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Pasifika women fall under the ‘vulnerable’ group when it comes to mammograms and are urged to get checked. (Image: Tina Tiller)
Pasifika women fall under the ‘vulnerable’ group when it comes to mammograms and are urged to get checked. (Image: Tina Tiller)

SocietyMay 18, 2022

Missed mammograms are putting Pasifika women at risk

Pasifika women fall under the ‘vulnerable’ group when it comes to mammograms and are urged to get checked. (Image: Tina Tiller)
Pasifika women fall under the ‘vulnerable’ group when it comes to mammograms and are urged to get checked. (Image: Tina Tiller)

More than 50,000 New Zealand women are overdue for their mammograms – and the biggest decline in screening during the pandemic has been among Pasifika women.

I had a lump in my breast big enough that I could point to it without even looking at it,” says Fuatino Leaupepetele, a dean at Bishop Viard College in Porirua. She was diagnosed with breast cancer on her mother’s birthday, when her daughter was just 10 months old.

She had a breast removed, her hair fell out, she dealt with more needles than she had ever dealt with in her life, and she dreaded the prospect of death. 

Breast cancer is the most common cancer for women in Aotearoa. On average, nine women will hear the news today that they have breast cancer, and more than 650 women die of the disease every year.

Leaupepetele is Sāmoan. Nationally, around 170 Pacific women are diagnosed with invasive breast cancer each year – and this vulnerable group is the most at risk of dying from the cancer. Pacific women are more likely than all other ethnicities to have more aggressive grade three tumours, and have a much higher incidence of the higher-risk subtype HER2+ breast cancer.

One in nine NZ women will be diagnosed with breast cancer in their lifetime (Image: Getty Images)

Breast screening is free every two years for women aged 45 to 69, but first you have to register with Breast Screening Aotearoa. When Leaupepetele noticed the lump on her breast and went to her doctor to get it checked, she was just 35.

Today, 50,000 women in the country are overdue for their mammograms, the often lifesaving X-rays that are used to detect breast cancers. Pacific women have experienced the biggest decline in screening participation during the Covid-19 pandemic, due in part to the prolonged lockdown restrictions in Tāmaki Makaurau. “Living busy, hectic lives is another reason Pacific women struggle to get to their appointments,” says Dr Maryann Heather from Auckland healthcare centre Etu Pasifika. “Pacific people in general, but especially the women, have this mentality of putting everyone first before themselves and so getting a mammogram done isn’t seen as a priority, but we need to flip the script and let Pacific women know that they’re important and if you want to be around longer for the people you’re putting first, you have to prioritise your health.” 

While some do find it uncomfortable, both Leaupepetele and Heather want to reassure women that getting a mammogram doesn’t hurt. “I have come across women who have heard stories that it’s a painful experience and that’s why they don’t want to get their mammograms done, but it’s not true,” Heather says. “There’s no pain when going for a mammogram and the awkward feeling doesn’t compare to experiencing breast cancer,” Leaupepetele adds. Television and radio presenter Stacey Morrison, a Breast Cancer Foundation NZ ambassador who qualified for the free screening a couple of years ago, describes her experience as “not even sore, but a little weird”.

In an effort to increase participation in breast cancer screening, Breast Cancer Foundation NZ this month launched the #GiveUsOurMammograms campaign, calling for action from the government to prevent avoidable deaths from breast cancer in Aotearoa. The campaign invites women to share photos with a #GiveUsOurMammograms poster that will then be delivered to government ministers.

“Breast screening is one of the most effective ways to reduce deaths from breast cancer,” says Adele Gautier, a research manager at the foundation, which is currently investigating an ultra-mobile screening unit to increase access to screening for Pacific communities. Gautier says the decline in participation in the last two years is likely to result in a higher percentage of systematic diagnoses in the future.

“It will cost around $15 million to address this issue and prevent women being diagnosed late,” Gautier says. “We have spoken to minister of health Andrew Little, associate minister of health Dr Ayesha Verrall, Māori and Pacific ministers as well as the prime minister [to tell them] that in order to do an extra 1,000 mammograms a week to catch up, we need extra funding, so $15 million is to help with mammogram costs, staff and creative ways to use our resources to create an intensive ‘follow-up’ programme that actually builds more capacity in the system for the long term,” she says. 

(Image: Breast Cancer Foundation NZ)

For Heather, this issue is particularly close to home. In 2003, the doctor was working in American Sāmoa when she received a call from her mother back in Aotearoa to say she had been diagnosed with breast cancer. “It was interesting because I had two hats on, one as a doctor and one as a daughter. When I took my doctor hat off, I was emotional and I flew back to my mum in Wellington immediately,” Heather recalls.

It started with a lump on her mother’s breast that felt strange, so she decided to get a mammogram done. Getting checked immediately meant the specialists were able to pick up the cancer early, and she had surgery to remove the breast, went through chemotherapy and radiation and come out as a breast cancer survivor. Heather and her mother are now advocating for no further mammogram delays, especially now that Covid-19 restrictions have eased.

Gautier says during lockdown, especially under alert level four, screening clinics had to shut down, partly due to staff being deployed to help with Covid-19 efforts. “People were also worried about catching Covid if they turned up to their appointment,” she says. But now Aotearoa is at an orange traffic light setting, breast screenings have resumed.

Having open, truthful yet hard conversations about breast cancer with your loved ones helps debunk myths that mammograms are painful, Heather explains. “For many Pacific families, talking about our breasts is very much taboo and we tend to avoid or change the topic, but we need to normalise the discussion on mammograms and not feel embarrassed when reminding mum or your aunty about their appointment. That’s a massive factor in ensuring we all live longer to see our families flourish.”


Listen to Breast Assured on Apple Podcasts, Spotify or your favourite podcast provider.


How do you get a mammogram?

  • When you turn 45 years old, you’re eligible for the free mammogram check. Register with BreastScreen Aotearoa online or freephone 0800 270 200.
  • You’ll receive an invite to come for a mammogram in your area and to confirm your appointment, give the freephone a call.
  • A support person is welcome to attend your appointment. The appointment itself should take around 15 minutes.
  • During a mammogram, each breast is pressed firmly between the plates of the mammogram machine for a few minutes so a clear X-ray picture can be taken. At least two X-ray pictures of each breast are taken.
  • The results should arrive within three weeks, along with information on further actions from there.

This is Public Interest Journalism funded through NZ On Air.

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Illustration: Ali Al Boriny
Illustration: Ali Al Boriny

The Sunday EssayMay 15, 2022

The Sunday Essay: A Palestinian catastrophe

Illustration: Ali Al Boriny
Illustration: Ali Al Boriny

I thought a similar tragedy must have happened to every other kid in the world. I was mistaken.

The Sunday Essay is made possible thanks to the support of Creative New Zealand

Original illustration by Ali Al Boriny.


I don’t recall when I first heard about the death march, which was part of what came to be known as Nakba; the Palestinian Catastrophe. All I know is I have always known about it. It was part of our childhood. I saw it every time I saw my grandparents on our usual weekend stroll to see them. It wasn’t a “thing” that we talked about all the time; it was our life.

I was aware that I hadn’t even been born when it happened, but because it was so intertwined with our life, I always felt that it happened to me. It felt like a distant sad memory in my head, but strangely enough I don’t recall feeling mad or angry about it. It was so normalised; almost every single child friend I had back in Jordan had a relatively similar experience. At school we could recite the name of the Palestinian village or town every single kid’s family came from – we used to introduce ourselves by saying our name, the name of the Palestinian place our family came from and the year they were dispossessed (i.e. 1948 or 1967).

It wasn’t an exceptional story to us. I thought a similar tragedy must have happened to every other kid in the world. I was mistaken.

This is a relatively recent photo of my grandmother Salma (d. 1998), and grandfather Suleiman (d. 2008). They were both expelled, along with their three children, from their hometown al-Lidd, southeast of Tel Aviv in post Mandatory Palestine. It was 1948.

Until 1948, al-Lidd was a town with a population of around 20,000, predominantly Arabs. In 1947, the United Nations proposed dividing Mandatory Palestine into two states, one Jewish and one Arab; al-Lidd was to form part of the proposed Arab state. In the 1948 War, Israel captured Arab towns outside the area the UN had allotted it, including al-Lidd.

Operation Danny was the codename for the Israeli attack on al-Lidd. At first, al-Lidd was bombarded from the air. This was followed by a direct attack on the city centre. The few men of al-Lidd, armed with old rifles to defend the town, took shelter in a Mosque. After a few hours of fighting, they ran out of ammunition and stopped resisting, only to be massacred inside the mosque by the Israeli forces. Palestinian sources recount that in the mosque and in the streets nearby, Israeli troops went on a rampage of murder and pillage. 426 men, women and children were killed (176 bodies were found in the mosque). The following day, the Israeli soldiers went from house to house, taking people outside and marching about 50,000 of them (al-Lidd’s population doubled with the influx of refugees during the war), out of the city towards West Bank. Houses, every single one of them, were looted and the refugees robbed before being told to start walking.

The occupying soldiers set up roadblocks on the roads leading east and were searching the refugees, particularly women, stealing their gold jewellery from their necks, wrists, and fingers and whatever was hidden in their clothes. They took their money, along with everything else that was precious and light enough to carry.

On July 13, 1948, in the height of the Middle East summer, my grandparents and every other Palestinian Arab in the town, were ordered by the Israeli occupation rulers to walk into a death march.

Around 50,000 people walked for three days, in 30-35 degree temperature. Up to 350 people died from the heat, thirst, and exhaustion.

Palestine refugees on the death march, 1948 (Photo: Fred Csasznik / Public Domain)

My grandparents survived the death march and reached West Bank. From West Bank, they walked again to Gaza, where my father was born in 1950. The work and living prospects in Gaza were bad, and word came from Jordan that Palestinian refugees were welcome to settle there, so my grandparents decided shortly after my father’s birth to move to Jordan with their four children.

The walk from Gaza to Jordan proved to be very challenging. It meant sneaking through then-Israel in a hostile atmosphere. Emergency martial laws in Israel were applied which put all Arabs into lockdown. Movements of Arabs were very risky, even more so if it was considered “trespassing”. There was a strong belief that if they were detected they would be killed on the spot, the same fate that met Kafr Qasim villagers few years later.

My grandparents left Gaza on foot, and kept walking east at night only, to stay under the cover of darkness as much as possible. The fear was astronomical.

There were 50 people in the group, most of them children, including my father who was seven months old.

My grandfather was extremely worried that his son’s incessant crying would compromise the safety of the entire group. Eventually he became scared and desperate enough to abandon his son. A few men who were following behind saw a baby on the ground and brought him back. My grandmother almost lost her mind when she realised what happened.

This incident developed a strange and special bond between my father and his father. My grandfather’s trauma was complex, and he responded by acting tough. He never carried his baby again. I think he felt remorse and that he was not a good parent. A year or so later, my grandmother was in the kitchen when she heard her son crying in their bedroom. She hurried to tend to him but he soon stopped. When she peeked into the bedroom, she saw my grandfather was holding and soothing Dad. She burst into tears and ran to the bedroom to celebrate the moment, but when my grandfather heard the clattering he almost dropped my dad. He wasn’t prepared to be seen emotional and “weak”.

As a child, the story of my dad’s abandonment was just that. It was void of emotions. Actually, it gave us kids the giggles. It felt like a joke, and we were teasing Dad for it as if it was his fault. I never asked Dad how he felt about the story and what his memories were. That question didn’t fit with the acting tough attitude had all developed. Now I wish I had asked.

The iconic “Where to ..?” by the Palestinian artist Ismail Shammout, who was on the same death march as my grandparents.

A few nights after walking out of Gaza, my grandparents crossed the border into Jordan. Jordan was a new place to them and they had no money or possessions to start a new life. But everything considered, they were safe.

From that time on, their living conditions kept improving but the scars never healed. They never saw their home in al-Lidd again; Israel never accepted the Palestinian refugees’ right to return. I don’t remember ever seeing my grandfather smiling.

My grandparents kept the key to their house in al-Lidd, in anticipation of an imminent return to home. As days and years went by, the key became to us a symbol of hope and steadfastness. It’s now not uncommon to see picture frames of a house key or even an original key itself framed on a wall in an exiled Palestinian’s family house.

“Home” is a concept I struggled with. Throughout my childhood in exile, home experience was confusing. The direct and natural answer to the where-are-you-from question was Palestine. Although I was born and bred in Jordan, the exile feelings were powerful. It was akin to an out-of-body experience, where my body was in Jordan but mentally I was elsewhere. References to Palestine were in literature, schools, places of worship, TV news and drama, shop names, arts and music, sports, food, and every single aspect of my life. Other than the attachment to Palestine, there was an overwhelming feeling of insecurity: everything felt fragile and temporary. It was not uncommon to see people holding their passports in their shirt pocket, in anticipation of a sudden need to get moving, or more likely to prove who they were if they were to be made stateless.

Statelessness was something I didn’t quite understand when I was a child. I learned it was a bad thing and I had a fear of it. Statelessness was, and still is, one of the biggest issues for the Palestinians. Although my family were granted Jordanian citizenship, along with the majority of Palestinians in Jordan, we were treated as second-class citizens, a fact I was reminded of every time I dealt with even the smallest ranking public servant at a government department. Still, I thought I was among the lucky ones, compared to the tragic situation of Palestinian refugees in nearby Syria and Lebanon, or still in besieged Gaza and occupied West Bank.

The scenes on TV of sufferings and killing of Palestinian children in particular was something I could never erase from my memory. Sheer chance put me on a different path, but that didn’t matter. As a child, my mind couldn’t distance itself from the collective experience of Palestinian children everywhere. I felt I like was that kid separated from their parents who were either killed or detained in Israeli prisons; that arrested kid; that kid sitting next to a sewage gutter in a refugee camp. It was definitely me, and it felt more real than my shadowy physical experience.

A few years back, I decided I was not going to tell my children about the death march story. There was no point in passing on that memory. I knew sooner or later they would know about it, but at least I could  delay it a few years. Now I am sharing this story with you, dear reader, and my children for the first time.

.شكرًا جزيلًا على قراءة قصتي، و أتمنى لكم السعادة و العدالة

Thank you for listening to my story, and I wish you happiness and justice.

 

Editor’s note: Nakba Day is today, May 15.

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