Boston Fellow Iman Berrahou is addressing disparities in cervical cancer screening rates for LGBTQ people by creating a sustainable media campaign to increase education and awareness of this issue among community members and health care providers.
Working with her community site, the Boston Alliance for Gay, Lesbian, Bisexual, and Transgender Youth (BAGLY), Berrahou is creating powerful videos of LGBTQ people describing their experiences—positive or negative—with cervical cancer screening. She is also videoing interviews with providers that have expertise in treating LGBTQ people. The final product will be launched at a public community event and distributed online, and will be the foundation of a medical education curriculum designed to improve the care received by LGBTQ patients. The goal is to improve both patients’ and practitioners’ comfort surrounding cervical cancer screening for the LGBTQ community and to empower LGBTQ people to become health care advocates within their community and for themselves.
Berrahou recognized the educational potential of her project at the very first filming session, during which a participant shared her story of being diagnosed with high grade cervical dysplasia through Pap testing. As the woman described her challenges in navigating the cervical cancer screening as a lesbian, and the impact that her diagnosis had on her fertility and family planning, she and Berrahou, “laughed, cried, and managed to capture the emotion in her story on film,” Berrahou says. “I left that day feeling excited for the impact that this project will have. We are now working to edit the film into our final video campaign in preparation for public distribution. I can’t wait to see what change this project inspires.”
Berrahou, a student at Harvard Medical School, said her Fellowship project grew out of her experiences interacting with LGBTQ patients in the clinical setting, where conversations about cervical cancer screening frequently veered from routine descriptions of the Pap test to lengthy, multi-visit conversations about gender dysphoria, past sexual and emotional trauma, and damaging prior encounters with medical providers due to discrimination or mistreatment because of their sexual orientation or gender identity.
“Recent research has confirmed what these clinical anecdotes suggest: there are markedly lower rates of cervical cancer screening in the LGBTQ population,” Berrahou says. “It became clear to me that there was a need for substantial education of both providers and patients to close the gap in adequate cervical cancer screening between LGBTQ people and heterosexual, cisgender women.”
Berrahou’s Fellowship project also reflects her belief that health disparities in vulnerable populations are one of the most pressing health-related issues we face today. Wealth gaps, stigmatization and discrimination, and myriad other social injustices are interwoven in disparities in access to care and health outcomes experienced by minority groups in this country and abroad, she asserts.
“The solution to these problems is complex, but, in my mind, the first step is recognizing these systemic social disparities exist and also recognizing the way they impact the health of the people and communities we serve,” says Berrahou. “The next is step is to take action. Whether it is on a small scale through interactions with patients, at the community level through education and engagement, or at a national or global scale through research and advocacy work, each of us has a role to play.”
For Berrahou, one of the most exciting things about the campaign is that it lends itself to long-term sustainability by virtue of its video format. Because they can easily be disseminated and shared online, the videos can potentially reach a wide swath of the community in Boston and beyond, facilitating outreach to hard-to-reach populations such as those who avoid seeking health care and LGBTQ people who feel they have no safe space in which to comfortably discuss their health concerns. “I hope that, by distributing our video project online, starting important conversations, and spreading the word about this health disparity, this project will have a long-lasting impact in the LGBTQ community,” says Berrahou.
She is equally excited about her plan to use the media campaign to create a training curriculum that will educate medical students, residents, and other providers about how to approach cervical cancer screening with LGBTQ patients. “One of the best ways to change the care that this community receives is to help educate and train the doctors of the future,” Berrahou says.
Berrahou relishes the opportunity the Schweitzer Fellowship has given her to explore what it means to be an agent of change and a leader at this early stage in her medical career. “I have had the chance to develop a project about which I am passionate, to engage with a vulnerable patient population to improve one aspect of the health care they receive, and to learn how to create change for a community,” she says. “I want to continue to develop these core concepts of community engagement and leadership in my future career as a doctor.”
She is grateful for the many individuals and organizations that lent their support to the project, among them her ASF mentors and peers, the young people of BAGLY, other organizations in Boston, and of course, the people who shared their stories on video. “The providers and community members who volunteered to share their stories and experiences with cervical cancer screening are the heart and soul of this project,” Berrahou says. “Their willingness to be vulnerable in front of a camera in the hopes of improving the experience of others is inspiring.”