Community Outreach
Mammography Van
January 7, 2008
For Begley and Orlando, road trips are routine — and revered
Their workdays often start at 5:30 a.m. in an Allston garage, and end around 6 p.m. in a radiology lab at Dana-Farber. For these two Dana-Farber employees, most of the hours in between are spent in parking lots and street corners miles from campus, yet they still have contact with 20-50 patients per shift — some of whom arrive at their "office" with the sunrise.
Deb Begley, RT, (R), (M), and Donna Orlando, RT, (R), (M), are radiology technologists staffing Boston's Mammography Van, the only vehicle of its kind in the Commonwealth of Massachusetts. Run as a joint venture between the City of Boston and Dana-Farber, the 35-foot-long van is fully equipped to provide annual breast screenings and health education, which Begley and Orlando deliver primarily to underserved women, minorities, and others who might not have access to such care. Each Tuesday through Thursday (as well as some weekends), they take their rolling clinic to neighborhood health centers, homeless shelters, and faith-based organizations in the area. They even visit a local women's prison.
The mammograms [they provide] are given free when necessary; although the program accepts health insurance, about half of the approximately 4,000 women who visit the van for the 10-minute procedure each year don't have it. Tech aide/health educator Luz Montero, MPH, joins Begley and Orlando on their treks, and serves as interpreter for their many Latina patients. Asians, Haitians, African-Americans, and other groups are also frequent visitors (with interpreters helping out as needed); no matter what the population, the van has become a familiar, beloved presence for residents.
"We get wonderful feedback from the community and health center staff about what a warm and inviting atmosphere Deb and Donna create on the van, making it easier to come in and get a mammogram," says Karen Ruderman, program director for the van since Dana-Farber began running it in mid-2002. "It's a scary process for a lot of women, particularly those who have never had one, but Deb and Donna help put them at ease. Women are more likely to return next year knowing Deb and Donna will be there to greet them and do their exam. It's such an important step in early cancer detection, and provides women a great opportunity to take charge of their own health."
Jack Meyer, MD, director of breast imaging at Dana-Farber, adds that "There are often language and physical barriers to cross, but the work Deb and Donna produce is excellent and they take great pride in the finished product. This is a wonderful service to the community and much of the success is secondary to their efforts."
Sounding boards
The van boasts a strong 45 percent rescreening rate, and Ruderman believes the camaraderie this sister-like duo share is a big reason.
Both mothers and former school bus drivers who live on the south shore, Begley and Orlando took different "routes" to get to their positions. Begley performed mobile mammography for seven years on the same van when it was run by Mobile Diagnostic Services, a private non-profit radiology group, and joined Dana-Farber after that company folded and the Institute took on the service. Orlando had recently retired after giving mammograms at MIT for 20 years when she received a postcard in 2006 saying Dana-Farber (where she had once worked as an on-call technologist) was looking for someone to partner with Begley. Once they met, both knew it was a perfect match.
Today the self-appointed "Double Ds" say they couldn't imagine a more "incredible" job. Whether or not Begley (who is also the van's back-up driver) is at the wheel, they make sure the oldies music is playing when they set up the van and begin seeing visitors each shift. The screenings themselves are their central focus, but Begley and Orlando have become sounding boards for a litany of other health concerns and life events that patients share with them.
"People just feel they can talk to us," says Begley. "We recently met some Somalian refugees who had just arrived in Boston the day before, and they told us incredible stories of how they had escaped their villages and were separated from their children." Other women may discuss or show signs of abuse; in these cases, and when they note other medical concerns, the technologists will connect patients with outreach coordinators at the sites.
The Double Ds know their work is appreciated by both the comments they receive and the efforts women make to reach them. "One time in Lawrence a tiny, elderly lady walked 3.5 miles to the van in the pouring rain — her ride hadn't shown up, but she didn't want to miss her mammogram," says Orlando. "We see that type of thing a lot."
After each day's shift, the van goes back to its Allston garage and Begley and Orlando go to Dana-Farber, where they process films from the previous day's screenings and go over them with radiologists. In those cases where cancer is found, the women are contacted by other staff and encouraged to begin treatment at Dana-Farber or elsewhere.
"Sometimes we already have a feeling, because we felt a lump during the procedure, but we never tell the woman," says Orlando. "There are a lot of tears shed on that van, but a lot of laughs too."
— Saul Wisnia
saul_wisnia@dfci.harvard.edu
