Site Search:

OUR RESEARCH: CULTURAL AND SOCIAL CHANGE FOR BETTER CARE

WHAT WE ALREADY KNOW Our cultures—our societies powerfully influence how breast cancer is addressed, in good and bad ways, assuming that getting the highest cure rates is the most important good. How can we efficiently and appropriately effect cultural changes that can help increase cure rates for women in low and middle income countries? IBCRF is making a focused effort to improve breast cancer outcomes in Bangladesh. Over the last few years we have accumulated some data which reinforce our sense that addressing cultural issues thoughtfully must have a significant priority in our work if we are to be successful overall. In a series of 245 women who came to one of our free walk-in clinics and were found to have a serious breast problem, fully two thirds (163) women (79 of whom had obvious cancers) never received any treatment or evaluation at all in subsequent months. Initial evaluation and discussions with these women indicate that societal structural violence (Harvard anthropologist Paul Farmer’s term for the spectrum of indirect and direct social forces which limit individual choices) –poverty, gender discrimination, cultural extremism, class and religious barriers all played a role in these circumstances. THE BIG ISSUES HOW DO WE SENSITIVLY AND EFFECTLY ADDRESS SUCH HUMAN RIGHTS ISSUES AS EXTREME POVERTY AND GENDER DISCIRIMINATION IN WORKING TO IMPROVE OUTCOMES FOR POOR WOMEN WITH BREAST CANCER IN A COUNTRY LIKE BANGLADESH? Cultural and Social Change Project 1: A village randomized trial of a “pot song” on breast problems in Bangladesh RAISING AWARENESS OF BREAST CANCER ISSUES THROUGH THEATRE AND FOLK SONGS A Report from Professor Anthony Roberto, Principal Investigator I recently went to Bangladesh to work on a project for the International Breast Cancer Research Foundation (IBCRF). When my wife and I lived in Bangladesh in 2000-2001, we saw a performance from a group called Rupantar. "Rupantar," meaning transformation, is an NGO that raises awareness on different women's and other social issues. It also tries to mobilize men and adolescent girls and boys in this process to create a supportive environment for the women. To communicate with rural people, it uses plays and traditional folk songs. Even though we didn't speak the language, it was a very powerful performance and left a lasting impression on us both. So, I immediately thought Rupantar might be an excellent way to spread the word about these clinics. Over the past two years, we worked with Rupantar to develop a theory-based pot ("folk") song specifically designed to encourage women who are experiencing breast problems to visit a local breast problem clinic (and also to encourage men to encourage their wives to visit a local clinic if they notice any problems). The performance was guided by the extended parallel process model, and is being evaluated using a posttest-only control-group design in 20 (hopefully) villages in rural Bangladesh. The pot song is done, the study and survey have been designed, and I went to Bangladesh in the summer of 2009 to help make sure everything was in order before we implemented and evaluated it on a larger scale (i.e., I trained the interviewers, observed the first experimental and control performance -- and the data collection that took place afterwards, and conducted a debrief with the interviewers and Rupantar to address any issues that arose). Below are a few images (and one video) from this experience. Here is a photo from the interviewer training. I was working with 14 interviewers (7 female and 7 male). They were a wonderful group of people to work with. However, most of them spoke very little English, so it was also an interesting challenge. Fortunately, I had a couple of great interpreters. The Rupantar banner. The audience for the control performance. I'd say you are seeing about 2/3 of the audience at the time this photo was taken (and even more people showed up as the night went on). The audience for the experimental performance was just as large, but unfortunately we arrived when it was too dark to get any good photos. In all, we estimate that approximately 750 women, men, and children (and at least one goat) attended each performance. A still photo of the experimental manipulation, which is a theory-based pot ("folk") song performance created by Rupantar. Click this link to see a two minute video clip from the breast cancer pot song performance (this video was taken during the middle of the performance). The entire performance is about 20 minutes long. Elias Fakir (the gentleman who wrote the pot song) and me in the studio where the background scroll was undergoing a few last minute adjustments. Cultural and Social Change Project 2: In family advocacy for treatment of breast cancer in poor women in Bangladesh To begin to help facilitate Bangladeshi women getting care for serious breast problems, we are talking with community leaders and with leaders of Banchte Shekhta, a Bangladeshi women’s rights organization. To learn more about this project write to Professor Anthony Roberto at anthony.roberto@asu.edu Click here to see how you can help