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Profile: Cervical cancer screening outreach nurse

Her father had an overwhelming respect for nurses, which was what initially made her consider the career, but when Rita Sandhu's mum was diagnosed with breast cancer, she began to realise that a lot of people from black and minority ethnic (BME) communities don't fully understand the disease. 

And when Walsall, with a population of more than 171,000, was looking for a cervical cancer outreach nurse in 2010, the she stepped up to the plate. 

“The reason I'm so passionate about what I do is that I've had members of my family, loved ones, who have suffered from cancer and passed away. Some are still fighting it. Because of that, when I talk to ladies I always tell them - this is the advice I would give to any one of my loved ones. I try and put everything into it.”

As Walsall's only cervical screening outreach nurse, Rita, 35, doesn't only deal with BME women, but those from the gypsy and traveller community, sexual abuse victims, women with learning disabilities, and those who just feel uncomfortable with being screened in the mainstream service. She's responsible for setting up special outreach clinics, health promotion and home visits for the women she is trying to help, who she affectionately refers to as “my ladies”. Due to Rita's efforts, screening rates in Walsall have increased by 1%. 

Whereas in many GP practices and sexual health clinics, appointments only last ten minutes, Rita can spend anywhere between 20 minutes and three hours with each of her patients, even calling them out of her work hours to offer support and explanations if they have inadequate results. 

“I don't rush my ladies, the ones who need time I do tend to spend that time with them. I find it's really important to spend quality time with them, because with the nature of the outreach service I feel like the core of these women's problems need to be dealt with before they actually have screening,” she said. 

Rita added: “With some of the stories that women tell you, it's quite difficult not to let it affect you. Some of the stories that I hear from these ladies, especially the ones that have a traumatic background, make you kind of feel a part of everything.” 

Reasons why women don't attend cervical screening can range from fear and lack of understanding, to seemingly obvious problems like a GP not having an electric couch.

“For a lot of ladies, visiting the GP can be impractical and undignified if they have to get on a couch that can't go up and down,” Rita said. Home visits for physically disabled women who would otherwise be prepared to go through the screening process are just one part of the service that Rita created. She said: “I thought, nurses go into people's homes for other care, so why not a smear test? Why can't we provide that service?”  

After that, Rita started to contact GP practices and learning disability teams to let them know someone out there can provide the service if it's needed. 

She said: “The majority of physically disabled women I've spoken to have said it isn't that they don't want to get screened, it's just very uncomfortable for them. Even getting into the position a smear test has to be performed in can be hard if they have a disability which affects their legs.” Rita added: “When these ladies are in their home environment and the service can be provided within their four walls, that's quite successful in itself.”

Although statistics show virtually all of the 3,300 cases of cervical cancer diagnosed each year are related to HPV, research conducted by YouGov found that 43% of BME women did not know that the two were related, compared to 36% of white female participants. 

Since 2008, girls aged 12-13 have been offered a vaccination against the two common high-risk HPV types. There is also currently a catch-up programme for girls aged up to 18. Government statistics suggest an 87% uptake rate. 

Rita is not greatly involved with the HPV vaccine programme but she said young women may get the impression that it provides instant immunity to cervical cancer. “It's important to have the information that only having one of the injections doesn't work, they need to finish the course. It's important that they're told it's not a cure. But still, if I had a daughter I would want her to have the vaccination.” 

On average in England, 78.6% of women aged 25-64 attend cervical smear tests, but Walsall is below average at 77.8%, meaning nearly one in five eligible women is not regularly screened. 

Screening is integral to preventing cervical cancer, the twelfth most common cancer in women. In those aged between 50 and 60, screening can prevent 75% of cervical cancers, and 45% in women in their thirties.

But sending out letters to explain the importance of screening doesn't always work, as Rita revealed. “A lot of GP surgeries assume that if someone speaks a language, they read that language as well - but when people get leaflets in their language sometimes it doesn't actually help.” 

Explaining over the phone in someone's own language what screening means only takes a few minutes, but it makes a huge difference as “after that, the majority will decide to opt in” Rita said. 

Rita's “one-woman band” screening initiative has halted Walsall's declining screening rates, winning her the top Cervical Screening Award 2012 from charity Jo's Cervical Cancer Trust for her “innovative” campaign. 

Rita said the most challenging and rewarding part of her job is the women who attend the service. She said: “When I first started I tried to mingle in with the community and find out why so many women weren't accessing the mainstream service. I just tried to find out what these ladies actually want in terms of opting back into the [mainstream] screening programme. Unfortunately not all ladies I've spoken to have opted back into the programme, but the ones that haven't I can quite happily say is just a handful.”



For more information and to enter the 2013 Cervical Screening Awards visit the Jo's Trust website