Meeting the Challenge
Date: April 20, 2010
Taking on Prostate Cancer in Baltimore City
CHARLENE NDI HAS spent her entire career reaching out to the poor and underserved to bring them vital healthcare. She is understanding and compassionate, bringing humanness to discussions of this often faceless population. Still, there is a practicality and
deliberateness about her that makes one immediately understand that she not only cares about this immensely difficult problem, but she can help solve it as well.
And, do not be mistaken, it is a monumental task before her and her team, one
that can at times seem insurmountable.
As Program Manager for the Maryland Cigarette Restitution Fund’s Public Health
Grant at Johns Hopkins, she and her team are charged with bringing prostate cancer
screening to uninsured African American men, age 45-70, who live in Baltimore City. The city has some of the highest prostate cancer death rates in the nation, and African American men suffer disproportionately to their Caucasian counterparts. State legislators are hopeful the CRF-sponsored screening program, which began in 2001, will lead to earlier detection of prostate cancer and, as a result, better treatment outcomes for African American men, and over time, an improvement in the City’s prostate cancer death rates.
Ndi has only been with the Johns Hopkins Kimmel Cancer Center’s Cancer Disparities Program since March, but already under her brief management, the program achieved a screening milestone—a record 718 men were screened in 2008.
This year, the program’s goal is 900, but she will have help through a new partnership
with the Baltimore City Health Department. In addition, she has bolstered an already impressive team, adding two health educators who have extensive experience and contacts in community outreach. “We have assembled an excellent team. They know the population and are seasoned, so we can hit the ground running,” says Ndi.
According to State statistics, there are 40,000 uninsured African American men n Baltimore City. Ndi knows that for many of these men, the conditions in which they find themselves are more immediately threatening than the prospect of getting prostate cancer. When one doesn’t know where his next meal is coming from, facing tomorrow takes more courage than facing the potential of getting cancer. Cancer can wait.
As a result, the first challenge for Ndi and team is finding these uninsured men and engaging them in discussions about cancer screening. These men are struggling just to get by, Ndi explains. Many of them are homeless, some are already dealing with health issues, some are addicts, and others are just coming out of prison. Ndi knows that many of them don’t have the very basic of needs met—a roof over their heads, a pillow to lay their heads on at night, and food on the table. When people are just trying to survive, she knows getting them to participate in cancer screening, and particularly a test that includes a digital rectal exam, will not be greeted with enthusiasm. While potentially life saving, let’s face it, it is unpleasant for most men. For a population in varying stages of transition, it is an even harder sell, but she is committed. She refuses to give up on them no matter how difficult it is to reach them, so she meets them where they are.
“We don’t care where they are,” says Ndi. “We just want to get to them.”
Accessibility is critical to success, Ndi says, so she and her team are setting up screenings at transitional housing shelters, drug treatment centers and needleexchange programs, job-readiness programs, parole and probation re-entry programs, churches, and community centers. “This year, we’re promoting a calendar of events with groups, including Our Daily Bread, Project PLASE, Healthcare for the Homeless, and the Maryland Center for Veterans Education and Training, so that people know we’re going to be in their neighborhood on a particular day,” says Ndi. “People want to feel like they are a part of something big, so we’re out there beating the drum, setting up booths at health fairs and other community events, partnering with radio and television stations to get events advertised, and getting fliers into the communities.” Creating a festive atmosphere, like balloons and a small give away, usually an insulated lunch bag is so important for underserved men, although it seems like such a little thing. But to someone living on the street, a bag to protect their food is priceless. “They come to see what’s going on, and it gives us the opportunity to talk to them about screening,” says Ndi.
This lesson was validated at this summer’s African American Men’s Health Conference at the Convention Center. Ndi’s group was on hand for prostate cancer screenings. Though 500 men were registered for the conference, most of the 82 men screened during the conference were not registered participants. They walked in off of the street to see what the event was about and decided to be screened.
As Ndi continues to face and meet the challenges of prostate cancer screening, she and her team also have begun making inroads to these communities for colon cancer screening. Since 2006, the Cancer Disparities Program has coordinated screening of underserved men and women for colon cancer through a subcontract from a Center for Disease Control grant to the Maryland Department of Health and Mental Hygiene; so the infrastructure for screening for this cancer was already in place. Working with the Baltimore City Health Department and Sinai Hospital, they hope to screen at least 50 men and women through a CRF-supported initiative this year.
According to DR. JEAN FORD, Director of the CRF Public Health Grant, “Charlene presents the unique blend of qualities that this program needs: management experience, in-depth knowledge of our community, and a commitment to improving its health.”
Despite the difficulty of the task before her, Ndi remains optimistic. “What we are trying to do speaks to everything I have done for over the last 30 years,” says Ndi. “I love this job.”