A colleague told me about working on an oncology unit where she heard the stories of many patients and patients' family members concerning the late stages in which their cancer was found. It can be easy at first to just wonder and question, "Why did they not seek treatment earlier?"
There are obvious reasons why people do not go immediately to a healthcare professional when something seems wrong: fear, embarrassment, denial. But when the reasons are access, education, money, or racism, there is a sense of injustice that comes across.
The first inclination may be to provide more care and more services for those underserved by utilizing the public health system. WIC (The Special Supplemental Nutrition Program for Women, Infants, and Children) and CHIP (Children's Health Insurance Program) are just examples of wonderful programs provided. If you just glance at the latest bulletin board in a community center or church you will find many programs and opportunities. There are even mobile mammogram units that will travel to underserved areas. So, if we look around we may see a good amount of outreach but there are still many citizens falling through the cracks.
Getting the populations in need to these services and programs is a whole different obstacle. For instance, my nurse colleague cared for an African American mother of 3 with metastatic breast cancer a few years ago.
Her husband had been abusive and was now incarcerated. She worked 3 jobs to provide for her family in order to just meet basic needs such as food, clothing, and shelter so the luxury of caring for her health was not one she felt she could afford. As long as she could provide for her family and function daily, the issues of preventive care or health promotion were not ones she felt that she was provided time to consider. She had to live her life day to day and caring for herself became an accessory.
Stories such as these are not uncommon. For this reason, Dr Higginbothams' story in the beginning of this journal about the river and the bucket of water resonated with me. He is correct, in that we cannot stop what we are doing and focus on the roots of the problem. Focusing on the root for the future may be the goal but all along we must continue our steadfast work to implement and document the programs and efforts we have now to reach as many people in need as possible.
Nursing has done an excellent job in providing programs, education, and training in order to reach those who cannot reach us. You will read about a few of these exceptional cases in this issue on healthcare disparities. Also, you will read about issues and concerns involving various types of disparities. It is so important that we reflect on the good work our nursing colleagues have done and the efforts that we have made while continuing to reach and strive to accomplish more. For as long as there is one story such as the one above, there is more work to do.
Jeanette Lancaster, PhD, RN, FAAN