Oglala Sioux Tribe Increases Screening Using Patient Navigation and Reminders
The Oglala Sioux Tribe lives mostly in Oglala Lakota County, South Dakota. The county spans 3,500 square miles and has the highest poverty rate of any county in the United States. The Pine Ridge Hospital, operated by the Indian Health Service (IHS), is the only hospital in the area that provides mammograms. Its Women’s Clinic provides mammograms and cervical cancer screenings. The Kyle Health Center, 72 miles away, also provides cervical cancer screenings.
An IHS report pdf icon[PDF-9.8MB]external icon shows that American Indian women in the Great Plains area are less likely to be screened for breast or cervical cancer as recommended than women nationwide. In 2019, about 38% of American Indian women in the Great Plains area were up to date with cervical cancer screening, and 40% were up to date with a screening mammogram. Nationwide in 2018, about 83% of women were up to date with cervical cancer screening, and 72% were up to date with breast cancer screening.
Many women of the Oglala Sioux Tribe can’t afford transportation to the hospital or the health center, and many are uninsured. Nearly 15% of women in Oglala Lakota County who are younger than 65 didn’t have health insurance in 2018, according to the U.S. Census Bureau.external icon
The coronavirus pandemic affected services, making it even harder for women to get screened for cancer. The hospital stopped doing mammograms from March through August 2020, and again from October 2020 until April 2021.
Working Together to Bring Women Back for Screening
Several organizations worked together to help women in the Oglala Sioux Tribe get screened for breast and cervical cancer. The partners included the Oglala Sioux Tribal Health Education Program, the Avera McKennan Hospital & University Health Center’s Walking Forward research program,external icon and the Pine Ridge IHS unit.
The Great Plains Tribal Leaders Health Board,external icon an awardee of CDC’s National Breast and Cervical Cancer Early Detection Program, also supported this effort by providing a patient navigator through the Walking Forward program. From July 2019 through August 2020, the patient navigator worked with staff at the Women’s Clinic. She called or sent letters to women who were due for a cancer screening test. The patient navigator and clinic staff members also educated women about cancer screening and prevention. The patient navigator gave gas cards to 125 women who needed help with the cost of transportation to the clinic for screening. From February to August 2020, 225 women got screened despite the pandemic.
“A patient told me her provider informed her about the gas card that would help alleviate her travel expense, and that was the only reason she came to get her mammogram,” a radiology technician at the Pine Ridge IHS unit said.
The certified nurse midwife who referred the patient added, “That patient was diagnosed with breast cancer. She had no symptoms but had not had a mammogram for years. Because of this program, we detected breast cancer early and saved this woman’s life.”