by Allison Dvaladze
It was a welcome sight to see so many familiar faces gathered under the Georgia Race for the Cure tent, selling homemade goods, and marking another year as breast cancer survivors. Breast cancer is the leading cause of death among women of reproductive age in Georgia, and despite progress, over 55 percent of cases are discovered in the later phases of the illness when treatment is more difficult and more expensive.
I had arrived the night before, just in time for a short trip to the Kakheti region of Eastern Georgia for a wine-filled family supra (Georgian feast) and a cursory inspection of my son’s tree house before heading into Tbilisi the next morning to participate in the Georgia Race for the Cure. I last attended the race on a steamy day in July 2011, so the pleasant October air was a welcome change. Two years ago, I was at the very beginning of this journey, observing and recruiting participants for my MPH thesis on barriers to detection and treatment of breast cancer in Georgia. It was an exhausting month of emotional interviews with survivors who shared the pain, fear and confusion as well as the faith and empowerment they experienced with a cancer diagnosis and what followed. The month left me feeling helpless at times, yet compelled to respond to their desire to support other women on the path to survivorship.
As my running partner, Dr. Julie Gralow, and I closed in on another lap around the course, I thought about all of the remarkable people and plans that had come into place during the past two years. By chance I recruited into my study an old friend with whom I had lost contact, but with whom I was now reunited. We celebrated her health and our history. I had found new partners with whom I had old ties. And, I made new friends and colleagues in the most unexpected ways. Georgia has a curious way of bringing loose ends together.
It was through such a friend in Georgia, Dr. Levan Jugeli (Consultant, UNFPA/National Screening Centre), that I learned about Dr. Gralow (Director of Breast Medical Oncology at Seattle Cancer Care Alliance (SCCA) and now Ellison Center faculty member) in Seattle and the Biennial Eastern Europe/ Central Asia Breast Cancer Advocacy, Education and Outreach Summit. The Women’s Empowerment Cancer Advocacy Network (WE CAN), headed by Dr. Gralow and Dr. Jo Anne Zujewski (National Cancer Institute), is headquartered at the UW School of Medicine and SCCA and has been improving women’s health through exchanging perspectives, resources and strategies in the region since 2003. The summit initially grew out of a USAID-funded PATH project initiated in Ukraine in 1997 to improve health care for women with breast cancer.
The 2013 summit brought together over 50 advocates including 20 participants from 12 countries in the region, to share best practices for empowering cancer patient advocates. Mariam Jashi, Deputy Minister of Labor, Health and Social Affairs (MoLHSA) welcomed the attendees and stressed the importance of awareness, early detection and screening. Dr. Gralow drew attention to the fact that breast cancer is the leading cause of cancer-related death in women and the most common cancer in females worldwide. More than 1.3 million cases of breast cancer are diagnosed each year with more than 55 percent of breast cancer related deaths occurring in middle and low income countries. US Ambassador to Georgia, Richard Norland, whose mother is a breast cancer survivor, also gave opening remarks, echoing the importance of early detection and enthusiasm for the regional approach. He also participated in the Race for the Cure with his wife Mary Hartnett and the First Lady of Georgia Sandra Roelofs.
Over the course of the summit, advocates from Georgia, Armenia, Belarus, Kazakhstan, Kyrgyzstan, Poland, Romania, Russia, Tajikistan, Ukraine and Uzbekistan shared lessons learned and best practices for advocacy, screening and survivorship networks. Georgian and Russian participants expressed pleasure at coming together to address common challenges and share notes on women’s health issues. Given their shared legacies and other commonalities such as limited resources and low awareness, bringing advocates together from across the region provides a unique opportunity for exchanging ideas on overcoming stigma and other challenges in similar or applicable environments. Participants also discussed coordinating future events for a larger regional impact. After the summit, the participants, joined by the Ambassador and Mary Hartnett and First Lady Sandra Roelofs and her parents, continued sharing ideas between toasts to friendship and collaboration and performances of Georgian music and dance.
On the following day, breast cancer survivors and patient advocates came together for a full day of advocacy training lead by trainers from the Livestrong Foundation. While the morning started out calm and quiet with a thoughtful welcome from the First Lady (a nurse, MPH student and active champion of screening), it was not long before the participants became animated and emotional. They worked on understanding the difference between a problem and an issue and how to talk about solutions, identify stakeholders and develop effective messages. By the end of the day everyone was exhausted, but energized by the possibilities.
In addition to providing a forum for sharing ideas among advocates and improving advocacy skills, the event brought Georgian and American medical and public health professionals together, fostering plans for future collaboration. Personally it was fulfilling to see my research come full circle and to have the opportunity to be involved in giving back to the women who had opened their hearts to me and shared their pain but also their hope.
WE CAN was founded by Dr. Julie Gralow, professor and director of the Breast Medical Oncology Program at SCCA and Jill Bennett Endowed Professor in Breast Cancer at the UW School of Medicine. WE CAN has held past summits in Lithuania, Belarus, Ukraine, Kyrgyzstan, China and Uganda.
The event was coordinated by WE CAN in collaboration with representatives from the Ellison Center for Russian, East European and Central Asian Studies, SCCA and Fred Hutchinson Cancer Research Center at University of Washington, the Georgian National Screening Centre, The Black Sea Countries Coalition on Breast and Cervical Cancer Prevention, Georgian National Reproductive Health Council and Ministry of Labor, Health and Social Affairs (MoLHSA). It was supported and sponsored by Susan G. Komen, UNFPA Georgia CO, USAID JSI-SUSTAIN, Livestrong Foundation, Hoffman-La Roche, Hera, IWA, Betsy’s Hotel, mGroup, UGT, AVON, Winner Women Club and Nino Tsiskaridze and Ted Jonas. This would not have been possible without the hard work and dedication of everyone involved, but especially the Georgian team: Dr. Levan Jugeli, Dr. Maka Maglakelidze (Black Sea Countries Coalition on Breast and Cervical Prevention) and Dr. Lika Mikaberidze (Reproductive Health Council); and in the US: Ksenia Koon, Olivia Dooley, and Julia Chase (SCCA/UW).
Advocacy, awareness-building and screening services are an integral step in curbing the emerging trend of breast cancer as a significant health threat to women worldwide. With support from the Tbilisi Municipality and the United Nations Population Fund (UNFPA) Georgia Office, The Georgian National Screening Center began offering free of charge screening services for women in Tbilisi in 2008. The program was expanded nation-wide in 2010 with support from the NCDC and Public Health Department.
Allison Dvaladze is Assistant Director for Outreach at the Ellison Center for Russian, East European and Central Asian Studies. She worked for the National Democratic Institute for International Affairs and The Messenger Newspaper in Georgia from 1999-2004 and returns often with her husband and children to visit family and pursue her passion for women’s health. She received her MPH in Global Health from UW in 2012.