 Hello, I'm Marcia Joyner and we are navigating the journey. Navigating the journey is dedicated to exploring the options and choices for end of life care and to assist people to talk about their wishes. It's time to transform our culture so we shift from not talking about end of life to talking about it. It's time to share the way we want to live our lives at the end of our lives and it's time to communicate about the kind of care we want and don't want. We believe that the place for this to begin is not an intensive care unit. One of the areas we talk about least is breast cancer. This is October, Breast Cancer Awareness Month, and we are going beyond the pink ribbon. We are highlighting breast cancer disparities among African American women. Overall, white women are slightly more likely to get breast cancer, but African American women are more likely to die from it. In fact, breast cancer mortality is roughly 40% higher in African American women than white women. Why? Why? Even looking at the mortality rate which has decreased for all women since 1990, the decreases began earlier and greater for white women than they are for African American women. Why? Behind every great movement stands a team of passionate organizers, communicators, and visionaries. Meet ours. Our guest today is Linda Mitchell, President of Honolulu Black Nurses Association. The Honolulu Black Nurses Association mission is to represent and provide a forum for black nurses to advocate and implement strategies to ensure access to the highest quality of healthcare for persons of color. The National Black Nurses Association represents 150,000, that's a big number, African American registered nurses, licensed vocational practical nurses, nursing students, retired nurses from the USA, Eastern Caribbean, Africa, and 92 charter chapters in 35 states. Wow. Linda. Hi. Good morning. What a pleasure to have you. Oh, I'm so thankful to be here and thanks for having me here on the show today. Well, this is October, breast cancer awareness month, and what better than to talk about somebody that spends your life taking care of people with cancer, all kinds of cancers, especially. This one was troubling to me because it lumps African American women in one category. And for our audience who may or may not know this, we as African Americans, which is something we call ourselves or somebody else called us, somebody else made up that term, we, I say we are the indigenous people of the United States because we don't exist anywhere else in the world. We were created here in the United States. We were bought from different places of Africa, dropped in the United States. Everybody knows the slave master, cohabitated with the slaves, and thus we have all of these mixtures that don't exist anywhere else in the world. And when I read this about black people, African Americans, as they call us, I'm still for anybody that doesn't know. I'm still back in when black was beautiful because I really like being black and beautiful. I'm stuck. Anyway, to lump us all in this one category seems somehow, especially since it's scientific that they missed the boat. So you tell me, what is it that looks at black women and why is it the mortality rate is higher? Okay, basically we have late diagnosis, meaning that women come in and when they see their doctor, they're late in the stages of breast cancer. Usually they're at a stage four, so we don't have a high survival rate. We don't get it as often, but we die more often because we have that late diagnosis and we're trying to get women to understand that having breast cancer is not a death sentence. You know, if you go to your doctor early enough, you're getting your yearly mammograms and that starts at age 40. They want women at age 20 to start getting clinical breast exams, at least every three years and then at 40 you get them at least once a year. What we're finding is that we even have women that are insured that are not going to get their breast mammograms yearly and that's a big concern. Susan G. Coleman has taken on a project and their funding, it's a $27 million funding that Coleman is launching for African American women for health equity and initiatives to fight the disparities in breast cancer outcomes for the African American community. Now in the Obamacare, and I say wasn't because I don't know what they're doing now with quote Obamacare, but wasn't mammogram, wasn't that one of those things that was prevented? Wasn't that listed in that? Yeah, that's preventative care and it's something that they can get at no charge to themselves. So they really need to be educated and be aware of anything that changes with them as far as their body, they need to know their wrist and that's looking at your family history to make sure that you're aware that if you have a familiar history then it may put you at high risk for breast cancer. My mom died at an early age with breast cancer, I think I was about five years old so I'm so compassionate about breast cancer and that's why I'm always in the community educating and helping women to understand the need to have their breast cancer exams because I feel like no little girl should ever live without their mom. And so we have to take care of ourselves. Now I've had breast cancer which is, you know I talk about it, my daughter they refused to give her a mammogram and said oh no you don't, but she said my mother's had it. Right. And she was 35 I guess it was, something like that, she said oh no you're too young. And she really had an awful time getting them to understand that this is what she wanted. Right. And back, and I'm not sure when that was, but insurance companies weren't covering them until you reached a certain age, that has since changed. If you have a familiar history of breast cancer, your primary care provider should be providing you with the means to get that mammogram. Now what about people that have quests, you know the state Medicaid? Right. Can they get the mammograms? Yes, Medicaid members and women can get breast cancer exams yearly, so we also have men that get breast cancer, which is really kind of rare, but it is something that does happen, so we do include them in that too if they have family history as well. But yes, Medicaid members can get breast cancer exams. Now let's make the difference here, Medicaid is paid for by the state, Medicare is federal, and so those of us over 65 get Medicare, but the state of Hawaii has more than 300,000 people on Medicaid, and so is there an outreach to them? Yes, they are managed under the Quest Integration Program, and actually I work for United Health, and we run the Medicaid program for the state, so we have members that are enrolled, sometimes they're dual enrolled in both Medicare and Medicaid, and they are and can get all their preventative exams without any cost to themselves, the state does pay for that. So there is an outreach, not just, okay so we're talking about it, but do we really reach for those people because it seems to me that people that are on Quest, there should be a more aggressive outreach to them because that is what all of us pay for for their health care, it seems to me that they should be primary in reaching out to those people to reduce some of those costs. They are reached out to by they have community health workers, they have what they call field service coordinators that go out and have a caseload of members, we also have those that we have social workers that interact with a lot of our Medicaid members, and we also have an initiative to make sure that the gaps in care such as things that they need like the colonoscopy is done, they're getting the mammograms, if they're diabetic they're getting the diabetic checks and so forth, so they are reaching out to these members and so we are really striving to make sure that they are getting these preventative exams because that could be the determination of whether they have a disease that can be prevented. If you go early enough, you have a great survival rate in those folks that do reach out and have their preventative exams done as they are supposed to. Tell me how many, I've heard all these different kinds of breast cancer, tell us what those are and what that means, different types of breast cancer. Well it depends, they have different types of breast cancer, some breast cancers are more aggressive than others and Susan G. Coleman in fact has went beyond the pink ribbon, it's more than pink with them now because they really are striving to make sure that women can get in early, they're even finding breast cancer in women at the ages of 25 which years ago that was never a diagnosis that was projected in these women and now we find that women are getting it much earlier and it's more aggressive. In African American women, tumors seem to grow a little bit faster so we are really warning our African American ladies to make sure that they're getting their breast exams because it's imperative that they're caught early, if they're caught in the late stages then the survival rate is higher, I mean lower and then if it's caught early enough then it's much lower and it can be diagnosed and treated and they usually come out pretty good so the metastasis and the breast cancer tumors that are going faster are what the cancer research is really looking into now, why is this happening and what they can do to get rid of those types of cancers. Well we need to take a break and we'll be back in a minute and then I would like to talk about the Black Nurses Association, okay, we'll be right back. This is Think Tech Hawaii, raising public awareness. Thank you, we all play a role in keeping our community safe. Every day we move in and out of each other's busy lives. It's easy to take for granted all the little moments that make up our every day. Some are good, others not so much, but that's life. It's when something doesn't seem quite right that it's time to pay attention. Because only you know what's not supposed to be in your every day, so protect your every day. If you see something suspicious, say something to local authorities. Hi, I'm Marcia and we are visiting with my dear, dear friend of a couple hundred years, Linda Mitchell who is president of the Honolulu Black Nurses Association and they are having an event. The Honolulu, now I've got to read just to get it right, the Honolulu Black Nurses Association partner in pursuit of the promise of because, breast cancer awareness, understanding, screening, survivor support, and empowerment. It's a community forum and fashion show on Saturday, the 28th at 4 p.m. at Crock Center in Copper Lake. Did I get that right? Yes. And can we get a picture of this, can we? No? No. Where is everybody? So tell me Linda about the Honolulu Black Nurses. How long have you been, how long has the organization been together? Well we were founded by our founder with Mercedes Foster and that was under Governor Cayetano's. Right. Term and we have been on the island for almost 18 years. We are a branch of the National Black Nurses Association and our branch offices are in Maryland. We are about, we are very transient here with our membership but we are always recruiting. We work in partnership with other organizations such as the Susan G. Coleman, the American Cancer Society, the American Kidney Foundation and so a lot of times when they're out in the community you will probably see some of our nurses there working with them to get their message out and their word out and then us as nurses educating on the importance of health and medical exams and seeing your primary care doctor and just getting those preventative exams yearly. Now you mentioned transient so that means you have nurses coming and going with the military? Correct because our nurses are usually, a lot of our nurses are here in their active duty and so when they PCS to another place then we lose our nurses so we are in always in an active recruiting stage so if there's any nurses out there that are RNs or LPNs we welcome you to join us and like I said we are a branch of the National Black Nurses Association which I'm really proud of. So is it just, is it open to everyone regardless of race? Yes it's open to everyone regardless of race. Our name came from our founders because back in the day black nurses weren't allowed to be in the American Nurses Association and so they started their own because they found that they needed to reach out to their people to make sure that we are getting the equality we needed in medical care that we did find we do have a lot of disparities when it comes to African American people. That seems strange that it took so long because I remember growing up at a time when nursing was one of the few professions that were open to black women when you know you had to be a nurse a school teacher or a secretary that was it yeah and so it seems strange that it was so long before there was an organization of black nurses right right it did it was at during the time that they were formed out of Howard University it probably at that time probably took them a time to get organized and and you know get the nurses on board but it was done and it's been successful ever since so like you gave you know the statistics of how many we serve how many nurses are now part of the 150,000 nurses all over in each state to include the Caribbean here in Hawaii as well so we're proud of that that we're here and we have a chapter now do you would like when you have these hurricanes and what now do you go out like the Red Cross volunteer to go to other places yeah we actually partner with the Red Cross in those efforts and so nurses that want to go out and provide those services and to help the victims of hurricanes are always welcome to do that we do have an outlet for that we here in Hawaii our chapter we had all went through the Red Cross training to be you know first responders so we can be called on upon upon any disasters here in Hawaii so that's also something that one of our outreaches as well but tell us again more about your event on Saturday this is a beautiful program okay our event on Saturday is a way that we want to honor our survivors and at the same time we want to educate our survivors and make sure that they're the women out there know that there is there are survivors and survivors are are the true warrior warriors and they have went through the journey and so we like to honor them each year Susan E Coleman has supported us in this with a grant so we will be honoring our breast cancer survivors and bringing awareness and education to other women because it's open to the public again it's October the 28th it's at the Crock Center where is the Crock Center the Crock Center is out in Eva Beach it's out where the the rail is you know the rail starts so it's the Salvation Army is really the what the Crock Center is I don't know the acronym for the KROC but it's a beautiful place we should have a great time and in honoring our survivors we have them showing how they went through their journey and they will be doing a parade of fashions to show that they are standing among all women and they are beautiful and then they'll be given their story so we're just so excited about this event we have Dr. Sander Underwood coming she is a nursing professor at the University of Milwaukee and Wisconsin and so she'll be arriving on Island on Friday and we'll be speaking so please come out and join us there's no tickets that we sold it's a donation it's a welcome but they're not required and usually all our donations go toward our efforts the Honolulu Black Nurses Association's efforts in the community doing charitable community events we also give a scholarship away to a nursing student and we also will give back to cancer research great now it mentions a forum education forum the forum will be Dr. Underwood speaking we have a patient navigator coming from Queens hospital who will be giving information to those underserved and underinsured what is it navigator patient navigator patient navigator helps you navigate to the system because the health system can be very complicated and so they help you navigate through and make sure that you are you know getting through the system to make sure that you are assisted in every area that's necessary what they usually do is they have the programs right now they have a B triple CP which is a program that offers free mammograms so they'll be giving that information to us also on October 28th and they'll have for those women that are missed that's a population that we really would like to reach out to the ones that are underinsured the ones that are underserved so she the patient navigator will have information pamphlets things that will assist them in navigating through this so this is open to everybody not just african-american women yeah it's open to everyone and we are reaching out to our local our local women here in hawaii um our um pacific islanders are you know everybody we're a melting pot here so everybody's a person of color here so everybody's welcome come out we're gonna have a good time have some food we'll have door prizes and then we'll end it with the parade of fashions including our breast cancer survivors telling their story i tell you that i am a breast cancer survivor and many years ago i was asked if i would be on a calendar a nude calendar yes for survivors and i thought okay i never thought of me as being shy but i was terrified of taking my clothes off right but once i got there and looked at all these other women with no clothes on i thought oh i can do that so if anybody's interested it is my facebook page okay that's beautiful yes i once i got up the guts to do it yes and i thought oh if everybody else could do that i can't do i guess that i never thought of me as shy right yeah and we want women to know that they're beautiful uh once they go to that journey uh we have women that once they share their story it's just very empowering and you'll have a woman sitting there and thinking that they couldn't get through this journey of breast cancer going through their chemo and their radiation you know losing their hair they don't feel very attractive anymore and are beautiful and we just want women to know you are beautiful you are the survivors of our true warriors and so when i look at them i know that my mom would be proud that i'm you know carrying on this fight for breast cancer we want to just abolish breast cancer we don't want any more breast cancer and i think that we can do that is there a way to to look at that not just once you find it but is there a preventive there's something because you know now they do all kind of preventive for other things is there a preventive to keep this from growing or or not well once you have it it just depends on what you know what stages you are but but you have to have something before you can so you have to have just you know you have to get screened know your wrist you know you have to talk to your doctor you have to know what's normal for you if you see anything that's not normal like you know discharge coming from the breast or if the breast if there's pain that won't go away any of those kinds of things you should report right away to your doctor don't just think that that's normal because pain is really not normal in the body it's letting you know that something is terribly wrong you know we get headaches and we just oh we got a headache tick tall and all and then the next day you still have the headache and knowing that pain is not normal and things that don't go away quickly should always be brought to a doctor's attention so that they can examine you and make sure that whatever it is that they can take care of in the earlier stages such as breast cancer you know so and just getting your clinical breast exams and your mammograms are very important and if we do that yearly as our preventative guidelines tell us to do I think that we will combat this disease and bring it to a halt well thank you so much for being here and we look forward to seeing you on Saturday and I am delighted thank you so much for spending this time with us and we'll see you next week okay thanks for having me on the show aloha aloha