National Breast and Cervical Cancer Early Detection Program Awardee Highlight: U.S. Affiliated Pacific Islands The U.S. Affiliated Pacific Islands reflect on the value of community to implement the breast and cervical cancer screening program. Audio Descriptive Text • U.S. Affiliated Pacific Islands. American Samoa Department of Health. Commonwealth of Northern Mariana Islands (CNMI). Guam Department of Public Health and Social Services. Republic of Palau Ministry of Health. Republic of the Marshall Islands Ministry of Health (RMI). • U.S. Affiliated Pacific Islands. Strength in Community. CNMI. Group of community health workers. • Group of community health workers in Guam. • Photos of the Southern Region Community Health Center in Guam. • Photo of an office in Guam Breast and Cervical Cancer Early Detection Program with a flyer about screening services, eligibility criteria, and documents required. • Rachel Ramirez, GBCCEDP Health Educator, Guam • CNMI. Outreach Screening Clinics in Saipan, Tinian, and Rota. Photos of CNMI health care workers and mobile outreach bus. • Group of community health workers in Palau. • Sheila Tmarsel, Case Manager, Palau. • CNMI. Outreach Screening Clinics in Saipan, Tinian, and Rota. Photos of CNMI health care workers in presentations. • Suzanne M. Philippo, Coordinator and Data Manager, RMI. • Several patients waiting in the health care center. • A health care worker with a patient. • Several patients waiting in the health care center. • Public Education and Outreach in the Commonwealth of Northern Mariana Islands (CNMI). Photos of CNMI health care workers in presentations. • Rachel Ramirez speaking. • Photo of Guam's Department of Public Health and Social Services in a conference. • Photo of members of Guam Cancer Care, most of them wearing shirts that say "Get Your Pink On. Join The Fight". • Photo of people wearing "Get Your Pink On" shirts. • Photo of a LiveHealthyGuam health care specialist. • Guam Breast and Cervical Cancer Early Detection Program staff member and patient filling out a form. • Guam Breast and Cervical Cancer Early Detection Program staff members at K57 AM in Guam. • Guam Breast and Cervical Cancer Early Detection Program flyer that has its logo watermarked, a photo of a woman, and says "Free mammogram and papsmear for those who qualify. Women are eligible if they are 21 to 64 years old with no insurance or underinsured." • Rachel Ramirez speaking. • On Palau, teamwork is essential to community outreach and screening. Photo of Sheila Tmarsel and her colleagues from the Republic of Palau Ministry of Health. • Sheila Tmarsel speaking. • Health conference by the Republic of Palau Ministry of Health held at a basketball court. • Palauans holding banners promoting cancer screenings. • Photo of a group of Palauans in front of a cervical cancer banner. • Four individual photos of health care workers. • Sheila Tmarsel speaking. • Sheila Tmarsel with her colleagues at a conference with banners. • Charissa Rivers, Public Health Advisor, PSB, DCPC, CDC. • Two women in front of a cervical cancer banner. • Photos of women in a health care facility. • Photo of health care workers filling out information. • Debra Younginer, Deputy Branch Chief, PSB, DCPC, CDC. • USAPI NBCCEDP; Friends and Supporters. Photos of CNMI people and health care workers with banners. • Dr. Helentina Garstang, dedicated to supporting the RMI NBCCEDP team. • Group of Marshallese women and their children. • Dr. Helentina Garstang presenting. • Suzanne M. Philippo speaking. • Rosalie V. Zabala, MSW. Friend and mentor to the Guam team, Rose was an untiring advocate for cancer screening, even while dealing with her own cancer struggle. • Photo of Rosalie V. Zabala at a conference. • Photos of Rosalie V. Zabala at a hospital with her family and with colleagues. • Rachel Ramirez speaking. • Photo of Rosalie V. Zabala celebrating her birthday. • Veronica Wase. Founder of RMI Breast Cancer Society and she is an advocate for her community. • Suzanne M. Philippo and three of her colleagues in front of a banner that says "Ikdrik. Hope. Iakwe". • Suzanne M. Philippo and colleagues in a health care facility. • Seven women, one with a child, in front of a banner that says "Ikdrik. Hope. Iakwe". • Suzanne M. Philippo and six of her colleagues outside of a facility. • Suzanne M. Philippo speaking. • Two banners with Veronica Wase promoting women to beat cancer, one banner in Marshallese and the other in English. • Photo of Veronica Wase. • USAPI Hopes for the Future. A photo of a woman with flyers and a banner that says "Here's Why Pap Tests Can Save Your Life!". Another photo of a couple wrapping a ribbon around a palm tree in the middle of a road. • Woman speaking to an audience outside a facility in the Marshall Islands. • Suzanne M. Philippo speaking. • A video with three girls speaking in Marshallese. Them says "Cervical Cancer, or "women's cancer," is the biggest killer of women in our islands. Every year many of our women die from this disease, HPV. Is the vaccine dangerous for us? No." • Suzanne M. Philippo speaking. • A group of young Marshallese women posing in front of a tree. • Photos of Sheila Tmarsel with colleagues and family members. • Photo of Palauan families with banners promoting vaccinations and better health. • Sheila Tmarsel speaking. • Photo of Rachel Ramirez entering patient data on a computer and wearing a face mask. • Photo of a health care specialist wearing a face mask. • Photo of Rachel Ramirez and her colleagues in front of a banner that says "Prevention Saves Lives". • Photo of women in a conference. • Rachel Ramirez speaking. • Dedicated to the many selfless program staff of the USAPI. Photo of a woman holding a banner that says "Hope is the first step towards finding a cure". Script [Rachel Ramirez] Our program was funded in 1999. And we started screening in 2001. Even now there's still a lot of women that doesn't know, that there is a Guam Breast and Cervical Cancer Early Detection Program. And even, I will not say even literacy level, low literacy, but even those with, with, with degree still, still, still refuse to do their screening. [Sheila Tmarsel] Ethnicities, we said in Palau, uh, would tell us that the reason why we don't come and access the program is we always thought this program is only for Palauans. For some Palauans they would say that, um, we know about the program, but we just don't have time. [Suzanne M. Philippo] One of our barriers is our cultural taboo. Sometimes they don't want other people to know that, you know, they're sick and they don't want, they don't want to come to the hospital. If a lady comes in for screening and she sees one of her relatives, she won't go to the clinic because it's against our custom. [Rachel Ramirez] So how would you approach in that time, that's a challenge to us, right? It doesn't stop you from doing what you are doing, right? From reaching out to them, from educating them, from giving them more information. That's why it's really important to have data driven information given to the public so that they will know how important it is to get screened. That's one aspect that you have to intensify in Guam, public education. If you can change someone's behavior, to give an informed decision about their health, that's really fulfilling for me. [Sheila Tmarsel] I don't see why we have to spend our time going to the community and do the screening and not following up on these people. Then what's the point of screening. The reason why we wanted to go out to the community and screen is to identify these people and bring them in. We go out of our way to make sure that woman comes in for their appointment. It's hard to work with those non-compliant patients, but we always remind ourselves, tell ourselves that let's not get tired of these people. Let's make sure they really come in for their appointment. [Charissa Rivers] We are looking at a health equity framework in which we are trying to make sure that the Asian American Pacific Islander group is also equally represented in who we are trying to reach and get screened. [Debra Younginer] We know now that these women are getting screened, it's the same as reaching women everywhere. We're trying to save lives. So it doesn't matter where they live or who they are, or their ethnicity, it's a woman and it's her life. And we want to make her have the best life that she can. [Suzanne M. Philippo] She helps a lot of women, especially being a Marshallese doctor. She speak their language. The underserved ladies, they cannot speak English. And then when they see a Marshallese lady being a doctor, they will finally, we have a Marshallese doctor. We can communicate well with her. She's very devoted, committed to the program, regardless of being busy, She's very devoted, committed to the program. Advising them and asking how come you're not coming back? The patient comes in, you know, with problem, she'll be asking, oh, why now, what took you so long to come? Your life is very important. [Rachel Ramirez] When she was diagnosed in 2016 with a stage four very invasive cancer, she never give up. She'd still continued to work despite treatment in between chemo. She would always say to us, I still have a mission to do, to bring back selfless love to the community. As our promise to her, continue the work that she was doing. Her vision is, please don't miss anyone if you can, don't miss anyone to be screened in our program. [Suzanne M. Philippo] When she goes to churches or the communities she talks about her experience when she had cancer. People really listen to her story. And what she went through with chemo. People actually come in for a screening after listening to her. We go out there for outreach, we keep these promotional items, you know, they just took them. But then comparing to, survivor talking about their experience, people actually listen, they come straight to the clinic. She doesn't want any other to experience what she went through. And she convinced ladies to have mammogram or have come to the clinic for clinical breast exam. She really tells them that, you know what I have gone through, I don't want you to go through it. [Suzanne M. Philippo] I'm hoping that there will be no more cervical and breast cancer. You know, the HPV vaccine, we also collaborate with immunization going to the school and, um, making sure that these little girls, they get vaccinated with the school and making sure that these little girls, they get vaccinated. Thirty years from now, I think maybe there'll be less cervical cancer. I hope we are free from cancer. [Sheila Tmarsel] My hope for the next thirty years in the program, is to be able to utilize all the resources given to us from CDC or other programs to develop sustainable systems and processes to make sure that these women are screened and to screen them before it's too late. So that's my, that's my hope, to have them take charge of their own health. [Rachel Ramirez] This job is really something that entails a lot of dedication and passion. There's always unity in our work. I believe in the saying that in unity, there is power, you know, and in power there is change. When you envision a change, uh, you have to be united with that vision, uh, work with that vision and together, we can make a change, yeah.