An intriguing case early in her medical training sparked Francesca M. Gany’s interest in the challenges involved in providing healthcare for immigrants. Now, as Chief of Memorial Sloan-Kettering’s Immigrant Health and Cancer Disparities Service, Dr. Gany works to identify the causes of health disparities in underserved communities and to develop ways to more effectively deliver care to ethnically diverse populations.
My interest in immigrant health began with an illuminating experience at Bellevue Hospital during my internal medicine residency. Recent immigrants from Senegal kept arriving at our clinic complaining of abdominal pain radiating around their waists to their backs. Laboratory tests revealed nothing wrong, so I enlisted the help of an anthropologist, and we went into the community to investigate.
We learned that in Senegal there is a condition that occurs in people who are removed from their familiar support system and are overworked. This stress-related malady, called Tooy, is treated in Senegal with a gelatinous substance from a tree — along with emotional support from the community and from healers. Using a substitute gelatin, talk therapy, and telephone contact with healers in Senegal, we helped nearly everyone get better.
I realized that if this was what it took to understand health issues in one tiny (at the time) immigrant group, the medical community was probably misunderstanding many other culturally specific expressions of distress and failing to provide effective treatment. I continued investigating these issues — which include removing cultural, economic, linguistic, and other barriers to the delivery of sensitive healthcare — over the next few years at New York University. I eventually founded the NYU Center for Immigrant Health, and then the Cancer Institute CORE (Cancer Outreach, Outcomes, and Research for Equity) Center. In 2010, I brought my group to Memorial Sloan-Kettering to establish the Immigrant Health and Cancer Disparities Service, and we’re continuing the programs that were successful at NYU and adding new initiatives.
Immigrants and minorities have disproportionately high rates of many types of cancer and lower survival rates than people from other groups, and often experience difficulty in accessing effective treatment and support services. This is a serious concern. More than 11 percent of the US population is foreign born. In New York City, 35 percent are foreign born and more than half are minority. My work, and the work of our service, is to try to identify the causes of health disparities in these populations, and to develop, implement, and test interventions to overcome these disparities. We also conduct outreach and education, deliver services to underserved communities, and train practitioners and scientists who are members of these communities.
One of the most fundamental barriers to care is language. For example, 25 percent of New York City residents have limited English proficiency. This makes it impossible for them to understand health information, answer questions from doctors and nurses, give consent for procedures, and follow treatment instructions given in English. Among immigrant cancer patients in local hospitals, we have found that 16 percent do not actually know what type of cancer they have, even months into treatment, and up to 25 percent fail to finish their initial treatment.
Socioeconomic factors, including limited access to transportation, insurance, and legal and financial resources, are also barriers to care. The Immigrant Cancer Care Action Network (ICCAN) Portal Project is one of several initiatives spawned by the Cancer Awareness Network for Immigrant and Minority Populations (CANIMP). [CANIMP, which has been funded by the National Institutes of Health and the National Cancer Institute, is a program Dr. Gany helped establish while at NYU.] ICCAN works with community-based organizations to address socioeconomic barriers to care at 12 area hospitals, including Memorial Sloan-Kettering, providing case-management help to patients so that they can complete their cancer treatment. ICCAN also advocates on the state and national level for better insurance coverage and resources for these marginalized communities.
One of the goals of Memorial Sloan-Kettering’s Immigrant Health and Cancer Disparities Service is to identify communities at high risk for certain cancers, conduct research on these cancers, and promote risk reduction and treatment. For example, our South Asian Health Initiative focuses on oral cancer due to the prevalence of smokeless tobacco use. Another program targets breast cancer in Arab American women, who are at increased risk of developing the disease at younger ages but may be reluctant to get screened. Our staff also works with the Mexican Consulate to provide health services, screening, and education to New York’s Mexican immigrants, allowing us to reach this population, which is at higher risk for many diseases, including cervical cancer. In addition, we have a project aimed at helping taxi drivers, who are also at higher risk for developing cancer and cardiovascular disease. Their constant exposure to vehicle exhaust may play a role, along with a largely sedentary lifestyle, and the high stress levels associated with their work.
The accomplishments of our service are the result of the work of a dedicated, multilingual team that goes into the community when and where it is needed — which means often at night or on weekends. Whether it’s a Staten Island community center, a church in Queens, or the taxi holding lot at Kennedy Airport, we go wherever we have to to make it work.