Lucknow, Uttar Pradesh, India—When patients complain of a cough or fever, or have high blood pressure or diabetes, Sarita Yadav, a 30-year-old staff nurse at Jankipuram Urban Primary Health Care Center (UPHC), knows how to care for them.
Likewise, when women reveal they are worried about pain or lumps in their breasts, she is confident and competent to offer help right away, in the UPHC where she is based. But this wasn’t always the case.
In fact, until April 2019, when the nurse of 5 years completed a daylong Jhpiego-led training in breast examination, health care providers like Yadav had nothing to offer women concerning breast health.
“We used to feel ashamed that a person has come [to see us], and we are not able to help her,” Yadav says. “We didn’t know what breast examination is. We used to tell [women] we don’t have any information about this, so they should go elsewhere to get checked.”
Yadav couldn’t even advise where they might get the care they needed.
Now, she herself performs clinical breast exams and works hand in hand with local accredited social health activists (ASHAs) to spread awareness to communities about what normal breasts look and feel like, and what constitutes abnormal. She also teaches women how to examine themselves, urging that they stay vigilant. She wants all to know they can come to her, at this local facility, for clinical breast exams if any abnormality concerns them, such as pain, a mass or nipple discharge that doesn’t resolve.
If her findings call for further examination and diagnoses, she doesn’t simply suggest that patients find somewhere to go for advanced screenings and treatment. Rather, she knows exactly where to refer her patients—to an urban secondary facility with diagnostic capacity—and how to follow up with them.
To battle breast cancer—the number one cancer killer of women in India, where it claimed an estimated 87,090 lives in 2018—Jhpiego began investing in breast health in April 2018. Now, in collaboration with the Government of India and private-sector partners, Jhpiego is expanding a program along the continuum of care from early diagnosis to treatment. Working with state government departments for noncommunicable diseases in Uttar Pradesh and Jharkhand, Jhpiego has helped to establish breast health services in 225 facilities in various districts across these two states, most notably at health and wellness centers, UPHCs, and district hospitals. Currently, 500 frontline health providers like Yadav and 140 medical officers are competently performing clinical breast exams and teaching women how to check themselves.
“Women’s lives depend on integrating breast health into the primary care system,” says Somesh Kumar, senior director of global solutions and innovations at Jhpiego. “We are helping India to decentralize breast health care by leveraging nurse power out in the communities.”
The emphasis on saturating the country with breast health awareness is paying off. More than 1,000 ASHAs were instrumental in identifying 108,000 women aged 30–65 who potentially would benefit from affordable breast health services offered at intervention facilities close to their homes.
“ASHAs have been additionally instrumental in coordinating women’s care by helping them to navigate a single-day diagnostic visit to the referral [district] health facility,” says Maura McCarthy, Jhpiego’s lead for breast health initiatives. “However, much work remains in order to ensure that women with symptomatic breast disease have local access to timely diagnosis.”
To date, 43,920 women have been screened at primary health care centers, with 2,020 referred for further testing and diagnosis, and 20 identified as needing treatment for breast cancer.
Among those screened and referred was Vidyawati Devi, a 34-year-old wife and mother who had been feeling pain in her left breast for more than half a year before she mentioned it to relatives during a visit in Lucknow. They told her about the new breast health examination facility available nearby, at Jankipuram UPHC. She went right away to get checked. It was Yadav who invited her to lie down on an exam table and make herself comfortable as the nurse respectfully drew the curtains for privacy.
“She explained everything to me and also taught me how to examine my breasts myself every month after my menses,” Devi says. “After checking me, she wrote my details on a card and referred me to Veerangana Avanti Bai Women’s Hospital in Lucknow.”
Yadav so impressed upon Devi the importance of early diagnosis and treatment that she went for further screening the very next day.
“Because of the card I carried, they knew my case,” she says. “The madam [nurse] there examined me and wrote medicines for me. She told me to come back if I did not feel better. I took those medicines, and now I am fine.”
Yadav followed up with Devi after that referral visit and was happy to learn she was cancer-free and no longer has symptoms of breast disease.
“I have seen women dying because of breast cancer,” Yadav says. “But now, they’ll have information. They will become aware. They will recognize the [symptoms] of the disease so they’ll get the treatment on time.”
Harleen Sidhu is a communications officer for Jhpiego in India. Indrani Kashyap is the Asia regional communications specialist for Jhpiego. Maryalice Yakutchik is Jhpiego’s communications manager. Ajay Singh, program coordinator in Lucknow, Uttar Pradesh, also contributed to this story.