Blind Women Revolutionizing Early Breast Cancer Detection.
Noorunnissa and Ayesha Banu, accomplished Medical Tactile Examiners (MTEs), have undergone comprehensive training through EnAble India’s initiative as integral members of the Discovering Hands program. Originating in Germany under the visionary leadership of Dr. Frank Hoffmann, this transformative program focuses on harnessing the unique abilities of blind and visually impaired women. Their heightened sense of touch and acute tactile perception are leveraged to perform meticulous breast examinations, leading to the timely detection of potential breast cancer tumors.
During Noorunnissa’s upbringing, her aspirations included becoming a doctor, nurse, or a paramedic. However, she was well aware that these aspirations were unlikely to become a reality. Born blind, the prospect of pursuing medical education remained unattainable for her. Consequently, Noor proceeded to complete a Bachelor’s degree in History, Economics, and Sociology from Jyoti Nivas College in Bengaluru. Nonetheless, her post-education endeavors are now poised to significantly impact the well-being of numerous women. Noor has assumed the role of a medical tactile examiner (MTE) who has undergone training to conduct early screenings for breast cancer through the Discovering Hands program. Her inspiring journey underscores how her chosen path is making a meaningful difference in the lives of countless women.
“I recently conducted screenings for women during a medical camp held in a rural region of Karnataka. I thoroughly explained the entire process and its significance to them. They began referring to me as ‘doctor,’ which brought immense joy,” Noor shares. In India, a new case of breast cancer is identified in a woman every four minutes, and tragically, a woman loses her life to breast cancer every 13 minutes. Although Noor and her friend and colleague, Ayesha Banu, who is also visually impaired, might never achieve the title of “doctor,” they comprehend that their efforts will bring about positive effects for women and contribute to the timely detection and treatment of breast cancer. These two young women belong to the inaugural group trained by certified educators Ashwini Rao and Dhakshayini S through the Discovering Hands program, which operates under the umbrella of EnAble India—an NGO situated in Bengaluru.
Formulated by Dr. Frank Hoffmann, a German gynecologist, the initiative embodies a method for breast examination that educates visually impaired women to become Medical Tactile Examiners (MTEs) without reliance on devices, gadgets, or machinery. The program’s goal is the early detection of breast cancer tumors through manual palpation performed by blind and visually impaired women. Utilizing this technique, MTEs are adept at identifying breast cancer or tumors in their preliminary stages, measuring less than 0.3 mm, leveraging their distinctive tactile expertise. The introduction of the Discovering Hands program to India was orchestrated by the National Association for the Blind, Delhi, which has already successfully trained four consecutive batches of MTEs.
Hailing from EnAble India, Noor and Ayesha serve as MTEs at Cytecare Cancer Hospitals in Bengaluru. Meanwhile, the second group of five women is presently undergoing internships at both Cytecare and Apollo Hospital in the city.
The path to becoming Medical Tactile Examiners (MTEs)
According to Rituparna Sarangi, EnAble India’s Senior Manager, this initiative aligns perfectly with the NGO’s mission of providing essential skills to the visually impaired for their everyday activities, education, and means of earning a living.
Ashwini Rao, who leads the Discovering Hands Programme and serves as a trainer, elaborates, “The training program spans nine months, during which they are required to take a theoretical examination after the initial six months. Subsequently, a three-month internship follows, involving practical experience under the guidance of a gynecologist or breast oncologist. Upon completing the internship, participants return to EnAble India for their practical exams, which are supervised by Dr. Hoffmann himself.”
The participants are also educated about human anatomy and the female reproductive system, with a particular emphasis on the intricacies of the breasts. Rao further explains that EnAble India extended the training period by an additional three months to impart computer literacy, mobility skills, employability training, life skills, and counseling to the visually impaired women. These acquired abilities enable them to navigate the hospital environment, compile reports, engage with patients effectively, and demonstrate empathy towards them. With certification from the Frank Hoffmann Institute in Germany, Rao has successfully trained two groups of students thus far, and the third batch is set to commence this month.
Early detection of breast cancer symptoms
Ayesha and Noor were enrolled at the Jyoti Seva Residential School for the Blind in Bengaluru during their early years. Following the completion of their undergraduate studies, they pursued a computer literacy course at Mitr Jyoti.
It was during this course that they learned about the introduction of the MTE program by EnAble India. They applied for the program and commenced their training towards the end of 2019. However, due to the pandemic, they could only finish the course by the conclusion of 2022. After completing their training, they began their internships at Cytecare Hospital. During this period, they gained experience in conducting screenings on hospital staff, shadowed doctors in the operating theater, and acquired the ability to differentiate between benign and cancerous growths within a hospital environment. Presently, both of them are employed full-time at the hospital.
Breaking down the procedure for screening, Ayesha elaborates, “To begin with, we extend our greetings to the patient and inquire about her family history, previous surgeries, and medical background, all while meticulously recording these details on our computers using the patient history form. We also provide a comprehensive explanation of the examination process and actively encourage them to ask any questions they may have, in order to address any uncertainties they might be experiencing,” she expounds. In the examination chamber, once the patient has removed her upper attire, she assumes a seated position.
Subsequently, the MTE examines her breasts, noting any changes in skin texture, as well as checking for signs of lymph node enlargement in the neck and collarbone areas. Moreover, they assess the symmetry of breast contour and the temperature of the breast skin. “Following this, we request the patient to recline on the bed. We utilize five tactile braille tapes called DOCOS, positioning them across various sections of the breast. Utilizing a palpatory approach, we perform an examination on both breast regions and the adjacent chest area, extending from the collarbone down to the base of the breast crease. Additionally, we perform lateral assessments on both sides of the breasts. This manual examination involves the use of two fingers, specifically the index and middle fingers, in a circular, rotating motion,” she adds.
Creating a meaningful impact within communities
Dr. Poovamma CU, a seasoned breast oncologist at Cytecare, shares that she was introduced to the concept of Discovering Hands when the young women commenced their internships at the hospital. “During their internship period, I guided them in distinguishing between normal and abnormal lumps. Their approach is incredibly systematic, attributed to their heightened tactile sensitivity which surpasses ours due to their reliance on another sense,” she comments. Dr. Jayanti Thumsi, a surgical oncologist at Apollo Hospital in Bengaluru, expresses her admiration for the MTEs’ depth of knowledge in the field. She highlights their unmatched curiosity and genuine interest in the subject matter.
“They undergo training to identify early signs of lumps and irregularities within the breast. When they engage with communities, they possess the comprehensive knowledge and information needed to address any inquiries effectively.” Nevertheless, it’s important to note that this screening process doesn’t replace the established triple assessment for breast cancer, which involves a clinical breast examination conducted by a qualified breast surgeon, alongside mammogram, sonomammography, MRI, and biopsy. These remain the ethical standards for diagnosis. Dr. Poovamma explains that this initiative holds value because the concept of preventive health checkups, such as undergoing a screening mammogram after the age of 40, isn’t consistently taken seriously by women.
“In India, we frequently encounter advanced stage three and four breast cancers. Even though women residing in urban areas might have access to specialized medical assessments, there remains a hesitation towards undergoing screenings. Conversely, women in rural regions might not even be aware of such screenings. When these young women venture into these communities, they assume a significant role in fostering awareness about breast cancer. Their conversations with women during examinations contribute to this awareness,” she highlights. “Furthermore, many doctors are occupied with their commitments and cannot consistently attend screening camps. This initiative offers a remarkable solution, creating a mutually beneficial situation where women in rural areas receive screenings and these women are gainfully employed,” Dr. Jayanti adds. Early detection of breast cancer is instrumental in ensuring timely treatment and enhancing the patient’s chances of survival.
The path forward
Sarangi explains that the selection of women for the MTE course involves identifying candidates from various channels. This interest is generated through WhatsApp groups, their dedicated platform EnAble Vaani, as well as partnerships with other organizations. Following an internal evaluation to verify eligibility, potential candidates are carefully screened and then admitted into the course.
While receiving support from medical professionals, corporate entities, and the Indian Cancer Association, Sarangi emphasizes the necessity for a shift in the approach to breast cancer screening. “Presently, we’re witnessing an encouraging increase in people’s willingness to participate, which is promising. We’re exploring avenues to implement this approach across Public Health Centres (PHCs), local clinics, and rural hospitals,” she remarks.
“Recently, we organized a screening event for 22 employees at KSIT Engineering College in Bengaluru. Additionally, we are in the process of arranging camps in the Hassan district and have recently extended our screenings to include women with intellectual disabilities,” Ashwini shares. Noor and Ayesha have further expanded their involvement by participating in screening camps in locations such as Hoskote and Madanapalli within Karnataka.
“We aim to create awareness in order to prompt women with any irregularities in their breasts to seek medical attention promptly. This can significantly impact outcomes, as many women tend to overlook their health concerns,” remarks Dr. Poovamma. The young women express gratitude for their involvement in a profession that enables them to assist others while promoting early detection awareness for breast cancer. “Being an MTE has taught me to manage my emotions and has bolstered my confidence to confront challenges,” states Noor. Ayesha adds, “Participating in medical camps has exposed me to diverse scenarios, enhancing my sense of confidence and empathy.”
