in a small town in Eastern Albania

Through my PCPP project my counterpart and I will be holding our second workshop in the isolated village of Stravaj, educating women about Breast Cancer. Planning these sessions are quite a challenge, as we must take much into consideration: weather (snow), transportation (it takes about 2 hours to get to these remote mountain villages) and potential for event participation (the day/time/weather all need to be right for them to show up). Once it snows, all bets are off and we must wait until the thaw to hold our sessions. In many developed areas, this might not be an issues, as people have cars and can drive and meet us there. Our project primarily targets some of the poorest areas of Albania, and in Europe by extension. These are places with internet, power, and cell phone access. Let's hope the weather holds up!