Affirming Cultural Diversity

The needs of a diversity of communities should be affirmed in the planning of breast cancer programs and services. A fact which was noted many times during the course of this project is that the medical system and most of the cancer support organizations represent Anglo, white and middle class culture.

The supports a woman feels comfortable turning to -- the issue of "who" and "how" supports are provided -- varies in every community. Depending upon their culture and background, women may find disclosure in groups around intimate matters difficult or inappropriate. Some consider breast cancer to be a very private matter. In these cases women find greater support in one-on-one supports with their families, friends or professionals whom they trust.

Special efforts have to be made to encourage the involvement of volunteers from diverse communities in cancer support groups: "To encourage people volunteering, we need to have the current staff take anti-racist training."

"Trust" is key to providing support to these communities: "If someone comes into our homes to talk with our mothers or sisters, the first thing they are going to ask is 'who is your mother? where are you from?'" Initiatives of support for breast cancer must take into account the importance of family, friends and the church, especially in African Nova Scotian communities.

In some cases, communities have lost their traditional practice of "natural helpers" as well as confidence in their own abilities and experiences to provide support. As a result, women have increasingly turned to medical professionals or "experts". Unfortunately, many African Nova Scotian and First Nations communities are greatly under-served by medical professionals. In the case of First Nations communities which are served by committed community health nurses, support is often limited because of lack of resources.

Providing supports for women with breast cancer in First Nations communities must be seen within the larger context of Band Councils trying to provide health care to communities which have historically been under-served and under-funded. For many First Nations health centres the priority today is breast health education and increasing efforts to promote early detection and treatment through well-women clinics.

The gaps in providing support to African Nova Scotians, First Nations, Acadian and women of other cultures, must be addressed on a number of levels, starting with needs assessments. Women who were interviewed underscored the importance of being involved in needs assessments which would shape future programs: "Don't just set programs without consulting people in the community about what they think their needs are...we know the barriers. We know what does and doesn't exist."

"Not recognizing cultural diversity is a subtle form of racism".

Suggestions:

• Provide a holistic form of support to women, eg. an African Nova Scotian multi-disciplinary health care team in every community which could provide support to women with breast cancer.

• Encourage and inform communities about scholarships and bursaries in order to ensure that people from a diversity of cultures enter medical professions (eg. one person informed this project that there are only 11 African Nova Scotian nurses and no African Nova Scotian doctors).

• Train staff and volunteers from various cultures to work in cancer support and health services in order to respond to needs of their communities.

• Provide anti-racism training for staff and volunteers of cancer agencies.

• Offer leadership training for black women to provide appropriate forms of breast cancer support. Also need more grief counselling and other specialized counselling.

• Continue to produce materials for different cultures and language groups, such as the "Living in Balance" pamphlet and First Nations' training binders produced through a partnership involving ABCIP, CCS-N.B. and First Nations women. Also make wider use of CCS-French language materials, training and information.

• To ensure that medical services and cancer agencies provide greater access to and involvement by the black community, it is important that there be more black representatives on staff, "since it is especially hard to talk about private things, like breast cancer with people you don't know."

• The incidence and particular characteristics of breast cancer among black women should be identified and addressed in the planning and carrying out of: support programs and services, statistical information-gathering and research.

• Breast cancer is felt to be such a personal issue in First Nations communities that it is difficult to establish the rate of incidence among women. Education and grass roots supports need to be put in place to encourage women and their families coming forward to community health centres where they can get further support.

Next: Legitimacy of Self-Help and Survivor's Experiences