Articles by Idelle Davidson

HEALTH/MEDICINe
Mammogram Crusader
By Idelle Davidson

Mobile mammogram units make it possible for all women to take this vital test. One woman has made it her life’s work to ensure they get that chance.

It’s the morning shift at a chicken processing plant in rural North Carolina. Line workers are already hot and tired. The sounds of the conveyer belt and the plucking machines make it hard to hear. Each woman taps her supervisor on the shoulder when it’s time for her appointment outside the factory. Grateful for a break, the workers stow their aprons and gloves in their lockers. They brush chicken feathers off their faces and hair nets as best they can and make their way to the parking lot.

They’re heading for a 33-foot customized RV parked a few feet away, the words "Mobile Health Outreach" emblazoned above the front windshield. Inside the van is a fully operational, FDA-certified traveling mammography facility. It’s equipped with a friendly receptionist and a technologist, changing rooms with bench seats and knee-length cotton dressing gowns, an x-ray suite, and a darkroom. Within 20 minutes the women have been screened and are back at work.

Among the plant’s employees is Mary Siler, who checks the product as it comes off the line. "For me, having a mammogram on a van meant I didn’t have to drive anyplace," she says. "It also makes it possible for the ladies here who don’t drive." For Mary and her co-workers, there was simply no excuse to avoid having a mammogram, which is paid for in full by their employer.

Mobile Health Outreach is the creation of 54-year-old executive director Jean Griswold, a bubbly whirlwind of a woman whose speech quickens considerably when she’s excited. That happens just about every time the subject turns to mammograms. Ten years ago Griswold poured her passion and life savings into outfitting this lab on wheels to screen women for breast cancer. She hasn’t looked back since.

"I fell in love with what ‘mobile’ could do," says Griswold, an advisory board member for InTouch who sold medical x-ray equipment in the 1970s and 1980s. "We reach the unreachable. We see the women who fall through the cracks."

Backwoods to Boardrooms
Indeed, Mobile Health Outreach travels to some of the poorest and most rural areas of the Carolinas, Virginia, and Georgia. Among their clients are assembly-line workers in low-paying jobs at textile mills, factories, and food processing plants. "Many times we’re dealing with people who are marginally literate with a 5th-, 6th-, or 7th-grade education," says Griswold. And she is more than glad to help.

Mobile Health reaches a diverse group. The van rolls out to churches, Indian reservations, convalescent homes, malls, health fairs, and community events. They also travel to schools, agencies, and corporations where busy teachers, administrators, and executives all benefit from the service. Since 1991, Mobile Health has provided more than 44,000 mammograms. According to Griswold, theirs is the oldest mobile mammography program in the country not affiliated with a hospital or university.

A week or two before their screening, the women are invited to watch a video at work about mammography. Either Griswold, her operations manager Sheila Moran, or one of the technologists demonstrates how to do a monthly breast self-exam.

Among women they screen, the breast cancer detection rate is double the national average, says Griswold, who fires off statistics as easily as others recite the days of the week. "If you look at the national norms, out of every 1,000 women who have a mammogram this year, you’ll find three to four breast cancers. Our numbers range between six to eight detections per 1,000 women screened. That’s because we see the women who don’t pick up the phone to call the doctor’s office to make an appointment for a mammogram. They don’t take off work and have it done."

Taking a Stand
Up until recently, Griswold struggled to keep the program afloat. Fewer than half of the 5,000 to 6,000 women they screen every year have medical benefits. They either carry private insurance or Medicare, or their employers cover part or all of the mammography cost. "In the past, every time we screened a woman without adequate medical insurance, we got little or no reimbursement," says Griswold. "It cut a big hole in our operating capital. It was either close the company or figure out another way, because I wasn’t going to say, ‘You’re not going to have a mammogram,’ and then have that woman develop breast cancer!"

Thanks to First Union National Bank in Charlotte, North Carolina, Griswold was able to save her program. The bank forgave a $229,000 debt owed on the assets of Metrolina Outreach, which was what Griswold called her company prior to 2000. This allowed her to establish Mobile Health Outreach as a not-for-profit group that she runs but no longer owns.

"I draw a huge salary of $24,000 a year," she says, laughing. "But we’ve got to keep the program going and there’s never enough money." Her personal investment of $300,000 is long gone. She’ll never get it back, she says. "That part is a gift to the community and the women I love and serve," Griswold says.

Although money trickles in from some of the pink-ribbon jewelry sold at their website, Mobile Health relies on grants and donations. Their largest donor is the Charlotte affiliate of the Susan G. Komen Breast Cancer Foundation. They’ve also benefited from church fundraisers and donations from a grateful textile mill, and from Blue Cross/Blue Shield. Griswold is now hoping to raise enough capital to retire her 10-year-old RV and replace it with a new model.

She said that her husband of 3 years, John Lynn, is more than supportive of her. He regularly lends a hand. "We met because I was having problems with the processor on the van, which develops the x-ray film image. He’s a physicist-engineer and he said, ‘I can fix that!’"

It’s the women Griswold meets and their stories that inspire her to keep going, she says. She remembers one woman, a 36-year-old waitress with no medical insurance who felt a lump in her breast. The health department said she didn’t qualify for free services, and a local hospital that sees patients without insurance could not schedule her for 4 months. Mobile Health saw her within 2 days. The x-rays showed a malignancy.

Mobile Health called a doctor the woman had seen previously for a different problem. "This surgeon would not see her because she did not have insurance," says Griswold, indignantly. "Just flat refused to see her, which appalls me. And it was a female surgeon too!" So Griswold called Phil Visser, MD, a general surgeon who sees indigent patients at Carolinas Medical Center in nearby Charlotte. Dr. Visser performed a lumpectomy. The woman is now on her way to recovery.

Some of the stories "just break your heart," Griswold says. About 7 years ago they drove into Georgia at the request of a textile firm to teach their employees about the importance of mammography and proper breast exams. About 100 women gathered around Griswold who stood on a folding table in a room filled with huge machines and piles of boxes. After her hour-long presentation, a woman who Griswold describes as "in her 40s and drop-dead gorgeous" came up to her.

"She put her hand on her breast and said, ‘I’ve got a lump here under my arm. Three years ago when it first developed, I went to my doctor. He sent me to have a mammogram. It came back negative and he told me to go home and not worry about it. But it keeps getting larger and now I’ve got these shooting pains down my arm. Is it really okay for me not to worry?’"

Before Griswold left that day the woman had an appointment with a surgeon. The textile plant has since closed and Griswold doesn’t know what became of the woman. But the case has haunted her because it stands out as a stark reminder. "We see this so much in poor rural areas because they are not educated about health care," she says.

That’s why Griswold’s program, giving people access to preventive care, is so important, says Dr. Visser. "I don’t think there are many people who actually recognize that there is a need for something and then have the gumption to make it their life’s work and hope that along the way they have enough money to pay for food and rent."

To critics who question whether the standards of a mobile mammo-graphy unit can be high as a facility in a hospital or clinic, Griswold answers with an emphatic, "Baloney!" In fact, mobile units must meet the same qualifications as fixed sites. The U. S. Food and Drug Administration certifies all mammography facilities in accordance with the Mammography Quality Standards Act. "Mobile mammography is plain old mammography that happens to be in a mobile van," says Edward Sickles, MD, a radiology professor at the University of California in San Francisco.

There’s a whole lot more to Jean Griswold than Mobile Health Outreach. She’s the mother of four from a previous marriage and the grandmother of two toddlers who are "the light of my life," she says. She’ll even take time off from work occasionally to travel with her husband and scuba dive.

Yet for Griswold, the pull of her program is like a strong ocean current. She gets swept away, despite fleeting thoughts of staying home and playing more with her grand- kids. "There have been many times when it would have been much easier to say, ‘I don’t want to do this anymore,’" says Griswold. "And then I’ll get a phone call from someone thanking me for the mammogram that saved her life. And I’ll say, ‘That’s why I do what I do.’"

We're Losing Mammography Facilities
"Screening mammography is in a crisis situation," says Jean Griswold, executive director of Mobile Health Outreach in Charlotte, North Carolina. In the past 2 years, the state has lost about 17 screening sites, she says. "Right now there are not enough mammography facilities in North Carolina to appropriately take care of the women who are age-eligible for annual screening. At the same time we have a graying of America, we have an influx of more people into the state, and this is a picture of what’s happening everywhere in this country."

The loss of facilities is significant, agrees Marie Cinninger, Associate Executive Director of the American College of Radiology (ACR). In tracking all ACR-accredited screening facilities (stationary and mobile units) nationally from April 2001 through November 2001, the organization found some startling statistics. Although 145 new facilities opened their doors during that time, 400 others closed. And it’s not easy to find a mobile unit. Only 337 exist in the country, according to the U. S. Food and Drug Administration, which certifies mammography facilities. No professional organization for mobile facility operators exists.

"There have been a number of closures, which is a great concern to us," says Cinninger. "Reimbursement is also a huge issue. Medicare has not increased reimbursement for screenings even though they have placed more mandates on facilities." When mammography units don’t make a profit, they shut down, says Griswold. That means less access to screenings for everyone, including the poor and uninsured.

For More Information
To find an accredited mammography facility contact the American College of Radiology at 1-800-227-6440 or go online to www.acr.org. Follow the links to "Accredited Facilities," then to "Mammography." All sites, whether stationary or mobile, are grouped together by location.

To find out how you can start a mobile mammography service in your community contact Jean Griswold at:
Mobile Health Outreach
704-597-0046
E-mail: info@mobilehealth.org
www.mobilehealth.org