Leah walked into the Bishvilaych Center in a panic. After receiving an invitation for a Bishvilaych evening in her neighborhood about women’s health in her mail box with approbations from her neighborhood Rav [rabbi], she knew she should be taking better care of herself.
Leah had noticed a (lump) change and quickly went to her doctor to be examined. Her doctor did not feel qualified to examine her and had referred her to a surgeon, when she decided Bishvilaych would be able to help her.
Breast cancer is the most common cancer in Israel and the second leading cause of death in women. Jewish women in Israel, in particular, are at relatively higher risk for breast cancer compared with other women globally, possibly due to the relatively high incidence of mutations in the BRCA1 and BRCA2 genes.
Early detection (regular mammography and clinical breast examinations (CBE)) can drastically reduce mortality rates (American Society of Clinical Oncology, 2011). Women on a lower socio-economic level, those with less education, and the ultra-Orthodox, however, consistently show lower adherence to scheduling of routine mammography and CBE.
Women in Israel who do receive regular screenings, tend to be affluent and are knowledgeable about their families’ breast cancer histories. In lower socioeconomic strata (SES) and religious populations, many women do not know their family histories of cancer as they are often kept a secret.
Additionally, highly religious communities do not participate in public discussions of women’s bodies and do not use the word “breast” in their media for reasons of modesty.
Internal evaluation of Bishvilaych program participants’ and clinic patients’ screening histories indicates that nearly 70% of religious women have never had a CBE. This is in comparison with the already high rate of 33% of women in Israel’s general population who have never had a CBE.
Despite the need, current breast health promotion activities targeting this population are seriously lacking. Health information is most often disseminated through secular media (internet, magazines, television, etc.) and women in general rely on the media for health information. Given that this avenue is unlikely to impact religious women, providing effective, culturally-sensitive education programs that focus on prevention and risk-matched screening while targeting women in this population is a crucial step towards decreasing morbidity and mortality.
Over the past two years, a unique nonprofit medical organization called Bishvilaych (translation: Just for you)has taken on this challenge with an ongoing multifaceted breast health program. This program addresses the lack of knowledge about breast cancer and low CBE attainment through culturally-tailored educational workshops, involvement of religious leaders, and physician training.
In order to increase women’s likelihood of obtaining breast examinations, Bishvilaych workshops provide women with knowledge, community-specific resources, and the opportunity to receive a CBE that same evening.
The common practice in Israel is that CBEs are primarily performed by breast surgeons. There are very few internists, family physicians, obstetricians, or gynecologists who perform CBEs. This limits the number of qualified professionals who can perform the exam, even if women were seeking them. There are simply not enough surgeons in the country to examine the number of women there are if all were to get a yearly CBE.
This is particularly problematic for religious women. During Bishvilaych’s pilot of this program, ultra-Orthodox women reported that they refuse to have a CBE done by a male doctor- and that they were terrified by the idea of seeing a surgeon for a screening exam. They therefore did not go for them.
In order to address this obstacle, Bishvilaych’s project trains female internists, family physicians, obstetricians, and gynecologists - that work in the identified communities – in CBE.
The “Your Health is in Your Hands” Project consists of culturally-tailored, rabbinically-endorsed and supported community education workshops on breast cancer, screening, and genetics, encouraging screening compliance, raising the level of breast cancer knowledge in the community, and demystifying fears and stigmas surrounding screening.
At these workshops, women receive booklets with a detailed overview of cancer prevention, screening, and genetics along with a list of breast cancer-related resources and community-matched listings of locations to receive mammograms and CBEs by female physicians. Through training female physicians who do not currently provide CBEs, this project will improve religious women’s access to care and increase the number of physicians that can effectively conduct CBEs throughout the country.
In addition to these elements, through meeting with the rabbis in each community, this project hopes to increase religious leaders’ knowledge of breast cancer, screening, and mortality rates in the religious community- with potentially wide-ranging benefits to that community.
Bishvilaych is the first and only woman-to-woman nonprofit organization focused on medical care and health promotion for ultra-Orthodox Jewish women in Israel, although any woman may apply. Established in 2004, its mission is to foster informed self-care among women and promote medicine as inclusive of social, physical, and mental health in both lay leaders and health professionals countrywide.
Current initiatives focus on the religious Jewish women in Israel, as this population often suffers from information poverty as well as from the stress of large families, overcrowded living conditions, and economic privation. Given these factors as well as religious and socio-cultural barriers to accessing accurate health information and services, Bishvilaych has pioneered innovations in direct health services, community and medical professional education, public health research, and advocacy at the policy level.
Since opening Israel’s first women’s comprehensive medical center in 2006, it has provided direct care to over 2,000 women, their outreach initiatives have reached over 25,000 women, and training courses have educated over 200 medical professionals. Bishvilaych’s success at reaching underserved populations in particular has received both verbal acclaim and funding from Israel’s Knesset and the Ministry of Health.
"Every woman deserves to be cared for, to receive comprehensive medical care for her own benefit and for the benefit of all for whom she cares and who care about her", says the founder of Bishvilaych, Sara Siemiatyki.
For more information about their upcoming Breast Health Programs or to learn about theirwoman-to-woman comprehensive medical center, call Bishvilaych at 02-502-1096 orvisit their website at www.bishvilaych.org. For a short video, click here.